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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© GETTY IMAGES HIGH DENSITY 32 OCTOBER 2017 | Med Esthetics subjects treated with minoxidil and PRP both experienced signifi cant hair growth compared to placebo. The confl icting clinical evidence has led to a range of opinions and practices on incorporating PRP injections into hair restoration services. "I use PRP in virtually all of my transplants as a wound- healing accelerant and to re-establish a microcirculation to the transplanted follicles. But the hard data is not there to routinely use PRP injections for people with thinning hair," says Dr. Reese. During surgery, he places a PRP gel—topically—in the wound at the time of closure to aid in healing. "There's no question, from a wound healing standpoint, that PRP offers the benefi t of adding microcirculation," he says. "We impregnate the PRP into the openings to aid in wound healing at the donor sites; we also coat the follicles that are to be transplanted with this activated PRP to re-establish microcirculation, which we believe aids in the rapidity of the take of the follicles and in earlier hair growth out of those transplanted follicles. At the end of the transplant, we use the remaining PRP topically on the scalp to minimize crusting post-transplant." Dr. Niedbalski does use PRP injections to slow hair loss in his patients, and he has been studying the use of ACell extracellular matrix with PRP to determine if the combina- tion improves effi cacy. "PRP alone does not last very long, so you have to repeat the treatments three to four times a year to maintain the benefi ts," he says. "ACell alone is less of a stimulant for hair growth, but when you combine the two, the ACell sequesters the growth factors in the PRP and slowly releases them over time, and the results seem to last longer." He uses non-activated PRP. "When we traumatize the scalp with the injections, that naturally releases thrombin into the tissue, so the PRP activates once it's in the scalp," says Dr. Niedbalski, who injects the PRP in a vertical fash- ion with a 4mm, 32-gauge needle. "So I'm fi lling a column all the way down to the base of the hair follicle," he says. This is followed with horizontal injections of ACell suspen- sion, using a fanning technique and a 32-gauge needle. His goal is to reach the lower third and bottom layer of the hair follicle where the stem cells reside. "Hereditary hair loss makes those stem cells in the hair follicle go dormant. It doesn't get rid of them; there are still plenty of them there," says Dr. Niedbalski. "If we can prop- erly stimulate those stem cells, they will regrow a healthy follicle that produces a normal hair." He performs the treatment every two years for men with an average rate of hair loss. "For women, we'll start out with two injections right away at zero and then at four to six months. We repeat that at 18- to 24-month intervals," he says. "In women, hair loss affects the donor hair as well, so we typically don't have permanent hair to transplant and have to rely on stimulation alone, so you have to keep at it a little more frequently." The study with which he is involved includes three other centers, which are comparing the use of ACell and PRP to PRP combined with adipose-derived stem cells. "Once injected, stem cells look for dysfunctional cells. Because the stem cells in these patients' hair follicles are dysfunctional, it may help improve their function," says Dr. Niedbalski. "An- other arm of the study involves using stem cells for people who have scarring alopecia from scalp diseases, such as lichen planopilaris, to help mitigate the damage and control the scarring process." The researchers' goal is to have data available in 12 to 18 months. Dr. Niedbalski's hope is that the continued study of stem cells combined with efforts taking place outside of the United States—such as culturing skin cells and stimulating them to become hair follicles and harvesting hair follicles to tease out and culture the follicular stem cells for reinjec- tion—will one day provide more relief to hair loss patients. "Developing new techniques is important because until we can stimulate the growth of new hair follicles or wake up dormant hair follicles, we're working with less and less hair each time we see the patient," he says. "Until we can stimulate the growth of new follicles or wake up dormant hair follicles, we're working with less and less hair each time we see the patient."

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