Hair Regeneration – Non-Surgical Hair Transplant Alternatives

This is a rather lengthy discussion of various hair restoration options. Foremost will be PRP/PRFM, light therapy including hair growth lasers,  ACell, and various medications. In hair loss you are not alone. Over 40% of the total market are women who suffer from thinning hair or medical hair loss; 77% of men and women do not know there are scientifically proven and medically approved hair loss treatments; 40% of men have noticeable hair loss by age 35, 65% by age 60, and 80% at 75 years of age; Almost half (45%) of men and women would spend their life savings if it meant reversing hair loss and receive their hair back (but at Landmark Aesthetics you don’t have to).

Platelet Rich Plasma

PRP is short for  Platelet Rich Plasma  Platelets are small disk-shaped cells in your blood that contain powerful cytokines, growth factors, and other regenerative and healing molecules, allowing them to stimulate the healing process. In fact, the cytokines released by platelets are responsible for nearly all repair processes that occur within the body, playing an important role in cellular communication and accelerating tissue and wound healing. PRP is simply a concentration of these growth factors and proteins. Concentrating them allows us to harness the regenerative properties to help stimulate repair and regeneration. When used to treat hair loss, PRP can help thinning hair grow thicker. PRP is also widely used in orthopedics, and has been noted in the news as a treatment of choice for elite athletes including Kobe Bryant and Peyton Manning. It is a completely natural treatment — after all, it’s your own blood — that is widely used in regenerative medicine, including hair restoration for thinning hair. Its clinical application for hair restoration has recently been supported by a study published in the journal Dermatologic Surgery. Regenerative medicine is a new and constantly evolving field, and we await long-term clinical data for hair growth or re-growth from ACell and PRP treatments. Physicians throughout the US and around the world have used this therapy to treat hair loss with excellent results, and though there is not trial data, the results of clinical studies have been positive. The procedure is well tolerated, minimally invasive, can be performed outpatient, and offers the potential for growing back your own hair without a more intensive procedure like a hair transplant.What conditions can ACell and PRP Therapy treat?

Hair Regeneration with ACell as developed by Dr. Amiya Prasad has intriguing results. The treatment uses an advanced stem cell-based wound healing technology to reverse hair thinning and kick start the growth cycle of hair.

With the help of hair restoration, hair that was previously thinned and weakened grows progressively thicker and stronger, and also comes back darker. Hair follicles become healthier and more active, producing thicker hair strands, thus reversing and alleviating the signs of a previous hair loss.

Thinned hair that almost disappeared comes back thicker after hair restoration. Existing surrounding hair also becomes thicker, adding to volume density of hair.

Hair Transplant Enhancement and Alternative

The Hair Regeneration treatment is so effective in thickening hair that most people who undergo the treatment don’t feel they need an additional hair transplant. This, however, is dependent on the degree of hair loss they have at the time of their treatment.

Understanding that hair transplant surgery is limited by the number of hairs available for grafting, choosing to have hair transplant surgery after this procedure allows for more strategic placement of grafts with more density, since significant scalp coverage has been achieved first with Hair Regeneration.

Two young men with tremendous thickening of their existing hair and stopped progressive hair loss. Thick, natural-looking hair meant they avoided doing a hair transplant altogether. Both men didn’t respond to finasteride (Propecia®) that they were taking prior to the hair restoration treatment.

Hair restoration can also work synergistically to enhance the results of hair transplants which have already been performed.

  1. The combination of the wound-healing materials in Hair Regeneration is used to improve healing of the incisions created by follicular unit transplantation (FUT) or follicular unit extraction (FUE) on the donor area on the back of the head.
  2. Hair Regeneration can prevent progressive, future hair loss — an important issue that hair transplants do not address. It has been shown that a significant percentage of people who undergo hair transplants often need more surgery since they continue to lose hair.
  3. Hair Regeneration’s wound healing components improves the healing of transplanted hair follicles, thereby increasing the survival rate of transplanted hair grafts.

Hair Regeneration reverses the hair thinning cycle and stops continued hair loss. Clinically, Hair Regeneration appears to repair dysfunctional elements within the hair follicle that are unable to produce quality hair, resulting in hair thinning.

What is Extracellular Matrix?

Extracellular matrix (ECM) or ACellular matrix, produced by the company ACell, is a byproduct of porcine bladder tissue that has proven regenerative properties.

It has multiple 510(k) clearances for use in clinical and therapeutic practices. ACell’s MatriStem™ is the second generation of their core extracellular matrix technology that provides a basement membrane surface that is ideal for epithelial cell growth in various medical applications.

ECM’s regenerative properties has been proven to help in the production of new skin and muscle tissue. The product itself is stripped of all cells, including muscle tissue, to prevent any allergic reactions or rejection when used on humans.

Extracellular matrix works by holding platelets and stem cells in a matrix recruiting adult other stem cells, along with increased blood supply, to the area where the healing is needed. It transforms adult stem cells  into active progenitor cells that then stimulate the healing reaction. ECM provides a temporary non-crosslinked scaffolding for tissue reconstruction that mimics surrounding healthy yet damaged tissue. Eventually the ECM is reabsorbed after allowing healing and hair restoration by a person’s own cells and tissue resulting in fuller hair.

How Does Extracellular Matrix Work for Hair Restoration?

The complexity of the hair follicle is evident by the limited success pharmaceutical and biotechnology companies have had  in creating new solutions for hair loss. The search for “hair cloning” remains unsuccessful [There has been success with cloning skin for burn victims that has hair follicles RenovaCare]. There is no magic protein to turn the hair follicle on but maybe someday? Right now we use the body’s natural processes in ECM.  As the normal healing process from an injury recruits platelets and the sustained release of their growth factors, so too does the Extracellular Matrix.

WOUND HEALING CONCEPT — WHERE INACTIVE ADULT STEM CELLS ARE CATALYZED BY THE HAIR REGENERATION TREATMENT AND TURNED INTO ACTIVE PROGENITOR CELLS. RENEWED ACTIVITY  AT THE CELLULAR LEVEL INVIGORATES THE HAIR GROWTH PROCESS FOR THICKER HAIR GROWTH.

Fotona Hair Restoration Treatments

Fotona is actually on the cutting edge of a new horizon in hair regrowth. Erbium is different than the Nd:YAG or 810 nm Diode we use for hair reduction. Occasionally, people having small hair treated for hair reduction or those with PCOS, have had hair increase. This is something that takes more energy to get rid of, but the reason it happens is lower infrared energy can stimulate hair growth. I think this is due to photobiomodulation of the stem cells at the follicular level. The reason Erbium works so well is the particular wavelength and the molecular interactions with water.

An article by New Beauty describes the hair restoration used in NYC by Dr. Doris Day. We have discussed these protocols at a Fotona conference in Fort Worth prior to this article.

  • Fotona Dynamis uses Erbium to get a much deeper penetration and stimulation of the hair follicle (Photobiomodulation, Infrared Stimulation). The protocol takes 5 mins and needs to be done every 2 weeks.
  • LLLT- Low Level Laser/Light Therapy using lower energy diodes for a longer period has improvement, but not as robust as Erbium.

ACell and PRP Injection Therapy

Baldness and thinning hair is a problem that affects both men and women, and while it’s not physically debilitating, the toll that changes in physical appearance take can be extremely detrimental to your mental and emotional health, causing stress, self-esteem issues, and even relationship problems. If you are concerned about hair loss, you should know that not only is it a common problem, it is also one that can be treated.  ACell is a product that has been developed to help wound healing by encouraging adult stem cells to create their own new, healthy tissue. PRP (Platelet Rich Plasma) is derived from the patient’s own blood. Through a special processing method, growth factors found in the platelets are concentrated at 3-5 times what normally would be found in the blood, stimulating the hair follicle to grow. These have both become common treatments in other areas of medicine from dentistry to reconstructive surgery, but it is only recently that these have begun to be used in combination as a way to combat hair loss. At Landmark Aesthetics we use it for collagen rejuvenation as well.

More about ACell®

ACell® is a unique proprietary medical product that is used for many different types of surgical procedures, including the treatment of burns, ulcers, traumatic wounds, and reconstructive surgery especially urologic. It is manufactured using tissue from porcine bladders, and is safe for use except when a known allergy. The chemical structure is extremely similar to human tissues, and during its manufacture, ACell is sterilized via electron beam radiation.  This non-crosslinked, completely reabsorbable, acellular extracellular matrix scaffold is rich with naturally-occurring collagens and proteins, maintaining an intact epithelial basement membrane surface for wound healing. ACell® is manufactured in a fine powder or in solid sheets, called MatriStem® Surgical Matrix (this is why you’ll sometimes see ACell referred to as MatriStem). This matrix creates a scaffold for healing to occur, triggering new blood vessel formation and recruiting different cells to the site of injury. The new cells, including progenitor cells, have the potential to differentiate into numerous types of site-specific tissues. As you heal, the scaffold degrades and is completely reabsorbed by the body, leaving new, healthy tissue where scar tissue would normally be expected. ACell also stimulates the growth of new follicles through stem cell activation in the scalp.Though ACell does have anecdotal success of evidence when used on its own to restore hair (often in cases where there is scalp repair or the patient has had a hair transplant), in more conservative cases ACell is injected in combination with PRP.

ACell and PRP therapy can be used to treat hair loss that results from a number of causes, including:

  • Male Pattern Baldness, including miniaturized hair on the scalp. The therapy is especially helpful in the early stages of balding
  • All stages of Female Pattern Hair Loss
  • Alopecia Areata or Alopecia Totalis
  • Hypotrichosis (fine or reduced hairs) in the eyebrows or beard
  • Hair loss induced by metabolic causes, including iron deficiency and medication

To summarize, ACell delivers additional growth factors, stem cells, and collagen factors that PRP does not have as well. When added to the PRP solution, it enhances hair regrowth while allowing for miniaturized hairs to grow back fuller with greater density. By premixing the ECM with PRP we are skipping the step of waiting for the adult stem cells to migrate to the injection sites. Bottom line most patients need ONE PRP + ACell treatment for better results than multiple PRP alone treatments for hair regeneration.

At your initial consultation, Dr. Baber will examine you carefully to determine whether you are a candidate for ACell and PRP therapy, and other options available. In this procedure, ACell is combined with PRP and injected directly into the scalp, the entire procedure takes roughly 90 minutes to two hours to complete, and you can get back to work right away.

First, a blood sample is taken which is then specially processed to produce the PRP. A topical anesthetic is applied to completely numb the scalp treatment area (the patient can also be sedated, but sedation requires having someone else to drive you home after the treatment). The ACell and PRP are combined and then administered via a series of injections to the affected area, using a tiny needle. After the initial injections, another technique, called micro-needling, can be used with the serum to cause micro injuries to the scalp, further inducing and stimulating the scalp to release more growth factors.

Questions

Are there any side effects from the procedure?
ACell and PRP therapy is generally well tolerated and it does not require a long recovery period. You may experience some discomfort and tightness of the scalp from the injections for 1-2 days, which can be managed with a non-narcotic analgesic like ibuprofen. This generally resolves within 48 hours. You shouldn’t wash your hair for the first 24 hours, but after that, you can wash and style it as your normally do. If there is swelling, avoid vigorous activity until it is gone.

What kind of results can you expect from ACell and PRP Therapy?
Following ACell and PRP therapy, new hair growth can be seen in as early as 1-3 months. It is typically seen between 4-8 months, and hair can continue to improve up to a year after treatment. To date, results have been maintained without additional injections for up 2 years in many patients, but more research is needed to determine if this new hair growth is permanent. Initially, as new hair growth is turned on, there may be some shedding of hair. This is a normal growth cycle of the hair.  For optimal results, it is recommended to do this procedure every two months for three sessions then on a yearly or biannual basis.

What is the difference in PRP and PRFM?

PRP is mostly platelets in an unactivated form, while the PRFM is a fibrin matrix that is activated by calcium. ACell provides a matrix for platelet support and prolonged release of growth factors.

How much does PRP hair treatment cost?
The answer depends on the area that needs to be treated and also on the number of sessions required. In New York, the average cost of PRP hair treatment costs from $1500-$2500 per session. Here in Jacksonville we can do the procedure as low as $500 depending on the goals.

How soon will I notice results after PRP treatment?
Hair growth cycle is a slow process and as such the results take time to prove. On average, it takes anywhere between 6-12 months to see results and it depends on the area treated.

How long do results of PRP last for?
Based on numerous discussions and publications, if the treatment was done by an experienced physician, the benefits of the treatment should last 3-5 years. We use two different types of PRP or PRFM and there is discussion as to which type is the best. Some advocate the importance of PRFM others the total number of platelets.

What is the down time after the PRP treatment?
There is no downtime after PRP. Because this procedure involves cleaning of scalp and injection into it, it it recommended that the hair not to be washed for 24 hrs after the procedure. If you work form home, you can return to your regular activities, If you plan on returning to office, you might want to consider having it done Friday or when you have the next day off.

Summary

The benefits of PRP/PRFM hair loss therapy are:

  • Patient Safety, it is your own body’s healing ability used to generate your hair.
  • Natural and Non toxic
  • No adverse or allergic reaction
  • Convenience: PRP treatments can be done in our clinic in less than an hour

. The absolute contraindications to PRP/PRFM treatments are:

  • Platelet dysfunction syndrome
  • Critical thrombocytopenia
  • Hemodynamic instability
  • Septicemia or local infection to injection site

Relative Contraindications to PRP treatments are:

  • NSAIDs use within 7 days of procedure
  • Corticosteroid injection at treatment site (1 month)
  • Systemic use of corticosteroids (2 weeks)
  • Cancers (hematopoetic or bone)
  • HGB < 10g/dl or platelet count < 105/ul

PRP/PRFM treatments for hair restoration seem to be more effective for women than men.The underlying Testosterone/DHT conversion in men usually does not yield as good of results since the underlying issues remain untreated. In women, hair loss is typically endocrine system related and yields much more dramatic results in reversing hair loss.

Other treatments that are beneficial to maintain hair growth after PRP or PRFM are:

  • Topical medications– Topical minoxidil 5% foam, topical Propecia -compounded, Nizoral 2%
  • Oral Medications- Finasteride (Propecia) and spironolactone (better for women)
  • No well controlled studies have show the benefits of nutritional oral supplements for hair growth. But these were all done with nutrition as the only modification. Good vitamins including all of the B vitamins as well as D3, as most are probably low due to sun avoidance, are likely helpful and inexpensive. It makes sense if the hair is actively growing, a good vitamin supplementation would nourish the new protein synthesis.
  •  PRP- Platelet Rich Plasma/Serum scalp treatments with injection and microneedling

Medtronic’s Magellan  is used to get larger volumes of platelets in addition we have added a 20 minute LLLT session immediately after the injections and recommend  three additional 30 minute LLLT sessions two weeks apart with all PRP + ACell treatments. Also we encourage the Hair Medica hair care system.

Surgical Transplant

NeoGraft: Follicular Unit Extraction Uses Minimally Invasive Techniques to Produce Excellent Results

 By age 35, two-thirds of men will have some degree of hair loss. By the age 50, the number rises to 85% who have significantly thinning hair, while 25% suffer from male pattern baldness before the age of 21. Male pattern baldness and thinning hair can cause anxiety and affect the self-confidence of men both in their interpersonal relationships and their professional lives.

We are privileged to offer such advanced technology as NeoGraft here in Jacksonville. We can restore hair and a fuller hairline without the evidence of scar or the “doll’s hair” look of older techniques. A NeoGraft treatment produces little to no discomfort, requires no scalpel incision or stitches, and it does not leave an unsightly linear scar at the back of the scalp.. Most patients can return to work after a few days. Or, if one wants to be more discrete, take a vacation for a few weeks, and return to work without anyone noticing any recent surgery. There are also fewer activity restrictions compare to traditional strip methods. Learn more about NeoGraft. This can be combined with PRP to enhance the result overall. To schedule a consultation please fill out our contact form.