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 52 NOVEMBER/DECEMBER 2015 | Med Esthetics time because our current systems are providing outstanding results and the technology is still undergoing improvements. Surgical technique is the most important aspect of the trans- plant procedure," he says. "I have used NeoGraft, ARTAS and SmartGraft tech- niques," says Dr. Giannotto. "All are good although results may vary from surgeon to surgeon depending upon tech- nique. ARTAS is totally robotic in that the machine harvests the grafts and in some instances creates donor incisions as the physician controls the parameters of the procedure from a computer screen. NeoGraft and SmartGraft are physician-assisted automated FUE procedures in which the physician holds the handpiece and actually selects the units to be harvested. All of these automated systems add irrigation to keep the grafts moist and collect the grafts via suction. There is no gold standard, but my new workhorse for large cases (greater than 2,000 grafts) has become the SmartGraft machine. What ultimately gives the patient the best results should be the criterion for choosing a particular procedure." Even with advances in FUT and FUE technologies, about half of hair restoration surgeons prefer traditional surgical tech- niques. "Although there are advantages to ancillary machines such as decreased labor for the surgeon and a reduced num- ber of staff required, I personally don't favor the use of ancillary devices in my procedures. I fi rmly believe the machines used in hair restoration cannot replace the precision and judgment of a skilled surgeon," says Dr. Kahen. Regardless of which surgical technique you prefer, it is vital to develop a long-term plan before settling on a treat- ment modality. "Women need to be careful about transplants because of the progressive nature of hair loss," says Dr. Ep- stein. "And men need a long-range plan for the same reason." ONGOING RESEARCH Current noninvasive hair restoration options offer moderate improvement for most patients at least in the short term, but physicians working in this specialty are hoping more effective treatments will be available soon. Bimatoprost (Latisse, Allergan), which patients have been using for several years now to grow longer, stronger eye- lashes and enhance brows, may offer some hope for scalp hair as well. Results of Phase 2 trials of Bimatoprost Scalp, due for completion in January 2015, were disappointing, according to a report from the Belgravia Center, one of the largest hair restoration centers in the U.K. The acquisition of Allergan by global pharmaceutical company Actavis may slow any further progress for a time. Drugs that inhibit prostaglandin D2, found in excess amounts on bald scalps, are already being used to treat asthma, and KYTHERA (acquired by Allergan in June 2015) has initiated trials of KYTH-105, a selective oral antagonist of PGD2 for use in treating androgenic alopecia. In early research studies, PGD2 inhibitors were found to extend the anagen (growth) phase of the hair cycle, thereby promot- ing the growth of hair. "I am fascinated with prostaglandin therapy and am excited to see where that may be headed," says Dr. Wendel. Dr. Weiss is looking forward to further advances in robotic technologies. "Eventually, I believe robotic technology will be developed not only for the extraction part of the hair transplantation procedure but for graft placement as well," he says. "We are looking forward to watching that technology develop. I also think we will fi nd less invasive ways to restore hair growth. Stem cell technology offers one possibility. Researchers have been able to isolate cells important to hair growth and eventually we may be able to inject a stem cell solution that will stimulate hair growth—but probably not for 15 to 20 years." Dr. Epstein is more optimistic. "We hope to see more stem cell research and perhaps a breakthrough in stem cells for hair restoration in the next fi ve years," he says. Scientists are investigating stem cells in different ways for use in hair restoration. Angela Christiano, a dermatology professor at Columbia University with a special interest in hair genetics, has formed a company to investigate growing hair stem cells in the laboratory that can be injected into the "Women need to be careful about transplants because of the progressive nature of hair loss. And men need a long-range plan for the same reason." Low level laser therapy (LLLT) has proven effective for hair regrowth both as a stand- alone treatment and an adjunct to surgery. PHOTO COURTESY OF APIRA SCIENCE

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