Hair Restoration Blog

Q:

Hello Dr Mohebi,

I recently read an article on the web that you commented on Harvard research for hair cloning.  I am in my early 40′s, fairly broke, and eagerly awaiting the day that hair cloning is successful and available to the market.  For the past decade, I keep hearing the same promises that it will arrive in 5 years, but still no luck.  Can you comment on why it is not here yet, and perhaps when we will see it.  Thanks in advance.

A:

Hair multiplication also referred to as “Hair Cloning” is a hot topic in hair restoration over the last few years it is garnering more and more attention.  The research for multiplying hair (hair cloning) has been going on for years now in several centers around the world over the past few years.  The study that we performed with collaboration with some scientists in Cedar Sinai is only one of the many steps that need  be taken to successfully multiply hair.

Hair multiplication would offer superior benefits to patients and represent a significant advance for medical science and hair restoration. Still the march towards this being a medical reality moves slowly for a several different reasons:

1.  Although hair loss has detrimental effects on patients’ lives, is yet to be recognized as a burning issue in medical field to warrant more funding for hair loss research.
2.  Hair multiplication studies are usually done in private setting without the support of larger institutions such as universities and NIH (National Institute of Health).
3. The growth rates of the hair stem cells are extremely slow in cell cultures.  That makes the overall period of hair multiplication timelier and adds exponentially to the cost of these studies.

The combination of above three factors and other obstacles in this process has made progress of hair multiplication very slow.  My best estimation of current research is that hair multiplication is probably at least 8 years away from practical medical application.  The reason for this is that any new medical treatment or device needs to go through different phases to obtain FDA approval for its use in the U.S.

The last phase necessary in development of a new treatment is ‘clinical trials’. The phase three is done on volunteer patients to find out more about long term complications that might be associated with the treatment. At this time no study has reached the clinical trials stage this makes it unlikely that we can have hair cloning available to public within the next eight years.

Hair stem cell and its role in future of hair restoration has been a hot topic in recent years. Hair multiplication also referred to as hair cloning is a process of culturing cells responsible for development of hair follicles. This is necessarily done by generating new hair in refined laboratory conditions.. The concept is that then those hairs manufactured hairs could then be transplanted for hair restoration purposes. It is easy to understand how success in the area of Hair Multiplication would be another quantum leap in hair restoration. People affected by patterned baldness could have the stem cells of hairs from their permanent zone multiplied for hair transplant.

A new article was published in e-Publication Development by Chi W. et al. This article reviews a critical stage of hair development regarding which one of the two hair stem cells is most important for size and shape of new hair.

Dermal Papilla (DP)

Dermal papilla (DP) develops a new hair. The DP is located in the hair bulb. Dermal papilla’s interaction with stem cells from the bulge area leads to generation of a new hair. Laboratory tests on mice indicates that the number of DP cells in the follicle correlates with the size and shape of the hair produced .

The study of mouse model allowed for selective ablation of DP cells in-vivo. The result of the study demonstrates that

• DP cell number dictates the size and shape of the hair.
• DP cells help develop hairs of different sizes or types.
• The number of DP cells plays a critical role in the size of hair shaft that will get developed.
• DP cells play an important role in activation of stem cells leading to the formation of new hair shafts.

These scientists also observed that when the number of DP cells fall below a critical threshold, follicles fail to develop new hairs. Based on this new development, it is easy to understand the mechanism of degeneration of hair in hair loss situations in relation to a drop in the number of DP cells.

Reference:

Chi W, Wu E, Morgan BA. Dermal papilla cell number specifies hair size, shape and cycling and its reduction causes follicular decline. Development. 2013 Mar 13, http://www.ncbi.nlm.nih.gov/pubmed/23487317

Recipient sites are the very fine incisions made in the balding scalp to receive the follicular unit grafts extracted from the donor hair of the permanent zones of the scalp. Hair transplant surgeons utilize variation in technique when making of these sites during hair transplant surgery.

The use of ‘premade sites’ and the termed ‘stick and place’ have been used harmoniously in hair transplant surgeries for years.  In our practice at US Hair Restoration centers we primarily utilize pre-made sites rather than stick and place. This is because in our perform a substantial number of ‘Gigosession Hair Transplants’ and the use of stick and place would unnecessarily prolong the procedure; while also increasing the duration in which grafts are out of the body. Recently, we have started to making recipient sites even before removing the grafts in many of our hair transplants (strip and FUE). We do this for two important reasons:

1. Making the sites before hands minimizes the time that grafts have to stay out of body and technicians can start implanting grafts as soon as we are done with removing the grafts (in FUE cases or strip procedures).
2. There are some evidences that an incision (wound) that is made a few hours earlier contain more growth factors and would healing associated cells than a fresh wound.  So we can assume that the process of healing is already started by the time we are inserting the grafts. This can accelerate the healing of the transplanted grafts. (1)

It is important to recognize that the best hair transplant surgeons incorporate surgical techniques and procedures that are best suited to the success of a particular patients surgery.

1. View Reference Here

FUE Hair Transplant Update – 2012

Hair transplant technology has made strong advancements over the past decades. The latest technology of hair restoration makes medical hair transplant procedures an option for most men from all walks of life. Follicular Unit Extraction (FUE) is a method in which hair follicular units are removed individually rather than taking a strip of the scalp and dissecting it into follicular units.

FUE transplant has been around for over 10 years along with strip hair transplant surgery.  Each one of these procedures has their own advantages and disadvantages. The truth of the matter is there are many hair restoration centers which may promote one method vs. the other, strictly because they are capable of performing it.  They may lean towards recommending FUE hair transplant as oppose to strip follicular unit transplantation.

Who is a good candidate for FUE transplant?

If performed correctly, FUE transplantation is a great solution for some hair loss sufferers, especially those with minimum hair loss or those trying to avoid a linear scar on their scalp.  We also use FUE for people who suffer from significant pain or other donor complications with previous strip procedure, and those with violated donor area for which removing more hair through strip is impossible.

Why strip hair transplant is still more popular?

Most of hair transplant surgeries in America are still done through strip (FUT) for many reasons.

•  Strip hair transplantation gives liberty to the surgeon to maximize the quality and viability of the hair follicles.  We anticipate some number between 1-5% as the highest for a trans-section of hair follicles.  This is because the grafts are all harvested under 3-D magnifications with stereotactic microscope.
• In FUE cases patients may have a high transection rate, meaning that some of the grafts are cut or damaged in the process of graft harvesting and may never grow into healthy hair.  The transection rate might be very low in most people, with an average of 0 to 10%. However, in some people it might be significantly higher based on their hair’s characteristics. For example, people with curly hair are at higher risk of transecting their hair grafts even with current techniques. A FOX Test could be done in for people that we expect high transection rate.  The FOX test can determine the patients who are not good candidates for FUE procedure.  The FOX test is a small FUE transplant that determines the levels of a transection before the actual FUE transplant.
• In FUE Transplantation, we can harvest – 1500 to 2000 grafts in one session.  Sessions larger than that may keep hair grafts outside of body for a long enough period of time to jeopardize the grafts’ survival. US Hair Restoration Centers in Beverly Hills and Los Angeles has conducted studies that lead to better determination of how long a graft can be viable inside scalp after punching and before completely extracting them.
• These days, we have several methods, such as trichophytic closure, to minimize the visibility of the strip transplant linear scar.

Undecided between FUE transplant and strip FUT?

At the end we recommend you to do your homework before choosing one way or another then find a good hair transplant doctor who is capable of offering both these techniques.  He or she can walk you through your best options.

Q:

Hi Dr Mohebi,

Can you tell me your opinion on products like iGrow (low level laser therapy).

Thanks so much,

A:

Hello,

Unfortunately, there has been very little research done on different types of laser treatments for hair restoration and most studies are done in small numbers, lacking significant results.  As you already know there are a variety of devices such as laser combs, hoods, or brushes, yet most of these do not show significant improvement like I continue hearing from my patients who used them before. In spite of all this, I have heard a growing number of hair specialists talk about how they are seeing good results from the Laser Cap.

It seems like the best candidates are people with generalized hair thinning, as in typical female patterned hair loss.  Laser cap treats entire scalp with 224 individual red 5mw – 650 laser diodes.  This is much more coverage than the comb or other hand held laser devices offers.

I reviewed your file and based on your microscopic evaluation from 3 years ago you might be a good candidate.  However, I would like to evaluate your current condition with another microscopic evaluation.

The 19th Annual ISHRS meeting for 2011 was held in Anchorage, Alaska. It was my first trip to Alaska and I was looking forward to seeing the beauties of the largest state in America.  Being very busy with many different activities, it made my time for sightseeing nearly impossible. I was required to be available one day prior to the opening day of the conference to get prepared for the many different events which were to come.

Hair Transplant Workshop

Dr. Mohebi and other faculties teach Hair Transplantation Techniques in ISHRS Meeting Anchorage, Alaska

I was one of the faculties for the surgical workshop. There were many new hair transplant surgeons who came from around the world to this annual scientific meeting to learn more about the art and science of hair restoration. The workshops included topics such as hair line design, cutting, placing, anesthesia, and donor harvesting and I was there to teach the latter course. There was great interaction between the faculties and students as they got the chance to learn the hands on techniques of surgical hair restoration.

Latest techniques of Hair Transplantation

The main thrust of the conference was the lecture series which gave a forum to many lecturers covering multiple topics regarding the many different areas of hair restoration. Since hair transplant surgery is still a relatively new field in the medical world, the greatest emphasis was on new technologies in hair transplantation, the latest techniques of hair transplant surgeries, devices, tools and methods of diagnosis and the treatment of hair loss.

ISHRS 19 Meeting: New Hair Transplant Surgical Instruments and Techniques Panel, Drs. Parsa Mohebi, Alan Bauman, Sara Wasserbauer and Kongkiat Laorwong

This year I was the moderator for the Giga-Session Hair Transplantation Panel. The panel included 2011 Golden Follicle Award winner Dr. Jerry Wong and Doctors Sharon Keene, Arthur Tykocinski, and Akaki Tsilosane. The discussions included properly choosing the best candidates for large number of grafts hair transplant surgeries (Giga Session Hair Transplants), planning for surgeries, as well as the full spectrum of Giga-Session Hair Restoration.

The Laxometer II was one of the newest innovative technology devices presented by me. The Laxometer was developed as a response to the need within the hair restoration industry for a measuring device for calculating the scalp laxity or skin mobility before hair transplantation surgeries. The Laxometer precisely measures the mobility of the scalp giving greater accuracy for larger surgeries or if a patient has a tight scalp. This device was introduced to the market for increasing the safety, precision, and efficiency of the hair transplantation.

Another device presented at the 19th Annual ISHRS Scientific Meeting was the upgraded Restoration Robotics, now called ARTAS System. This machine is now FDA approved for use in the United States and several lectures were presented about this new hair transplant technology. ARTAS was developed to help meet the need for increased precision and speed for scoring the follicular grafts in Follicular Unit Extraction (FUE) hair transplants. This is considered a very new technique in hair transplantation, but the robot currently only assists in one step of hair restoration. That is scoring the follicular grafts.  We still do not have a perfect automated system to extract and transplant the hair grafts. This device will need more time for testing and post-operation, long-term patient results.

Other New Technologies for Hair Restoration

In last few years, we have witnessed emergence of several new tools in hair transplantation that carried the claim to be the latest technologies and ground breaking tools for the field.  A lot of devices claimed they could change the way hair transplantation was done. However, many of those new tools did not deliver on their promise.  This has been a trend which has continued to be repeated for several years now. One of these devices was the NeoGraft that was sold to many non-hair transplant doctors with the promise of the simplicity of use and the minimal need for a surgeon’s involvement. The company has stated that the technicians can run the machine for the most part. One major issue the NeoGraft company forget to point out to these new costumers is the fact that hair transplant surgery requires experience and proper training in order to deliver great result. No machine, especially in the wrong hands, can substitute for lack of experience and expertise.

There were a number of lectures presented regarding the problems involved in hair multiplication, auto-cloning, hair stem cell research, and others important topics. Like years previous, there were several debates about Strip FUT vs. FUE,  manual FUE vs. automated FUE, also sharp vs. blunt punches for Follicular Unit Extractions.

Controversies in Hair Restoration

This year we had many controversial lectures such as lasers for hair restoration and growth factors, as well as mesotherapy and PRP (Platelet Rich Plasma).  The ISHRS allows for an open forum for hair transplant surgeons to share their innovative ideas, work, and theories that they can be giving constructive criticism and analysis by other experts in the field. This has been effective in keeping members of the society updated with new ideas and methods for hair restoration. It is unanimously agreed by members of ISHRS that hair restoration surgery is a progressing science and art which is rapidly growing into more advanced technologies and cellular level manipulations. It is well accepted that greater research is needed in order to thrust the industry forward in these new innovative areas for the art and science of hair restoration

Laxometer II

Often times we receive inquiries at US Hair Restoration about the latest hair transplant technology, and we feel obligated to spread the news about the latest hair transplant technology.  We are excited about the new generation of Laxometer, the newest hair transplant device invented by Dr. Parsa Mohebi. The Laxometer II is a handheld device which revolutionizes the art and science of hair restoration. Being in the growing sector of the cosmetic surgery arena, progressive updates on hair transplant new technology is critical.

Applications

The revolutionary Laxometer II increases the number of hair grafts which can safely and precisely be transplanted in one surgery. A hair transplant of more than 3500 hair grafts once upon a time took two or more surgeries to complete, but with this latest technology in hair transplantation, it can be done in only one procedure.

The Laxometer II, the new technology in the hair transplant industry, is basically a measuring device which is used to calculate the laxity of one’s scalp. An accurate measurement of scalp laxity is critical when determining how large the donor strip can be. This latest breakthrough hair transplant technology gives a precise measurement which can be increased as a result of patients actively doing daily scalp exercises. The larger the available strip, the more grafts can be made available for transplantation.

At the International Society of Hair Restoration Surgery’s 19th Annual Scientific meeting in Alaska in September 2011, Dr. Mohebi unveiled his new invention for purchase to all hair transplant surgeons. This latest technology in hair transplant surgery was welcomed with anticipation and applause as it will help to continue the industry progressing forward.

Here is a video demostration of the Laxometer work: Laxometer Instructional Video

Prostaglandins have been traditionally used for the treatment of both open-angle glaucoma and ocular hypertension. The funny thing is doctors accidentally found out the prolonged use in these eye drops surprisingly increased the density and pigmentations of eyelashes. This epiphany is what brought up the idea for why they later used and marketed these drops for cosmetic purposes to elongate the eyelashes in the form of Latisse.

The active ingredient of Latisse, bimatoprost, is present in Allergan’s product.  The drug company Pfizer sells a similar product called Xalatan.  Xalantan (latanoprost) behaves similar to prostaglandin PGF2α and for the same reason can increase the growth of eyelashes.

As mentioned, the effect of Xalantan on length and pigmentation of eyelashes was proven several years ago. There are several positive studies which indicate the effects of Xalantan on hair in the other parts of the body such as eyebrows or scalp hair. However Xalantan is still not approved, nor currently recommended for scalp hair restoration. More research is needed to address its efficacy for hair loss prevention in its pattern form.

There is a recently published study in the Journal of American Academy of Dermatology called “Assessing the Efficacy of Topical Treatment by Latanoprost on Hair Growth and Pigmentation in Androgenetic Alopecia.”

This study was writen by Blume -Peytavi et al. in the Department of Dermatology of Charite-Universitatsmedizin in Berlin. In this study the researchers evaluated the number of hairs, their thicknesses, and pigmentations in a 24 week period while patients used the medication topically on their scalp. They concluded that Latanoprost significantly increases hair density in the form of terminal (thick, mature hair) and vellus hair (peach fuzz). It is recommended that this product could be used as a hair loss medication in the future, but more research is needed to assess its long term effects before we can truly consider latanoprost as a hair loss medication.

DHT and Hair Growth Inhibition in Mice

There is new research about hair growth and the effect of DHT which indicates more details of DHT (Dihydrotestosterone) mechanism on hair growth in mice through inhibition of insulin-like growth factor-1 in dermal papillae cells of hair.  The study results are published by Growth Hormone Research Society (Zhao et al.).
The researchers showed IGF-I [Insulin-like growth factor-I (IGF-I)] present in some hair follicle stem cells (dermal papillae) was increased following the stimulation of their sensory nerves in mice.

We know DHT inhibits hair growth by negatively modulating growth regulations.  The researchers found DHT blocks the release of calcitonin gene-related peptide (CGRP).  They noticed an increase in the IGF-I and proteins which are being made from that effect.  They demonstrated the administration of DHT for three weeks lowers the levels of CGRP, IGF-I AND IGF-I mRNA in the skin of mice. The number of growing hairs was decreased and the re-growth of hair follicles was blocked after the administration of DHT to those mice. Observations of this sort makes clear DHT causes its anti-growth effects on hair through decreasing IGF-I in dermal papillae hair cells.

These new research reports on hair, growth factors, and hair stem cells will lead us in the direction of finding more efficient ways for treating human hair loss in the future.

Q:

Hello Dr. Mohebi,I had a hair transplant consultation with you about a week ago regarding my hair loss type and the best method that suits my need. I am still doing some more reading and researching and I came across to the Bio-Matrix Strand by Strand (non-surgical) process.  I really would like to get your input on this particular process and if this is something that you recommend for someone like me who has lost almost 90% of his hair and might not get even 80% of it if I go through the surgical process…

I would really appreciate it if you can also advise whether you perform this method or not and if so how much it will cost approximately if I decide to do the non-surgical….

Thank you so much in advance and looking forward to hear from you…

Close up image of a Biomatrix - The mesh that keeps hair attached to the scalp. Click to see enlarged picture.

A: