Doctors Share Hair Transplant & Hair Loss Information

What percentage of patients respond to PRP and Acell injections and what is the optimal concentration of platelets and Acell. I am currently 55 years old.

I think you have summed up the current state of PRP/Acell perfectly. I began using PRP at a roughly 5X concentration in 2010 after visiting Joe Greco, who was the first I know of to report on the benefits of injecting ³activated² PRP using his Harvest system. Prior to my endeavor to use PRP, Joe reported that PRP could increase hair diameter. Although I did not feel his study was scientifically sound, I could rationalize this because I have seen perturbation, which is really a turn on of the inflammatory process, increase hair diameter. Although diameter increase following the natural inflammatory process was rare, it seemed plausible that magnifying the inflammatory process by concentrating platelets could amplify the natural inflammatory process and thus result in greater hair diameter increase.

Joe told me that he was getting a positive response in 75% of his patients. I cannot say what percent we are seeing primarily because I do not see all my patients back within a year¹s time simply because most live out of state.

What I can say is that some report improvement and some do not. Results typically last about one year. No one knows if a repeat injection given annually will continue to promote improved coverage. Some come back annually. Some responders do not.

When Joe told me that he was using an extracellular matrix as a scaffold to improve the release of growth factors, I theorized that we could add Acell to the PRP. I began at low concentrations of 1mg/cc, but have since increased to about 5 mg/cc. I¹m not sure that it adds any benefit. It may. It may not. Based on what I was doing, others began using Acell with PRP. Some use much higher concentrations of Acell today.

In 2012 I began using the Angel system to make PRP primarily because I wanted a 6X concentration of PRP and I wanted a low white cell count. The white cells increase the risk of post surgery swelling. I also wanted a 1x concentration for a topical spray to promote healing and prevent infection due to the high white cell count in the 1x topical spray. Later I told Dr. Cooley about the Angel system and he adopted it.

I have some positive results by photograph and some more interesting positive responses using cross sectional trichometry, which is a measure of the surface area of 4 sq cm of hair. Carlos Puig is currently doing a study evaluating the response of females to PRP and ACell injections. So Šstay tuned for those results.

At your age of 55, a hair transplant is probably ok, but I never encourage anyone who is comfortable with nothing or with medical therapy to do a surgical procedure.

What I can tell you about PRP and Acell is that there is no formula that works in all patients. I tell patients who don¹t respond that there is no need to do a second treatment. When someone does respond, I tell that person it may be worthwhile to do another treatment. I believe that most who spin their own PRP inexpensively probably are making a 1x concentration that most likely has a very limited benefit. The cost of PRP is really due to the equipment you have to buy to spin the PRP.

I think you have hit the nail on the head. What we need is some controlled trials. I would love to see this happen in the next year. In the mean time, stay tuned and wait for more specific protocols.

My mother had esophageal band surgery a couple of years ago due to her excessive weight problem. Following this she has noted progressive hair loss and a change in her personality. I’ve read that band surgery and stomach stapling can cause hair loss. Is this true?

Bariatric (Weight Loss) Surgery: Metabolic, nutritional, psychological and physiological Consequences Bariatric or weight loss surgeries have become commonplace in the USA and in other countries, in part due to an ever increasing incidence of obesity in the context of a societal standard of beauty that emphasizes a thin, shapely physique. Lobbying by various organizations, as well as medical studies detailing the present and future consequences of untreated obesity, has led to insurance coverage for these surgeries, which were previously deemed “cosmetic”. This article will detail some of the physical and mental aspects of the often rapid weight loss which occurs after bariatric surgery.
The bariatric surgery community utilizes a number of procedures to promote rapid and hopefully permanent weight loss. Some of the earlier methods have been abandoned or modified due to unacceptable morbidity in the post-operative period, both immediate and long-term. Currently used techniques most often decrease absorption of calories or promote early satiety (feeling of fullness), or some combination of the two.

Unfortunately, the decreased absorption of calories is accompanied by decreased absorption of macro- and micro-nutrients. This often leads to nutritional deficiencies of varying degrees of severity. Sometimes these deficiencies may go undetected for some time, until they have had a profound effect on the patient. Many of these deficiencies can be very difficult to treat (refractory) once established. They may cause significant derangement in the patient’s physical, mental and emotional health.

Nutritional deficiencies associated with bariatric surgery:
Multiple vitamin deficiencies: D, A, B12, B1
Multiple mineral deficiencies: iron, magnesium, calcium, zinc
Macronutrient deficiencies: protein, fatty acid, caloric
The endocrine system may also be deranged; hyperparathyroidism may occur, secondary to vitamin deficiencies, and this condition may cause multiple physical and mental/emotional disorders. This may lead to new micro nutrient disorders, or exacerbate those which have already resulted form the surgery. All of these factors together may set the stage for multiple, interrelated metabolic conditions that may have an overwhelming effect on the patient after bariatric surgery.
In addition to the physiological issues detailed above, mental and emotional distress or overt illness may also occur subsequent to these procedures. This may range from mild depression to full-blown psychosis. The etiology of these symptoms is only partially clear. Some may be due to radical, sudden changes in body image. Others manifestations may be due to metabolic derangements such as magnesium deficiency, hyperparathyroidism, and/or various B vitamin deficiencies. Unfortunately, authorities say that the psychological effects of bariatric surgery have yet to be as fully elucidated at the physiological ones have been.
Another major issue in the post-operative period has to do with the cause of the obesity itself. It is widely believed that many overeaters use food for “self-soothing”, in other words, it calms their anxieties, cures boredom, temporarily alleviates depression (but worsens it in the long run), may act as a substitute for caring relationships and love interests, and generally supports the individual emotionally. When the ability to eat is radically curtailed, this whole quasi-“relationship” the person has with foods is interrupted, sometimes with disastrous consequences. This is one of the many reasons that bariatric surgeons must screen the population of patients so strictly, and this is also one of the reasons that psychotherapy before and after such procedures is seen as mandatory. It is of interest that current studies reveal a substantial percentage of these patients eventually regain much or all of the weight they initially lost, despite the “permanent” nature of the surgery.
Hair loss is another very common consequence of bariatric surgery, and of course can exacerbate the psychological problems the patient may develop. The germinal cells found in the bulb at the base of the hair follicle are among the most rapidly dividing cells in the body. This is one reason that hair is so sensitive to any stressors experienced by the human organism.
It is well known that people may experience an effluvium, or shedding, under the influence of myriad stressors. These can be physiological or psychological, and the hair loss may be permanent or temporary. Bariatric surgery may be an overwhelming stressor, and even in the most optimal cases, it is a major perturbation to the body as well as the mind.

The progression of male pattern baldness differs among men. Some men become concerned about recession which often begins at a very young age. Often times men keep their eye on this recession as their main concern only to later realize that their hair in the front and on top is beginning to miniaturize or become thinner. Other men don’t experience much thinning. Instead, they see progressive recession at their temples, leaving an island of hair with normal appearing density growing increasingly smaller over the years. Kind of like an island shrinking in rising waters. Our patient shown here does not appear to have experienced any classic recession at his temples but rather, universal thinning at his frontal area and crown. Our patient received 3709 grafts on November 12, 2012. Although it has only been 3 months, he has seen some growth at this early stage. Our patient’s donor and recipient areas were treated with ACell and platelet rich plasma (PRP). Needless to say, he is very happy with his result at this very early stage of growth. He is aware that he won’t see his final result for another 5-9 months, perhaps even a bit longer.

Click on thumbnail to enlarge

Update: 4 months update photo comparison with some great growth:

It is really unknown what causes shock loss.  Shock loss is hair loss resulting from a hair transplant procedure. There are many theories, however. Shock loss most likely is due to an inflammatory response as a result of physical trauma.  It is really quite uncommon in the donor area. It is more common in the recipient area. The density of incision sites may play a role as high density incision sites tend to produce shock loss more commonly. Shock loss will occur only in the area where the incisions are made. It will not occur in adjacent regions.

Shock loss begins about 2 to 3 weeks after a procedure and it will continue over a period of a few weeks. If you experience hair loss months after a procedure, it is not due to shock loss, but rather due to progression of hair loss or some other factor unrelated to the hair transplant procedure.

Some feel it is due to the injection of epinephrine, which is commonly added to the anesthetic. This is most likely untrue as you will not see shock loss in areas where anesthesia is given, but rather only in areas where the incision sites were made. You also more commonly see it in the recipient area while epinephrine is also given in the anesthetic given in the donor area during a hair transplant surgery. Even though the same anesthetic with epinephrine is given in the donor area, you do not see shock loss in the donor area when it occurs in the recipient area.

The inflammation might result from physical trauma, but it also might be due to the free radicals that accumulate in tissue that continues to metabolize outside the body in an anaerobic state. Free radical scavengers in the storage fluid along with cooling of the tissue outside the body might help reduce the amount of free radicals produced by the grafts. One might also limit the free radical load by limiting the recipient area density during a hair transplant.

Shock loss is uncommon in the donor area with both strip harvesting and with FUE or CIT.

When shock loss occurs, the hair will generally begin to grow back after a hiatus of 3 months. It is only the fine wispy baby like hair that seems most prone to remain dormant following shock loss. This sort of baby fine, short, lightly pigmented hair produces the least amount of coverage, however, so it will not be missed as coarser, darker, longer terminal hairs will take their place when the hair transplantation produces new hair growth beginning three months after the hair transplant.

I am female and have a lot fallen hair during 5 mounts last 2 years I had same problem but I had mesotrophy my hair and it was effective for me. I would like to know prp is working for growing the new hair or not because my husband done prp 8 mount ago but nothing is change and he didn’t get back any result from it please consulting me.

PRP and Acell can improve hair diameter and coverage in up to 70% of individuals who are suffering from miniaturizing hair loss. PRP and Acell also seem to work in some patients with alopecia areata. PRP and Acell do improve hair quality in all individuals. PRP must be activated so that the platelets release their growth factors, however. Some physicians inject the PRP, but never activate the platelets. Platelet activation is an important aspect of of the PRP treatment. Without platelet activation, you should not expect any benefit from the PRP. Of course with platelet activation, the PRP seems to improve coverage in only 70% of the patients who receive the treatment.