Dr Nigam, my own experience

[drnigams]

Ginkgo,ONE,
My surgeon is in uk till 6th june,taking consultations.

Regards opening clinics outside mumbai...
I can offer doubling with progenitor stemcells and dpcells..without dp culture and multiplied stemcells...and it will give similar results...ofcourse better with the injections after 6 weeks.
But the problem is manpower cost.

You can confirm from tom..

In case of invitro doubling this is how the process goes...blood test,preoperative profile,checking of equipments,medicine trolley,consent form,fumigation etc...

step1)30minutes to plan a hairline,minimal shaving as per the number of grafts required,testing for every medicine like local anesthetic for any allergy.
Applying emla,ice and than for safety7 i v line.
Very slowly local anesthetic is given with help of ice,dermajet,ouchless needles etc.to avoid pain this process consumes a lot of time.

2)Patient lies on prone position,we(2docs) extract the grafts from the either side,Normally we send 75 grafts to lab,outside mumbai,i will have to extract stemcells and activate without multiplication,this is known as same day minimal manipulation process in a special minilab section at the clinic.(1technician will do this).


3)we will extract 2000/300 grafts for dp cells,one technician will isolate dp cellsand the doc will implant the follicle back at donor.

4)Now we will extract 200 grafts from the donor and one technician or doc will bisect under special 50x magnification at precise point,he will also check for any transected extraction and warn the doctor.

5)now the patient will turn to supine position and local anesthesia will be given and as per patients preference,we will inject the tiny dp lower of the graft with 21 number needle or to make sure the angles are perfect we would have create incisions in the beginning of the procedure..to avoid bleed or propping out or loss of visibilty due to blood..as pre incision method 3/4 hours before,is critical for density ,as there is no blood,incision is sticky and it takes grafts smoothly.In the process through out a nurse applies ice all over ..for pain management,helps in reducing swelling,and minimal bleed and clear field to work.

6) After implantation of these 200 grafts,patient turns back to prone position,where we implant the upper half of the grafts at the donor.
The same steps are repeated.
You must have noticed we do not keep grafts out of scalp for longer than few few minutes,to improve survival,in typical fue,one takes out all the grafts and than implants all back,and the graft is out of scalp for few hours ,same is in fut.
The initial process also involves making of tumescent anesthesia ,we add triamcelone to it which reduces 90% swelling possibility,TOM have deranged clotting time,as he did not stop his natural supplements and had very thin blood..other ht surgeon might have delayed his procedure,but because of triamcelone acetate in anesthesia and ice application..he did not have any swelling .
Not to forget one nurse is supposed to maintain the patients record regards what has gone in,,number of grafts ,single,doubles,triples..atleast 30 minutes are lost inbetween ,as the patient discusses the final hairline,,and majority of time he/she wants lowering and we have to convince with x number of grafts available,if you lower further ,the density will be less)

7)The dpcell injection,progenitor stemcells and prp injection is given allover the donor and recipient after again local anesthesia,ecm paste is applied all over the donor and recipient,and finally area is cleaned,no bandage but a bandana is worn to avoid swelling.

8(The doctor explains the follow up procedure gives medicines,and his number,gives a special spray ****tail of certain products with antibiotic..for grafts survival as it takes 8/9 days for blood supply to resume totally.
We keep the grafts in same medium we use for culture of dpcells and stemcells..this media does not do anything to stemcells but extraordinarily prevents grafts from injury or apoptosis.
Not to mention the pre ,during and after procedure videoscopy,macro pics.Food/juice breaks...Of course we can avoid the massesuer for relaxation of patient and doctor for better ergonomics and concentration which is offered at mumbai..
Patient receives his follow up kit bag,thankyou card and a flower bouquet..and leaves

FUE REQUIRE2/3 PROFESSIONAL AND INVITRO DOUBLING REQUIRES 8/9 PROFESSIONAL..AS MANPOWER COST IN INDIA, IS ONE FOURTH THE COST OF USA,UK..the procedure will become expensive...
Thats why i feel as of now...FLY BALD ..FLY MUMBAI IS BETTER..till i finalize my partnership in TOP cities across the globe with the local HT surgeon..i can't run around the globe...At ISHRS..i may have a bussines counter for new partners with drnigams doubling technique..and meetings..in october 2013..at San Fransisco.
Believe me ,we will get the doubling to various cities across the globe in next 2years..it is only about ht docs getting confidence after having a look on their patients with small patch test ,and finalization of financial agreements..

We all know HT collegues are resistant to change easily,except the new,younger ones...it is 10 years now.. when fue was introduced..and still only 40 to 45 % work of ht is done by fue rest by fut still..!

Already had a meeting with two top usa surgeons,uk surgeons ,canada and ireland surgeons at WCHR..i will not keep it to myself..would love to focus on pure HM..

Hello Dr Nigam,
Is there any progress with your accommodation in the UK? I'm wondering if you would be able to offer the doubling procedure without the cultured injections (as these don't have European approval), or would this not produce good results? If this stand alone procedure proved satisfactory, surely this could be an alternative to HASCI?

[drnigams]

ONE,
Numbering of the grafts are in process,will post tmr.
Briefly,

Tom( it is HE and not SHE) wanted to lower his hairline and temples including a different style i.e forwarding of his ...lateral locks...

Total sqcms of ... hairless area at temples ,hairline.. to be filled was..approx 40sqcms(tom is sending me the exact measurement tmr)

Available grafts of doubling were approx 1000(exact number tmr,with singles,double,triples count..as i am out of mumbai today) ,as he enrolled for the same and will do a similar 1000 grafts at the same hairline and temples in his next visit after 6 weeks,when he takes multiplied stemcells and dp culture injections.

We drilled approx1300/1400holes(exact tmr) at his donor,for extraction for doubling,extraction for stemcell isolation for the lab,extractions for dp cell isolation(after dp cell isolation the grafts are reimplanted at the donor from where it was extracted),Extraction for dpculture...few were unsuitable drills(graft was not extracted but drill was made).

These extracted grafts were bisected in such a way under magnification,so that upper part contains epidermal and few dermal stemcells and lower part contains dermal stemcells with a part of dermal papilla...

Incisions (with very fine blade, as lateral slits)are made at the recipient in consultation with the patient after hairline is drawn at the beginning of the extractions from the donor.
After the implantations and extractions are over...all the recipient and donor site is injected with injections of..
1)trichogenic dp cells
2)progenitor stemcells
3)growth factors
4)extracellular matrix and prp

After this procedure a paste of culture media with ecm is applied at recipient and donor holes,for zero scar process externally..which tom is provided also for home use for 7 days along with a special spray for graft survival.

We should get 100% donor regen and 100% recipient regen..thus no graft should be lost..and we can theoretically have many such sessions..even if we have a weak donor..

This technique is much superior to invivo technique..where a partial follicular unit is bisected blindly..and cannot,bisect the follicle at the hair bulb level..and specially if progenitor stemcells,dp cells are not used to support the graft repair or regrowth...!

The upper half of the bisected follicle may be missing a complete dermal papilla ,dermal cup sheath will make these cells and dp cell and dp cultured cells(after 6 weeks) injected will compensate and help in new dermal papilla formation.

Similarly the lower half of the follicle is a part of dermal papilla ,it is missing the bulge stemcells,hair shaft etc

The injection of progenitor bulge cd200 cells with all other epidermal and dermal stemcells of the follicle with trichogenic dp cells will help create a new follicle from a fragment of the follicle,6 weeks later multiplied epidermal /dermal stemcells and dermal culture will further strengthen both the bisected parts...

By the end of 2nd session he will have a density of 60/70 G per sqcms at hairline..which is approx.30 in the first session..and we hope to thicken his rest of the scalp hair with HM treatment and our medical prescription will counter androgens and micronflammation..
Thus without depleting any follicle at the donor ..we should get similar number of extracted hair as bonus..which are used at hairline...

Dr. Nigam sorry,

I did not understand that the procedure used by Tom. It would be appropriate that she should specify, so as to make it clearer to all users who read (old and new).

Thanks!

[Arashi]

ONE,
We should get 100% donor regen and 100% recipient regen..thus no graft should be lost..and we can theoretically have many such sessions..even if we have a weak donor..

If this would be true, you would have created unlimited hair, right ? And thus solved the hairloss problem. Forum can close down, nothing more to talk about

[drnigams]

Arashi,forums should continue..how do people like you and me meet...

We will miss our friend im.

If this would be true, you would have created unlimited hair, right ? And thus solved the hairloss problem. Forum can close down, nothing more to talk about

[garethbale]

If this would be true, you would have created unlimited hair, right ? And thus solved the hairloss problem. Forum can close down, nothing more to talk about

Haha, problem solved. No need for Replicel, Aderans, Histogen...we can all go home

Can't see 100% being achieved but would love to be proved wrong

[Arashi]

Hehe you're sure setting your own bar high Dr Nigams But even if you'd get 'only' 80% regeneration, I'm sure you'd have the whole world flying into India.

[drnigams]

Arashi,
somewhere you said..after your cosmetic surgeries..you are being approached by our other half...you got to give me a big party..next year..when you get your ROYAL CROWN...
Doubling is just an extension of ht...HM is the real challenge...

Hehe you're sure setting your own bar high Dr Nigams But even if you'd get 'only' 80% regeneration, I'm sure you'd have the whole world flying into India.

[Arashi]

Doubling is just an extension of ht...HM is the real challenge...

But why would we want HM when doubling already brings us unlimited hair ?

[drnigams]

HM will be very cost effective,less painful, specially for an nw7,who will need bigger number of hair,hm can avoid multiple visits for nw7...
i do not know..but i meet patients who are scared of ht...

But why would we want HM when doubling already brings us unlimited hair ?

[bananana]

HM will be very cost effective,less painful, specially for an nw7,who will need bigger number of hair,hm can avoid multiple visits for nw7...
i do not know..but i meet patients who are scared of ht...

Dr Nigam, you're completely right, HM is the way to go. Especially for the reasons you mentioned. I'm looking forward to seeing results of your improved technique...

I'm posting less on the forum these days, cause I can't read all that pessimistic garbage thats flooding the place. While we have every reason to be happy because of all the progress done lately, some people just refuse to.
Oh well...

Anyways, the best of luck to you with future improvements.