For a long time now HT surgeons in the US have been offering what I call “subjective” evidence of how well their procedures work – from actual grafts and FUE to newer treatments like PRP, ACell and “ADSC” injections.
For instance, they say things like this:
“Patient feels his hair is fuller and thicker”
“Patient is much more satisfied with the way he looks”
“Patient feels more confident”
“Patient’s hair looks thicker and hairline looks natural”
Hair density is increased
Notice that ALL of those kinds of statements are based on visual observation and the opinion of the observer, or else they are hearsay (second-hand) statements.
Or, these HT surgeons will show before-after photos taken from a moderate distance, that only give the viewer a rough idea of how well the procedure worked. These “distance” (or whole head) photos are even more common when a HT doctor is trying to sell people on a new treatment, like PRP. The idea is always to give a “big picture” idea of how well the treatment works. But reports with serious details and specifics – such as actual before and after HAIR COUNTS in a pre-measured area – are never provided.
I think this old marketing tactic the HT industry uses of appealing to broad emotions and desires with vague and subjective indicators, but not providing hard, quantifiable evidence (such as hair counts) has got to be changed.
If these doctors want us to believe these new treatments REALLY work then I am afraid we are now going to have to demand detailed close-up photographs and precisely-measured hair counts – or these doctors should not expect us to believe them at all!
Hi Forhair, thanks for the link but the pictures are really far from any hard evidences.
My apologies if I may sound blunt but in my view , after so many hair regeneration statements made in the past 3-4 years from your clinic I would have expected you would have plenty of before/after photo made at macro levels and with marks (obviously showing also the recipient site).
At this stage I am really wondering what methodology you are using in evaluating such hair regeneration and if you can share with us.
Hopefully , you do not get me wrong because I do really appreciate Dr Cole effort in pushing/testing new protocols but at some point you also have to back up your claims otherwise people will lose the trust in whatever you are saying.
Thanks and Best Regards
I’ve been saying that we are getting follicle regeneration for more than 3 or 4 years using an extracellular matrix in a viscous hyaluronic gel (Agel). The initial study was designed to look at FUE extraction sites. When we did not use the Agel, we found 1% more extraction sites than we recorded. When we used the Agel, we could not locate 49% of the extraction sites. We could not locate these sites often due to improved healing without hypopigmentation. To confirm this, I performed a study where I removed 12 grafts from an isolated area. I found at least one hair regrowing in 5 of the extraction sites. In this study, I covered the extraction sites to prevent the gel from oozing out. Still, some did ooze out. My best guess is that we get at least 1 hair in just over 30% of the extraction sites when we follow a minimum depth approach. When we use a deeper approach, we remove stem cells from the CK15 positive population. The CK15 positive cells generally exist between 0.8 and 1.6 mm deep.
What I am doing to get follicle stem cells is to remove follicles and mechanically separate the cells. Alternatively, we could do this enzymatically. My goal is to obtain 50-micrometer diameter particles, through mechanical separation. These particles are full of stem cells. I then do two things with these follicle stem cells. I add them to my mixture of platelet lysate, which I call cytokine-rich plasma, and I add them to my Agel. Incidentally, I also prefer to obtain some adipose cells with the follicles I remove from the donor area. I do not place any hope for Kerastem. The injection plane is too deep and these adipose cells are too far withdrawn from the scalp hair or hair in general to make a difference. However, there is hope for micro fat transfer where we harvest adipose from the area of the hair follicles. We plan to offer this later in the year.
Last week, we began adding microparticles to our platelet lysate and we will soon add them to the follicle stem cells because microparticles have been shown to help in the culture of follicle stem cells. The goal with the microparticles in platelet lysate, which is pure growth factors, chemokines, and cytokines, is to get a sustained release of these growth factors in addition to the initial burst. The platelet lysate has 5 to 8 times the concentration of specific growth factors. We found that these elevated levels of growth factors initiated early regrowth of grafts with up to 99% in the growing phase at 4.5 months and 80% at 3.5 months. We want to determine the advantages of not only an initial burst but also a sustained release.
The caption says “2 months results following injection of follicle stem cell”, does it mean this is a pure stem cell treatment and none of PRP or Acell was involved ?
Is this is an alopecia areata patient?
No pre-shaving of the area that was treated with stem cell injection?
1 - No grafts. Only follicle stem cells.
2 - It probably is alopecia areata.
3 - Follicle stem cells comes from the patient’s donor area.
4 - We remove the follicles to make the stem cells. i guess it can be shaven or non-shaven.
I don’t see any reason why it will not work on diffuse hair loss
1 - No grafts. Only follicle stem cells.
2 - It probably is alopecia areata.
3 - Follicle stem cells comes from the patient’s donor area.
4 - We remove the follicles to make the stem cells. i guess it can be shaven or non-shaven.
I don’t see any reason why it will not work on diffuse hair loss
My response:
If the 2-month before-and-after photos represent a female alopecia areata patient then the results do not apply to AGA patients.
What becomes of the follicles that are removed to make the stem cells?
And how many follicles are removed to make the stem cells?
Are these follicle stem cells being implanted into the donor area or the recipient area or both?
Good questions, and also what exactly is the process you’re using to “make” the stem cells? (I assume they mean “extract” stem cells, but how do they confirm that what they’re extracting are actually stem cells?)
I’m trying to figure out exactly what Dr. Cole is doing with these follicle stem cells.
I’m even trying to figure out exactly what follicle stem cells are. I’ve never heard any other researcher talk about follicle stem cells before. I hear them talk about ADSCs, DP cells, and sheath cells, but not follicle stem cells so I need some basic information about what cells Dr. Cole is using and exactly what Dr. Cole is doing.
Also, if it takes one follicle to get enough follicle stem cells to grow one hair then the treatment would be pointless. So he must do some culturing. And if he does mass pass culture he could bump up against the hair inductivity problem? Mass pass culture of hair cells thus far has resulted in loss of hair inductivity.
I think what Hairsite meant was whether the patient in the pic had his head shaved before stem cell injection , is the regrowth purely due to stem cell injection or just his own hair growing back after being shaved.
Dr. Gho talked about follicle stem cells. That was how his “HST” (for “hairfollicle stem cell transplant”) procedure was supposed to work. Basically he extracted hair follicles from the donor area and bisected them longitudinally, supposedly leaving stem cells on either half. Theoretically then either side of the follicle would give rise to a complete follicle, with zero loss. He referred to this as a “stem cell transplant” because you are moving stem cells from one part of the scalp to another. The description of the procedure is still on Dr. Gho’s website -
It looks like Dr. Cole is claiming to do something like the same thing. But my question for Dr. Cole is, how is he certain that he’s isolating stem cells? To me, just bisecting the follicles isn’t good enough to know for certain that you have a pool of stem cells on each half. Does he verify this by actually viewing the stem cells under a microscope? (highly doubtful). Does he verify it with some kind of chemical marker specific to HF stem cells? In my view if he (or Dr. Gho) can’t verify this with 90% accuracy, then the whole thing is just guesswork.
Why? Because of the anatomy of the hair follicle. The “bulge”, where the HF stem cells sit, does not wrap around the follicle shaft 360 degrees, but only sits on one side of the shaft. It takes up maybe (rough guess) 60 degrees of the 360 degrees of the shaft’s circumference. When the longitudinal bisection is made, how are they certain certain thry’re getting sufficient stem cells in either half? (Dr. Cole’s procedure might be a bit different than Dr. Gho’s, where he’s removing an unspecified part of the follicle – I think – and creating some kind of mixture which is “rich” in stem cells. But how does he know this?)
To me, you either have to be able to confirm that stem cells are present microscopically (which I sincerely doubt they’re able to do with each extraction), or chemically with a marker (also HIGHLY doubtful). In my view there is no other way of confirming this for the patient. Since it’s based on something like guesswork, grossly there will be a lot of mistakes and most of the time, only 1 half of the bisected follicle will actually contain HF stem cells. Therefore practical usefulness of this procedure will be MUCH less than optimum. Thanks to chance (where the bulge itself is actually bisected along with the entire follicle), it will work a certain percentage of the time, but it’s doubtful it will actually work the majority of the time.
Dear Dr Cole, I am in the process of setting up my research on Bone Marrow Derived Apheresis Stem Cells for Scalp treatment … and I came up with the same idea as you to use autologous hair follicle derived stem cells, in order to induce trichogenicity in the harvested stem cells! … Nowadays just waiting for cryofreezer, for temporarily storing the stem cells, for repeat sessions! … let’s see how it goes! I am based in Islamabad, Pakistan! Recently came back from Dubai! … HairSite said you are looking for other doctors/ Centre’s to join your research … May be we can join hands? Regards, Dr M Nadeem Umar, FCPS Surgery, Hair Restoration and Cosmetic Surgeon, Islamabad, Pakistan ( www.drnadeemumar.com )
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… Nowadays just waiting for cryofreezer, for temporarily storing the stem cells, for repeat sessions! … let’s see how it goes! I am based in Islamabad, Pakistan! Recently came back from Dubai! … HairSite said you are looking for other doctors/ Centre’s to join your research … May be we can join hands? Regards, Dr M Nadeem Umar, FCPS Surgery, Hair Restoration and Cosmetic Surgeon, Islamabad, Pakistan (