NOV-DEC 2015

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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CROWNING GLORY 50 NOVEMBER/DECEMBER 2015 | Med Esthetics System published in the October 2014 issue of Lasers in Surgery and Medicine compared 24 female patients treated with iGrow to 18 pa- tients treated with a sham device. The iGrow produced a 37% increase in hair growth, signifi cantly higher than the sham de- vice. The iGrow System is FDA approved for both men (January 2013) and women (December 2014). "We have been using LLLT for years, especially in the post-op care of transplant patients," says Dr. Gian- notto. "Healing is quicker and graft growth is accelerated. LLLT as a stand-alone program is a wonderful way to help stop the progression of hair loss in men and women. It can also be used as a preventive measure in patients just begin- ning to notice hair loss. The original FDA study showed that 87% of men using LLLT stopped the progression of their hair loss. My patients love the program." Platelet Rich Plasma (PRP): "I have performed countless platelet rich plasma (PRP) procedures in my clinic over the past two years generating successful results. PRP is truly an innovation to the world of hair restoration," says Dr. Kahen. "I also use PRP therapy in conjunction with my hair restora- tion surgery procedures. It helps patients recover quicker while also creating more density and speeding up the hair growth process. PRP is more appropriate for patients with androgenic alopecia." Dr. Wendel calls PRP her go-to treatment "for women with androgenic alopecia or alopecia areata, not alone but in combination with minoxidil and LLLT. We have the larger devices in our practice but often use the LaserComb (Hair- Max) or LaserCap (LCPro). We have more experience with these devices and don't believe that bigger is always better." "PRP is an awesome way of enhancing healing and growth after transplantation," adds Dr. Giannotto. "We use it on every patient undergoing a restoration procedure. PRP can also be used to prevent or slow down the progression of hair loss. Several of our patients have noticed good hair growth beginning several months after the procedure. It is important to counsel the patient undergoing just PRP (no surgery) so that they understand that this is not a perma- nent solution to hair loss and usually requires maintenance sessions every four to six months." Dr. Epstein doesn't use PRP as a stand-alone procedure but he does fi nd it useful for some patients to provide © GETTY IMAGES additional treatment of their hair loss. "We combine the PRP with ACell MatriStem, which is a regenera- tive matrix that seems to improve outcomes," he says. Dr. Weiss and Dr. Urato do not offer PRP, saying there isn't enough evidence to support its effi cacy. SURGICAL SOLUTIONS "Surgical hair restoration tech- niques have certainly progressed, especially in the last fi ve years. When I started performing hair restoration surgery, we were in the era of mini-grafts and micro-grafts," says Dr. Giannotto. "This technique was re- placed by follicular unit transplantation (FUT) in which a strip of donor hair with follicles intact was removed. This strip was dissected under microscopy and the grafts were iso- lated and implanted into the donor area. Using microscopic studies, this technique was refi ned by dissecting follicular units from the strip—defi ned as a group of one to four or more hairs—and the glands that supply them. Splitting follicular units down further destroyed their growth potential. The advantage of the FUT method was that a variety of follicular unit sizes could be isolated mimicking natural hair growth patterns." The downside to FUT is that, while it offers good results in the transplant area, it is painful and often leaves a trouble- some scar in the donor area. "We prefer FUE (follicular unit extraction), which leaves no linear scar, causes less discomfort and allows for quicker recovery," says Dr. Weiss. "We use the ARTAS robotic system to aid follicular extrac- tion with all of our patients now. We have found it to be better than handheld automated devices because of its computer algorithms, precision and accuracy—all of which facilitate a better quality procedure." When describing the benefi ts of ARTAS to his patients, Dr. Weiss likens it to a baseball pitcher who will inevitably tire during a long game. "The pitcher eventually gets tired and his accuracy and precision decline. A robot is not subject to such fatigue and continues to produce high quality grafts for the duration of the procedure," he says. "The ARTAS robot allows me to improve the quality of care I can offer patients." About half of hair restoration surgeons are now using some type of automated system for FUE. Dr. Epstein uses several handheld, powered FUE devices, including the NeoGraft Automated Hair Transplantation System and a custom-designed E-Fue System. "We don't use ARTAS at this Saw palmetto offers a natural remedy for patients who cannot use minoxidil or fi nasteride.

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