REGENERATIVE MEDICINE & STEM CELL THERAPIES- EMERGING FIELD IN HAIR RESTORATION

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Scalp cloning vs. Hair cloning?

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Your thought is ingenious but the scalp transplant would involve very major surgery under general anesthesia with higher risks. More over it will have circumferential scarring, which may not look natural.

 



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Warning for the use of Minoxidil!

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Well The reason they write not to use on shaved head is if you are having sensitivity to minoxidil and if you are exposing your shaves head to sun for long time there may be irritation. Although this is not very common but if you are having sensitive skin and if you have more sun exposure you may not apply Minoxidil with shaved head. Shaved head infact makes the application easy and with direct application on long hairs can make your hair stiff and the crusting on the scalp under the hair may not be easy for you to remove.

Same way hair loss can be due to many reasons some skin conditions with hair loss may have more skin irritation if Minoxidil is applied and therefore  it is best suited for hair loss such as Androgenetic alopecia ( male pattern baldness or common baldness) . Because this common baldness has some link to father or mother side genetically it is written on the information leaflet given with minoxidil that  those with no family history of hair loss may not use it. Since you certainly have a pattern hair loss it is Ok for you to use it without any problem. In fact it is the right indication for minoxidil

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Donor recharging, Donor Sealing or Donor Farming

"Recharging donor" area which is also known as "Donor sealing"  even called "Donor Farming" is not new by concept and some surgeons have even practiced this in past. The typical indication would be
1. When surgeon has by poor & aggressive planning over harvested a particular area of donor scalp and that looks thin compared to other parts of donor area. The best way to recharge is to take anagen BHT. When well performed there is no reason why BHT would not grow.
2. When the shock loss has occurred in donor area where hair does not grow back
3. when patient wants to keep the hair very short and want to avoid visibility of dotted scars. The transplanted BHT will bring back the pigments to the donor area and reduce the visibility
4. It may be useful esp. if someone wants to intentionally over harvest good quality scalp donor hair for better cosmetic result in the front and therefore replace donor with BHT instead of using BHT at the front or top.

More over when donor recharging done in the fresh wound immediately after extraction would cause higher chances of BHT growth rather than recharging done in the previous FUE scar with reduced blood supply.

Concealer or Hair Thickening Cosmetics

Toppik, Dermmatch or Nanogen are the Hair cosmetics or concealer which by static adhesion to the existing thin hair will thicken the hair and also by covering the skin reflect no light there by it can give the better cover and volume to the hair thinning area.



Hair thickening Fibres ( Nanogen, Toppik, Hair Magic), particles (DermMatch) , spray  (ProTHIK, Fullmore, Mane), scalp colour cream (COUVRe) or tattoo (Dermography) is temporary (party) solution.

It may have some value in early thinning and in post hair transplant early growth phase.

They are very inert material and would not harm your skin and hairs even on long term use. You can get more info on www.toppik.com , www.dermmatch.com or www.nanogen.com. They can easily be removed on shampoo wash.

Because these products are directly available on their website located abroad when some people in India may want to buy this in India following is the contact details in India:

1. Toppik powder in India: http://www.nutraskyncare.com/

Midas Chamber 301,
Opp. Laxmi Industrial Estate,
Off New Link Road,
Andheri , Mumbai – 400053.
Tel: 0226740022/32428898E-mail:- sales@nutraskyncare.com

2. Nanogen Powder

Telephone : 0-98241-46737 Email : admin@nanogenindia.com  

3. Hairouse Powder: ( More economical of the 3 )

 Nithyasha Health Care , 14, Rukimini Niwas, Gogtewadi,Senapati Bapat Marg, Mahim 16, Tel 224225096, 224225296, 09224585251

 
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Ferritin and Hair Loss in woman

Low serum ferritin hair loss?

Iron deficiency is defined as having a ferritin level of under 40ng/ml or iron saturation of Ferritin under 20%.

Iron deficiency is the most common cause of Chronic Telogen Effluvium ( CTE) in premenopausal women ('During one period, a woman will lose around 10-15 mg of iron, while throughout a pregnancy around 600-1000mg will be lost) . 72% of women in the premenopausal group were found to have iron deficiency as the cause of Chronic Telogen Effluvium (CTE).

In postmenopausal women; medications are the most common cause of telogen effluvium.

The loss of this ferritin from the follicle cells can affect the ability of the hair to grow. This leads to the development of vellus (non pigmented fine hairs), which can be an early indication of deficiency. The presence of vellus hairs is easily mistaken for miniaturized hair seen in androgenic alopecia. We should note here that Iron deficiency hair loss could therefore mimic the pattern of androgenic alopecia hair loss.

When low ferritin levels and female hair loss coexist, the patient is most likely diagnosed with Chronic Telogen Effluvium, or CTE. This hair loss condition usually occurs in women of childbearing age (18-50 years old), and results in evenly-distributed hair loss. Women with low serum ferritin hair loss usually notice one of two things:

• Increased loss of hair during shampooing or brushing.
• Less density of hair, as in a thinner feeling ponytail, or less hair to clip back.

If iron levels are insufficient to maintain blood health, the body "robs" iron from other cells. Since hair is not as essential to the body as is blood, the body often sacrifices the less important function of hair growth for the essential function of blood maintenance.

It is important to note that hemoglobin is the standard measure for iron in the blood, and while hemoglobin levels can diagnose anemia, they do not always correspond with low serum ferritin hair loss. A woman can have plenty of hemoglobin, yet still suffer from low serum ferritin levels

Rushton suggests that serum ferritin concentrations of 40 ng/mL or greater are required for maintaining good hair while 70ng/ml is required for regrowth

Iron metabolism

 

Total body iron averages approximately 3.8 g in men and 2.3 g in women.

Typically about 65% of the iron is in hemoglobin (in red blood cells) and about 4% in myoglobin (in skeletal muscle). About 30% of the iron in the body is stored (as ferritin or hemosiderin) in liver, bone marrow, and the spleen other tissues cells. A small percentage of the body's iron is in transport between various compartments of the body (in association with transferrin) or is a component of enzymes in cells throughout the body.

 Ferritin is a protein complex that contains about 23% iron. It's formed in the intestine when iron unites with a special protein called apoferritin. It is then stored in the body's tissues, especially the liver, spleen, and bone marrow.

Iron Deficiency and Ferritin:

Iron is stored mainly in the liver, within the iron storage proteins ferritin and hemosiderin. Iron stimulates the liver to make ferritin, and serum ferritin provides a reliable estimate of body iron stores. Ferritin is a protein found inside cells that stores iron so your body can use it later. Some Ferritin is released in the blood when the cell uses the iron. The amount of ferritin in your blood (serum ferritin level) is directly related to the amount of iron stored in your body.

Lower-than-normal levels may be due to:

• Heavy menstrual bleeding
• Intestinal conditions that cause poor absorption of iron
• Iron deficiency anemia

The fall of iron stores normally passes through several stages: lowered iron stores, iron depletion and iron deficiency anemia.

1) Lowered iron stores: This is indicated when the iron stores are reduced but not exhausted. No clinical effects are detected.
2) Iron depletion: Shows up in laboratory tests. Hemoglobin concentration may be well below ‘normal’ for that individual’s reference range. This can be detected by Ferittin Test.
3) Iron deficiency anemia: No iron is left remaining in the bone marrow. Hemoglobin production falls to the point where concentration is well below the reference range.

It is important to note, therefore, that iron deficiency (low iron stores, i.e. low ferritin) can occur even if the patient is not clinically anemic and has normal haemoglobin levels

The deleterious effects of iron deficiency are partly due to impaired delivery of oxygen to the tissues and to a deficiency of iron-containing compounds. Clinical features include restlessness and irritability lower IQ scores in adolescent girls fatigue in nonanaemic women, and abnormalities in response to infection and impaired T-cell proliferation.

It is believed that as people have reduced or do not have red meat intake

There may be a number of reasons why the amount of iron absorbed is not sufficient. Firstly, only about 10% of ingested iron is absorbed into the blood each day, and this is dependent on the type of food in the diet. Certain foods may inhibit the absorption of iron, such as tanins found in tea and coffee, also bran and egg albumin.

One can lose iron by: intestinal bleeding, excessive menstrual bleeding, poor digestion, long-term illness, ulcers, and heavy use of anti-acids. [Irritable bowel syndrome too]

Controlling iron deficiency

You can maximize your iron absorption by eating a combination of iron-rich foods such as red meat, green, leafy vegetables, shellfish, egg yolk, nuts and cereals with food or drinks that are high in vitamin C for example, a glass of freshly squeezed orange juice.  Avoid tea until at least an hour after eating as it contains tannin, which interferes with iron absorption.

One method of controlling iron deficiency in the body is to stimulate the liver to synthesize ferritin, the protein that stores iron in order to maintain the correct balance. Hair follicles are known to contain ferritin, and when the circulating stores of ferritin decline then these stores are called upon to ensure support for more essential cells, such as bone marrow.

Treatment:

1.     Eat a balanced diet that includes plenty of iron. Sources include red meat, spinach, broccoli, prune juice, kidney beans and chickpeas.

2.     Add Vitamin C-rich foods to your diet to help boost absorption of iron: Vitamin C sources are citrus fruits and juices, berries, green peppers, tomatoes, broccoli and spinach.

3.     Iron supplementation. The use of an iron supplement may help low ferritin hair loss by adding more iron to your system. The rationale for iron supplementation is that once the serum level is raised to the necessary threshold point, hair growth will resume. However, one of the biggest drawbacks to this type of treatment is that it takes a long time, because ferritin levels must be increased gradually. Allow 2-3 months for hair to stop shedding, and 6 - 12 months for new hairs to become long enough to make a visible impact. Woman usually needs between 18 and 30 mg daily
Excess iron can accumulate in the body. This increases the risk of heart disease, cancer, and some other conditions that are worse than hair loss.
Many people find that eating red meat is a better option than pills when serum ferritin levels are low. The iron in red meat is absorbed well.

"If you need to take iron supplements, do not take them at the same time as vitamin E, Antacids, tea or coffee. And choose an organic form of iron such as ferrous gluconate or ferrous fulmerate. Inorganic forms of iron, such as ferrous sulfate, can oxidize vitamin E.  Only about 10% of ingested iron is absorbed into the blood each day, and this is dependent on the type of food in the diet. Take after food to reduce GI side effects. Continue treatment for 3 months after the hemoglobin reruns to normal so as to ensure replenish the storage.

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Why the transplanted hair grow permanently?

The Pattern loss is genetic hair loss where the hairs at the top central and horse shoe shaped are is where the hairs gradually miniaturize and die because these hairs are  Genetically Hormone (5DHT) sensitive. This is the reason this hair loss is also called Andro Gentic Alopecia (AGA).The hairs at the back and side of the head are permanent and are resistant to this effect of 5 DHT hormone.

When the head is developed from embryo the frontal and parietal bone area of the head has migrated Neural crest tissue but the occipital and temporal bone area ( back and side of the head ) does not have this tissue of origin. It is believed that certain genes responsible for AGA affect only these hairs which are having Neural crest origin and the area at the back and sides escape the effect of these genes. As a result even if this hairs transplanted in the front they keep growing because they remain unaffected by 5 DHT.

The analogy is it is not the problem of the land but the seeds are bad in the front and when the good seeds from the back of the head are planted in the front they grow normally because the land is fertile.

BALDING MUSIC VIDEO

Prolactin and Hair loss

High Prolactin level and Hair Loss:

It has been shown recently that some hair loss is related to higher Serum Prolactin level.

An abnormally high level of prolactin (hyperprolactinemia) is a condition characterized by elevated serum levels of the hormone prolactin in non-pregnant individuals. Hyperprolactinemia may cause progressive pattern hair loss due to an indirect effect on increasing free testosterone level. Prolactin also enhances LH (Luteinizing Hormone) receptors in Leydig Cells, resulting in testosterone secretion, which leads to spermatogenesis.

Prolactin delays hair regrowth in mice. It has been shown in research that Treatment of organ-cultured human scalp HFs with high-dose PRL (400 ng/ml) results in a significant inhibition of hair shaft elongation and premature catagen development, along with reduced proliferation and increased apoptosis of hair bulb keratinocytes. Human scalp hair follicles are both a target and a source of prolactin, which serves as an autocrine and/or paracrine promoter of apoptosis-driven hair follicle regression.

Conditions associated with elevated prolactin secretion

 

Hyperprolactinaemia is the term given to having too-high levels of prolactin in the blood, which can result from:

• Prolactinoma
• Excess thyrotropin-releasing hormone (TRH), usually in primary hypothyroidism stimulates prolactin secretion
• Many antipsychotic  Anti depressant medications
• Increased Emotional stress
• Pregnancy and lactation- Oxytocin sectreion by nipple stimulation releases Prolactin. Estrogens provide a well-studied positive control over prolactin synthesis and secretion, and increasing blood concentrations of estrogen during late pregnancy appear responsible for the elevated levels of prolactin that are necessary to prepare the mammary gland for lactation at the end of gestation.
• Some sexual disorders
• PCOS ( POLY CYSTIC OVARIAN SYNDROME)
• It has also been shown that prolactin levels after sex are 4x higher than prolactin levels after masturbation but these hormonal changes are very short term and does not affect hair loss
• daylight exposure significantly alters prolactin levels. This temporary increase in the number of telogen hair follicles
•  

Dopamine released by Hypothelamus in turn inhibits Prolactin.

Treatment:

In one of the studies at Argentina Prolactin Inhibitor like Bromocriptine (dopamine receptor agonists), Quinagolide, Pergolide, Cabergolide have been shown to help those with Hyperprolactinemia and have not been benefited otherwise.

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Tonsure or head shave does it help hair growth?

Well there is religious reasons why many people tonsure there head ( in Hindus at times it a sacrifice of symbol of aeasthetics esp. in females). But it is a common belief esp. in some parts of India that if you are losing hair and have thin baby hairs and if you repeatedly shave your head you may grow new hairs or better hairs.
Well shaving or tonsure is only external to skin and does not directly affect the roots which are responsible for the hair growth. The hairs outside the skin does not get the blood supply or nutrition and does not even have any repair capacity and may even be affected by environment.
By removing the outside hairs you are not actually stimulating hair follicle to grow hair. As in case after of shaving of the beard hair the initial stubble feels thorny strong and sharp the initial hair growth after shaving of the head feels thorny sharp and that has perhaps given this belief. But within few days again when the hairs grow little longer that feeling disappears.

Perhaps the benefit of shaving head is the ease of using or applying Minoxidil. Other thing is the illusion of less hair fall because the small hair are not visible when they fall but the long hairs are apparently visible. So person with shaved head or short hair may be psychologically benefited.

In some religion young babies are tonsured with the belief that it will grow new or better hairs. This is not true. In many religions they do not tonsure/shave off their child's hair. At 1 year, the babies usually get mature hair with baby hair falling off. On the other hand, it is know of kids who still have baby hair even after a few tonsures. Shaving does not help hair growth is controlled by genes and hormones.

Trichophytic Closure

In the Strip Surgery (FUT /FUSS) after removal of the hair bearing strip of skin from the back side the gap is closed by stitches or by staplers. Well the suture mark or linear scar due to this remains permanently in the donor area and very often remains visible if the hairs are kept short or the scar becomes wide.

 


This linear scar does not grow the hair and therefore the scar visibility of this hair less line is more with wet hair, oiled hair or short hair. Trichophytic closure is a special technique of closure of the gap. The advantage of this closure is the linear scar of stitches will grow the hairs though it and therefore the line has a better concealing capacity even when hairs are short or wet. This is because the technique brings the hair roots ( Follicular Units) under the stitch line; as a result the hairs grow through the linear mark.If done properly, and the outcome successful, the hair growing through the scar will camouflage the typical straight linear appearance of the scar. What this means is that the scar will still be present but less visible. The quality of the scar may also improve with this closer.Generally, after the fourth post-operative month, trichophytic closure yielded better cosmetic results than subcutaneous closure.

There are 4 methods which involves trimming off the upper edge of the incision and then closing the wound in such a way the hair near the edge can grow through the scar. The skin is de epithelized to less than 0.5 mm so as not to damage the sebaceous glands and stem cells close to bulge and remove the burial of epithelium ( Best executed by Dae-young Kim technique)  1. Upper edge  (Marzola) 2. Lower Edge ( Fretchet) 3. Lower edge ledge ( step) shaped trimming ( Paul Rose) 4.  Both upper and lower edge trimmimng (Kazuhito Yamamoto)

Well some times because of partially cut Follicular Units at the edge of the wound cyst formation may be a problem in this closure. If due to fibrous skin or tension on the wound the scar line become wide the Trichophytic closure becomes ineffective in its purpose.when the hair is growing through the scar during the healing phase, there may be more inflammation and discomfort, ingrown hair, itching, scabs, numbness, pain, peri-lesional redness and edema as compared to the standard closure.It is a good policy to prefer not to use a trichophytic closure when it is anticipated that you will need several strips harvested over the long term, preferring to use the trichophytic closure on the “final” procedure.
 




It is not likely that the person will be able to shave their head without any apparent difference between the strip site and the non-scarred skin in the area. The reason for this is that the scar tissue is still somewhat different in appearance from non-scarred skin and there is a subtle but definite change in the direction the hair that grows through the scar making the scar line stand out from the surrounding scalp.It becomes very difficult sometimes to use this technique when the pt. has had previous work and we are struggling to obtain enough grafts and still be able to close the incision without excessive tension. Since you have to overlap the incision by 1-2 rows of follicles, there has to be enough elasticity to safely close the incision. If there isn't, the patient must decide what is more important too him, more grafts or a trichophytic closure. the trichophytic closure transects hair follicles this results in no better than a 60% survival rate in the donor area scar. It kills hair. It has been also claimed that the trichophytic closure is a sales tool for strip surgery for those who do not want to offer FUE.

AHRS meet at Mt. Abu ON 11TH SEPTEMBER

At the 2nd Annual scientific meet of Association Hair Restoration Surgeons (AHRS) of at Mt. Abu ON 11TH SEPTEMBER DR. Mahadevia presented his 2 PAPERS 1. various techniques and instrumentation of FUE ( FOLLICULAR UNIT EXTRACTION) and 2. Can FUE megasession replace Strip method in Future? Both papers were highly appreciated by eminent faculties from India and Abroad and Dr.Mahadevia was personally congratulated by many about the high quality of the papers. The PowerPoint presentations can be viewed here

Dilemma fue

View more presentations from DrBishanMahadevia.

Fue megasession

Video of FUE on Unshaven Head by Dr. Mahadevia

8 new genes found associated with Alopecia areata

According to the study published in the July issue of Nature  the  professor of dermatology and genetics at Columbia, Angela Christiano et al have found  a connection between the gene called ULBP3 on Chromosome 3 and the Alopecia Areata recently. This gene is normally not found in the hair follicles but it was observed that ULBP3 proteins were found in high concentrations in hair follicles affected by alopecia areata. ULBP3 attracts immune cells (called cytotoxic cells, Natural  Killer or NK Cells) receptors called NKG2D . If an infection is present in the body, cytotoxic cells  can help fight the infection or destroy damaged cells, but if there is no infection or damage, these immune cells end up attacking healthy tissue. These genes ULBP3 are already associated with a number of autoimmune disorders, including type 1 Diabetes  & Rhematoid Arthritis.

Two other genes were also expressed in hair follicles, while the remaining five genes were involved in immune system response.

The researchers discovered that the number of alopecia-associated genes a person had correlated with the severity of the condition. Those who carried 16 or more genes (the genes are in pairs) were more likely to progress to alopecia universalis, or total hair loss.

In people with alopecia, immune system T cells are present in large numbers in the hair follicle. Microscopic look is like the hair follicle is being attacked by bees, which are the T cells. Among the eight genes, one in particular -- ULBP3 -- has been shown to attract toxic cells that can invade and destroy an organ. In a person without alopecia, ULBP3 is turned off. But in people with alopecia, ULBP3 proteins are plentiful in the follicle.

In people with alopecia areata, a huge expression of the ULBP3 gene in the outermost layer of the follicle is seen as per  Christiano. ULBP3 is a danger signal that signals to T cells to come in and attack the follicle. It's like putting nectar on the hair follicle, and then the 'bees' come in and do their damage.

When the follicle is attacked, the hair falls out. If the T cells remain, which they do in alopecia areata, the follicle goes dormant.

The mechanism of genes pathway in Alopecia areata has opened a new vista of developing the new drug for this disease that affects over 5 million people only in America  the disease is life-altering - sufferers, especially children, experience social stigma. It affects their quality of life and can lead to long-term psychosocial impact.

More over ULBP3 genes might work as a biomarker for Alopecia areata.