Hair Restoration Blog

Q:

Comment or Question: is hair cloneing/multiplication currently available at your practice? please leave a voice mail

A:

Hair multiplication is not available at our hair transplant centers or any other hair restoration clinic for that matter because present-day technology has not yet been able to successfully multiply hair for the purpose of hair restoration.

But there have been numerous studies and publications on hair multiplication, also known as hair cloning. And there is one company, Intercytex, , which has been considered by many experts to be at the forefront of hair multiplication research.

Intercytex announced that their staff finished phase II of the study and started phase III (the stage in which scientists try their particular product and method on a large number of people and follow them for eight to 10 years and wait and see if there are significant long-term side effects and complications to take into account).

However, at the last annual meeting of the International Society of Hair Restoration Surgery (ISHRS), it was announced that Intercytex hadn’t even successfully completed phase II of the study, which means phase III hasn’t been started. We don’t know which specific obstacles impeded the progress of this work, but we are aware that it generally takes about eight years for phase III of most studies to be completed.

So, the research might get started in about eight years, maybe longer, after which we may find hair multiplication proven to be safe and effective.

People ask about hair multiplication, hair loss, stem cell hair regrowth, and hair cloning transplant all the time.  The last annual meeting of the International Society of Hair Restoration Surgery (ISHRS), where all authorities in medical hair restoration get together, did not have any good news for the people who are eagerly following the progress of hair multiplication research.  In fact, the newly disclosed information from Intercytex who is considered the leading group working on hair multiplication revealed that they never successfully finished phase II of their study on hair follicle multiplication.

This is contradicting with what they released previously regarding completion of phase II and the commencement of phase III.  This is considered a step back in the field of hair restoration and it means a longer waiting time for people who are impatiently waiting for hair multiplication to become a reality.

When any new treatment modality is being researched, scientists need to go through several phases to establish its effectiveness and safety.  Phase III of a study is when a few subjects (human) are being treated with the new modality on a longer period of time to assure the long term effect and safety of the new treatment.

The reason for the delay in completion of phase II of hair multiplication research was not fully disclosed.  However, knowing this fact leads us to believe that using multiplied hair won’t be possible at least in the next 8 years.  We at US Hair Restoration are collaborating with the academic center in some different stem cell hair research.  Our research is still in its early stages, but we will release our findings of this hair stem cell research as soon as they are available.

I just gave a lecture on a new application for Laxometer in mega and giga session hair transplants in the annual ISHRS (International Society of Hair Restoration Surgery) meeting in Amsterdam, Netherlands.  As we presented the Laxometer in the prior hair restoration scientific meetings, Laxometer can make us capable of increasing the precision of strip removal method of follicular unit hair transplants while minimizing the risk of donor scar complications.

This year, I presented a new application for Laxometer for its use in patients who have limited laxity of the scalp due to prior hair restoration surgeries or for those who require a maximum number of grafts in one session (3000+, 4000+, 5000+ and so forth).  I performed a research in US Hair Restoration last year in which we removed the strip in sequences for hair transplant surgeries using Laxometer before and after removal of each section of the strip.  This method has increased the safety of the strip removal while decreasing the risk of donor wound complications.

The result that was presented in the ISHRS meeting indicated the effectiveness of Laxometer at increasing the number of grafts in a strip hair transplant while minimizing the donor complications of a hair restoration surgery.  Based on our findings, we now use Laxometer in our California hair transplant offices on a regular basis and obtain positive results consistently.

I just read a new article presenting an interesting case presentation and thought it might be useful for the readers of our hair restoration blog.  The article is published in the Journal of American Academy of Dermatology this month (July 2009).

It goes over mesotherapy, a remedy that has been proposed for hair loss and its adverse side effects.  Mesotherapy has recently become an advertised method for the treatment of different types of alopecia despite the lack of any data regarding its efficacy and possible side effects. The substances injected into the scalp include “cocktails” of natural plant extracts, homeopathic agents, vitamins, vasodilators, and drugs that may stimulate hair growth such as finasteride and minoxidil.

The authors report two cases of patchy alopecia that developed after mesotherapy for the treatment of androgenetic alopecia. In the first patient, alopecia developed after injections of the heparinoid vasodilator mesoglycan; the 3-month follow-up examination revealed a small residual area of cicatricial alopecia. The second patient developed reversible alopecia after multiple scalp injections of homeopathic agents. These cases underline the possible risks of mesotherapy as a therapeutic technique for hair loss.

This could be considered another modality that was presented for male hair loss without a solid value like many other similar hair loss products.  We have always said in this blog that the hair loss product market is a “buyer beware” market and you need to do your research and, preferably, discuss with your doctor before you try any new modality for treatment of your hair loss.

Q:

I would like to ask Dr. Mohebi about hair stem cell research. If you can explain what it is, how long has it been in research, and in what phase it is at this moment? I’m 31and notice that I had AU, around the age of 29-30. At the time I was going through a lot of stress that made me feel like I’ve brought this on myself. I was taking treatment injections for my eyebrows to see if I can at least save my eye brows. Well, I got tired of the injections, and just left it in the hands of the Creator. Are there eyebrow and eyelash replacement that can be obtain and if so where? I just had a little girl and I really want to take some decent pictures with her and it bothers me at times that I can’t even do that, so I can relate to all who are going through the up’s an down’s and the fight within and without to BEAT-AU, and others. I guess only time will tell.

A:

Hair stem cell research is becoming very promising for treatment of many types of hair loss. Phase 3 of the study on hair multiplication was started about 3 years ago and it is still ongoing. The purpose of phase three study of any new treatment modality is to prove that there are no long term side effects on the volunteer patients who undergo any new treatment. Hair stem cell technology seems to be a real therapeutic option for many types of hair loss conditions for the next 5 to 10 years.

Having said that, some details about the process of hair multiplication is not quite clear yet. There is not much information released on the quality of multiplied hair and we are not quite aware about the final cost of the procedure. When it comes to AU (Alopecia Universalis) we cannot know for a fact that hair multiplication is the answer to this condition considering the mechanism of AU and the fact that the patient’s own immune system tends to destroy hair follicles.

It is likely that multiplied hair follicles have the same antigenic properties so they could be recognized by the immune system and destroyed the same way that the native hair was initially. A combination of some sort of anti-immune treatment and transplanting multiplied hair might be the answer, but we cannot know for sure before they are investigated thoroughly in the future.

Single balding spot of alopecia areata

Alopecia areata (AA) is an autoimmune hair loss condition that presents itself in the form of patchy hair loss in scalp and other hair bearing areas.  The role of emotional stress in alopecia areata has been discussed before in medical literature, however, the exact mechanism of it has never been explored.  I just found a new article on the relationship of the stress response to the pathogenesis of alopecia areata that was investigated by subjecting normal and skin graft-induced AA-affected mice to light ether anesthesia or stress due to restraining the animal.

Plasma corticosterone, adrenocorticotropic hormone, and estradiol levels were determined in this study as indicator or stress level, whereas gene expression in brains, lymphoid organs, and skin was measured by quantitative RT-PCR for corticotropin-releasing hormone, arginine vasopressin, proopiomelanocortin, glucocorticoid receptor, mineralocorticoid receptor, corticotropin-releasing hormone receptor types 1 and 2, interleukin-12, tumor necrosis factor-alpha, and estrogen receptors type-1 and type-2. The mice with alopecia areata had a marked increase in hypothalamic-pituitary-adrenal tone and activity centrally and peripherally in the skin and lymph nodes.

There was also altered interaction between the adrenal and gonadal axis compared with that in normal mice which proved that the stress level has been higher in those animals. Stress further exacerbated changes in the activity of hypothalamus pituitary axis in mice with alopecia areata.

Alopecia areata animals had significantly blunted corticosteroid and ACTH responses to acute ether stress (physiological stressor) and a deficit in habituation to repeated restraint stress (psychological stressor). All the findings in the study suggests that altered brain responses during stress may be associated with the occurrence of alopecia areata, which prove the hypothesis that the stress is an important factor in occurrence of alopecia areata.

As we said before, treatment of alopecia areata is through observation of the patient and in some cases injections of steroid could be useful.  More experimental studies have shown some improvements in extensive types of alopecia areata such as alopecia totalis.  Hair transplant should not be done in patients with active alopecia areata since patients may lose transplanted hair through the same mechanism.

Where can we take hair for hair transplant other than the back and sides of the scalp?  This is a common question that I am asked on a regular basis.  The answer is “hair can be harvested from almost any part of scalp or body that grows hair and it can be transplanted to any part of the skin.  We have performed hair transplant from many different areas of the body on patients who do not have sufficient donor hair on their scalp for transplantation or in people who had old hair transplant procedures that violated the donor area with multiple punch biopsies and through scarring.

Pubic area is prepped before harvesting hair for hair transplantation into the balding spot of patient

It is important to understand that scalp donor hair is always the best option when it comes to hair quality for the best result in hair transplant surgery.  The scalp hair has a longer growth phase (anagen) that is about 1-6 years and a shorter resting phase (telogen) that lasts around 4-6 weeks.  This makes scalp hair a more economic choice for hair restoration surgery.  When using scalp hair for donor, almost every transplanted hair stays in growth its phase and only a small portion goes into the dormant phase in which hair falls and another hair grows in a few weeks.

Body hair, in general, has a shorter growth phase which could last only about a few months and a longer resting phase.  That is why body hair never grows more than a certain length.  There are some limited studies that show that transplanted body hair can change their innate characteristics and increase its growth phase when transplanted to the scalp, but we still need more research to provide information on the details of the process.

At US Hair Restoration, we have used pubic hair successfully in a patient with great demand due to his fine scalp hair and violated donor hair that could not provide sufficient hair for transplantation into the scalp.  The patient’s hairline has been restored using scalp hair from the occipital area (back) of the head and the balding spot on the crown was reinforced using pubic hair.

So if you are lacking adequate hair on your donor area of the scalp or need a large number of grafts, you may be able to consider other options including pubic hair transplant.  Obviously, the donor quality should be evaluated closely by a good hair transplant doctor to determine the candidacy of the patient for body hair transplant to scalp.  The details and methodology of this process is being published in medical journals.

I just found this article on transplantation of artificial hair.  Artificial or synthetic hair for the treatment of male pattern baldness or androgenetic alopecia has been tried in many countries, but has been unsuccessful at getting FDA approval in America for a variety of problems that it had.  The result of the study published in Journal of Cosmetic Dermatology is very limited in terms of the number of participants and transplanted hair but it is worthy of mentioning in our hair restoration blog.

The article discusses the problems of the artificial hair implantation such as poor quality fiber, untrained operators, and inadequate techniques.  However, the paper aims to establish safety and efficacy of a new artificial copolyamide fiber implantation in male patterned baldness or androgenetic alopecia.

In the study, ten healthy adults with androgenetic alopecia who had failed prior conventional therapies such as medical or surgical hair restoration were implanted with copolyamide fiber and were followed for a minimum of 3 years. Implantation consisted of 100 test fibers followed by subsequent sessions of up to 500 fibers every 4-6 weeks to achieve a density of 20-40 fibers per cm(2).

The techniques of implantation and follow-ups maintained a strict adherence to schedule.  In this study 10,000 fibers were implanted with a mean of 1000 fibers per patient. With the exception of one patient, implantation was found to be safe, aesthetically pleasing, and psychologically rewarding to its recipients. Sebum deposition and temporary pitting at entry point of most fibers were universal. Recurrent mild folliculitis occurred in 30% of patients.

The other complications such as facial swelling, cellulitis, and severe scarring were not seen in this study. Between 15-20% of all transplanted fibers fell every year and maintenance of the procedure was shown to be necessary.  In conclusion, the choice of fiber implantation technique and mandatory follow-up were deemed to be some of the important contributory factors towards positive results.  Hair restoration with artificial hair might become more popular in the future for patients who lack good quality donor hair with extensive baldness.  However, other studies on a larger number of patients need to be done before it can really prove to be safe for practical use.

How to choose a hair restoration surgeon has been addressed in our hair restoration blog before.  However we still get a number of questions on a regular basis from other parts of the world from hair loss patients who are shopping around for a hair restoration procedure.  For most of those patients, the quality of a hair transplant clinic is the best factor to decide which hair transplant clinic to choose.

Being in Southern California, I see hair transplantation results from other hair transplant doctors and I might be able to say who can be in a list of best hair transplant doctors in Los Angeles.  It would be hard for me to really say who is the best hair transplant doctor in America, let alone other countries that I have limited exposure to and have not had a chance to see their best hair transplantation results.

As we said before, searching for a good hair transplant doctor can be a difficult job. In large metropolitan areas such as Los Angeles and Orange County, referrals for cosmetic and hair transplant surgeons come far and wide. Compared to other cosmetic surgical procedures, hair transplant surgery and in particular follicular unit transplantation is one of the newer fields. You can find a variety of hair transplant surgeons with different levels of experience in your country. Overall, hair restoration and other cosmetic procedures should not be taken lightly. Just because you see a billboard stating “the most experienced Hair Transplant surgeon in …” does not make it a true statement.

Most hair transplant surgeons now in days offer a free hair transplant consultation. You should know that the end result of hair transplant surgery is permanent and it should be to your liking. Take advantage of the situation and shop around. It isn’t enough to just visit several hair transplant doctors.  You also need to educate yourself on the hair transplant process, the surgical techniques and the hair transplant surgeon’s background before visiting the doctor.

By doing so, you can appreciate a good technique and a knowledgeable doctor when you see one.  US Hair Restoration offers a free physician consultation for everyone and we specialize in state-of-the-art exclusive follicular unit transplants (FUT), mega sessions for people with extensive hair loss and follicular unit extraction (FUE), or minimally invasive hair transplant that does not leave a scar in the donor area.

In today’s world it is getting easier to look your best. Modern hair transplant surgeries with undetectable results have become a demanding field in many large metropolitan areas.  This is my one single advice on how to find the best hair transplant or the best hair transplant doctor: do as much research as you can and then meet your hair transplant doctor prepared with good questions and see if he is someone you can really trust.

Parsa Mohebi, MD
Hair Transplant Surgeon

Biatoprost has been available and prescribed as a glaucoma medication, used to control the progression of glaucoma and to manage the ocular hypertension. Biatoprost reduces intraocular pressure.  One of the side effects of this glaucoma medication is lengthening of the eyelashes.  In December 2008, the use of this product for eyelash lengthening was approved by the FDA.  The cosmetic formulation of bimatoprost is now sold as Latisse by Allergan.

This is not the first time that we take advantage of a side effect of a medication for other applications.  Another example is minoxidil which was originally used only as a blood pressure medication. As a result, growing hair was reported as one of its side effects.  Now minoxidil, or Rogaine, is one of the FDA approved medications for hair loss prevention and treatment.

Latisse is in the market for those who are interested in having longer eyelashes.  Eyelash hair transplant surgery is another method that uses scalp hair to be implanted into the eyelash area.  The best candidates for eyelash hair transplantation are the people who do not have any eyelashes on all or part of their eyelashes.  If you have eyelashes and are looking forward to having them longer and fuller, Latisse might be a better option.