Medesthetics

OCT 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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COURTESY OF ROBERT NIEDBALSKI, MD; BACKGROUND © GETTY IMAGES HIGH DENSITY After ruling out medical conditions, such as thyroid problems or polycystic ovarian syndrome, he considers the degree of hair loss using the Ludwig Classifi cation system. "Women who have Ludwig 1 hair loss are not good candidates for surgical hair restoration because we can't put enough follicles up in the scalp to make an appreciable difference," says Dr. Reese. "These patients are best man- aged either through using Rogaine or minoxidil combined with LLLT, or LLLT on its own. They have a 90% chance of slightly thickening the hair using these adjunctive thera- pies, and if that gives them enough volume, they don't need a transplant." He will consider surgery—along with minoxidil and LLLT—for Ludwig 2 women. "That's a good classifi cation to consider surgical hair restoration," says Dr. Reese. "If the woman is a Ludwig 3, then we have to look at one of two options: one would be wearing a wig; the other would be surgical hair restoration—if she has enough per- manent follicles for transplant—but she's probably going to need more than one procedure to get satisfactory results." Strip Method vs. FUE In recent years, follicular unit extraction (FUE) has become a popular alternative to the strip method of hair transplanta- tion because it creates smaller, less visible scars. But it's not the best option for all patients. "One theoretical disadvan- tage is that donor follicles from the high fringes or the nape of the neck are not always genetically permanent, and you want to take follicles from a more diffuse area to prevent areas of concentrated scars," says Dr. Reese. "If I'm seeing miniaturization high and low in the donor zone, I tell the pa- tient that if we do FUE, we are potentially taking a signifi cant percentage of the follicles from donor follicles that are not necessarily permanent." Dr. Niedbalski uses the strip method in 60% to 70% of his transplant surgeries and FUE for the remaining 30% to 40%. In addition to taking follicles from a more diffuse area, "it's a little tougher to control how much tissue is around the base of the graft with FUE," he says. "So the follicles tend to be a little more delicate when you take them out with FUE than when you take them out with the strip. If someone has an objection to having a strip scar, whether because of their hair style or how their hair grows, then we use FUE." Incorporating PRP The use of PRP as both a standalone and adjunct therapy is becoming commonplace in hair restoration. But it is impor- tant to consider the evidence when determining whether and how to offer it in your practice. In November 2016, Dermatologic Surgery published the results of a study by Dr. Reese, Carlos Puig, MD, and Michelle Peters. The re- searchers investigated the use of PRP injections in women with female androgenic alopecia. "Most of the women felt that there was benefi t of doing the injections, but there was not a statistically signifi cant result," says Dr. Reese. A different study published in Dermatologic Therapy (Sep- tember/October 2016) comparing PRP to minoxidil 4% and placebo in women with alopecia areata showed that 30 OCTOBER 2017 | Med Esthetics Dr. Robert Niedbalski is investigating the use of extracellular matrix in combination with PRP to improve hair loss. BEFORE TREATMENT 8 MONTHS AFTER ACELL PLUS PRP

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