ACell, a Current Review of Applications in Hair Transplant Surgery

[uselessgomez]

Wow, NICE repair work, Dr. Cole!

I am very impressed.

[RichardDawkins]

Right now iam really happy with the turn the things go. Thats what i think was missing the last decade before. The interaction between hairloss sufferers and surgeons and the will to go new ways, even if they may sound "unbelievable" at first.

[SilverSurfer]

What would you think on using beard hairs taken from the neck area, either below or in the area of the adam's apple(looking for the lowest point). Plucking in a straight 1 cm line horizontally. Measuring the density of the area before the plucking and 3 months or 6 months after.

I would go with an area located at the lowest point of where beard hair grows to use as reference and then measuring 1 cm up and across. This way you would have as reference the lowest point of the beard and the measurement would just have to be taken from that point and above.

To measure the growth in the recipient area I think the best way is to get a totally bald spot and try in a few hundred hairs like Dr Hitzig and Dr Cooley did and then measure what percentage 'took' in. Measure the caliber and the cycles (which appears to be the most difficult).

[SilverSurfer]

The repair looks very good by the way. The patient must be very happy. Congratulations.

[SilverSurfer]

Measuring regrowth of the plucked area

Dr Cole,
I find the method you are proposing to be accurate. I just have one question, if the hairs come from the beard, who would want a tatto in that area? Or in any other area of the head. Isn't there a better way to keep track of the area without the tatto? Are you referring to a permanent tatoo or some temporary kind of ink that will fade away easier?(I don't know if it exists but it would be useful in this case)

[wolvie1985]

"My concern with plucked hairs as follows: When someone plucks hair to groom themselves, they are not plucking almost the entire follicular structure. These hairs will likely grow back. When you are plucking to get growth from Acell, you are plucking almost the entire intact follicular structure."


Please enlighten us doctor on how the act of a 'grooming' pluck differs from an HT pluck. As has been brought up here before in response to your previous anti-plucking manifesto, if the world's female population had figured out a way to pluck an eyebrow in a certain way so that the hair doesn't grow back, we probably would have seen it by now.

[John P. Cole, MD]

As you know, I am still waiting to see confirmation that Acell and plucked hairs produce a viable alternative. Until then, I will stick with FUE plus Acell on the grafts, as well as, treat my donor area with Acell.

Here is an example of a repair case that wanted fuller coverage and to look more natural. He had multiple prior pluggy transplants that left him unnatural and with multiple scars in his donor area. The prior grafting left him with few scalp hairs to graft.

When I do a repair case, I ask the patient if they want more hair and to be more natural or do they simply want to appear more natural. If they want more hair, I try to leave as much hair as possible from the original grafts because you can never get 100% of the hair to re-grow with you attempt to redistribute it. Then after adding hair, I reduce the larger grafts that are still visible. If they want to look more natural, but don’t want more hair, then I reduce the grafts using my method of FUE, which I call CIT. If they simply want to be bald, I try to remove all but single hair follicular units and then try grafting the removed follicular units into the donor scar.
Given that the donor scarring in this situation was so severe, it would have been difficult to make the donor area of this individual appear entirely normal. Therefore, simple removal of the grafts might have required the patient to keep the back and sides long rather than giving him the option to shave his head.

Based on his limited donor supply, I had no choice other than body hair. Body hair does not work in all individuals, but it worked well in this case. His beard hair grew well, but his chest hair did not. Adding Acell to the chest hair grafts in the follow up procedure resulted in a better chest hair result 10 months later.

The photos here show that grafting body hair can produce a nice result. When body hair works, it is a proven entity. I feel Acell may improve the results of body hair grafting, but we will need time to see. Body hair is not for every patient. You should have a test procedure done prior to a large procedure. You should do the same with plucked hairs and Acell in my opinion.

We grafted a small number of head hairs to the top, but most of the coverage is from beard hair and chest hair. We treated the scars with beard hair and chest hair. We also treated the extraction sites with Acell in the follow up visit. We treated only the scar area with Acell in the first visit. We also treated the area with PRP in both procedures. In the follow up procedure, we put Acell powder on the grafts and injected it into the recipient site.

In the follow more recent procedure I de-bulked some of the frontal hairline plugs. The latest photos were from the most recent procedure. The goal here was to add more density to the perimeter of the crown where you see the purple marks. The idea is to attempt to match the density in the center of the crown at the perimeter. If grafting will not accomplish this, we might consider de-bulking the central crown plugs.

As you can see, it is possible to treat a class 7 with grafting alone even when the donor area is markedly scared and when it is a repair case. My concern with plucked hairs as follows: When someone plucks hair to groom themselves, they are not plucking almost the entire follicular structure. These hairs will likely grow back. When you are plucking to get growth from Acell, you are plucking almost the entire intact follicular structure. I’m still looking for evidence that you can get two from one from this method. I’m also looking for a case that makes a measureable difference in appearance and yet leaves an almost intact donor area.

I would start by measuring a pre-operative hair mass index in one tattooed area of the donor area along with as accurate a hair count as possible. I would then pluck hair from the tattooed area and place the plucked hairs in two different boxes in a bald scalp. I would treat one box with Acell and the other box without Acell. I would then calculate the yield at 6 months and one year in each box. I would also measure the hair mass index and hair count in the donor area tattooed area 6 months and 1 year later. If everything looks good, you have a positive sign that Acell benefits plucked hair growth and that the donor area grows back.

Keep up the research. it's interesting.

[CVAZBAR]

Also we will doing our first case of eyebrow plucking with ACell + PRP and remodeling some of the plucked eyebrow hairs to reshape an eyebrow. Will keep you posted

Please keep us updated on the Stem Cell/Acell/PRP injections that you were talking about on the show. I remember you saying it would take you weeks to learn the procedure of extracting Stem Cells from hip. You did say you already performed the ENHANCED PRP, so hopefully we find out results asap. Ive had hard time halting my hair loss and I believe this can be the magic injection to do the job. Thanks, I appreciate your attention to this forum.

[Gary Hitzig MD]

Also we will doing our first case of eyebrow plucking with ACell + PRP and remodeling some of the plucked eyebrow hairs to reshape an eyebrow. Will keep you posted

[Gary Hitzig MD]

Potpouri

I have not been in contact with Dr. Cotsarelis yet. Probably my fault as I have been dealing with the ridiculous snow and ice storms.
As I have said, I do believe that miniaturization past a certain point will not respond to any therapy. My goal would be to prove myself wrong--but I will not offer excitement to anyone because it's what they want to hear.
We will see. Jerry has talked about Expanded DONOR at this point, and I believe that to be very smart in his analysis. We will expand our analysis as we have viable results.
As I have always said--Stay Tuned!!!

BTW plucking hairs leaves NO SCARS when performed correctly. There is a learning curve (as we went through) on how to do this. It is not so simple!
GH

[CVAZBAR]

DR. Hitzig, were you able to get in contact with Cotsarelis to share ideas or is that not happening afterall?

[RichardDawkins]

Oh thats the point, i have a theory about the possible "scars" when plucking hairs.

I think this problems only occur in people who pluck thir hairs because the just do it for the sake of doing it. When we plcuk hairs its because, like rapunzal said to fine tune some areas like nose hairs or eyebrows.

But those people do it for other reasons and not with the intention to fine tune something. So sometimes their hair will stick in the follicle region and begin to develop scar tissue. After some time there will be more scar tissue.

Its because the didnt pluck their hairs in a "clean" way. So i think with combination of Acell we dont have to fear scaring like in those patients.

But thats only because of the ECM and the "clean" plucking.

@rapunzal : I know this from my eye brows and this really sucks. I dont know for how many years i pluck them, but the still come back and sometimes they have this epitelial tissue stick to them.

So if you would have the right equipment you could test autocloning yourself and create yourself a nice monobrow :-)

But jokes aside, it would be nice if Dr Hitzig and Dr Cooley could answer the other questions here

[rapunzal]

haha .. knowing my luck they will probably regenerate even without Acell

[John P. Cole, MD]

You could have them removed permanently via FUE.

[rapunzal]

1. I have never said "unlimited donor", but rather "expanded donor". Everyone knows that hair grows back after plucking but we also know from the long term observation of patients with trichotillomania, hair can be plucked to the point of failure, although this takes repeated cycles of plucking.
Dr Cooley

i have been plucking two radical eyebrow hairs that are clearly distinguishable from the others for the last 15 years. im hoping one day they will reach the point of failure.