ACell, a Current Review of Applications in Hair Transplant Surgery

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Originally Posted by HairRobinHood

Cool - it seems he learns fast (at least faster than Cooley).

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I hope so.

I find this interesting. This is another FUE extraction site treated with ACEll in a hyaluronic acid mixture after 5 weeks. It is still too early to tell if the hair might regrow in the extraction site though I have seen this. It does appear that a single hair is forming in the extraction site, which appear as a black nub. What is interesting is the appearance of a capillary in the skin. These are usually missing following FUE and help lead to the loss of pigment in the extraction site. I've done enough FUE to spot extraction sites anytime I look at a donor area even when no hypopigmentation occurs. It is an observation based on experience with FUE. With this donor area, I could not find any evidence that FUE was performed. The red circle is where I would expect a follicular unit to be. The entire donor area looked like this. The black circle is 10 sq mm.

The long hair after 5 weeks is a result of a completely non-shaven procedure of 1464 grafts. I call this C2G. It is still to early to say for sure because I need more results, but this is an example of what I have seen in donor areas treated fully with ACELL with my method of FUE where I use minimal depth control. The initial problem was treating all the extraction sites with a powder. I overcame this with mixing it in a viscous hyaluronic acid. More recently I have been mixing in a more viscous cellulose. I have a few comparative examples where I am looking at powder, hyaluronic acid, and cellulose. Time will hopefully tell. I think the minimal depth incision technique along with Acell may result in better healing than a full depth incision. Maybe we will see more hair regrowth over time. Maybe not. Still no one could comb through this donor area and find any evidence that a hair transplant had been done. It appears that we really are coming full circle today. Not only have we produced optimal results in the recipient area such that you cannot tell that a hair transplant has been done. Even the trained eye cannot see evidence that a hair transplant was done in the donor area. Still we need more results to confirm that such results will be consistent.

thanks for the post doc

can you briefly explain full depth extraction to partial depth ?
is partial the removal of the entire follicle with less surrounding tissue depth or does it leave a portion of the follicle behind which might contribute to the reformation of another follicle

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Originally Posted by drcole

I find this interesting.

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I find this interesting too. Dr. Cole, frankly, your post and your whole ACell/CIT concept sounds like a 100 mhp driving Mercedes Benz with a missing wheel. I really wonder what good are all these “Societies of Hair Restoration Surgery” on this planet. It seems just to say each other “Hello, business colleague!” once a year? I guess not even the last …

A full depth incision would be from the surface of the skin to below the bulb. In a recent morphometry study done by Paco Jimenez, he found the distance from the surface of the skin to the base of the hair bulb was 4.156 mm +/- 0.439 mm. Thus a full depth incision around a follicle would be more than 4.156 mm deep on average. Paco goes on to say that most of the stem cells are primarily located between 1 mm deep and 1.8 mm deep or roughly the length of the isthmus of the hair follicle based on the well known bluge stem cell marker CK15. A minimal depth incision would be only as deep as necessary to extract a full intact hair follicle. I avoid plucking hair follicles and I certainly do not like to amputate them.
When I extract a full intact hair follicle, I ease it out. I do not cut around it and remove it. Easing the follicle out means that bits and pieces of the dermal sheath are left behind in the dermis and adipose. These bits and pieces leave potential stem cells behind. These stem cells have the potential to create new hair follicles.

When you ask Acell to do little things, it is possible that it will. When you ask it to do something on a large scale such as regrow an entire arm, you are not going to see it. I’m asking Acell to regenerate a tiny portion of dermis and epidermis. We are seeing that Acell can do this. We are also hoping that it will continue to be successful in promoting follicle stem cell neogenesis. To me the latter is not as likely as.

What we are seeing here is the formation of capillaries that are not usually seen following extraction of intact follicular units even with my minimal depth approach. My theory was that with the loss of the hair follicles, the body did not need to regenerate the capillaries. We also saw a decrease in pigmentation of the skin in many individuals following the removal of scalp hair follicles. With Acell we are seeing normal pigmentation and the formation of capillaries. In other words, it looks like normal skin. It is very exciting to me. In my opinion, the positive results we are getting with Acell are simply one more nail in the coffin for strip surgery.

NY has been similar to Antarctica recently wreaking havoc with patients and office hours.
I have been very excited with my conversations with Artericyte (Please look them up). The feeling is that VEGF (Vascular Endothelial Growth Factor) is highly attractive for Adult Stem Cells which Matristem needs to convert to Active Progenitor Cells. Whether we need to utilize the wealth of stem cells from hip bone marrow aspirate is yet to be determined.Dr. Cooley will be working with the company as well as they have a principle in Charlotte. My team will be travelling to Philadelphia to learn the office technique. Where it may prove very valuable is in Auto-Cloning with Plucked hairs as it offers quick support and re-modeling of these somewhat skeletonized hairs. We will have to see.
I believe the early encouraging results from the enhanced PRP/ACell is even more exciting. If consistent, we have a "Vaccination" for hair loss.
One question we are trying to answer is how much micro-needling damage we need to create in the scalp with ACell injection to remodel scalp hair follicle stem cells to produce active progenitor cells--we may need to do more than one set of injections to achieve this. I believe the answers will come fast and furiously.
I am glad Dr. Cole is seeing the fruits of ACell. The question comes if the donor area is remodelled with the subsequent production of skin and hair, why perform a tedious and costly FUE as opposed to a strip method that "repairs itself". I think all methods have their place and my job as I see it is to try to help solve the problem and let each apply that solution to their respective techniques.
Thank You all for your encouragement and feedback--you don't know how helpful it has been!

Dr Hitzig,

Are there, or will there be problems controlling the direction of growth with your injections?

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Originally Posted by drcole

In my opinion, the positive results we are getting with Acell are simply one more nail in the coffin for strip surgery.

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I guess you didn't see Dr. Hitzig's ACell-strip-closure results?

If I'm not completely wrong, and just from what I have seen so far from Dr. Hitzig concerning strip-closure with ACell, that was so far the best I have EVER seen in my life concerning strip surgery - and basically I'm NOT really a "strip supporter", I have to add!

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Originally Posted by HairRobinHood

I guess you didn't see Dr. Hitzig's ACell-strip-closure results?

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I don't understand your response; it seems something of a non-sequitur.

The point seems to be that if FUE surgery could be consistently accomplished with little or no loss of donor hair, why would FUT continue to be used?

Dr. Gary Hitzig discusses his recent findings on last Sunday's The Bald Truth