Interesting post on another forum

[JJJJrS]

This is from a moderator at another popular hair restoration forum who's training to be a hair transplant surgeon:

I think we're saying the same thing with regard to Dr. Gho's technique/Particular Longitudinal Follicular Unit Extraction. I'm not claiming it has anything to do with multiplying stem cells or reactivating dormant follicles. He simply uses a technique to separate the two areas of stem cell activity within a hair follicle (the bulge cells and the dermal papilla/hair matrix cells) and implant one region in the recipient area, and leaves the other behind in the donor region.

Because certain studies have indicated that both regions of stem cell activity are capable of creating a regular cycling hair follicle, the surgeon has effectively created two follicles from one. Most patients refer to this phenomenon as a "universal donor procedure," because the precious donor supply is preserved during the extraction process.

Frankly, I think this will be the "wave of the future." However, in my mind, one important variable remains: is any special growth serum needed to fully induce activity in the bulge stem cells after implantation? In an ACell procedure, this is supposedly what the porcine bladder extract does (when ACell is used in conjunction with the "plucking" or "hair duplication" technique), and Dr. Gho uses a fairly extensive medium when implanting as well (which he describes in his Journal of Dermatological Surgery article), but it's not clear whether or not this is necessary.

I've spoken with several surgeons who believe simply separating the bulge stem cells and implanting these partial grafts without any sort of special treatment will still lead to terminal follicles in the recipient region. Now, this may sound more simple than a process involving a growth medium treatment, but I personally think it would take a lot of work with new tools and possibly even a new FUE-like technique before really being reproducible on a satisfactory scale.

He's a fairly credible source so it's nice to see that he finds the procedure promising. I think it's also very interesting that surgeons are starting to look into the procedure and actually keeping an open mind on it. So far Gho is the only one to offer such a treatment but I wonder how long it will take until another doctor (not named Dr. Nigam ) claims to offer donor regeneration. IMO it's only a matter of time but for how long is anyone's guess.

[Brock Landers]

I think Cole does something similar. If you watch the Cole video on HS, he talks about "minimal depth" extraction, basically leaving some of the stem cells in the donor, and uses ACELL to treat the donor. His regrowth is 20%-60%, but it sounds like the concept is the same. Don't take out the whole graft, leave stem cells in the donor, and hope for 2 for 1....only difference is Gho claims much higher regrowth

[d2001chen]

My understanding from Spencer's interview of Dr Gho is that though the donor and the transplant both regrow hair, this can be done only once. Another transplant from the same donor site is not possible (wont grow in both sites again I think). Even with this limitation, this is significant step forward.

I too viewed Dr Cole's talk about the 20-60% regrowth in the donor region. He does not talk about re-transplant possibility from the same donor site though. Surprisingly there has not been a lot of discussion on this!

[ccmethinning]

My understanding from Spencer's interview of Dr Gho is that though the donor and the transplant both regrow hair, this can be done only once. Another transplant from the same donor site is not possible (wont grow in both sites again I think). Even with this limitation, this is significant step forward.

I too viewed Dr Cole's talk about the 20-60% regrowth in the donor region. He does not talk about re-transplant possibility from the same donor site though. Surprisingly there has not been a lot of discussion on this!

That is incorrect. In Gho's procedure, the donor can theoretically by used unlimited times. The thing is, after repeated extractions from the same follicle, the follicle becomes slightly damaged from the twisting motion of the drill, and donor hair regrows slightly twisted. This is however not a problem if that follicle is only extracted from once, but only 2,3 or more times.

[JJJJrS]

I think Cole does something similar. If you watch the Cole video on HS, he talks about "minimal depth" extraction, basically leaving some of the stem cells in the donor, and uses ACELL to treat the donor. His regrowth is 20%-60%, but it sounds like the concept is the same. Don't take out the whole graft, leave stem cells in the donor, and hope for 2 for 1....only difference is Gho claims much higher regrowth

I too viewed Dr Cole's talk about the 20-60% regrowth in the donor region. He does not talk about re-transplant possibility from the same donor site though. Surprisingly there has not been a lot of discussion on this!

I was actually the one who asked Dr. Cole the original question that led to the video . Since it's related to this topic, I'll post a link to it:

Acell Vs. Histogen and Follicle Regeneration - Hair Transplant Tips

I think if Dr. Cole shared some of the pictures demonstrating donor regeneration and people could independently verify his claims, then I'm sure there would be much more discussion. From what he's said, it seems that at this point the donor regeneration is inconsistent and that he's working on ways to improve that aspect. I'm sure when he's ready to release more pictures, information we'll hear about it.

In general though, I think it's great to see Dr. Cole and other surgeons work towards moving the industry forward. For better or worse, I think advancements in surgical hair restoration, i.e., expanded donor supply, no scarring, are the closest we'll get to a cure in the near future. From a patient standpoint, we need better options then FUT.

[JJJJrS]

That is incorrect. In Gho's procedure, the donor can theoretically by used unlimited times. The thing is, after repeated extractions from the same follicle, the follicle becomes slightly damaged from the twisting motion of the drill, and donor hair regrows slightly twisted. This is however not a problem if that follicle is only extracted from once, but only 2,3 or more times.

This is one of the interesting aspects of the procedure that I wish there was more information on:

1) Is this twisted configuration due to the drilling, like you say, or inherent to the procedure, i.e., splitting the hair follicle based on the two stem cell regions?

2) Does the hair in the recipient also grow a little twisted like it does in the donor?

3) In subsequent procedures, does HASCI know which grafts know have been extracting before and which have not? Is it visually obvious? From gc883uk's pictures, I personally couldn't tell and I don't think Iron_Man could either.

[534623]

1) Is this twisted configuration due to the drilling, like you say, or inherent to the procedure, i.e., splitting the hair follicle based on the two stem cell regions?

Where is the difference between "twisted configuration" and "modified configuration"?

Dr. Gho mentioned in the recent interview definitely "modified" after multiple extractions ("splitting") of the SAME follicle/SAME follicular units. That means, that such follicles can get "unextractable" like many other normal/untouched follicular units which he simply can't extract due to "bizarre" (are neversaynever's etc hair follicles "bizarre"?) configurations = hairs itself emerge on the skin surface rather in a row than in a nice triangular configuration or are too far apart or follicle bulbs in the dermis are splayed too far apart etc etc). That's all.

Anyway - a short snippet from a published report about what were reported and discussed during the recent ISHRS meeting:

Another area needing investigation is whether FUE depletes the donor such that fewer hairs can be harvested compared to strip excision. Again, that point of depletion is dependent upon multiple factors including hair length, curl, diameter and color.
It was mentioned at the meeting that harvesting only a portion of the follicular unit can make the FUE scar less visible, yet transected hairs by our current literature show a lower percentage of growth and finer hair fiber when growth does occur. However, is the transection from the FUE harvest different from existing studies that deal with transection of in vitro follicular units?
At the meeting, Dr. Jose Lorenzo, while addressing another topic, showed magnified photos of heavily harvested areas that, if consistent with the studies mentioned above [which studies, Mr. Reed? No references necessary?], should have shown miniaturized hair growth [in the donor area] from transected follicles. But none were present!

The "!" behind the last sentence/word indicates, that NOBODY (?) from the ISHRS is aware about the real "current literature". In my opinion, that clearly indicates incompetence - sorry, but what else?

[Skywalker]

The thing is, after repeated extractions from the same follicle, the follicle becomes slightly damaged from the twisting motion of the drill, and donor hair regrows slightly twisted. This is however not a problem if that follicle is only extracted from once, but only 2,3 or more times.

I think we might be exaggerating this, Dr Gho said that if you extracted the same follicle then because of the twisting the probability of success was affected - but only marginally - he didn't consider it to be a massive problem. At least, that's what he said when I was there and he was talking to me and also the doctor with whom I had my consultation.