Dr. Cooley and ACell

[HairTalk]

We performed approximately 3000 plucked grafts and these were placed at relatively low density over the entire thinning area. The goal is to not only get 3000 grafts of new hair, but also to thicken miniaturizing hairs in between the grafts. We will determine this in 12 months.

Dr. Cooley, will this patient's donor zone be monitored in addition to his recipient?

If we may ask, what does your clinic currently charge for a fully-plucked procedure, relative to what it charges for F.U.T. or for F.U.E.?

Thank you.

[UK_]

Well, I don't know that's true: If Dr. Cooley plucked 3,400 hairs, and 200 of them grow in, his yield would be ~6% — that's appallingly low compared with the 90+% most F.U.T./F.U.E. procedures are supposed to give, and, if this happens, I don't think anyone would want to seriously pursue ironing the "kinks" out of plucking. If, on the other hand, he gets upward of 70% growth, I do think it will be something remarkable, exciting, and promising.

I think, unfortunately, Dr. Cooley does a bad job presenting his work in photographs. I agree with Debris and Plopp in that, were I not guided to do so, I honestly would not find any difference in Dr. Cooley's before-and-after images posted on the first page of this thread. I very much hope the other patients of Cooley on whom he's been trying this method are Norwood VIIs, or close to, for on them one could clearly interpret growth and lack thereof, rather than just try to hunt for particular strands of hay in a somewhat-thinned haystack.

HairTalk, correct me if I am wrong, but the small thatch of hair in the frontal area was 400 twin-hair plucked grafts in which an average regrowth rate of circa 50% was seen, the results of the rest of the scalp (3000 plucked grafts) will be determined after a period of 12 months.

It is too early for Dr Cooley to state whether the 3000 grafts were successful, but the point of my post was that we have not seen a total failure of this process, we must be positive of the fact that atleast some hairs are growing back, conflate these findings with that of Dr Coles and I truly believe there is atleast something, small it may be, to be positive about.

Even if plucking works perfectly — let's say 100% yield — it's not believed to avoid the necessary ~four-month period in which grafts, initially shed, grow back (and are not seen). Dr. Cooley's "after" image was taken three months post-op.: how could those longer hairs be regrown grafts? Even with F.U.T. or F.U.E. — which are proved procedures — one rather more likely would not have visible evidence of re-growth at the three-month mark, would one?

Exactly, hence the 12 month wait.

[VictimOfDHT]

You know what I hate, when a doctor comes here, says a few words that gets us all excited, then leaves to never be seen again, at least for some time, leaving us with even more questions than answers. Do they do this on purpose ? I have no doubt they do. It's not about "being busy" either.

[HairTalk]

You know what I hate, when a doctor comes here, says a few words that gets us all excited, then leaves to never be seen again, at least for some time, leaving us with even more questions than answers. Do they do this on purpose ? I have no doubt they do. It's not about "being busy" either.

Well, what's a good alternative? Doctors come on to share their results when they feel it is appropriate to do so. Would it be preferable for people to hear nothing at all until it catches on as a new "gold standard"? Should doctors instead constantly monitor fora such as this, and post responses when they've nothing new to say?

I feel you're being a bit unfair.

[VictimOfDHT]

What's being unfair has to do with it ? We're not asking them to tell us stuff they don't know. Nor are we asking them to tell us what the future holds. We're asking them about stuff they themselves choose to come here to tell us about, as if to entice us. Coming here a second time or a third to answer a question or two does NOT require them to sit here and "monitor" the forum. As you can see, many people post questions following a post/thread by a doctor but in many cases their questions go unanswered, and they keep checking and checking.
At least it would be nice to let us know that's all they have and won't be commenting/answering any questions until they have something new.

[UK_]

@VODHT - to be fair, we are only at the half-way point since Dr Cooley stated there would be an update, I didnt even expect Dr Cooley to respond yet.

[Jerry Cooley, MD]

Thanks again for all the comments and questions. I do not routinely monitor this forum and count on Spencer giving me a heads up if there is something I need to respond to.

Since I presented my work with ACell, many physicians asked me about using it and I have since heard good feedback from them regarding the results (for standard transplants). I am in constant communication with several colleagues investigating ACell. The main way we exchange information is at our annual ISHRS scientific meeting, which is in Anchorage, Alaska this September. I will be leading a symposium on ACell and will be joined by Gary Hitzig and John Cole. I believe Jim DeYarmen will be discussing his work with ACell/PRP and hopefully Drs Rassman and Bernstein will be sharing their results as well.

A few more comments about the plucked technique. It's much more difficult than it sounds. There are many nuances to it that simply have to be worked through by trying it over and over. I do monitor donor areas and no one has complained of any permanent thinning, although the time to full regrowth has been surprising variable, from 2 months to 6 months. The actual regrowth of the grafts is even more variable, reflecting variability in the regeneration process rather than the telogen cycling seen in standard transplants.

To be clear, I spend most of my time doing standard FUT. I think anyone who is a good candidate for medical treatment and standard FUE/FUT should follow this route. For those absolutely opposed to FUE/FUT, this might be a consideration but all of the inherent uncertainties have to be accepted. It is also a consideration for patients in need of repair who have minimal standard donor areas.

I understand the frustration about this new technique and the lack of information. I can only ask that people keep an open mind and have patience as the process unfolds. In my opinion, the fact that we are ever able to regenerate new follicles opens up an exciting avenue of study for hair restoration. In the coming years, new treatements like Histogen, Aderans, RepliCell, etc technologies will add to this new paradigm of regenerative hair restoration.

[HairTalk]

Thanks again for all the comments and questions. I do not routinely monitor this forum and count on Spencer giving me a heads up if there is something I need to respond to.

Since I presented my work with ACell, many physicians asked me about using it and I have since heard good feedback from them regarding the results (for standard transplants). I am in constant communication with several colleagues investigating ACell. The main way we exchange information is at our annual ISHRS scientific meeting, which is in Anchorage, Alaska this September. I will be leading a symposium on ACell and will be joined by Gary Hitzig and John Cole. I believe Jim DeYarmen will be discussing his work with ACell/PRP and hopefully Drs Rassman and Bernstein will be sharing their results as well.

A few more comments about the plucked technique. It's much more difficult than it sounds. There are many nuances to it that simply have to be worked through by trying it over and over. I do monitor donor areas and no one has complained of any permanent thinning, although the time to full regrowth has been surprising variable, from 2 months to 6 months. The actual regrowth of the grafts is even more variable, reflecting variability in the regeneration process rather than the telogen cycling seen in standard transplants.

To be clear, I spend most of my time doing standard FUT. I think anyone who is a good candidate for medical treatment and standard FUE/FUT should follow this route. For those absolutely opposed to FUE/FUT, this might be a consideration but all of the inherent uncertainties have to be accepted. It is also a consideration for patients in need of repair who have minimal standard donor areas.

I understand the frustration about this new technique and the lack of information. I can only ask that people keep an open mind and have patience as the process unfolds. In my opinion, the fact that we are ever able to regenerate new follicles opens up an exciting avenue of study for hair restoration. In the coming years, new treatements like Histogen, Aderans, RepliCell, etc technologies will add to this new paradigm of regenerative hair restoration.

Thank you, Dr. Cooley. So, first, again, have you been treating the donor area of pluck-transplants with ACell, P.R.P., or any other compound, to facilitate minimal loss? It sounds as if plucking, by itself and with no "support," might not be exactly the source of "guaranteed-limitless supply" many of us have assumed.

Second, we do thank you for sharing with us your time and your knowledge, and we eagerly await hearing what was said at September, 2011's I.S.H.R.S. meeting.

[FullOfQuestions]

Does anybody know if the hair is permanent with this plucking method?

[Jerry Cooley, MD]

[QUOTE=HairTalk;33443]Thank you, Dr. Cooley. So, first, again, have you been treating the donor area of pluck-transplants with ACell, P.R.P., or any other compound, to facilitate minimal loss? It sounds as if plucking, by itself and with no "support," might not be exactly the source of "guaranteed-limitless supply" many of us have assumed.

A few months ago, ACell came out with finer particles that can be injected so we have been injecting the donor areas prior to plucking but have no results to share yet. As I have said before, this was never thought of as a 'limitless supply' but rather an 'expanded supply' that has some unique advantages depending on the patient. Moreover, it shows us the very real possibility of in situ follicle regeneration; this is the future in my opinion.

[LarryDavid]

If the transplanted hairs grow I dont see why this would not be an unlitimted donor supply because plucked hairs will grow back. Why is it just "expanded"? Do you assume that not all plucked hairs will grow back?

[Jerry Cooley, MD]

If the transplanted hairs grow I dont see why this would not be an unlitimted donor supply because plucked hairs will grow back. Why is it just "expanded"? Do you assume that not all plucked hairs will grow back?

You can only pluck hair so many times before depleting the cells in the follicles. After the stem cells are depleted, hair won't regrow. In trichotillomania, people develop permanent bald spots after they've been plucking for years. Whether ACell treatment changes this is not known at this time.

[UK_]

But this really is a massive stride in the right direction, Dr Cooley you have proved that plucked hairs do grow as an FUE graft would.

I totally understand there are still a lot of issues that need to be addressed, I remember when the Woods technique was first out (yeah ive been waiting that long).... they had a host of corners to iron out before successful yields began to increase.

When you pluck a hair you're damaging the follicle, so the body can either go down the regenerative or scar route, I guess it's mere pot luck when it regenerates but that wont always be the case, so yeah... Acell may be the winning factor if it can keep that "regenerative" mode in place when a hair is plucked.

[RichardDawkins]

I think the stem cells need only some regneration time to be "full" again. Even in those patients who pluck their hairs over years and years and years, the hair will grow back if they stop it. It will take a while but they regrow.

So with increasing the yield, you could pretty much say its "Regeneration time based infinite donor".

My guess is, that when you pluck hairs and the yield is different, that you plucked hairs which are not in Anagen Phase. And this part is essential. If you would plcuk all hairs in Anagen phase, well you would get almost 100 Recipient growth.

Also all the plucking time or in case of HST you just extract a very small amount of tissue. Just compare it with a fully extracted FUE Graft for example.

I think at this point, that three fully session equal to 4000 Grafts sessions are the top before you should give the donor a regeneration time. So in other words around 12.000 Grafts equal extractions and then a pause for some time, maybe two years or so.

Next tryout should be a hair line restoration with only plucked hairs and a high density.

[HairTalk]

A few months ago, ACell came out with finer particles that can be injected so we have been injecting the donor areas prior to plucking but have no results to share yet. As I have said before, this was never thought of as a 'limitless supply' but rather an 'expanded supply' that has some unique advantages depending on the patient. Moreover, it shows us the very real possibility of in situ follicle regeneration; this is the future in my opinion.

Thank you.

I understand repeatedly-plucked hairs might not re-grow indefinitely (I suppose patient-characteristics will go a long way in determining regeneration), but the supply, I do believe, would, if not quite limitlessly, be greatly expanded.

I know trichotillomaniacs sometimes can suffer from permanent hairloss, but, on the other hand, only so many hair follicles compose the eyebrows, which many women have plucked ~weekly, for decades, if not for a lifetime. If this trait of eyebrow hair carries over to the back of the scalp, I'm hopeful the donor supply for hair-restoration will be sufficient at least to recover a full head of hair for those not exactly at the Norwood-7 level; this, of course, assuming the transplanted hairs regrow consistently and reliably, and with proper characteristics and longevity, in recipient areas.

Another nice thing about plucking seems to be in the potential to transplant fine hairs without leaving scars — something even the cleanest F.U.E. procedures perhaps could not pull off. Now, if such delicate hairs actually would re-grow — and whether they even could be extracted with enough material intact at the base — I guess research would have to tell us.