Study by Dr. Cole about Acell/PRP and Donor Regeneration. Very good results!

[csoul]

Start on minute 2:52 and he explains all his study about Donor Regeneration with Acell. with photos before and after, numbers and more:

More than 60% of Donor Regeneration!

http://youtu.be/khVm4wSpzjo?t=2m52s

[hellouser]

Old news. If he got 60% of donor regeneration, he'd have multiple men going from NW6 to NW1.

No evidence of that.

[whatsgoingon]

HSC is proinflamatory? But isn't that jak inhibitor that 'cured' AGA a anti-inflamatory? Did he mix up words? Or am I not understanding something?

[John P. Cole, MD]

The Jak inhibitor was used in a different type of alopecia caused by an inflammatory process where the body attacks the hair follicles. This form of hair loss is usually treated with anti-inflammatory products like steroids.

Many things that seem to improve hair diameter are pro-inflamatory. Wounding for example is pro-inflamatory. The one thing you want to avoid with treatments such as PRP is anything that limits the beneficial aspects of the inflammatory process such as steroids and non-steroidal anti-inflammatory products like Motrin, Advil, Nuprin, etc.

We studied our donor sealing case carefully in preparation for publication. In an effort to insure we noted only those sites we were sure had hair re-growth, we decreased our percentage to 42% of the extraction sites. We are certain that there was at least one hair to regrow in 42% of the extraction sites in this study.

We find in general that 49% of our extraction sites cannot be located or they had hair growth with Acell application. Some of this represents follicle re-growth and some of it represents improved donor healing. There are many reasons for hair re-growth. One would be follicle transection. In the 42% study only 1 or 12 extractions had follicle transection. Thus, I'm absolutely certain we had follicle regeneration in this study after all follicles were removed.

One must follow a minimal depth extraction protocol in order to get follicle regeneration. Another important aspect is to minimize Acell leakage from the extraction sites.

[joachim]

The Jak inhibitor was used in a different type of alopecia caused by an inflammatory process where the body attacks the hair follicles. This form of hair loss is usually treated with anti-inflammatory products like steroids.

Many things that seem to improve hair diameter are pro-inflamatory. Wounding for example is pro-inflamatory. The one thing you want to avoid with treatments such as PRP is anything that limits the beneficial aspects of the inflammatory process such as steroids and non-steroidal anti-inflammatory products like Motrin, Advil, Nuprin, etc.

We studied our donor sealing case carefully in preparation for publication. In an effort to insure we noted only those sites we were sure had hair re-growth, we decreased our percentage to 42% of the extraction sites. We are certain that there was at least one hair to regrow in 42% of the extraction sites in this study.

We find in general that 49% of our extraction sites cannot be located or they had hair growth with Acell application. Some of this represents follicle re-growth and some of it represents improved donor healing. There are many reasons for hair re-growth. One would be follicle transection. In the 42% study only 1 or 12 extractions had follicle transection. Thus, I'm absolutely certain we had follicle regeneration in this study after all follicles were removed.

One must follow a minimal depth extraction protocol in order to get follicle regeneration. Another important aspect is to minimize Acell leakage from the extraction sites.

dear dr. Cole,

i think it's possible that with your technique (not doing full-depth extractions with acell) to get some donor regeneration. the point is, it's really hard to believe and to convince people.
what about the following proposal to get an ultimate proof: mark 1 cm2 with scalp tattoos and do a hair count. then extract ALL hair follicles in this area with your technique, and after 6 or 9 months, see what happens with donor regeneration. this would be a very easy test which wouldn't let any possibility of misinterpretation. of course, all the extracted follicles should also be monitored at the recipient site, and hopefully at least 90% should continue to grow there.
this would be an ultimate test to have proof of donor regeneration. because up to now there are not really many people on this forum believing that it really works. too much talk and pseudo studies with acell in the past years. and still we have no real transformation from e.g. a NW5 to NW1.

thank you

[HairIsLife]

If ANYONE could get 60% regeneration, baldness would nearly be cured. Inb4excuses.

[John P. Cole, MD]

I totally agree with your protocol suggestion for a number of reasons. When we harvest the entire donor area we find that many extraction sites heal flawlessly with Acell. The question remained whether there was regrowth or perfect healing. So we tried a smaller surface area of only 1 sq cm thinking we could evaluate they smaller area better. When we harvest a smaller area of only 1 sq cm, many sites heal flawlessly. It's hard to say for sure. Initially, we thought 60% in the 1cm case, but when we went back and studied not only the photographs, but also the video of the extractions, we were certain only about 42% of the sites exhibiting regrowth. One of those sites was purposely transected and i don't count that. i'm only interested in sites where follicles were extracted intact. This drops the total to 33%, but of course growth in a transected graft is important if you are the patient so let's not totally forget this.

removal of an entire sq cm is the ultimate test, but what if nothing re-grows. that's a hard sell to a patient. i'm working my way up to this level gradually, however. Give me time. What i can say to date is that a deeper extraction did not work as well as a more shallow extraction on a small case study.

i will conclude with the thoughts that no one believes this. I didn't even believe it, but Acell has cleared every hurdle i've ever put in front of it. At some point, you have to start believing.

[joachim]

I totally agree with your protocol suggestion for a number of reasons. When we harvest the entire donor area we find that many extraction sites heal flawlessly with Acell. The question remained whether there was regrowth or perfect healing. So we tried a smaller surface area of only 1 sq cm thinking we could evaluate they smaller area better. When we harvest a smaller area of only 1 sq cm, many sites heal flawlessly. It's hard to say for sure. Initially, we thought 60% in the 1cm case, but when we went back and studied not only the photographs, but also the video of the extractions, we were certain only about 42% of the sites exhibiting regrowth. One of those sites was purposely transected and i don't count that. i'm only interested in sites where follicles were extracted intact. This drops the total to 33%, but of course growth in a transected graft is important if you are the patient so let's not totally forget this.

removal of an entire sq cm is the ultimate test, but what if nothing re-grows. that's a hard sell to a patient. i'm working my way up to this level gradually, however. Give me time. What i can say to date is that a deeper extraction did not work as well as a more shallow extraction on a small case study.

i will conclude with the thoughts that no one believes this. I didn't even believe it, but Acell has cleared every hurdle i've ever put in front of it. At some point, you have to start believing.

i agree that it could be difficult to find a patient who allows to extract a whole cm2 because of the risk that this spot will stay bald afterwards. but the solution to this is very simple. nobody says that it has to be an area 1cm by 1cm. it would also be totally ok to have a rectangular area like 5mm by 20mm, or even 2.5mm by 40mm. the result would be a thin stripe which can be easily covered by the other donor hairs, so that there wouldn't be any real risk for patients. if necessary for photos and trichoscans, the stripe-like areas could be divided in more areas with multiple scalp tattoos. also, it would be possible to distribute the small spots all over the donor area, so that the gaps become even more invisible. it's only important to have a reasonable total size and total amount of extractions. 80 to 100 extractions would be good. but good documentation with before/after pics is of utmost importance. the scalp tattoos also should be done correctly.
if you pay some volunteer patient e.g. 1000 dollars for such a test, you will find such test candidates very quickly. you could be the first hair surgeon in the world who could really proof the first well-documented donor regenation. other surgeons failed multiple times on that task, some of them even trying to cheat for many years. probably you heard from your representative chuck that dr. Gho who claims donor regeneration for years now was exposed by some forum members here. he's cheating about this for over a decade now, but not many care about that and he will continue with it for another 2 decades.
the next who probably will show some degree of donor regeneration will be dr. wesley with his pilofocus device and acell.
however, until we don't have such an easy donor regeneration test with at least 1cm2 the whole donor regeneration story will always be unreal nonsense which is used by several doctors for marketing purposes.
i would love to see at least one doctor, you, who can really proof that it's true, once and for all. this would take hair transplants to a whole new level. i wish you good luck on that but i'm afraid that we will never see such an ultimate proof of your technique in the near future. i hope i'm wrong.

[Agahi]

I'll do it. Where are you located Dr. ?

I see now your profile says Atlanta. I will be moving to Jacksonville FL in a few months so fairly close. If you are interested in this experiment I'll do it for the greater good. The only thing I'd ask is a discount on fixing it if none of the area regenerates.

[Ktownmatti]

I had a procedure done with Dr Cole 10 months ago with PRP and A-cell. I can't speak to donor regrowth as I haven't been back for a follow up yet. However, I CAN say the donor area looks absolutely pristine. I buzz it to a number 2 and it looks perfect. Barbers can't even tell. I was only a NW 2/3 ish, so regrowth wasn't a motivating factor. I simply wanted the absolute best healing possible as I like to wear my hair short.

[John P. Cole, MD]

Ok, Agahi. We can give it a try. This is something I've wanted to do. Getting a top quality photo both before and after is essential.

I doubt Dr. Wesley will have any success with regeneration. He removes the bottom portion of the entire follicle. We know that CD34 cells are important and they are located at the base of the follicle. When you remove the entire base, you remove all the stem cells. Stem cells from adjacent follicles could migrate over. We know this happens in mice. We also know that adjacent follicle stem cells play a role in healing skin wounds. When I tried a deeper extraction, i was able to get only 3 of 17 extractions to show regrowth. I found that there was no regrowth in the 2 of 17 where I had follicle transection. There was no regrowth on the control side. The lower rate of regrowth with the deeper extraction suggests that stem cells come from the local follicle rather than from adjacent follicles. Also, the lack of growth on the control side where not Acell was used supports the benefit of Acell.

We had our first amniotic membrane patient to return last week. We extracted from 4 boxes. We applied Amniotic membrane to three boxes. We sealed one box. We left one box untreated. Then in one box I injected Amniotic membrane without removing anything so there are a total of 5 boxes we are following. The Amniotic membrane boxes healed faster based on history. However, the untreated box looks the best. The amniotic membrane boxes still have redness (pink) color in the extraction sites. This means there is something going on in these extraction sites because the pink color implies more blood flow. There is not hair regrowth yet. His hair was fine and the follicles were much deeper so I had to incise deeper. I had more follicle transection in this case. If my goal was to get the best grafts, I would probably have used a different punch or a different technique to minimize transection. However, my goal was to use the same punch and same technique in all extraction sites so I had to go with what i started with.

[Agahi]

Sounds good DR. I'll be in touch. I can PM you my email address if you would like.

[John P. Cole, MD]

that's fine with me. let's do it.

[FearTheLoss]

that's fine with me. let's do it.

Dr. Cole, it will be interesting to see what becomes of this trial for you.

Furthermore, I think your assumptions regarding Dr. Wesley are inaccurate. http://drcarloswesley.com/T/06082014.pdf this suggests both portions of the follicle are capable of producing hair, and hopefully something like ACell could improve the rate or regeneration. Also, Dr. Aaron Gardner confirmed that what Dr. Wesley is attempting to do should undoubtedly work.. Why don't you attempt to work with Dr. Wesley on this instead?

Regardless, I'm excited to see if this test actually comes to fruition and isn't all talk like most doctors have been in regards to this. I sincerely wish you the best of luck and would be headed your way in a second if you could prove consistent regeneration. Thanks for all you're doing, and thanks for being active on the forum.

FTL

[John P. Cole, MD]

We are certainly not working against one another. I really don't think he needs my assistance, but I'm always available if he ever does.

Numerous physicians have repeated this sort of study where the upper 1/2 and the lower 1/2 were bisected and then transplanted. They have even cut follicles into three parts. The results have varied between almost no growth on one side to about 50% on both sides. This particular study was at the upper limit of results. Limmer's study was at the lower limit when you combine the two. Follicle bisection really never made much sense to me. Why accept 50% growth from each half. That still adds up to 1 follicle. Bisection studies often add up to less than one total follicle. When you transplant the intact follicle, you expect 80 to 90% or more. Then if you can add a substance to the donor area and get another 30 to 40% to 50%, that adds up to more than one follicle and it consistently adds up to more than one follicle. Remember the goal is more than one follicle and bisection studies often add up to less than 1 follicle.

Another problem with bisection studies is that the resulting follicle is often finer than the original follicle. Diameter is always more important than the total number of follicles because volume of hair is what produces coverage and volume of a cylinder is based on the radius squared. Double the diameter and you get 4X the volume. Double the number of hair and you get 2X the volume. Sacrificing diameter is a bad trade off. I have not seen a decrease in diameter from my Acell studies, however, i really do need to measure it so I'm glad you brought this up. I need to look at the diameter of follicles derived from follicle neogenesis.

Now, if you were to dissect the lower follicle so that it contains perhaps 80% of the follicle and 20% remains on the top or 90% from the bottom and 10% at the top, i think the lower portion would have a higher yield, but the yield on the top would be less.

These are just some of my thoughts related to his work. We certainly are not on opposite teams or in a competition. We both have the same goals. I really wish him well for the simple reason that it is good for men with hair loss should he succeed. I want him to succeed. I don't think we want everyone pursuing the same path anyway because if that path proves wrong no one has been looking in the other direction.

It is coincidental that you refer to a study with Dr. Marco Toscani in Rome. I'm currently collaborating with him and Dr. Chiara Insalaco on an ISHRS research grant to study the affect of strip harvesting and FUE simultaneously and the affect of FUE on the donor surface area. The first case from this study presented back yesterday. Both Dr. Toscani and Dr. Chiara Insalaco are in the department of plastic surgery at the University Sapienza of Rome. Both physicians have a focused interest on hair transplant surgery. Dr. Insalaco sent me the results of her detailed investigation. The strip scar on the side without FUE was 2 mm in width. The strip scar on the FUE side was 5 mm in width. It has been my fear that combining strips and FUE would result in a wider scar. The first case seems to support this hypothesis. We still have a long way to go in this study, but it's already looking bad for the combination procedure. I don't do strips so my part in this study is to evaluate the surface area of a box where we extract FUE grafts. I have long found that the cross sectional trichometery decreases measurably following strip harvesting, but it remains very close to the same with FUE. This can only happen if the surface area decreases with FUE. I think this surface area change puts additional tension on the strip wound and causes the scar to widen. My theory is that combining strips and FUE at the same surgery is a very bad idea.