Presented by: Dr.Mir Laieeq Moderator: Prof. Iffat Hassan. Introduction Hair transplantation is a procedure performed in an outpatient setting under local anaesthesia. It is based on the theory of donor dominance i.e. terminal hair from the unaffected posterior scalp will continue its growth pattern even when transplanted to the balding frontal scalp Introduction In past,34 mm grafts containing 1530 hair follicles were used. But it resulted in unnatural appearance due to obvious plugs(Barbie-doll) Currently grafts with one to four hair follicles, referred to as individual follicular units are used giving transplanted hair having a more natural appearance. The net perceived density from a hair transplant is equal to the number of follicles transplanted minus ongoing hair loss.
Timeline 1939 Japanese dermatologist, Dr. Okuda, published a revolutionary method using small grafts from donor area to correct lost hair from scalp, eyebrow, and moustache areas. No impact in the Western Hemisphere due to the interruption by World War II. Late 50s Dr. Norman Orentreich, experimented with transplanting the hair on the back and sides of the head to the balding areas. Transplanted hair maintained their bald resistant genetic character 60s and 70s involved the use of larger grafts that were removed by round punches and often contained many hairs In 80s large punch grafts were gradually replaced with combination mini micro grafting Minigrafts (4-8 hairs) were used to create fullness and density, while the (1-3hair) micro grafts were used to create a refined and feathered hairline in front. 90s introduction of follicular unit hair transplantation the current "Gold Standard. Transplants hairs in their naturally occurring one, two, three, and four hair follicular unit groupings in which they grow naturally. 1995,Dr. Robert Bernstein proposed creating hair restoration using exclusively follicular units. Dr. Limmer was first to use the binocular microscope to examine the donor tissue to successfully isolate and trim the naturally occurring follicular units into individual graft Indications Androgenic alopecia(in men and women) Male pattern alopecia Cicatricial alopecia Traumatic alopecia Traction alopecia. Contraindications Diffuse female pattern baldness Nondonor-dominant alopecia Alopecia areata. Scarring alopecias are nondominant and, while active, do not respond to hair transplantation. Hair transplant is inappropriate in active phases of Lupus, infections and poor general health. Vitiligo and psoriasis can be aggravated by hair transplantation
Candidate Selection
Selection of appropriate candidate needs to be done from a medical and a psychological perspective. Assessment of areas of greatest concern and Whether the patient has realistic expectations A complete medical, surgical and hair loss history Previous hair transplants and scalp surgeries as well as scar formation. The etiology of the hair loss is determined, primarily via physical examination of scalp Clinicopathologic correlation(occasionally needed) The stage of patterned hair loss. Medications review with regard to their effects on hair growth and haemostasis. Appraisal of the density and caliber of donor hair in the occipital scalp as both have an impact on the perceived density of the transplant
FIVE BASIC CRITERIA FOR ASSESSING CANDIDATES FOR HAIR TRANSPLANTATION
(1)Age Patients >25 years are preferable. Unpredictability of future hair loss in individuals between 15 and 25 years of age. This subgroup also tends to desire a return to a full head of hair as opposed to a mature pattern of restoration done in older age groups (2)Hair shaft caliber Those with large-caliber(>70 microns) obtain much denser coverage than those with corn silk quality hair. (3)Donor hair density Measuring a 0.25 cm sq.field and multiplying by four is the preferred method. Patients who have >80 follicular units/cm sq.are excellent candidates. Those with donor hair density <40 follicular units/cm Sq.are considered poor candidates
FIVE BASIC CRITERIA FOR ASSESSING CANDIDATES FOR HAIR TRANSPLANTATION
(4)Degree of baldness (most important criterion) Those with complete baldness of the frontal scalp as opposed to baldness limited to the vertex are excellent candidates. When frontal baldness is corrected, there is dramatic cosmetic appearance. (5)Hair color Follicular unit grafting has made hair color less of an issue than when punch grafts were employed. Color contrast between hair and skin can make grafts apparent if not transplanted with great care. Individuals with salt-and- pepper hair, red hair or blonde hair are preferential to those with jet-black hair. Black-haired individuals are not exempt as hair transplant candidates, but should receive only one-hair follicular units in the frontal hairline for the most natural result. Proper technique eliminates most problems with dark- haired candidates Ideal candidate(summary) High density in donor area(80hair/cm.sq) Mixture of fine caliber hair to create hairline and coarse hair for density Minimal contrast between hair and skin color Some wave, curl and/or fizz Existing hair in recipient area which may be used for camouflage post operatively.
Donor density Type A 200 hairs per cm. sq. Type B 150 hairs per cm. sq. Type C 100 hairs per cm. sq. Type D 50 hairs per cm. sq. (type Ds are not good candidates for hair transplantation) Class I represents an adolescent or juvenile hairline and is not actually balding. The adolescent hairline generally rests on the upper brow crease. Class II indicates a progression to the adult or mature hairline that sits a fingers breath (1.5cm) above the upper brow crease, with some temporal recession. This also does not represent balding. Class III is the earliest stage of male hair loss. It is characterized by a deepening temporal recession. Class III Vertex represents early hair loss in the crown (vertex). Class IV is characterized by further frontal hair loss and enlargement of vertex, but there is still a solid band of hair across top separating front and vertex. Class V the bald areas in the front and crown continue to enlarge and the break down of bridge of hair separating the two areas. Class VI occurs when the disappearance of connecting bridge leaving a single large bald area on the front and top of the scalp. The hair on the sides of the scalp remains relatively high. Class VII patients have extensive hair loss with only a wreath of hair remaining in the back and sides of the scalp
Norwood Class A(2A-5A)
The Norwood Class A patterns are characterized by a front to back progression of hair loss. Norwood Class As lack the connecting bridge across the top of the scalp Generally have more limited hair loss in the crown, even when advanced. Since the hair loss is most dramatic in the front, the patients look very bald even with minimal hair loss Men with Class A hair loss often seek surgical hair restoration early frontal bald area is not generally responsive to medication dense donor area contrasts and accentuates the baldness on top. Fortunately, Class A patients are excellent candidates for hair transplantation.
Diffuse Patterned and Unpatterned Alopecia
These types of genetic hair loss pose challenge both in diagnosis and in patient management esp. in young diagnoses may be easily missed Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia manifested as diffuse thinning in the front, top and crown, with a stable permanent zone. Does not pass through the typical Norwood stages. Diffuse Unpatterned Alopecia (DUPA) is also androgenetic, but no stable permanent zone. DUPA tends to advance faster than DPA and end up in a horseshoe pattern resembling the Norwood class VII. Differentiating between DPA and DUPA is very important because DPA patients often make good transplant candidates, whereas DUPA patients almost never do, as eventually don't have a stable zone for harvesting.
Diffuse Unpatterned Alopecia (DUPA) in a 32 year-old male
The densitometry reveals extensive miniaturization. Key Concepts
Candidates should be made aware that AGA is progressive despite undergoing hair transplantation. Medications (e.g. oral finasteride) can help to maximize hair density from a transplant by minimizing ongoing hair loss. The surgeon should always assume that in the future these medications may be discontinued Additional hair transplants may be required, perhaps in another 5 or 10 years. The physician should emphasize how ongoing hair loss will affect the density and cosmetic appearance of transplant. Key Concepts
The number of expected procedures to accomplish both short- and long-term goals should be reviewed, as well as the limits on available donor hairs. Concentrating the transplants in the frontal scalp will allow maximum long-term density with minimal long-term cosmetic risk. Ideally a reserve should be left in the donor region for any unanticipated areas of MPB as well as thinning of the transplanted hair
Key Concepts Most female patients will not have sufficient donor areas of good density to adequately treat all affected areas. For most women the goal is limited to the transplantation of primarily the cosmetically most important areas like Frontal area Vertex whorl area and a 5- to 6-cmwide antero-posterior corridor through which the patient's hair normally parts The hair in these thickened areas is styled in such a way as to camouflage the untreated area Four conceptual zones in MPB Frontal Area between intended hair line and intertragal line Mid scalp area between frontal area and vertex transition point. Vertex area includes remainder of alopecic areas Evolving areas adjacent to 3 major zones.
Ideally each of the major areas is treated at the same time as adjacent evolving area of MPB lateral to them. Typically only one major area is treated at each session. It is only a general rule and variations are there depending upon size of recipient area. Some Mathematics! No. of follicular units/cm 2 is nearly constant in all individuals, normal density being 100 FU/cm 2 and no. of hairs per unit is 1 to 4 Since the follicular unit density is relatively constant; the same number of follicular units is needed to cover a specific size of bald area regardless of the hair density of the patient. A person can lose half the number of his hairs before he appears bald
Calculation of the number of hair units required for the recipient area Frontal area is triangular and the area is calculated by the formula x breadth x height Vertex is circular and its area is calculated by the formula: A = pr 2 (A = area, p = 3.14, r = radius). Usually half the calculated FU are transplanted giving good cosmetic results.
Mega sessions A session in which more than 1000 units are grafted is called a mega-session. It has several advantages:
It avoids multiple surgeries and the resulting absence from work
In multiple grafts, the first graft always yields the best results
A large session economizes donor supply Preoperative evaluation Complete history and physical examination. Appropriate lab studies focussing on excluding Bleeding dysesthesias (complete coagulogram) Hypertension Coronary artery disease Hepatorenal disease In females rule out potentially treatable causes by CBC,Iron profile,TFT Total & free testosterone,DHEA(if irregular menses)
Patient positioning During the removal of the donor strip, the patient is placed in a prone position with the head in a special prone pillow that allows comfortable breathing while face down During the creation of the recipient sites and insertion of the grafts, patients are usually in a semi-supine position
Anaesthesia Ananesthetic field block is first created using 30-gauge needles and 1-2 % lidocaine with 1:100,000 epinephrine along the inferior edge of donor area. Once anesthesia is obtained, 20 ml of normal saline or 50ml NS with 0.5ml of epinephrine can be injected to provide further anesthesia, hemostasis and dermal turgor or tumescence ; the latter helps to reduce the transection of hair. Local infiltration to create ring block of anaesthesia anterior to anticipated recipient area is commonly used technique. Lidocaine dose must be limited to 7 mg/kg with epinephrine(max 500 mg)or 4.5 mg/kg(max 300mg) without epinephrine. After 2 hours LA should be reinforced by 0.25%-0.5% bupivacaine with 1:100,000 epinephrine(max 200mg).This lasts 4 hours.
Donor Region
The amount of available donor hair is the primary limiting factor in hair transplantation In general, there are 6585 follicular groupings/cm.sq. in the occipital donor scalp. The mid occipital scalp between the two occipital protuberances is the recommended donor site Density of hair Ability to camouflage the donor scar(d/t lack of involvement by AGA) Donor density does not correlate with the extent of current or future hair loss in the frontal scalp or vertex. Techniques for graft harvesting 2 techniques for harvesting of donor: Elliptical donor harvesting Follicular unit extraction
Elliptical donor harvesting
Elliptical donor harvesting is performed in majority owing to Safe and rapid removal of large numbers of hair follicles Minimal transection of hairs. The width of the donor ellipse ranges from 7 mm to 1.2 cm, while the length should be less than 30 cm. The number of follicular groupings required determines the dimensions of the donor ellipse. Increasing the width of a donor ellipse creates more wound tension and may lead to a hypertrophic or wide scar.
Elliptical donor harvesting. Initial scoring of the excision may be done with a single or double #15 blade scalpel Double blades should be oriented parallel to the exiting follicles.(to avoid transection) The incision should extend into the subcutaneous fat but not deeper (5 mm into the scalp),to prevent damage to occipital artery and nerves. Elliptical donor harvesting. Lateral retraction using fine skin hooks exerts tension away from the excision and creates good visibility. The ellipse can be removed by scissors or a scalpel, being careful to avoid damage to any follicles in the subcutaneous tissue. Ellipse can be removed without the use of electrocoagulation (if incision is within Subcutaneous fat) Elliptical donor harvesting The donor ellipse can often be primarily repaired with no undermining if it is <1 cm in width. Some surgeons utilize a two-layer closure while others perform a single- layer closure. Staples or sutures (Vicryl or 3-0 silk) can placed and then removed 710 days later.
Absorbable sutures may be used for those patients who live a long distance away from the physicians office.
Dissection of hair This is perhaps the most important step in the procedure. The elliptical strip is first dissected into small slivers of 1 or 2 follicular unit width (1-2 mm) under a stereomicroscope( to avoid transection of hairs) The slivers are then dissected into units of 1-4 hair units either under a magnifying loupe or a microscope Whether the grafts should be skinny (thin) or chubby (thick with a little amount of dermis around them) is a matter of debate After separation follicular unit grafts must be put into chilled saline or an equivalent medium until they are placed into the recipient sites
Follicular unit extraction In 1984, Headington a paper demonstrating that hairs did not occur singly, but as naturally occurring groups that were referred to as the follicular unit. Each unit consisted of 1 to 4 terminal follicles. This paved the way, in 1990s, for the 'Rolls Royce of hair transplantation' follicular unit transplantation (FUT) Follicular unit extraction (FUE) represents the removal of individual follicular units from the posterior scalp via 0.751.2 mm punch device. The incisions are so small that they leave no visible scar after they heal. FUE is an excellent alternative technique for patients Who like to have closely cropped hair and do not want a visible scar Extensive scarring from previous transplant procedures.
Follicular unit extraction
But FUE is Time consuming Obtains fewer follicular groupings from each procedure Higher rate of transection of the follicular groupings. In the future, refined instruments and robotics will hopefully lead to more rapid and precise harvesting of individual follicular groupings ELLIPTICAL DONOR HARVESTING VERSUS FOLLICULAR UNIT EXTRACTION ELLIPTICAL DONOR HARVESTING FOLLICULAR UNIT EXTRACTION Visible scar if hair cut short Yes No Transection of hair follicles Minimal Variable Time required for harvest 10 to 20 mins 30 to 90 mins Need to create grafts Yes No Quality transplant Excellent Excellent ELLIPTICAL DONOR HARVESTING VERSUS FOLLICULAR UNIT EXTRACTION FOX Test It is important to note that the tightness with which follicular units are held in dermis varies and hence FUE may not be suitable in all patients. This test is to ascertain whether the patient is a suitable candidate for FUE or not. In FOX test, the surgeon takes out a few (about 100) grafts from the donor area and then evaluates how many complete/incomplete follicular units are extracted. Bernstein and Rassman classified FOX test into five grades. If the patient is FOX-positive (grade 1-3), the surgeon can go ahead with FUE Fox grade 4-5 (it is almost impossible to predict the emergent angle), the yield is too low for the FUE procedure to be successful.
Follicular Grafts
Earlier punch grafts measured 34 mm in diameter were often oriented in a perpendicular fashion and contained multiple follicular units, leading to an unnatural appearance. Nowadays, each graft contains just one follicular grouping and is oriented at an acute, 3045 angle toward the front and slightly toward the midline Thus, these grafts mimic the natural grouping and orientation of scalp hairs Different sizes of hair transplantation grafts. A The newer technique uses 1- to 4-hair follicular unit grafts.
B The older technique uses larger 10- to 15-hair grafts Over several hours, surgical teams can carefully separate 5002000 follicular units from the donor strip. Cutting instruments include #11 and #15 blades as well as #10 prep blades. Good lighting, comfortable chairs and well- designed instruments are prerequisites for producing follicular units with minimal transection
Some surgeons believe microscopic dissection or magnification reduces transection of follicles during the separation process
However, the data are still inconclusive HAIR TRANSPLANTATION IS A MIX OF SKILL AND IMAGINATION Hairline Design In men, the hairline defines the cosmetic success of a hair transplant. Because women have stable frontal, temporal and posterior hairlines, recreating a hairline in them is usually not necessary. As with hair graft creation, hairline design should mimic as closely as possible what occurs in nature.
Hairline Design
Trying to recreate the hairline a patient had before the hair loss began leads to cosmetic failure even if all the available follicular units are utilized. This is due to slow steady recession of the temporal and posterior hairlines as well as the frontal hairline.
The design of the frontal hairline should be such that it will remain balanced with the temporal and posterior hairlines. This requires recreating a frontal hairline which is higher and more receded than the one which was present before the process began. A common reason for cosmetic failure HOW TO PREVENT IT?
Hairline Design
Hairline should be considered a natural transition zone rather than a fixed zone . This ill-defined feathering zone is re-created by randomly placing, in an irregular pattern, follicular unit grafts along the newly created hairline . Dense packing of grafts should not be performed because this will lead to a hairline with an unnatural appearance. The level at which the hairline is placed varies from individual to individual and it is important to first examine each patient in a global, 360 manner. Hairline Design and Recipient Site Creation
While male pattern hair loss is progressive, transplanted hair will have long-term growth. The surgeon must assume that all patients will progress to the highest grade of involvement with only transplanted hair remaining. This assumption allows transplanted hair to look equally natural 1 year and 20 years after surgery. AN IMAGINATIVE ASSUMPTION Immediate postoperative appearance with graft placement and hairline design.
Anesthesia and Recipient Site Creation
A combination of supraorbital/supratrochlear nerve blocks, field blocks and local infiltration with 1% lidocaine with epinephrine can be performed. Hemostasis is essential for good visibility when creating recipient sites and for graft placement. The epinephrine in the local anesthetic (placed into the dermis and not the subcutaneous space) creates excellent hemostasis. Anesthesia and Recipient Site Creation Recipient sites should mimic the natural 3045 angle of hair growth on the scalp Instruments such as NoKor needles, slits (for combination grafts), rectangular punches, 18/19 size needles (for 1- to 2-hair units) and blades of different sizes are used. When making recipient sites, surgeons must be careful not to transect existing hair follicles. The key to success is to create recipient sites in a random, highly irregular pattern with 1030 FU/cm2, depending on the density of existing hair on the scalp.
Recreating the 3045 of hair growth on the frontal scalp. (A) Correct versus incorrect technique (B). Grafts should not be oriented perpendicular to the scalp surface Graft Placement Two to three surgical assistants place the grafts with microvascular forceps. Follicular units are grasped by their perifollicular tissue, avoiding trauma to the hair follicles. Regular surgical forceps are not recommended. Placement of the grafts into is the most challenging step. Methods for insertion: a)Stick and place method' involves making a recipient site, followed immediately by insertion of hairs into the site by an assistant
b) Creating all the required recipient sites at one time and then placing the grafts one by one
POSTOPERATIVE CARE Day of the procedure Apply non-adherent dressing overnight Oral paracetamol 300 mg/ codeine 30 mg every 46 hours SOS Oral prednisone 40 mg OD for 3 days to reduce frontal scalp edema Resume regular activities, but no heavy lifting or strenuous exercise until staples/sutures removed Sleep with head elevated Postoperative days 13 Day 1 remove dressing Shower each day and allow water to run over grafts Comb hair without allowing comb's teeth to hit perifollicular crusts Do not pick or scratch at perifollicular crusts Apply emollient to the donor site(s) daily Days 1, 2 continue prednisone Postoperative days 47 Resume light exercise Follow instructions outlined above for showering, combing and emollient application Postoperative days 7 10 Staples/sutures removed Resume regular exercise regimen Perifollicular crusts gradually disappear Complications
Complications are unusual. The extensive vascular supply to the scalp results in rapid wound healing and a low risk of infection. Temporary Excessive swelling (5%), Postoperative bleeding (<0.5%), Folliculitis, Headache, and Pruritus or numbness of the scalp. Persistent problems Permanent numbness in the donor or recipient sites Abnormal scarring around the grafts Hypertrophic scarring of the donor site Poor growth of hair grafts. Other potential complications. Lidocaine toxicity. 20 mg diazepam may be injected to raise the minimal convulsive dose. Lidocaine should be injected superficially and intermittently Max. Dose should not be exceeded. SYNCOPE. Keep patient supine or prone Control pain and anxiety Adequate hydration Blood glucose maintainence. Occipital scalp scar secondary to elliptical donor harvesting Follow up Generally no follow-up is required. The grafted hairs may start falling at 2 weeks due to postoperative telogen effluvium The hairs start growing by 3-4 months at the rate of one cm every month, with full cosmetic results at the ninth month. Minoxidil is started in the second week to promote hair growth and prevent delayed results
CORRECTIVE HAIR TRANSPLANT SURGERY A Usual Scenario Patient present for corrective surgery because of previous transplantation of 34 mm punch grafts that have led to unnatural large plugs,i.e. a pluggy transplant. 3 options can be tried: (1) Add a large number of follicular unit grafts containing one to four hairs between the larger plugs to soften their appearance; (2) Surgically remove the large grafts; and/or (3) Perform laser-assisted hair removal. (1)Adding follicular unit grafts
Transplantation of a large number of follicular unit grafts containing one to four hair follicles in front of, in between and behind large grafts will soften the pluggy appearance . This option is appealing for many patients because it allows for both cosmetic improvement and increased density But it cant be done if depleted donor supply from previous transplant procedures Some are reluctant to have another surgery following the emotional trauma from the initial transplant.
(A) Previous transplantation of 34 mm punch grafts can lead to unnatural large plugs of hair. (B, C) Addition of follicular unit grafts between and in front of the larger grafts softens the hairline and the overall appearance (2)Surgical removal of grafts
Done for cosmetically unacceptable hairlines & Large grafts with perifollicular white scar tissue. The grafts can be removed by either a 24 mm punch instrument or an elliptical excision. Also follicular unit extractions from larger grafts via 1 mm punch instruments This reduces the pluggy appearance of the larger grafts while allowing a more natural appearing graft to remain. Cosmetically evident scars develop in a small minority of cases. Pulsed dye, ablative, non-ablative, or fractional ablative laser treatments can be used to help improve the cosmetic appearance.
3 Laser-assisted removal of large grafts
As with other parts of the body, lasers only remove pigmented terminal hair follicles Typically 510 treatments are needed to permanently remove the majority of follicles. It eliminates majority, but not all of the hairs leading to substantial cosmetic improvement of the unnatural plugs. Some of the transplanted hair is retained for a more natural appearance. Laser therapy is an excellent option for patients who want to improve their cosmetic appearance in a safe,non-invasive manner. Hypertrophic or broad scars in the donor region No easy solution for repair. The best method for minimizing the risk of a wide scar is to keep the width of the donor strip to 1 cm. Scar revision leads to variable improvement. Pulsed dye, non-ablative or fractional ablative lasers may be used to help reduce the thickness and erythema of hypertrophic scars. Another option is to transplant a large number of follicular groupings into the scar in an attempt to provide camouflage Hair Transplantation in Scarring Alopecias
Hair transplantation can be successfully performed in scarred skin even though yield is lesser than non-scarred areas. More sessions are required. But patient satisfaction is high. Guidelines Any inflammation should be resolved completely before hair is transplanted. In the case of inflammatory scalp dermatoses, patients should have no evidence of inflammation for 6 months off therapy before the transplant procedure is performed. Biopsy specimen should be obtained if doubt about persistent inflammation All patients should be told that any future flare of scalp inflammation will likely affect the growth of the transplanted hair. Robotic Hair Restoration The FUE robot (ARTAS)is an image-guided system composed of a robotic arm, dual-needle punch mechanism, video imaging system, and a user interface. Inner punch has cutting capabilities to score the upper most part of the skin Outer punch has a blunt edge used for dissection of the follicular units from the surrounding tissue that minimizes injury to the grafts. The image-guided system allows this step to be accomplished with great precision.
Advantages Increased accuracy of harvesting grafts to minimize damage to follicles Ability to use FUE in a wider variety of patients Reduced harvesting time Increased graft survival
Debunking some myths! Myth #1 It is better to have a hair transplant when you are young. Fact: at an early age, the pattern of loss is unpredictable and the hair loss has a greater chance of being extensive in the future. Permanency of the donor area cannot be determined. Myth #2 Most women can benefit from hair transplantation just like men. Fact: In spite of the great advances doctors are still limited by a persons finite donor supply. In many women donor area is thinning as well as other parts of the scalp, making hair transplantation ineffective. . Myth #3 When large numbers of grafts are transplanted they do not get enough blood supply. Fact: The blood supply of the scalp is so great and it is so collateralized that it is able to sustain the growth of thousands of newly transplant grafts. But If the grafts are too, large or if the sites are placed too close together the blood supply can be overwhelmed resulting in poor growth. Also, blood flow is significantly compromised by chronic sun exposure and smoking. Myth #4 Large grafts produce more density than smaller grafts. Fact: Density depends upon the total amount of hair transplanted to a particular area, not the size of the grafts
Myth #5 Laser hair transplants are state-of-the-art. Fact: Not used by the most experienced hair transplant surgeons. In fact, laser hair transplants are really a misnomer, lasers have only been used for is to make the recipient sites . Even for this limited purpose, lasers are a problem. Lasers always produce more injury to the skin than a small slit made with an instrument Grafts placed into laser made sites will be less secure and there will be a greater chance of scarring in the donor area and poor graft growth.
FUTURE TRENDS
Cloning
Regeneration and cloning of hair follicles represents the next step in revolutionizing hair transplantation. With an unlimited supply of hairs, there will no longer be constraints based upon the density of hairs in the donor region. Keratinocyte tubulogenesis has been induced by cultured dermal papilla cells.
Chermnykh ES, Vorotelyak EA, Gnedeva KY, et al. Dermal papilla cells induce keratinocyte tubulogenesis in culture. Histochem Cell Biol. 2010;133:56776 Stem cells derived from Bone marrow- and umbilical cord were shown to be a reservoir for follicle regeneration
Yoo BY, Shin YH, Yoon HH, et al. Application of mesenchymal stem cells derived from bone marrow and umbilical cord in human hair transplantation. J Dermatol Sci. 2010;60:7483 Epidermal wounding, with upregulation of Wnt proteins, led to hair follicle regeneration in adult mouse skin
Ito M, Yang Z, Andl T, et al. Wnt-dependent de novo hair follicle regeneration in adult mouse skin after wounding.Nature. 2007;447:31620. Erythropoietin has been found to promote the growth of dermal papilla cells as well as to prolong the anagen phase of cultured human hair follicles
Kang BM, Shin SH, Kwack MH, et al. Erythropoietin promotes hair shaft growth in cultured human hair follicles and modulates hair growth in mice. J Dermatol Sci. 2010;59:8690. Mouse model for androgenetic alopecia should provide insights into mechanisms of disease and therapies
Crabtree JS, Kilbourne EJ, Peano BJ, et al. A mouse model of androgenetic alopecia. Endocrinology. 2010;151:237380. THANK YOU