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

[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.

[joachim]

i think dr. cole is totally right with his diameter/follicle bisecting statement. it was already raised in another thread that bisected follicles, even if both halves start to grow, the diameter was finer. and all in all, with bisecting follicles the chance for surviving follicles is smaller, and you would end up in less than one total follicle, like dr. cole mentioned.
thus, only if dr. wesley can show donor regeneration with the same diameter than before, then it can be success, otherwise it's doomed to fail. to me, the only advantage of pilofocus is that you don't see any white dots.
but if dr. cole achieves similar results and much better healing properties with acell, then it's a good deal and there's no need to adopt a new surgical instrument. all in all, i don't really have much hopes for pilofocus. the marketing was good though. it was hyped up by some users here so that everybody got excited.

however, i'm looking forward to the donor regeneration test of dr. cole.
if that fails as well, then i think we can all agree that donor regeneration will never ever happen. too many tried and failed already.

[hairlosskills]

Dr cole do you offer prp to patients who had surgery else where as a means of maintaining hair loss...and or promoting hair growth for the top of the scalp AND in the DONOR?
-thanks in advance

[hairlosskills]

To clarify what i said above, im experiencing some sort of telogen efflivium or diffusing in the donor as well as on the sides and my sideburns . Have you used your prp with this type of loss?

[John P. Cole, MD]

We've had pretty good success with PRP. We measure the cross sectional trichometry before the procedure and after. We recently had a woman who increased from a 60 to about 98 on her cross sectional trichometry with PRP one year later. That was a pretty good response. I think that not all respond probably due to epigenetics. There are questions that remain to be answered such as the optimal needle, the optimal depth to inject, the optimal way to activate the PRP, how often to inject, and the optimal hematorcrit. Everyone seems to be all over the place in terms of what they are doing. I like a 5X concentration, a 25 to 27 gauge needles, a 2% hematocrit, injection every 6 to 12 months, and injection in the dermis. i think the current recommendations in Europe are to repeat in one month and then every 3 months. i think this might be a little much, but maybe. Maybe we should repeat in one month and then every 6 months. It needs to be studied.

I think we are way off in terms of a panacea with Acell. That's why I'm looking at the smaller particles from Amniotic membrane. I'm hoping. I worry that some of the Acell leaks out of the extraction sites. I wonder if injecting would improve the results.

Maybe Acell will help the hair diameters from the bisecting that Dr. Wesley recommends. As usual, there are more questions than answers.

I do think PRP can help the sides of the head too. I've seen donor areas improve with PRP perhaps because the PRP drains due to gravity. I typically measure the cross sectional trichometry in the front, top, crown, and donor areas. Sometimes i measure the CST above the ears. When there is a strip scar, I measure both above and below the scar. We see some interesting responses to medical therapy and surgery. It's a great test. More physicians should use it. It's the most sensitive way to see if there has been a positive change.

[willy]

I can't wait for Dr. Cole's regeneration test on Agahi. If this happens it will be, in my opinion, the most exciting subject on this forum.

Sorry if this has already been answered but will the test also measure the quality of the extracted follicles as well as the regenerated ones? Does that make sense? For example, HASCI clinic would show impressive regeneration but it's because they only take out partial follicles and the recipient quality is that of a "half hair".