-
-
gc,
Just think.. how can i be precise with the bisection of the follicle at the exact level, when i do invivo..which is a blind dissection..4mm deep into the skin ,
and have ...hair root/bulb/dp...in both the bisected parts..especially since the root of the follicle is buried normally at the subcutaneous fat...
I could manage the invivo doubling..with invivo blind dissection , by extracting approx.2/3rd of the follicle(not bisection at the root)...and after adding my stemcells,dp cells,etc,i got regen..
at the recipient...
which was lesser than what i got with invitro...with my 8/9months observation of results with doublings...
But, after bisection in the invitro technique under magnification..my regen percentage increased significantly....as in case of invitro..i had part of hairbulb in both the bisected follicles...under magnification ,i can get precise point of bisection...
There is significant difference in the two bisected follicle fragment in case of invitro versus invivo..
I wonder.... how can anyone do either invivo or invitro doubling without injecting the stemcells,dpcells....and get good regen at the recipient..
gc.... you all are missing one point..in invivo TECHNIQUE..you all feel happy about 80% regen..
When in fact.... why... should there be ,any problem in DONOR REGEN...IN case of invivo technique ... by anyone..
When the root of the follicle at the donor is intact with it's blood supply..
What is the use of... monitoring or getting excited about in vivo donor regen.
Infact if it is less than 95 to100%.....IT IS BEYOND MY COMPREHENSION..
I believe the donor regen can be less than 90/100%.. only if someone is doing splitting of follicular units or damaging the follicles in the process of invivo extraction..(kindly explain ..if otherwise)
Yes, in case of invitro..the graft is completely extracted from the donor..hence regen monitoring is understandable....
I am in finalization phase, with an American company,who are creating a custom made high frequency ultrasound for visualizing the hair follicle bulb invivo..
I will inject a contrast into the follicle opening..for better visibility...this ultrasound ..i may pick up with me in october from San Fransisco..when i will be there, for the conference..
This ultrasound may help me bisect the follicle bulb more precisely..and i will than again do few.. invivo patch test before, if at all i restart invivo doubling..
This ultrasound will also help me inject my stemcells,dp culture more precisely into the telogen bulbs....
I am also in talks with photo microscope manufacturers for visualizing hair bulb,stemcells movement invivo after injection and precise location of targetted follicle morphology.....
Comment
-
Blonde,
Removal of graft by punch is same as in fue..so no additional trauma..same as in fue..
Yes, when i use to bisect previously... at a higher level..the recipient graft would be slightly thinner than bisected grafts implanted at the donor.
With my new protocol of bisection at the level of the root of the follicle.. with my early observation of few months ..do not show any difference from fue graft thickness at the similar time period...
bisected graft implanted at the donor will always be more thicker and robust..as it is implanted at NON AGA scalp and is sorrounded by good quality terminal hair..
That is the precise reason ..i implant the superior bisected part with major portion of root with rest of the follicle with bulge at the recipient...as the recipient is an AGA area.. which is slick bald or is surrounded by thinner hair,vellous hair ..
As against donor ,which is NON AGA scalp , with thick terminal hair all around..
Injections of stemcells ,dp cells,optional growth factors are not given into follicle structure ,but just around it ...and these injections will help to repair the bisected graft and not damage it...cotsarelis is talking about fgf9 growth factor injection around follicle..not for damaging it, but stimulating it..with wounding
Except.. the one step of bisection..all other injections.. support repair and regen of the graft...
Regen rate will be similar to fue implants..
Yes if i do partial extraction of grafts ,as invivo bisection..there will be thinner grafts at the recipient..which i do no more...
So there is noComment
-
Good answer Dr. Nigam...Comment
-
My personal opinion is that Invitro is better and more efficient than Invivo blind technique. There is not much difference if one of the bisected graft will be implanted back to the donor. Invivo is risky and that you can lose some of the grafts, for example out of 200 extracted grafts via Invivo by Dr. Gho, 50 died. So I think Dr. Nigam should concentrate more into Invitro.Comment
-
Comment
-
im,
The illusionary iron in you..seems to be melting down....
There is difference between extracting a graft(less diametre than fue punch) like an fue,with wider punch(larger diameter than extracted graft)..and causing minimal transection ..though blind ,but still safer,as complete graft is extracted with the root,especially with the use of wider punch.
...In contrast to extraction of partial bisected graft with .5/.6mm punch/needle/twblade...which is usually wider than .5/.6mm.. 2/3/4 follicle grafts..and to remain safe with blind invivo technique...
im...No new visual entertaining presentations...off late..you gave my nick name to arashi, in the last presentation of yours...!
QUOTE=534623;127863]Yeah, seems that's still really rocket science - for you ...
By the way - how do you harvest the grafts at all, before you "bisect" them in vitro and under magnification?
Let me guess:
You extract them VISIBLE like all the other FUE docs out there - and not blind...
[/QUOTE]
Comment
-
If you're asking me how can Gho possibly extract grafts blindly and do so successfully, then I can only say that his patented triple wave needle he uses with the guidance of the hair shaft allows him to bisect at the optimal point.
I suspect you are right in that Gho won't get it right all the time, I don't think that has even been in question, hence the reason why he only guarantees 80% regrowth!
The invitro process sounds interesting, but if it were this easy then why doesn't all the FUE doctors do what you're doing? Basically extract using a 1mm punch and bisect at the correct point under a microscope. It sounds so easy!
What would happen if you didn't make any injections afterwards doing the extracting and implanting? We would have FUE sized scars right? And would the bisected grafts still grow?
I wish you could do a 50 grafts patch test on a patient who shaves his head regularly down to a zero or grade 1, so we can easily see the grafts before and afterwards using Invitro procedure (with photos from the correct distance as documented in my own case and less of these super zoomed in photos focusing on 1 FU, to me they seem almost pointless).
Everything else up to now in terms of patch tests etc has been unverifiable IMO, perhaps the documentation on Tom will prove otherwise.
I hope you can succeed!Comment
-
I wonder, would Dr Nigam be able to demonstrate his in vitro bisection on a few arm or leg hairs? I realize the hairs there are not exactly equivalent to head hair, but might it be enough for a proof of concept? They could be implanted and tracked very easily. Getting metrics on the newly grown hairs would be a bit less difficult than it's proving to be on the head. Or do you think the biology between head and body hairs are too different for this to be proof of anything?Comment
-
invitro is the way to go, it makes perfect sense , if you look at this picture I don't get how you can extract these type of grafts invivo with .6mm punch without transecting it
Comment
-
Thats why with invivo blind technique, success is not always constant although he is trying to use special ultra sound. To me I wont perform it on my scalp as grafts are very precious to gamble with. Dr. Gho who does not use ultra sound even in his invivo technique then will experience more failure because it will be extra blind in my own opinion.
If ever one day I wanted to perform a hair doubling surgery with Nigam then it would invitro for sure. Its more assuring plus what difference it would make with invivo if I decided to return the other bisected part of the graft back to my donor? This is just my thoughts. How about you guys?Comment
-
I found a good comparison between Dr. Nigam and Dr. Gho technique in Hair Site website, this clarified everything to me between the hair doubling techniques of these two reputed surgeons.
Its the following:-
"LET US COMPARE THE ONLY TWO HAIR CLINIC IN THE WORLD FOR HOUR DOUBLING / DONOR DOUBLING –
Our friend Dr. Gho’s - Donor doubling & Dr. Nigam Hair Doubling with activated Stem Cells and DP cells:-
1G. Dr. Gho bisects the follicular unit and not single follicle longitudinally in Vivo (when the follicle already exist in the scalp), hence it is a blind technique. (As per Dr. Gho’s published paper he himself mentioned there are unsuitable or damaged grafts at the donor area. He bisects using a inner diameter, 0.6 mm triple waved tipped partially blunt FUE punch (he calls it triple wave punch). Since Dermal Papilla is embedded in sub-cutaneous fat cells hence it is unlikely Dermal Papilla cells would be present in the extracted bisected follicular unit or maybe he is able to extract part of Dermal Papilla. As per Dr. Cole’s website Dr. Gho tries to bisect the follicle at the line of Auber which he found difficult and was worried about loss or damage caused to the grafts. Although even if 1/3 proximal that is a root with outer root sheath and 2/3 distal which contains bulge stem cell and part of outer root sheath stem cells, generate hair up to 60% to 70% which has been shown in the earlier studies of Toscani, Rossi, Erjin, Jahoda, Roy and Micali. This also shows that if there is such a partial FUE or transacted FUE with proximal and distal stem cells it can still grow both the bisected follicles. Although the character and diameter of the hair may differ. Remember Dr. Gho is not cutting follicle unit into two but a folliclular unit(refer to his histo slide in his paper and not the picture mentioned in his paper) into two. Kindly refer his article donor hair follicle preservation by partial follicular unit extraction a method to optimize hair transplantation.
1N. Dr. Nigam bisects the hair follicle / follicular unit transversely in vitro under 50x magnification with special fine blades and also collects the spilled out approximately 1000 to 1200 DP cells and injects it back in to the bisected follicles along with autologus activated epithelial and dermal papilla cells, outer root sheath, stem cells through 25 to 50 separately extracted follicular units in Vitro (when the follicle is not existing in the scalp but the cutting is done under microscope with full vision hence there is no chance for unsuitable or damaged grafts). The bisection is done at the particular level on the follicle wherein the Dermal Papilla cells & outer root sheath cells are present in both the bisected parts of the follicle. Due to patent pending neither Dr. Nigam nor Dr. Gho has not mentioned that at what level they bisect the follicle.
2G. Dr. Gho’s technique utilized only preservative media which does not have stem cell or isolated stem cell for boosting and survival of bisected follicle & no growth factor, no stem cells were utilized. Dr. Gho claims in his website that stem cell is been extracted from the donor area and implanted in the recipient area which is false and misleading because bisected follicle unit is extracted and implanted in the recipient area.
2N. Dr. Nigam’s technique involves addition of isolated activated stem cells with growth factors isolated Dermal Papilla cells injections extra cellular matrix and 250 arterial PRP, Epidermal growth factor, follistation,, KGF, FGF and other (can’t disclose all as patent is under process)
3G. Dr. Gho claims that since he keeps the bisected follicular unit in the preservative medium (The medium is composed of the following ingredients: sodium chloride, potassium chloride, magnesium sulphate, sodium phosphate, calcium chloride, glucose, sodium bicarbonate, sodium lactate, sodium pyruvate, human serum albumin, insulin, bis(maltolato)oxovanadium (BMOV) and
a-tocopherol (vitamin E)) of nutritional factors hence this technique should not be claimed as stem cell hair transplant (Because no isolation of stem cell is done in a regenerative lab, hence the technique cannot claim any manipulation of stem cells. Although it is true even in a normal hair fall when a new hair grows it is because of the inherent multiplication of the stem cell present in the hair follicle. Any isolation or multiplication of stem cell is possible only in a FDA or European authority certified lab which our friend Dr. Gho does not have at present.
3N. Since Dr. Nigam has his own Lab he can extract few grafts from the body or from the donor area and isolate stem cell from the grafts, Dermal Papilla and Dermal Sheath cells, plus isolate and cultured with inducible Dermal Papilla cells and inject the solution into both the bisected units so that they are nourished with the required nutrition to develop.
4G. Unfortunately regulation in Europe are very strict for isolation, multiplication, activation of even adult stem cells not to mention embryonic stem cell or allogeneic stem cell, the use of which is legally 25 years away. Hence our dear Dr. Gho has shifted his lab and opened one unit in Indonesia to catch up fast and may be introduced activated stem cells into his present techniques.
4N. Luckily in India for Dr. Nigam research and therapy on adult autologus stem cell with minimal manipulation is legal and cleared by 3 regulatory authorities in India (Dr. Nigam has a clearance from these 3 authorities in India) and since he utilizes the activated stem cells in his medical procedure with monthly follow up with his all patients with a special consent form. Dr. Nigam’s technique is only be legal in few countries as on today across the globe including India.
5G. Dr. Gho has patented his process of longitudinally bisection of donor hair follicle, preservation by partial follicular unit extraction a method to optimize hair transplantation (kindly confirm the same with the patent authority and through his published paper in journal of Dermatological Treatment, 2010, 21:337-349. Since Dr. Gho himself calls his technique partial follicular extraction it is misleading to named it as stem cell hair transplant. This nomenclature of stem cell hair transplant is not usually objected by patent authorities but can be objected very well by European authorities of stem cells because claiming of stem cells therapy or its used is not legal in Europe. The word stem cell for hair transplant can only be used if it is isolated in FDA certified regenerative lab and / or activated and then injected back into the scalp. Unfortunately this is not the case of in Dr. Gho. Hence if this will come to the notice of Stem Cells authority they might take action against it but patent authority will not object for the same. Infact it is the inherent property of the existing stem cells in a hair follicle to denovo on its own to get activated and multiply to regenerate a bisected hair follicle if all the different type of stem cells is present in the bisected the follicle to regenerate a new hair follicle. Dr. Gho bisected graft are minimal outside the scalp by 4 to 5 hrs including 2 hrs in the preservative medium.
5N. Since Dr. Nigam has his own FDA licensed regenerative Lab in Mumbai (the license is already posted on the forum) Dr. Nigam’s Bio-Techs first isolate the adult hair stem cells present in a hair follicle, sorted out by magnetic beading system and then they activate (not multiplied which takes one and half a month) with serum free growth factors within 4 hrs of time and then they inject it into the bisected follicles. This hair doubling has been trademarked in India and Patent application is under process. We believe this is a actual stem cell Hair Doubling. At Dr. Nigam’s we do not keep the follicles outside the scalp for more than 50 min in any of the hair transplant procedure including Hair Doubling.
We make Patient lie-down in a lateral position and one Doctor extract and other Doctor implants the grafts simultaneously (most of the transplant elsewhere are done in supine or prone position where the surgeon has to first extract the graft which takes few hours and then implant the grafts except in DHI technique. We use PRP growth factor and extra cellular matrix to increase the graft survival. We make recipient incisions prior to the extraction of grafts to promote granulation of tissues and minimizing scalp.
6G. Dr. Gho’s technique of Donor Doubling or preservation can transform the NW7 to NW2 in 2 years of time and that also at a very high cost because on an average 1500 grafts can be replicated only after 6 to 7 months.
6N. Dr. Nigam’s technique of Donor Doubling or Hair Doubling are effective because in this technique both the bisected part of the grafts can be implanted at the recipient area hence through this technique NW7 can be transformed to NW2 in 10 – 15 days from the procedure.
7G. The cost and time to transform NW7 to NW2 (10000 grafts) through Dr. Gho’s technique will cost very high (approximately USD $13000 for 2000 Grafts which means US $50000 for 10000 Grafts) and this transformation will take atleast 5 years.
7N. The cost for 10000 Grafts with Dr. Nigam’s Hair Doubling technique for 2000 Grafts in one day is USD $5000 and USD $10000 (All Inclusive) for 10000 Grafts. The total time period required for 10000 Grafts is 10 – 15 days.
You must be wondering that the NW7 patient can donate only 2000 to 3000 follicular unit maximum. We can extract 3000 follicular unit from NW7 and we can double it to 6000 follicular units and can be implanted into the recipient scalp. The Balance 2000 / 3000 grafts can be taken from the body or beard and similarly can be doubled to 4000 /6000 grafts as body hair are single follicular Graft.
8G. Both Dr. Gho is using surrounding tissues with the bisected follicular unit
8N. Dr. Nigam is also using surrounding tissues with the bisected follicle
9G. Dr. Gho is using 0.6 mm inner diameter which means 0.7 mm FUE punch of outer diameter. Although his punch is triple waved tipped, which is partially blunt.
9N. Dr. Nigam uses the same 0.6 mm inner diameter which means 0.7 mm FUE punch.
10G. Blindly longitudinal bisection in vivo has a disadvantage since the hair follicles angles at the skin surface is different from the placement angles of the bottom part of the hair follicle with the root. Hence higher number of transected or unsuitable grafts are possible and it’s a time consuming process
10N. Since at Dr. Nigam’s the bisection of follicle / follicular unit is done under high magnification in vitro which is outside the scalp, negligible chances of transected or unsuitable grafts. Kindly go through Dr. Cole explanation of the same in his post on the forum
11G. Healing of the donor area with Dr. Gho’s technique is also better than traditional FUE.
11N. Healing of the donor area is exceptionally fast in Dr. Nigam’s technique due to the use of activated stem cells, growth factors, isolated DP cells, extra-cellular matrix and PRP. Some of the forum member has already commented that they have not seen such exceptionally fast healing of both donor as well as recipient area with complete healing bring the scalp to the normal state without dot marks.
Challenges for both Dr. Gho & Dr. Nigam:-
Dr. Gho and Dr. Nigam both have to get their documentation of Donor Doubling / Hair Doubling atleast on 5 patients independently by informed and computer skilled consumer or by a independent hair transplant Doctor and / or by independent editor of top credible hair loss forum. Dr. Nigam has already agreed for the above procedure for free of cost in Mumbai and similar response from Dr. Gho is awaited. Both these techniques are promising and can change the hair loss industry in better way before the real Hair Multiplication, Dermal Papilla implantation or macro follicle Organoid hair implantation becomes a reality in next 1 to 5 years as it is the next and may be the final breakthrough in the HT industry for MPB. Neither of their technique can claim multiplication but it can be classified as Donor Doubling & Hair Doubling respectively."Comment
-
Dr Nigam clearly comes out on top in that comparison.
In terms of cost and the speed of procedure he wins. We need to see results now.
$10,000 all inclusive for 5000 grafts doubled to 10,000 is an insanely good price that would rid you of the problem of hairloss for life.
Did Dr. Nigam quote this price himself?Comment
Tweet
Comment