ACell, a Current Review of Applications in Hair Transplant Surgery

[RichardDawkins]

ejj why did you delete your post?

[rapunzal]

Guys
I appreciate the time you both take to answer questions and provide your thoughts. Please continue to take time from your busy schedules to visit these forums to answer questions and provide your thoughts because with something like Acell that is very new there simply isnt enough information available.

pioneers can often be rediculed, dont be disheartened if you really believe you are making a difference because the satisfaction from eventual achievement will make the journey worth its while
cheers

[RichardDawkins]

I agree with this statement. It is important to get deeper in this Acell thing and also to go one step beyond.

For Example, Dr Cole is sceptical about autocloning, but maybe he can conduct some trials with patients and see if plucked hairs will grow and he can also put further effort in FUE and infinite donor reserves.

If FUE infinite donor is possible, my plan would be really simple, go for a FUE procedure and use Dr Hitzig and Dr Cooleys Plucked hair autocloning for do a little bit more fine tuning in my frontal area.

I am currently saving my money till someone will come up with "Yes i managed to get infinite donor with FUE"

But thanks again due to those results and the encouraging effort put into this, it is the first time i can gladly say " Well hairloss is only temporaire messing around but not in the long run"

Keep up the good work

[John P. Cole, MD]

I have been doing non-shaven FUE for many years. i strongly feel this is the future in FUE for all patients. It requires more preparation time, but it does allow the patient to return to work the next day without shaving. There still are many physicians who are unaware that patients do not need to shave their donor area. i've done well over 3500 grafts on a patient in one day without shaving the donor area of my patient. i think a good mark is about 2000 to 2500 grafts in one procedure non-shaven, however.

if you have a strip scar, you often do not want to shave your donor area. Who could blame you? in these instances, i am careful with how much donor area i trim. The last thing we want to do is expose the strip scar whenever possible.

Now here are some pearls of wisdom if both patients and physicians are reading. When i was doing strip procedures, i would often trim the donor area that i planned to take in patients who had existing strip scars. In my hands you can typically anticipate that a strip scar that is 3 mm wide is going to be 3 mm wide with the subsequent procedure. in other words, the width was based not on technique, but rather on individual patient healing characteristics. Knowing that the scar would be the same, i would let the hair down and step back away from the patient. i would then look at the donor area under bright lights. if i could see the strip scar even with the upper hair laying over the scar, i would not take as wide of an excision. often times the strip scar is most apparent over the mastoid process. if you measure 7 cm lateral to the midline of your scalp in the back donor area, you are over the mastoid process. that is the boney protrusion that sticks out between your ear and the mid-line of your rear donor area scalp. This is where strip scars are first evident. i think the bony prominence makes the scar most prone to be wide there. Also the donor area density is lower there than in the mid-line scalp. If i could see the scar i would reduce the width of my strip so that i could insure more hair was there to help conceal the strip scar.

Back in 1992 I noted that my first strip procedure produced a fine scar. I would often then make a second procedure and produce a second fine scar above or below the first scar. The problem was that the multiple scars would make the donor area appear thin with all the scarring. This was how physicians taught me to do the procedure. Then i got the idea to harvest from the same scar in the second procedure so that my patients still had one scar. That was a good idea. The problem with harvesting from the same scar was that the extra tension on the subsequent procedure tended to make the scar wider. That's when i came up with the idea to close in two layer. My colleagues thought it was ridiculous to close in multiple layers because there was no firm tissue to hold the deep suture. Well, the adipose was firm enough to hold either individual sutures or a running suture. Guess what? the scars reduced by 50% when i did this. Today, multiple layer closure is quite common. I could take a 5 mm wide scar and get it to 2.5 to 3 mm in width. Then i noted the big problem was an alteration of hair growth angles. The more tissue you take out, the greater that problem became. Furthermore, the more tissue you take out, the greater the reduction in follicular density around the scar. Finally, even the best of techniques cannot always stop a strip scar from going from 2 or 3 mm to 5 mm. Now you have a wider scar, less density around the scar, and distortion of hair growth angles. All these complications simply create headaches for physicians and patients. Today there are options available that allow you to avoid these complications.

With a non-shaven technique of FUE, we can trim the donor area first and see what the donor area would look like if we take all the follicular units that we trim. Of course I sometimes over trim to see what the donor area would look like if i took all the follicular units that i trimmed. if i don't like what I see, i can reduce the number of follicular units that i take. This is very important with patients who have prior strip scars. We need to insure that patients can conceal their strip scars following a procedure. When i was doing strip procedures (I've done over 8000 of them), we could only estimate what the donor area would look like. With the non-shaven FUE we can actually see what the donor area will look like if we take everything. if i don't like the coverage that is left following individual follicular unit trimming, I simply reduce the number of grafts that i take. This is yet one more advantage to the non-shaven technique.

I began doing this non-shave technique is 2004. Prior to this i would shave small patches of hair. It turns out that the shaven patch is the worst way to do FUE. Avoid it at all cost. Either go with the non-shaven technique or the shaven technique. The shaven patch is a bad protocol. Patients will not prefer this method even though many physicians still do it. This method thins out patches of hair. It is far better to stretch your follicle removal out over the entire donor area than to do it in patches.

Shaving is a faster way to proceed. Shaving is the preferred way if your transplant surgeon is a novice. If your surgeon has not done much non-shaven, don't let him experiment on you with a large procedure. He needs to start small and work his way up.

The non-shaven route takes more time to master. I remember doing it early on. i went home with a headache every day. Now i simply fly through it with no problem. It just takes time to get really good at it.

[HairRobinHood]

I agree with this statement.

Does it mean you agree that conversations with yourself?

[RichardDawkins]

@ Dr Cole : Ok this has its advantage but my point is, and i think anyone would agree here. That we would switch a full shaven head for infinite donor any time :-)

As i said before i hope you will go this way further with possible infinite Donor

[John P. Cole, MD]

Richard Dawkins, I am skeptical of autocloning. Nevertheless, it is one of those eye opening events that you have no choice but follow. i honestly think that Dr. Hitzig and Dr. Cooley need to inject the donor area with Acell, in addition to the plucked follicles. i'm really worried about what will grow in the donor area if they do not do this. I'm sure they will keep us posted on their results.

For me, i have no plans to test autocloning at this time. I learned something long ago. Patients come to me to get their hair back. i can assure this with FUE. i can't with autocloning. Still I'm totally in your camp with the concept of an infinite donor supply. We tried it with body hair. It worked well in some patients, but awfully in others. It was nearly impossible to predict the results. Today we are seeing a potential improvement by adding Acell to body hair transplants. Even if autocloning does not work and even if treating the donor area FUE extraction sites does not work, perhaps body hair and Acell will work. No matter which path anyone takes, they should proceed with caution. Do a little, see what works, and then do more. I'm so excited about what we are seeing in FUE donor area healing with Acell; however, that I just can't stop thinking about it. I certainly hope that is exactly where Dr. Cooley and Dr. Hitzig are with autocloning. My advice to anyone considering autocloning with plucked hairs remains that they should test the area with no more than 500 grafts. if it does not work for you, stop doing it. If it does work for you continue it.

Richard Dawkins, you bring up one more point. I cannot tell you how many patients I have seen in their 30s who started hair transplant surgery in their early 20s. There are so many of these individuals who wish they had never done a hair transplant. I worked on a repair case just this week with over 4 strip scars. His comment to me was that he started in the early 90s when long hair was cool. Then everyone started shaving their heads to conceal their hair loss. Now he wishes that he had not done anything. I wish he hadn't either. He got on the hair transplant freight train after watching an a TV commercial from an established clinic. He has not only multiple strip scars, but also pitted and pluggy grafts. His repair work will require at least 2 years of his time and my time. Waiting for an infinite donor supply for you is a good thing. My honest hope for you is that you will no longer want hair restoration by the time technology catches up to what you want. By the time many individuals hit their 30s, they no longer worry about their hair. They have other things to worry about like children, wives, and business. I hope you are able to put it behind you. I also hope your follicle loss does not put you in a place where you need an infinite supply of hair. Thus, my sincere hope for you is that you do not want hair transplants in the future and that your donor area is capable of restoring your hair loss should modern technology fail to produce the results you are in need of.

That leads me to one last comment. I don't read these forums on a regular basis. i have tunnel vision when i do. Did anyone see Jerry Brown's inauguration picture this month? I recall his inauguration in the 1970s. He was on the stage with Linda Ronstadt. Jerry had a hair loss problem at that time, but he looked like he had a full head of hair. Well, fast forward almost 40 years and it was all gone. The last thing you want is to start hair transplant surgery in your early years and wind up like Joe Biden with a huge bald spot in the rear. All of you guys take note. What you do today has an impact on what you will look like in the future. There is nothing wrong with waiting. Next year's model will be better than this year's model. We will have more time to work out the Acell, etc. kinks. For me, my first car was a Ford Galexy 500 that i had to bleed the breaks on every two days. I could not consider myself in that clunker today not simply because i'm too rotund to get under the car. We are simply not a match. Waiting will bring you nothing but the future. Hopefully the future will bring you peace with who you are in your absence of as much hair as you would like. Besides, perhaps modern technology will help you avoid surgery altogether.

[HairRobinHood]

For me, my first car was a Ford Galexy 500

No Mercedes Benz with just 3 wheels?

[gmonasco]

Did anyone see Jerry Brown's inauguration picture this month? I recall his inauguration in the 1970s. He was on the stage with Linda Ronstadt. Jerry had a hair loss problem at that time, but he looked like he had a full head of hair. Well, fast forward almost 40 years and it was all gone.

How cosmetic doctors would redo Jerry Brown’s face

Cosmetic doctors say that Democratic gubernatorial candidate Jerry Brown, 72, has had little or no plastic surgery, but they have plenty to recommend to him.

http://inyourface.ocregister.com/201...ns-face/22686/

[John P. Cole, MD]

This is what i use to measure Acell. Note how little powder there is to equal 15.6 mg. This scale has glass all around to eliminate air flow and allow for a more precise measurement of the Acell. The scale is quite precise and carries a costly price tag. I like to be as precise as possible when mixing the Acell in my delivery vehicle such as hyaluronic acid or cellulose. This is the Acell powder, which i fell mixes much more homogenous than the Acell flakes.