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the October International Society of Hair Restoration Surgery meeting in New York and body hair FIT.
This year’s ISHRS meeting included several very interesting talks. The most interesting were the discussions regarding storage mediums for grafts, an update on hair cloning, ischemia reperfusion injury of grafts, use of polarized light sources, plucked beard hair transplants, an update on follicular unit extraction, video surgery techniques, and hair multiplication.
The most important scientific break through in my opinion was the application of new graft storage mediums by the Moser medical group located in Austria. We all know that hairs removed from the donor region and relocated to the top of the scalp typically go in to a growth phase called anagen effluvium. In this phase the hairs cease to grow after a few days and then fall out two to three weeks after surgery. The Moser medical group has been experimenting with various graft storage mediums to prolong anagen and prevent anagen effluvium. The benefit of such a solution is obvious. Typically grafts that undergo anagen effluvium do not resume growth for 3 to 8 months after surgery. Some may take up to 12 months to resume growth, while a select few may never resume growth. A storage medium that prevents anagen effluvium would be a significant improvement and an advantageous occurrence to all those who receive a hair transplant. Furthermore, this medium might even improve the yield from hair transplantation. Imagine having a hair transplant that results in full regrowth immediately following our procedure rather than having to wait 8 months for most of the hair to begin regrowth. Hairs generally grow at a rate of ¼ to ½ inch per month. If you have to wait a minimum of 6 months for 60% of the hair to resume growth the majority of your hair will be 3 inches in length or less after 1 year. If your hair continues growth immediately after transplantation it could be up to 6 inches long after one year and you might have more total hair. Two other groups have been experimenting with storage mediums that we know of. One is Jerry Cooley and the other is our group – Dr. Cole and Dr. Rose. Of the three groups, the Moser group clearly appears well ahead of the curve. They presented data suggesting that they have found a solution which eliminates anagen effluvium altogether. They presented many parameters which influence anagen effluvium. They did not divulge the content of their storage solution, but did state that it involved a mixture of chemicals and ph buffers. I questioned Claudia Moser personally and she stated the solution contained much more than what we have worked with to date. They are attempting to get the storage medium approved in many different countries, perhaps even the United States. Until they have this approval, it is unlikely that it will distributed universally. They are not likely to release their ingredients due to the inherent risk to their intellectual property. I held a private conversation with Claudia Moser. She told me that their solution contains many ingredients in addition to antioxidants. We have worked with glutathione and glucose solutions that are ph balanced and approved in the United States. Claudia told me that the Moser solution has additional ingredients. Possible ingredients include additional antioxidants, hormones such as growth hormone and insulin, and nitrous oxide pathway modulators. Their storage solution may need to gain FDA approval prior to its release into the United States. We will keep you posted on the progress by the Moser Group to bring this valuable product to the United States. We feel it will be a major break through in hair restoration surgery.
Jerry Cooley presented a paper on ischemia reperfusion injury IRI. This was basically an expansion on the paper he presented last year in Chicago. Essentially he showed that ischemia reperfusion injury does occur with hair grafts. This is the same thing he said last year. He bases this statement on chemical reactions performed on grafts that were extracted from the donor area via strip harvest. Jerry went on to state that IRI is an important phenomenon to major organ transplantation and that it is inhibited by the use of various storage mediums. He offered no advice on specific mediums.
Both the Cooley talk and the Moser talk deal with the same subject. This is to improve hair yield and hair survival in grafted hair. We have been using a medium used on corneal hair transplants. We have not been able to inhibit anagen effluvium though. We also have worked very hard on Time Out of Body or TOB. We have not been able to inhibit anagen effluvium with either yet. We have seen anecdotal evidence that TOB does affect the rate of regrowth. In other words, a short TOB appears to reduce the time it takes to hairs to re-grow after transplantation.
IRI results in the production of various chemicals which are harmful to the grafts and to the recipient area. These toxic metabolites may reduce yield, slow re-growth and even prevent full re-growth in future hair transplants. The production of these metabolites begins immediately after the grafts are removed from the body. The longer they are out, the more they build up. Allowing the grafts to float in a typical solution of normal saline or lactated ringers allows the metabolites to affect their neighboring grafts, as well. For this reason, I do not like to allow the grafts to float in a solution. I prefer to isolate the individual grafts as much as possible to keep them moist. Antioxidants act like magnets or sponges to accumulate the oxidation by products resulting from anaerobic metabolism. Chilling the grafts to 2 to 3 degrees Celsius slows down the metabolism and reduces the rate of oxidation by product production in the metabolizing cells.
Several individuals presented their views on cloning. The most enlightening with Dr. Gho. He presented work that shows stem cells are present on plucked hairs. He did not give us an insight into when we should expect a break through though. Dr. Unger stated that his research had not resulted in any new evidence and stated that his research with halted due to a lack of funding. He is precluded from releasing all his data though by his funding sponsor. Moon Kim presented his ideas on DNA micro-arrays. The lab of Jung Chul Kim in Taegu, Korea is attempting to map the genetic code for the hair. Thus far, they have identified 10,000 genes related to hair. Moon stated that they have cultured dermal papilla cells in the lab. They stated that dermal papilla cells immediately extracted from the scalp are different than cultured dermal papilla cells. This is perhaps why we have been unable to get cultured hair cells to grow. Ken Washenik presented an over view of clonnning. Angela Cristiano presented some interesting studies done by others and some of her work at Columbia University. He presented the work of Dr. Johoda that resulted in a hair removed from him that grew on his laboratory assistant, Amanda Reynolds. Dr. Washenik did not present any clues into the status of the research at his own lab. It appeared that either no one is talking or there has been limited advancement in this field.
Dr. Gho presented his work on hair multiplication. He showed a graft that had many hairs on the surface of the skin, but only one bulb in the deep subcutaneous fat. He stated that the other hairs were transected and left in the subcutaneous fat. He went on to state that all the hairs re-grew in the graft. He removes the grafts with a 21 guage needle. He also introduced the concept of pili-multigenesis. He stated that some times a graft that contains only 4 hairs may grow more than 4 hairs. He states that the density of his donor areas does not appear to be reduced using his technique, but he also limits the number of grafts removed to about 500. This is much less than we transplant. This limited number of grafts may be why he sees no affect on the density of the donor area. He believes that the hairs he transects and leaves in the donor region re-grow. It may be that the grafts he feels contain transected hairs may have telogen hairs and even early anagen hairs that are not visible on the surface of the skin. Telogen hairs reside in the lower dermis, which is opaque. This may be what is growing in the recipient area rather than transected hairs. We see many grafts that contain many hairs on the surface, but fewer bulbs in the subcutaneous fat. When we look at these closely under a microscope, we see that the graft contains many telogen hairs in addition to the limited number of hairs that are in anagen with bulbs located deeper in the subcutaneous fat.
There was a presentation on the use of polarized light sources to improve visibility of the hairs. This technology has been around for over a year and has been used in dermatology. We have applied it to our procedure and have attempted to use polarizing filters. The polarized filters help to improve the visibility of hairs, especially white hairs. Unfortunately, this presentation was not given because Dr. Avram’s baby was born that morning.
Dr. Gary Hitzig presented a patient that he had grafted with plucked beard hairs. He stated that the plucked hairs re-grow. I have seen one of his patients 6 months after surgery and nothing was growing. I had to remove the implanted hairs, which had not fallen out. They were beginning to form cysts around them since the non-growing hairs were acting like foreign bodies.
Dr. Wong presented a video demonstrating his techniques for the lateral slit. This was very interesting. Dr. Jennifer Martinik presented a paper comparing vertical to lateral slits. One of the patients clearly looked much fuller on the lateral slit side. In others there was no difference or minimal difference. This clearly indicates that the lateral slit is better than the vertical slit at least on some patients. I believe these are the individuals with more hairs per follicular group, especially the ones with hairs that are more spread out rather than ones with multiple hairs exiting form a single follicular canal. |
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