ACell, a Current Review of Applications in Hair Transplant Surgery

[Jerry Cooley, MD]

"i will refresh you. Dr. Cooley presented two examples of what he called plucked hairs. One was a scalp hair and one was a beard hair. In reality, these were not plucked hairs. They were closer to an intact graft than a plucked hair."

No, Dr.. In reality, these WERE plucked hairs. Because they were plucked out of the scalp using tweezers. Period.

Sometimes when I pluck my hair, it comes out with what you consider to be a 'nearly fully intact follicle'. Sometimes I don't. Either way, that hair has been plucked, and plucked hairs grow back. You are telling us that if you pluck a hair in a certain way, it will not grow back. I am saying this is wrong. When Dr. Cooley says he has gotten better at plucking, I understand that to mean that he has a) gotten better at plucking the hair so that the cells come out with the follicle every time, rather than say 50% of the time b) gotten better at recognizing how much material is required at the end of the hair in order to achieve regrowth in the recipient.

What I'm saying is, it is well established that plucking a hair with a pair of tweezers by grabbing on to the hair and pulling - no matter what angle, strength or speed you pull - that hair will grow back. You are simply hypothesizing that this is not the case - and it's not enough to show images of a Cooley plucked hair and say "based on my knowledge and experience, too much of the follicle has been pulled out - it won't grow back in the donor". That flies in the face of all the other evidence we have that prove that plucked hairs grow back no matter how much material was pulled out with it.

We would have known by now that if you plucked a hair, maybe 10% of the time it won't come back because 'a nearly fully intact follicle came out with it'. Never heard that. Girls who groom their eyebrows don't hear "hang in there, cause 9 times out of ten, the eyebrow hair will grow back, but you can get lucky 1 times out of 10 and it won't'.

I have had handfuls of hair pulled out of my scalp at one time during wrestling matches. Guess what, out of all those handfuls, you would think that some of them would have had 'nearly intact follicles' pulled out. And yet all the hair grew back. So, I do understand what you're saying, Dr.. I just think your own claim is far more unfounded than the science you are attempting to discredit.

I agree with you completely. Hair grows back after plucking. I have no special, secret, magical plucking technique. I got better at plucking hairs with adequate epithelial cells attached to the shaft. No one has seen any thinning or lack of regrowth in the areas I've plucked. Nor would I expect them to, because I am not extracting complete follicles.

I've attached a photo of two single hair grafts from the same patient. The one on the right is plucked, and the one on the left is dissected from a strip. Both are single hairs from the same patient, so we're making a valid comparison. I chose the meatiest pluck I could get for this example. It even has the dermal papilla attached, which is quite rare for plucks. The difference is that the intact follicle on the left has the dermal sheath, which is quite apparent when you compare the width of these grafts. Also attached is a histologic stain of a plucked graft.....there is no dermal sheath on it. Hair will regrow at the plucking site because mesenchymal stem cells in the dermal sheath will regenerate a papilla, and epithelial stem cells in the isthmus will interact with this papilla to form a new hair fiber. Fifty years of basic hair research support this statement.

Someone on this Forum mentioned how frustratingly slow hair growth studies can be, and I echo this. I am accumulating more clinical experience with this technique, and time will tell what role it will play. There are many very good questions and it will unfortunately take time to answer them. Later this year, I will provide an update on my results. In the meantime, I recommend patients seek out standard medical treatments and if they are a candidate, do FUT or FUE.

Dr Cooley

[RichardDawkins]

SO i think that i speak for a lot of people here.

I think we need really to see more pictures to grasp the potential of both Acell/Plucking and Acell/PRP treatments.

There was also a question about some patient who underwent 4000 plucked hairs or something related to this, for this case also more input would be appreciated.

WHat does the community think.

PS: No iam not a naysayer, iam just really really interested in a promising solution, thats all.

[plopp]

Dr Cooley and Dr Hitzig,

I think a lot of repair (or otherwised scarred) patients - like myself - would appreciate it if we could have a little more info on the yield in scar tissue. As the spanish guy pointed out, we've heard everything from up to 50 % to down to only occasional success.

What's likely to be the most contributing factor in the success rate of autocloning in scar tissue? Would it be the thickness of the scar or the width? Any pointers in terms of those two characteristics as of yet?

Thanks!

[Jerry Cooley, MD]

Dr Cooley and Dr Hitzig,

I think a lot of repair (or otherwised scarred) patients - like myself - would appreciate it if we could have a little more info on the yield in scar tissue. As the spanish guy pointed out, we've heard everything from up to 50 % to down to only occasional success.

What's likely to be the most contributing factor in the success rate of autocloning in scar tissue? Would it be the thickness of the scar or the width? Any pointers in terms of those two characteristics as of yet?

Thanks!

I don't know the actual success in scar tissue but I believe it depends on several factors. When I said 40-50% in an interview, I was referring back to several cases I had recently seen in followup. I have attached a couple representative photos. In these photos, you see the hair shaft sticking out from being implanted 6 months earlier, and new hair sprouting out from around it. However I later had cases where the success was lower or even zero, as in EJ's case, which is very disturbing to me. I suspect that the wider and thicker the scar tissue, the lower the success. We need mesenchymal stem cells to make the follicle regeneration work, and they are likely absent in scar tissue. At this point, I prefer to tell patients that plucking doesn't work well in scar tissue but that we are actively working on techniques to overcome this.

[Gubter_87]

Dr Cooley; In these pictures it seems that the actual transplanted plucked hair does not grow, but new hair starts growing where it has been implanted.

Is this what happens in your experience? Will that plucked hair always be there at the same length or will it fall off or start growing?

Also the new hair looks quite thin. Do you believe it will grow in thicker in time?

[Jerry Cooley, MD]

Dr Cooley; In these pictures it seems that the actual transplanted plucked hair does not grow, but new hair starts growing where it has been implanted.

Is this what happens in your experience? Will that plucked hair always be there at the same length or will it fall off or start growing?

Also the new hair looks quite thin. Do you believe it will grow in thicker in time?

Sometimes the implanted hair seems to grow and sometimes new hair is seen branching out from the implanted hair, in which case the 'stub' is eventually shed or can be plucked out.

These are 6 month photos so the hair may be thin because of that or because plucked hair growing in scar tissue is thinner. I don't have enough data to anwer that yet. I predict they will be thinner because they are probably made up of fewer mesenchymal cells. Plucked hair that grows in non-scarred scalp looks normal, and is usually indistinguishable from surrounding hair.

[wolvie1985]

Dr. Cooley, how is your success rate with respect to implanting two or three plucked hairs in one incision to create a multi-haired follicular unit? Is it the same success rate as implanting a single hair - which I believe to be 75-80%?

[Gubter_87]

Dr Cooley; Thank you for your reply. In at least one of the pictures it also looks like you have gotten two hairs from one transplanted.
Is this correct and if so is it common?

[plopp]

Many thanks for the update Dr. Cooley!

If your theory of the presence of mesenchymal cells is correct, what does this imply when autocloning to completely bald or otherwise hairless (but non-scarred) tissue? That is, will surrounding follicles have any impact on the concentration of mesenchymal stem cells in the area?

Also, to follow up on the pictures. When you have follicles forming around the plucked hair like that, do you still feel like you can control the direction that they grow in, or do they come off somewhat 'unruly' so to speak, since (I guess) they aren't growing from the basic follicular structure that was provided by the plucked hair?

[KeepHoping]

Is there anyway I could get in touch with you via phone when you have the time? Or maybe email you? I filled out the contact form through your website and sent it through but haven't gotten a response yet, I understand you're busy but I'd love to have the chance to chat for a bit. Thanks.