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Hair Restoration Research

Study Confirms Importance of Dermal Sheath Stem Cells in Hair Growth Cycle

New research published in the journal Developmental Cell has confirmed the importance of dermal sheath stem cells in maintaining the hair growth cycle. ((Rahmani W, et al. Hair Follicle Dermal Stem Cells Regenerate the Dermal Sheath, Repopulate the Dermal Papilla, and Modulate Hair Type. Dev Cell. 2014 Dec 8;31(5):543-58.)) These cells, located around the lower portion of growing follicles, form the basis of an experimental treatment, being developed by Replicel Life Sciences, Inc., to regenerate hair-producing follicles. If successful, the treatment will be a game-changer for the hair restoration industry.

Colony of self-renewing dermal sheath cellsColony of self-renewing dermal sheath cells

The study, published in December 2014, sought to confirm what had been indirect evidence of a type of stem cell residing in the dermal sheath (DS) that was said to replenish dermal papilla (DP) cells. The authors of the study suggest that they now have definitive evidence that new DP cells are derived from stem cells in the dermal sheath “cup” (DSC). This development clarifies the relationship between the DS and the DP and confirms that DSC cells play a critical role in hair follicle regeneration by repopulating the dermal papilla cells at the end of the telogen (resting) phase of the normal hair cycle.

Importance of the Dermal Sheath Cup Cells

The number of dermal papilla (DP) cells in a hair follicle has been found to be a determining factor as to when the anagen (growth) phase of the hair cycle is initiated. ((Chi W, Wu E, Morgan BA, et al. (2013). Dermal papilla cell number specifies hair size, shape and cycling and its reduction causes follicular decline. Development 140, 1676–1683.)) The gradual loss of DP cells over time results in a longer delay in the onset of the anagen phase; a longer telogen (resting) phase; and a hair follicle that shrivels and eventually disappears. This process, called miniaturization, plays out over multiple hair cycles and has been shown to be the primary contributor to androgenetic alopecia and eventual baldness. ((Randall VA. (2008). Androgens and hair growth. Dermatol. Ther. 21, 314–328.))

While dermal sheath cup (DSC) stem cells are known to be long-lived and self-renewing, it is not fully understood how they replicate or why the pool of DSC cells becomes depleted over time. We do know, however, that the gradual loss of DSC cells results in a failure to produce the necessary number of DP cells. And without enough DP cells to trigger the anagen phase, the follicle begins to miniaturize. It is clear that maintaining the population of DSC cells after each iteration of the hair cycle is very important in preserving and maintaining healthy and mature terminal hairs.

Replicel Reacts to the Study

The new data confirming the importance of the dermal sheath cup (DSC) cells was celebrated by researchers and executives at Replicel Life Sciences, Inc., who have been studying this issue for over a decade. Replicel is set to start phase II clinical trials of RCH-01, their proprietary treatment for androgenetic alopecia.

In the RCH-01 treatment, cloned DSC cells are injected into balding areas of the scalp where they are expected to reverse miniaturization and regenerate healthy, hair-producing follicles. Phase I trials of RCH-01, the results of which were published in 2012, showed that the treatment could produce promising results and that it was safe to administer. Six months after patients were treated with RCH-01, overall hair density increased by an average of 11.8% in ten patients out of 16. In two patients, overall hair density increased by more than 19%. There were no significant adverse safety events recorded. ((Lortkipanidze, N. Safety and Efficacy Study of Human Autologous Hair Follicle Cells to Treat Androgenetic Alopecia. In Clinicaltrials.gov. Retrieved July 26, 2012.)) Phase II clinical trials are set to begin in 2015, with data collection continuing for 39 months.

Through a 2013 agreement with Replicel, Japanese cosmetics giant Shiseido may introduce RCH-01 into the Asian market as early as 2018.

Image c/o Developmental Cell 31, 543–558, December 8, 2014 ª2014 Elsevier Inc.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

New Research Identifies Hair Follicle Dermal Stem Cells as Playing a Role in Hair Growth

Scientists have known that dermal papilla (DP) cells trigger hair follicle regeneration, a mechanism that protects hair follicles against injury, disease and aging. They have also known that hair loss is associated with the gradual depletion and atrophy of DP cells. But what they did not know is how DP cells were maintained inside healthy hair follicles.

New research has shown that the hair follicle dermal stem cell plays a direct role in maintaining these hair growth inducing DP cells. ((Rahmani W., Abbasi S., Hagner A., Raharjo E., Kumar R., Hotta A., Magness S., Metzger D., Biernaskie J. (2014), Hair follicle dermal stem cells regenerate the dermal sheath, repopulate the dermal papilla, and modulate hair type. Dev Cell, Dec 8;31(50:543-58). ))

This discovery sets the stage for the development of new drugs designed to target these dermal stem cells in order to “replenish or rejuvenate the DP cells that are responsible for inducing hair growth,” says Jeff Biernaskie, PhD, one of the researchers.

Such drugs could be useful for repairing hair follicles damaged by disease or injury, or by medical treatments, specifically chemotherapy and/or radiation therapy. The development of such drugs, however, could be at least a decade or more out.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Caffeine Reverses Androgenetic Alopecia, Promotes Hair Growth in Cell-Cultured Hair Follicles

Androgenetic Alopecia and Limited Medicated Treatment Options

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Over half of all men by the age of 50, and the same proportion of women by the age of 80, will experience some degree of permanent hair loss due to AGA.

Much is known about how AGA causes hair loss. Normally, hair follicles repeatedly cycle through growth (anagen) and rest (telogen) stages, but in individuals with AGA, hair follicles in genetically predetermined areas of the scalp gradually spend more and more time in the resting stage. Additionally, each growth stage produces a smaller and smaller hair shaft caused by a progressive miniaturization of the hair follicle. Eventually, the follicle stops producing hair ((Alonso L and Fuchs E. “The Hair Cycle,” February 1, 2006 J Cell Sci 119, 391-393.)).

Hair loss caused by AGA can be stopped by existing medications, but to date, only two FDA-approved drugs are available for treatment of AGA: finasteride (Proscar ®) and topical minoxidil (Rogaine®). Unfortunately, up to 3 out of 10 individuals will not respond to one or more of these drugs ((Fischer TW, Hipler UC, Elsner P. “Effect of Caffeine and Testosterone on the Proliferation of Human Hair Follicles in vitro.” Int J Dermatol 2007; 46: 27-35.)). Because of this, researchers have searched for alternate treatments, especially for women since finasteride is not approved for use in female patients.

Caffeine: A Possible Alternative Treatment?

One possible alternative substance is caffeine. This is because as a phosphodiesterase-inhibitor, caffeine increases cellular metabolic activity ((Green H. “Cyclic AMP in relation to proliferation of the epidermal cell: a new view.” Cell 1978;15: 801-11.)). Researchers theorize that this could counteract the miniaturization of the hair follicle ((Fischer TW, Hipler UC, Elsner P. “Effect of Caffeine and Testosterone on the Proliferation of Human Hair Follicles in vitro.” Int J Dermatol 2007; 46: 27-35.)).

Indeed, using cell-cultured (i.e., in vitro or “test tube”) male human hair follicles, researchers have demonstrated that caffeine reverses testosterone’s inhibitory effect on keratinocyte proliferation, which could lead to increased hair shaft cell production. Researchers have also demonstrated that caffeine normalizes testosterone’s inhibition of hair shaft elongation ((Fischer TW, Hipler UC, Elsner P. “Effect of Caffeine and Testosterone on the Proliferation of Human Hair Follicles in vitro.” Int J Dermatol 2007; 46: 27-35.)).

Evidence that Caffeine can Stimulate Hair Follicle Growth in Cell-Cultures and Protect those Hair Follicles from the Effects of AGA

A 2014 paper in the British Journal of Dermatology ((Fischer TW, Herczeg-Lisztes E, Funk W, Zillikens D, Bíró T, Paus R. “Differential effects of caffeine on hair shaft elongation, matrix and outer root sheath keratinocyte proliferation, and TGF-β2-/IGF-1-mediated regulation of hair cycle in male and female human hair follicles in vitro.” Br J Dermatol. 2014 May 16)). reported that caffeine stimulated hair growth in cell-cultured follicles in three ways:

  1. It enhanced hair shaft elongation in both male and female cell-cultured follicles.
  2. It increased the number of hair matrix keratinocytes, i.e., cells that create the hair shaft and its surrounding protective structure (the inner and outer root sheath), in both male and female cell-cultured hair follicles.
  3. It increased the stimulation of a hair growth factor called IGF-1 in both male and female cell-cultured hair follicles.

The paper also reported that caffeine may protect cell-cultured hair follicles against the effects of AGA in two ways:

  1. It reversed testosterone’s suppressive effects on the anagen (growth) stage of both male and female cell-cultured hair follicles, one of the primary mechanisms of hair loss in AGA.
  2. It protected both male and female cell-cultured hair follicle against apoptosis, a process that leads to the end of the anagen (growth) stage of hair follicles. This is significant because premature exit from anagen is another mechanism of hair loss in AGA.

In sum, this 2014 research not only replicates a past finding that caffeine counteracts some of the hair growth suppression mechanisms of AGA but also, for the first time, shows that caffeine stimulates hair growth in both male and female cell-cultured hair follicles. Its beneficial effects have yet to be shown in humans.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Lichen planopilaris?

Q: What is Lichen planopilaris? — G.S., Pleasantville, NY

A: Lichen planopilaris (LPP) is a distinct variant of cicatricial (scarring) alopecia, a group of uncommon disorders which destroy the hair follicles and replace them with scar tissue. LPP is considered to have an autoimmune cause. In this condition, the body’s immune system attacks the hair follicles causing scarring and permanent hair loss. Clinically, LPP is characterized by the increased spacing of full thickness terminal hairs (due to follicular destruction) with associated redness around the follicles, scaling and areas of scarred scalp. In contrast, in androgenetic alopecia (AGA) or common baldness, one sees smaller, finer hairs (miniaturization) and non-inflamed, non-scarred scalp. Complicating the picture is that LPP and AGA can occur at the same time – particularly since the latter condition (common baldness) is so prevalent in the population (see photo). And LPP can involve the frontal area of the scalp, mimicking the pattern of common genetic hair loss. Interestingly, the condition is more common in women than in men.

For those considering a hair transplant, ruling out a diagnosis of LPP is particularly important as transplanted hair will often be rejected in patients with LPP. In common baldness, the disease resides in the follicles (i.e., a genetic sensitivity of the follicles to DHT). Since the donor hair follicles remain healthy, even when transplanted to a new location, we call common baldness donor dominant. It is the reason why hair transplantation works in persons with common baldness. In contrast, LPP is a recipient dominant condition. This means that the problem is in the recipient area skin, so if healthy hair is transplanted into an area affected by LPP the hair may be lost.

Because it is so important to rule out suspected LPP when considering a hair transplant and because it is often hard to make a definitive diagnosis on the physical exam alone, a scalp biopsy is often recommended when the diagnosis of LPP is being considered by your doctor. A scalp biopsy is a simple five minute office procedure, performed under local anesthesia. Generally one suture is used for the biopsy site and it heals with a barely detectable mark. It takes about a week to get the results. The biopsy can usually give the doctor a definitive answer on the presence or absence of LPP and guide further therapy. If the biopsy is negative, a hair transplant may be considered. If the biopsy shows lichen planopilaris, then medical therapy would be indicated.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Japanese Researchers Bioengineer Hair Follicles from Stem Cells, Dermal Papillae

Japanese Researchers Bioengineer Hair Follicles from Stem Cells, Dermal PapillaeCredit: Tokyo University of Science

Japanese researchers have demonstrated that scientists can bioengineer viable, hair-producing follicles from epithelial stem cells and dermal papilla cells. Using these components, the team produced follicles that exhibit both the normal hair cycle and piloerection (the reflex contraction of a tiny muscle in the hair follicles which creates what is commonly referred to as “goose bumps”). The bioengineered follicles also developed the normal structures found within follicles and formed natural connections with skin tissues, muscle cells, and nerve cells.

The scientists used a breakthrough type of hair multiplication to achieve a functional bioengineered hair follicle. In hair multiplication, germinative cells are harvested non-surgically and then multiplied outside the body in a laboratory. These cells are then injected into the skin where they, ideally, grow into hair follicles. The Japanese research team takes this concept one step further by first combining the stem cells and dermal papillae in the laboratory to create a germ of the hair follicle. This germ is then implanted into the scalp where it grows into a viable hair follicle.

The study opens the door to treat common baldness (androgenetic alopecia) and a host of other medical conditions that can cause hair loss.

View the Hair Cloning section to read more on hair multiplication and hair cloning methods.

Reference:

Koh-ei Toyoshima, Kyosuke Asakawa, Naoko Ishibashi, Hiroshi Toki, Miho Ogawa, Tomoko Hasegawa, Tarou Irié, Tetsuhiko Tachikawa, Akio Sato, Akira Takeda, Takashi Tsuji. Fully functional hair follicle regeneration through the rearrangement of stem cells and their niches. Nature Communications, 2012; 3: 784 DOI: 10.1038/ncomms1784

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

RepliCel Hair Cloning Research Leads To Patents, Trials In Humans

RepliCel Life Sciences; a company based in Vancouver, Canada; is investigating hair cloning techniques in order to develop a treatment for androgenetic alopecia, or common genetic hair loss.

Research conducted by the company’s scientific founders and lead scientists, Drs. Kevin McElwee and Rolf Hoffmann, has shown that a certain type of cell, called a dermal sheath cup cell, is integral in initiating the growth of mature hair follicles. ((McElwee KJ, Kissling S, Wenzel E, Huth A, Hoffmann R (2003) Cultured peribulbar dermal sheath cells can induce hair follicle development and contribute to the dermal sheath and dermal papilla. J Invest Dermatol 121: 1267–1275.)) This mechanism of follicle growth, when coupled with previous research on dermal papillae cells, is key to our understanding of hair loss and is a potential avenue for developing a treatment that could reverse hair loss.

In their 2003 study, “Cultured Peribulbar Dermal Sheath Cells Can Induce Hair Follicle Development and Contribute to the Dermal Sheath and Dermal Papilla,” the scientists found that the dermal sheath cup cells are the “reservoir” of stem cells that control both the hair growth cycle of a follicle and formation of new hair follicles.

These breakthrough findings led to RepliCel’s seeking patents for their proprietary process of isolating and preparing dermal sheath cup cells for the treatment of hair loss. Patents have been issued in Europe and Australia, and are currently pending in the US, Canada, and Japan.

In 2012, RepliCel is studying the safety and efficacy of hair regeneration from autologous dermal sheath cup cells. In the study, cells will be harvested from patients, replicated in a laboratory, and then injected into a balding area to determine if the treatment will stimulate the growth of new hair follicles in what was a bald area.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Prostaglandin Discovery May Lead To Hair Loss Treatment For Men And Women

Miniaturized human hair follicle shows concentration of Prostaglandin D2 (in green). Credit: Garza and Cotsarelis/Penn Medicine)
Miniaturized human hair follicle shows concentration of Prostaglandin D2 (in green). Credit: Garza and Cotsarelis/Penn Medicine)

Researchers at the University of Pennsylvania, who were investigating the biological causes of androgenetic alopecia or common genetic hair loss, have discovered that levels of a certain inhibitor protein, called Prostaglandin D2 (PD2), are elevated in bald areas on the scalp. This discovery could be an important breakthrough in developing a medical hair loss treatment that regulates the production of the protein, or one that blocks it from attaching to its receptor protein.

Prostaglandins are a family of proteins that have a wide range of functions, including controlling cell growth and constricting and dilating muscle tissue. According to an article in ScienceDaily, the researchers had previously found evidence that something was inhibiting hair growth, but they did not expect to find prostaglandins involved in the miniaturization of hair follicles:

“Our findings were unexpected, as prostaglandins haven’t been thought about in relation to hair loss, yet it made sense that there was an inhibitor of hair growth, based on our earlier work looking at hair follicle stem cells,” said George Cotsarelis, MD, chair and professor of Dermatology, and senior author on the studies.

In men with androgenetic alopecia, Prostaglandin D2 was found to be three times higher in bald scalp tissue versus areas of the scalp with hair. Additionally, when hair follicles in a laboratory culture were treated with PD2, the hairs were significantly shorter than non-treated ones. A derivative of PD2, called 15-dPGJ2, was found to completely inhibit hair growth.

The receptor protein that is active with both prostaglandins, called GPR44, may hold the key to limiting the effects of PD2 and, therefore, in regulating hair loss in both men and women. While the study looked only at men, the GPR44 receptor protein exists in women as well. So, theoretically, a topical hair loss treatment may be developed that would prevent or limit thinning or hair loss in both sexes.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Does Hair Transplant Procedure Do To Existing Hair?

Q: What does the hair transplantation process do to your existing hair? — R.V., London, UK

A: When we perform hair transplant surgery, we transplant into an area that is either bald or has some existing hair. The hair that is existing is undergoing a process called miniaturization. What this means is that the hairs are continuing to decrease in size – both in diameter and in length. When we perform a hair transplant, we don’t transplant around the existing miniaturized hair on your scalp, we transplant through it. And the reason why we do that is because the miniaturized hair, the fine hair that is being affected by DHT, is eventually going to disappear, so you don’t want there to be any gaps.

So the question is, does the hair transplant actually destroy the existing hair? The answer is that it doesn’t destroy, but it can “shock” it. In other words, creating recipient sites (that the grafts are placed into) will temporarily alter the local circulation of the scalp and this can cause some of the hair in the area to be shed. The reason why hair may be shed is that hair is naturally cyclical. In other words, hair is normally growing, shedding, and then regrowing again. When you stress the scalp, the growing hair may be shed prematurely, but then it regrows.

If you think about the process of electrolysis, it makes sense that you don’t damage follicles from making recipient sites during a hair transplant procedure. In electrolysis used to treat unwanted hair, you stick a needle in the follicle, and you turn on an electric current. And you burn it. And then what happens to the hair? It usually comes back and you need to do it a few more times, even though we are applying an electric current via a needle placed directly in the follicle. So it makes sense that by just inserting a fine needle – the tool commonly used to make a hair transplant site – into the skin, one would not destroy hair follicles. However, the cumulative effect of making hundreds or thousands of recipient sites does shock the follicles and, as a result, some may shed their hair.

It can occur with general anesthesia – when the scalp is not even touched – and it can occur with oral medications, from pregnancy, or after psychological stress. So if you have hair restoration surgery and there is shedding, and it takes six months to a year for the transplanted hair to grow in, during this time hair transplant patient will experience some thinning. Since miniaturized hair is going to eventually disappear anyway, some of the miniaturized hair that is shed may not return. But if it is healthy hair, and it is shed, it will grow back. And, of course, the transplanted hair will be growing in as well during this time.

I am often asked to describe how much can be expected to be shed. The answer is that it is an amount that is often noticeable by the patient, but not noticeable by anyone else.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Fat Cell Discovery An “Important Step” In Understanding Hair Loss

In what might be another illuminating discovery on the inner-workings of hair growth, Yale University scientists have discovered that cells from the fat layer in the skin of mice contribute to the stimulation of hair follicles.

An article by ABC News quotes the lead researcher, Valerie Horsley, saying, “The fat cells are important for hair growth. If they’re not there, the hair won’t grow. We don’t know for sure if it’s a cure for baldness, but I’m hopeful that we can get human cells to do the same as the mice cells.”

Dr. Bernstein, who was interviewed for the article, called the findings, “an interesting development in understanding why millions of people go bald.”

“It’s an important step. Mice models are not necessarily applicable to humans, but this is how we start to make discoveries,” he said.

Bernstein noted that the study’s findings don’t [directly] address genetic hair loss, in which a hormone called DHT causes hair follicles to shrink.

Dr. Horsley suggested that the next round of research should focus on finding out what cells are being effected by the fat cells, and why. She said, ”It’s very exciting because we really knew nothing about the fat in the skin. I’m hoping we can extend the research.”

Read more about research into the causes and mechanisms around hair loss in posts assigned to the tag “Stem Cells.”

Read the original article at ABCNews.com

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is the Difference Between NeoGraft and ARTAS Robotic System for FUE Hair Transplant Surgery?

Q: What is the main difference between NeoGraft and the ARTAS™ robotic system? — H.T., Staten Island, NY

A: The Neograft device is basically a powered FUE tool. It is still done by hand and therefore risks operator induced errors and damage to hair follicles. The ARTAS System, made by Restoration Robotics, uses electronic image-based tracking capabilities to map the individual follicular units. It does so to determine the optimal approach for automated graft harvesting. The robotic harvesting device produces consistently high quality grafts and low dissection rates.

For more information on these systems, visit the Follicular Unit Extraction (FUE) section or read Dr. Bernstein’s answers to questions on Robotics.

Read about Robotic FUE Hair Transplantation

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Dandruff Or Nizoral Cause Hair Loss?

Q: Can dandruff cause hair loss? I have a lot of dandruff and use the Nizoral Shampoo for it. And can the Nizoral be a reason I am losing my hair? — K.P., Suffern, NY

A: Dandruff (the medical term is seborrhea) does not cause hair loss as it is a condition that involves scaling and redness on the surface of the scalp and does not involve the growth parts of the hair follicle that lie deeper in the skin. Although Nizoral is an ineffective treatment for hair loss (it is sometimes prescribed for this) it will not cause hair loss.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Nizoral An Effective Hair Loss Medication?

Q: I use Nizoral for my dandruff. Does it work for hair loss too? — M.D., Danbury, CT

A: The active ingredient in Nizoral is Ketoconazole. This medication, originally developed to treat fungus infections, has slight anti-androgen action. It is supposed to work in hair loss by inhibiting the action of DHT on hair follicles. Although, in theory, it should be useful for androgenetic hair loss, there have not been conclusive scientific studies to show that it works to treat balding when used as a topical application for balding.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Hair Loss Cure A Possible Result Of Stem Cell Communication Research

Following some new research on stem cells, and their relationship with androgenetic alopecia (genetic hair loss), an article on stem cells and the way they organize hair growth was published in the April 29th issue of the journal Science.

At issue is not the conversion of hair follicle stem cells into the progenitor cells that stimulate hair growth, as with the prior research, but the ways in which large numbers of stem cells coordinate the cycle of hair growth over thousands of hair follicles. How do all of those hair follicle stem cells know when to grow hair, and how do they know what their “neighbor” hair follicles are doing?

The researchers studied hair growth patterns in rabbits and mice and discovered that certain types of molecules, which were previously known to act as a signaling mechanism for stem cells in maintaining an individual hair follicle’s growth cycle, were also important in enabling large groups of stem cells to coordinate their activity.

The scientists found that hair stem cells coordinate their regeneration with each other with the aid of a pair of molecular activator WNT and inhibitor BMP. When WNT and BMP signals are used repetitively among a population of thousands of hair follicles across the entire skin surface, complex regenerative hair growth behavior emerges via the process of self-organization.

Perhaps more importantly, they found that the stem cell communication pathway present in rabbits and mice is far more robust than in men and women.

“When each human hair follicle wants to regenerate, it can only count on itself; it’s not getting help from other follicles,” Chuong said. “But when a rabbit hair follicle regenerates, it can count on two inputs: its own activation, and the activation signal from its neighbors. Rabbits have a very active hair growth, and that is essential for their survival in the wild.”

The article suggests that if there was a way to manage that process in humans, or “turn back on” the stem cell communication process in human hair follicles, then a treatment could be developed which would substantially increase the number of hair follicles that produce healthy hair.

Read a summary of this new research at ScienceDaily.com.

For more discussion on recent research, visit the Hair Cloning topic.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Progenitor Cells Could Play Key Role In Hair Loss Prevention, Cure

We recently discussed ground-breaking research that pointed to the important differences between stem cells and progenitor cells in the development of common baldness, or androgenetic alopecia (AGA).

In the March/April 2011 issue of Hair Transplant Forum International, we see a review of that research and another indication of the importance of this research in achieving the goal of being able to clone human hair.

It is now well established that, in each hair cycle, stem cells divide and generate progenitor cells, and that these progenitor cells stimulate the growth of the hair follicle. In conducting the experiment, the scientists’ original hypothesis was that the number of stem cells would be lower in scalp samples from bald areas than areas of scalp with hair. Surprisingly, they found that the stem cells were present in both samples. However, they found that the number of progenitor cells in the samples with hair was significantly higher in comparison to the bald samples. These findings suggest that it is not a reduced number of stem cells that leads to AGA, but the decreased conversion of stem cells into progenitor cells.

The research also suggests that the conversion of stem cells to progenitor cells may be the crucial mechanism that, when disrupted, leads to miniaturization of hair follicles, and common baldness. If there was a way to prevent the breakdown of stem cell conversion to progenitor cells, that could, in theory, stop the process of miniaturization and prevent androgenetic alopecia from occurring.

The study’s results and the review in the hair restoration journal indicate that, while a great deal of research must still be conducted, the scientific community is zeroing in on the cause of, and a potential cure for, genetic hair loss which has affected men and women for millennia.

For further reading on this exciting topic, here are some links:

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

CBS Program on Hair Transplantation, Hair Loss Features Interview With Dr. Bernstein

Dr. Bernstein on CBS - Eye on NY

Dr. Bernstein was interviewed by Dana Tyler, host of the television program “Eye on New York” on CBS, for the show that aired on April 17th. The wide-ranging interview was the feature in a 9-minute segment on hair transplantation and hair loss.

Below is a partial transcript from the interview.

Hair Loss – Men vs. Women:

DT: How big a problem is it, men versus women? We heard the statistics but is it worse for one group or the other?

RB: It seems to be worse in women emotionally. Statistically it’s obviously more common in men, but the pattern is very different. When men lose their hair they lose it mostly in the front. And they can start in two different patterns. One is in the temples and in the crown or it can just go front to back. That’s called patterned hair loss and it’s pretty obvious. Women have a more diffuse pattern so it would be many years before you even notice it.

DT: What about the influence we hear, if it’s your mother’s father or your mother’s grandfather was bald then therefore, men, you will be. Is there any truth to that?

RB: Like many myths there is a little bit to it. There is a slight predominance coming from the mother’s side of the family. There is something called an androgen receptor gene, that has been found on the X chromosome, which accounts for the slight difference between inheritance from the mother’s side versus the father’s side. But most of the genetics is on the regular chromosomes, called the autosomal chromosomes, which is the same from both sides. So you can get it from either your mother or your father or your uncles or grandparents.

Early Hair Loss:

DT: Age-wise. Are there certain times – I mean, we talked about earlier in the 30s, but some young men it happens earlier.

RB: It seems that when people start to lose their hair early, it has a tendency to be much more severe. So the people who start to thin around 16, 17 usually become very bald. Time is usually on your side if you have hair into your 30s and 40s, [it’s] more likely you’ll have a full head of hair.

Hair Loss in Women:

DT: Speaking about women and the reasons behind women’s hair loss. A little different than for men.

RB: It’s genetic, as with men for the most part, but there are two different systems. Where in men it’s related to androgens directly, which causes the front-to-back pattern, in women they have another enzyme pathway which kind of evens it out and keeps their hairline longer. Also, because women have a tendency to thin all over, their genetic hair loss can be mimicked by other things, such as diseases that cause hair shedding or thinning — so anemia, thyroid disease, medications such as birth control pills — all those things can also contribute to hair loss, and it seems that those factors are much more common in women than in men.

DT: And then in trying to determine if a woman is going through that, because there are more factors is it hard to figure out why there is the hair loss?

RB: It’s a little bit more difficult [in women]. The main thing that you do is to look at the hair diameters. In genetic hair loss the hairs have different diameters. In [conditions] like anemia, or where there is shedding on medication, the hair comes out at its root. Where people think of hair loss as losing hair, most of hair loss is thinning because the hairs are actually thinner in diameter.

Preventing Hair Loss:

DT: Preventing baldness… is there anything that can be done?

RB: There are… But it’s not what you think. It’s not hats and combs.

DT: Fertilizing your head. (laughs)

RB: There are two medications, main medicines. One is Propecia, or the generic term is called finasteride, and what that does is it blocks DHT. And DHT is what causes these hair follicles to gradually miniaturize, or get smaller, and disappear. And the other is Rogaine, which actually stimulates hair follicles directly. Unfortunately, Propecia can’t be used in women because it can cause birth defects during child bearing years and it can also stimulate breast tissue, but it is very effective in men.

DT: So what does a woman do?

RB: Well, Rogaine will help a little bit. Lasers can help a little bit, perhaps not as much as the initial studies have suggested. And then, once you’ve lost your hair, surgical options are available.

Hair Transplantation:

DT: Hair transplants. I know that’s a complicated procedure. And Dr. Max [Gomez] was talking about the art of it, too, when you’re finding someone. Tell me a little bit more…

RB: The main thing in hair transplants is really to determine who is a good candidate. And the interesting thing is that because of the pattern of [hair loss] in men, men usually have a very permanent area on the back and sides of the scalp. So when you move that to the front and top, it will continue to grow. Because women’s hair loss is more diffuse, the back and sides are not always stable. So, when you’re trying to decide if a woman is a good candidate, you have to make sure that the hair, where you get it from, is going to last their lifetime. And only a small percentage of women are really good candidates for that transplant.

The Future of Hair Restoration – Medications & Cloning:

DT: What about the future? Are you optimistic about new options on the horizon?

RB: First of all, new medications are coming out. Latisse is a medication that can grow eyelashes. And we’ve just started studying it in eyebrow hair, and it seems to grow eyebrows as well. There are studies to see if you can grow hair on the scalp. And it certainly will, it’s just whether it’s practical and how well it works. It probably will be of some benefit.

DT: There always is progress, right?

RB: Right. And then [there are] hair transplants where we can take individual follicles rather than having to take a long thin strip, although that still seems to give you the best volume. And then we’re trying to multiply hair. In other words, the limitation of transplants is always that we don’t have [as much] hair as we’d like. So we’re working on cloning. We’re working on multiplying hair that can actually be plucked from the scalp. So that [the original hair] will regenerate, and you then can get the plucked hair to grow into new hair follicles.

For more interviews with Dr. Bernstein, and other media appearances, visit our Bernstein Medical “In The News” section.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Press Release: Hair Transplant Pioneer Studies Hair Cloning, Hair Restoration Procedures Using ACell’s Extracellular Matrix

Robert M. Bernstein, M.D., F.A.A.D., Renowned Hair Transplant Surgeon and Founder of Bernstein Medical – Center for Hair Restoration in New York, is Studying Four Applications of ACell MatriStem™ Extracellular Matrix in a Type of Hair Cloning, Called Hair Multiplication, as well as in Current Hair Restoration Procedures.

New York, NY (PRWEB) March 15, 2011 – Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and founder of Bernstein Medical – Center for Hair Restoration, has been granted approval by the Western Institutional Review Board (WIRB) to study four different applications of the ACell MatriStem extracellular matrix (ECM) in hair restoration.

Hair Cloning with ACell MatriStemHair Cloningwith ACell MatriStem

Two of the studies include its use in a type of hair cloning, called hair multiplication, where plucked hairs and transected follicular units are induced to generate new hair-producing follicles. The other two areas of study include evaluating the use of the ECM in current hair transplant procedures to enhance hair growth and facilitate wound healing.

Approval by the WIRB allows the researchers to conduct double-blinded, bilateral controlled studies. Controlled studies are the best way to increase the objectivity of the research and insure the validity of the results.

“The medical research we are performing is important because it may lead to hair multiplication as a way to increase a person’s supply of donor hair. In this way, patients would no longer be limited in the amount of hair which can be used in a hair restoration procedure,” said Dr. Bernstein. “Additionally, in the near-term, the extracellular matrix may be able to improve the cosmetic benefit of current hair transplant procedures. We are simultaneously pushing the boundaries of hair cloning methods and follicular unit transplantation.”

Hair multiplication, a variation of what is popularly known as hair cloning, is a procedure where partial hair follicles are stimulated to form whole follicles. These parts can either be from hairs derived from plucking or from follicles which have been purposely cut into sections. Generally, damaged follicular units will stop growing hairs. However, there is anecdotal evidence that an extracellular matrix applied to partial follicles may stimulate whole follicles to grow and, when applied to wounds, may stimulate the body’s cells to heal the damaged tissue.

This new medical research also attempts to show that ACell can improve the healing of wounds created when follicular units are harvested for hair transplant surgery. Currently, in follicular unit hair transplant procedures, a linear scar results when a surgeon incises the patient’s scalp to harvest follicular units. Occasionally, this scar can be stretched, resulting in a less-than favorable cosmetic result. If ECM can induce the wound to heal more completely, the linear scar may be improved. The extracellular matrix may also benefit general hair growth in hair transplantation in that the sites where hair is transplanted, called recipient sites, can be primed with ECM to encourage healthy growth of the hair follicle.

Dr. Bernstein is known world-wide for pioneering the hair restoration procedures of follicular unit transplantation (FUT) and follicular unit extraction (FUE). Follicular units are the naturally-occurring groups of one to four hair follicles which make up scalp hair. These tiny structures are the components which are transplanted in follicular unit hair transplants.

While hair cloning has been of great interest to hair restoration physicians and sufferers of common genetic hair loss, the method by which this can be achieved has yet to be determined. The use of ACell’s extracellular matrix to generate follicles is a promising development in achieving this elusive goal. In addition to the longer term implications of using ECM in hair multiplication, its impact on hair restoration will be more immediate if it can be proven effective when used in current FUT procedures.

About Dr. Robert M. Bernstein:

Dr. Bernstein is a certified dermatologist and pioneer in the field of hair transplant surgery. His landmark medical publications have revolutionized hair transplantation and provide the foundation for techniques used by hair transplant surgeons across five continents. He is respected for his honest and ethical assessment of a patient’s treatment options, exceptional surgical skills, and keen aesthetic sense in hair transplantation. In addition to his many medical publications, Dr. Bernstein has appeared as a hair loss or hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio; and he has been interviewed for articles in GQ Magazine, Men’s Health, Vogue, the New York Times, and others.

About Bernstein Medical – Center for Hair Restoration:

Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow transplant surgery are performed using the follicular unit transplant (FUT) and follicular unit extraction (FUE) surgical hair restoration techniques.

Contact Bernstein Medical – Center for Hair Restoration:

If you are a journalist and would like to discuss this press release, please email us or call us today (212-826-2400) to schedule an appointment to speak with Dr. Bernstein.

View the press release at PRWeb.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Loss Articles Feature Dr. Schweiger

Dr. Eric S. Schweiger - Associate at Bernstein Medical - Center for Hair RestorationDr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and protecting a balding scalp from the sun.

“Coping with Chemo-Induced Hair Loss” was published in a recent issue of Energy Times, a publication focused on wellness and nutrition. Dr. Schweiger commented on the way hair follicles can react to chemotherapy treatment for cancer patients:

Expect changes like “chemo curl.” Eric Schweiger, MD, explains that chemo shocks rapidly dividing cells like hair follicles in the scalp, causing the hair loss. “When the follicles grow again, the shock sometimes changes how they grow, temporarily resulting in a different hair texture and color, which eventually normalizes,” explains Schweiger.

In the article, “Genetic Testing to Predict Hair Loss,” published on HairLoss.com, Dr. Schweiger and Dr. Bernstein discussed the efficacy of genetic tests for hair loss:

[Dr. Schweiger] explains, “I think the test has probably identified a predictor of hair loss but not the only predictor. There is science behind the test and some published research studies; however, the longitudinal, larger studies have not been done, because this testing procedure is just too new.” Dr. Robert Bernstein, M.D., director at Bernstein Medical Center, agrees and adds, “These tests focus on one particular dominant gene, but what is becoming apparent is that hair loss is a complex genetic condition most likely involving several different genes.” He further notes that age, stress, hormone levels, disease and many other factors also are at play in determining factors for hair loss. “Just because a person has the genes for baldness, it doesn’t mean the trait will manifest itself. The truth is the cause and effect have not been proven and differ from person to person, and the association is not anywhere near 100 percent.”

[…]

“Right now, we predict future hair loss based on follicle miniaturization, using advanced microscopic equipment,” says Dr. Schweiger, “and I advise a man to do this at around age 25. If someone presents with more than 25 percent miniaturization, then it’s time to start a hair loss prevention regimen.”

Lastly, Dr. Schweiger contributed featured commentary to an article on HairLoss.com on a topic of importance to those suffering from hair loss, namely, protecting your scalp from the dangerous radiation given off by the sun. In “When You Lose Your Hair, Protect Your Scalp,” Dr. Schweiger encourages bald or balding individuals to take important steps to protect their scalps:

…if you notice your hair thinning or you have baldness of any kind for any reason, it’s important to protect your scalp from sun damage, precancer and skin cancer,” says Dr. Eric Schweiger, M.D., a board-certified dermatologist and hair transplant surgeon at Bernstein Medical — Center for Hair Restoration in New York City. That’s because 100 percent of the surface area on top of your head directly faces the sun’s burning rays when the sun is strongest, between 10 a.m. and 2 p.m. “In general, a mild sunburn on your scalp won’t harm your hair follicles. But any exposure that causes blistering can cause scarring and pre-cancer cells, which will harm hair follicles permanently, so you need to take special care of your scalp when exposed to the sun, even for only a few minutes,” explains Schweiger.

Set up a hair loss consultation with one of our board certified physicians.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Research Points to Decreased “Progenitor” Stem Cells as Cause of Male Pattern Baldness

Research published in the January 2011 issue of the Journal of Clinical Investigation (Vol. 121, issue 1) reveals another breakthrough in the medical community’s understanding of the causes of — and possible cure for — androgenetic alopecia, or common male pattern baldness. The new research shows that the presence of a certain type of cell, called progenitor cells, is significantly reduced in men with common baldness compared to men who are not bald.

An article on AOL, which calls these “faulty” stem cells the root of hair loss in men, sheds light on the findings:

Using cell samples from men having hair transplants, a team led by University of Pennsylvania dermatologist Dr. George Cotsarelis compared follicles from portions of bald scalp to follicles from scalp areas with hair.

They learned that on the same person, the bald patches had an equal number of stem cells as the patches with hair. But they did find a difference: the areas of bald scalp had a significantly lower number of a more mature type of cell, called a progenitor cell.

That finding suggests that stem cells in parts of the head without hair have malfunctioned, losing their ability to convert into progenitor cells. ((AOL, “Scientists Trace Root of Male Hair Loss to Faulty Stem Cells,” January 5th 2011))

The study showed that, contrary to conventional wisdom, it is not the total “number” of stem cells that causes hair loss. In fact, the scientists’ original hypothesis was that, “the miniaturization of the hair follicle seen in [androgenetic alopecia] may result from loss of hair follicle stem cells.” That hypothesis turned out to be inaccurate. Instead, the authors of the study indicate that the findings:

…Support the notion that a defect in conversion of hair follicle stem cells to progenitor cells plays a role in the pathogenesis of [androgenetic alopecia]. ((J Clin Invest. doi:10.1172/JCI44478.))

The study’s results suggest that further research into the mechanism for the conversion of hair follicle stem cells to progenitor cells is warranted. If scientists can devise a way to correct that mechanism, then, in theory, stem cells in men who are predisposed to have androgenetic alopecia can be converted to progenitor cells at a normal rate. That correction would, in theory, eliminate that person’s susceptibility to the hair follicle miniaturization which causes hair loss, and would effectively cure his male pattern baldness.

Progenitor Cells vs. Stem Cells

Compared to stem cells, progenitor cells are further along in the process of differentiating into their target tissue, in this case mature hair follicles. Whereas stem cells are pluripotent, meaning that they can differentiate into a number of types of cells, progenitor cells are already committed to a specific cell line. Another important difference between stem cells and progenitor cells is that stem cells can replicate indefinitely, whereas progenitor cells can only divide a limited number of times.

For further reading on this stem cells and the causes of hair loss, here are some links:

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does Sebum Cause Hair Loss By Blocking Pores On Scalp?

Q: I have been on finasteride for about 7 months. After my latest haircut I can see that my scalp is shiny. I read that is from sebum buildup and it can cause a layer that clogs the growth of hair. I was wondering if this is true and, if so, how can it be treated? — T.C., Philadelphia, PA

A: It is not true. Hair loss is caused by the miniaturizing effects of DHT on the hair follicle, not by blocked pores.

For more on this topic, view our pages on the causes of hair loss in men or the causes of hair loss in women.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What are the Obstacles to Hair Cloning Using Plucked Hairs?

Q: What are the possible obstacles that you see with hair cloning using the plucking technique? — D.E., Boston, MA

A: Plucked hair does not contain that much epithelial tissue, so we do not yet know what the success of the procedure will be. Plucked hairs will most likely grow into individual hair follicles that are not follicular units and therefore, will not have completely the natural (full) look of two and three hair grafts. This limitation may be circumvented, however, by placing several hairs in one recipient site. It is possible that the sebaceous gland may not fully develop, so the cloned hair may not have the full luster of a transplanted hair.

The most important concern is that, since the follicle is made, in part, by recipient cells that may be androgen sensitive, the plucked hair derived follicles may not be permanent. It is possible, that since all the components of a normal hair may not be present, the cloned hair may only survive for one hair cycle.

Since the ACell extracellular matrix is derived from porcine (pig) tissue, the procedure may not be appropriate if you are Kosher or allergic to pork. Of course, we do not know what other obstacles may arise since this technique is so new –- or even if the ones mentioned above will really be obstacles at all -– only time will tell.

Follow the latest in Hair Cloning Research

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is ACell for Hair Cloning?

Q: I’ve read about some recent advances in hair cloning techniques with ACell. How does this work? — C.A., Stamford, CT

A: We, and several other groups, are engaged in studies using ACell MatriStem, a porcine extracellular matrix (ECM), to induce hair follicles to multiply in the patient’s own scalp (in vivo). This process differs from what people normally think of when speaking about cloning, namely producing populations of genetically identical cells, organs, or even individuals, in a test tube (in vitro).

In the current studies, a part of a hair follicle is implanted into the scalp in an extracellular matrix (ACell MatriStem), with the goal of inducing a complete follicle to form.

The concept is that if a small enough part of the donor follicle is removed, it will completely regenerate. Then, ACell MatriStem will induce the new hair fragment, implanted into the recipient site on the top of the scalp, to produce a new follicle –- thus we get two hairs from one. In one model being tested, hair is literally plucked from the scalp carrying with it enough genetic tissue to grow a new hair.

For more information, view our ACell page in the Hair Cloning section.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Am I Losing Hair Despite Taking Avodart For Hair Loss?

Q: I am currently taking Avodart and have done so for around 8 months. Last night I had a significant loss of hair after taking a shower, nothing like I have ever seen before and found it very distressing. Can you tell me if this is hair loss or could it be something known as shedding and could you please tell me what is the difference between hair loss and hair shedding? — M.S., New York, NY

A: Hair loss is a very general term that can refer loss of hair for any reason. Genetic hair loss is caused by the effects of DHT on hair follicles that result in miniaturization -– i.e. a slowly progressive change in hair diameter that starts with visible thinning and that may gradually end in complete baldness. Hair shedding is more sudden where hair falls out due to a rapid shift of hair from its growth phase into the resting phase. The medical term for this is telogen effluvium. This process is usually reversible when the offending problem is stopped. It can be due to stress, medication, or other issues. You should see a dermatologist to figure out which process is going on. Dutasteride can cause some shedding when it first starts to work, but it would be unusual to do this after being on treatment for eight months.

Read more about the Causes of Hair Loss in Men, view our Hair Loss Glossary, or read more about Avodart Hair Loss Medication.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Length Is Hair After Transplant?

Q: Is transplanted hair the same length as existing hair? — G.E., Buckinghamshire, UK

A: The hair is first clipped to about 1-mm before it is transplanted. The transplanted hair will look like stubble for the first few weeks after the hair restoration procedure. It is then shed and the newly transplanted follicles go into a resting phase for about two months.

At about 10 weeks after the hair transplant, the follicles will gradually start to produce new hair. They start out as fine hair and then gradually increase in thickness and in length. The process takes about 6 months, with full growth about one year after the hair restoration procedure.

For a more detailed overview of what to watch for in the days, weeks, and months after a hair transplant, view our After Hair Transplant Surgery page.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Cutting Up 5mg Finasteride Tablets

Q: Hey doc, you told me to cut up 5mg finasteride into four parts. Why not five, so that it will be equal to Propecia which is 1mg? — H.F., Eastchester, NY

A: For several reasons:

1) you will lose some of the medication in the cutting process,
2) the generic dose can be slightly less than the brand, and
3) it is too difficult to cut into five parts – four is hard enough.

Note that due to the fact that finasteride stays in the hair follicle for a long time, the pieces do not have to be in four equal parts.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Dr. Christiano at Columbia University Identifies APCDD1, A Newly Discovered Gene Associated With Hair Loss

Dr. Angela Christiano of Columbia University in New York and a team of scientific researchers have identified a new gene involved in hair growth. Their discovery may affect the direction of future research for hair loss and the diagnosis and ultimate prevention of male pattern baldness.

The condition which leads to thinning hair is called hereditary hypotrichosis simplex. Through the study of families in Pakistan and Italy who suffer from this condition, the team was able to identify a mutation of the APCDD1 gene located in chromosome 18. This chromosome has been linked to other causes of hair loss.

According to Dr. Christiano, “The identification of this gene underlying hereditary hypotrichosis simplex has afforded us an opportunity to gain insight into the process of hair follicle miniaturization, which is most commonly observed in male pattern hair loss or androgenetic alopecia.”

The mutation of the APCDD1 gene inhibits the Wnt signaling pathway. Although this recently discovered gene does not explain the complex process of male pattern baldness, the importance of this discovery lies in the Wnt signaling that the gene directs, has now been shown to control hair growth in humans, as well as in mice.

Reference: Nature 464, 1043-1047 (15 April 2010) | doi:10.1038/nature08875;

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

O, The Oprah Magazine Discusses Hair Loss In Women, Female Hair Transplants With Dr. Bernstein

O, The Oprah Magazine - March 2010O, The Oprah Magazine featured hair loss in women in the beauty section of their March 2010 issue.

Dr. Bernstein was consulted for the article:

Hair transplant: A possibility if your hair loss is concentrated in specific areas. Hair follicles (in groups of up to four) are surgically removed from an area on your scalp where growth is dense and then implanted in the thinning patches. Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates, says Robert Bernstein, MD, a New York City dermatologist who specializes in these surgeries. (The price tag can run from $3,000 to $15,000.)

In October 2008 Dr. Bernstein appeared on the Oprah Winfrey Show, where he spoke with Oprah and Dr. Mehmet Oz about hair transplantation and gave a live demonstration featuring the hair transplant results of one of his patients.

Watch a video clip of Dr. Bernstein and Oprah discussion hair transplantation.

Read the full article at Oprah.com.

Reference:
“The Truth About Hair Loss,” “O” – Oprah Magazine, March 2010; p90.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Hair Cloning Technique Using ACell a Breakthrough?

Q: I just read a press release saying that researchers have developed a successful technique to clone hair by using a wound healing powder. To paraphrase, the press release says:

MatriStem MicroMatrix, a product of regenerative medicine, ACell, Inc., is a wound healing powder that promotes healing and tissue growth and has now proven to help regenerate hair in the donor and recipient regions of hair transplant patients. While intended to heal ulcers and burns, Gary Hitzig, M.D. and Jerry Cooley, M.D., have found that its properties offer a broader scope of treatment, including hair cloning. “We’ve made amazing breakthroughs using MatriStem as a hair cloning tool,” said Dr. Hitzig. “We’ve been able to multiply the number of hair follicles growing in the recipient area, and as an added benefit are seeing faster hair growth. This new hair cloning technique also makes hair transplantation surgery less invasive.”

Is this new technique really a breakthrough in hair cloning? And if so, when can we start cloning hair?

A: It appears from preliminary studies that plucked hairs stimulated by ACell are in some cases able to regenerate new hair. Because the hair is placed into the recipient area and is partially derived from cells in the dermis, it is not yet clear whether the hair will be effected by androgens over time or if it will continue to bald.

The research so far is promising and a number of doctors are doing research in this area, including Dr. Schweiger and myself at Bernstein Medical – Center for Hair Restoration.

For more on the topic, visit our Hair Cloning section, our page on ACell extracellular matrix devices, and answers to questions on Hair Cloning.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Does A Hair Transplant Work?

Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp — this idea is called Donor Dominance. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear — a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

Read more about Miniaturization
Read about the Causes of Hair Loss in Men

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Lgr5 Gene Discovery a Hair Cloning Breakthrough?

Q: I heard about the Lgr5 gene being a breakthrough in hair cloning. What’s the latest on that?

A: Many scientists feel that adult stem cells house the answer to cloning (regeneration) of hair follicles. One of the problems of hair cloning, however, is that the cells, once duplicated, “forget” that they are hair follicle cells.

It has recently been discovered that the Lgr5 gene, located in stem cells, appears to contain the “global marker” present in all adult hair follicles. If Lgr5 gene is the “calling card” of the cell, it may carry the cell lineage and shoulder the responsibility of signaling to surrounding stem cells what they are actually supposed to do as they multiply.

Recent experiments have shown that these Lgr5 cells maintain the cells ability to differentiate as hair follicles after many generations of being multiplied in the test tube and, therefore, have the potential of serving as the building blocks of entire new hair follicles. The successful exploitation of this gene would eliminate a major barrier to cloning hair.

Reference
Haegebarth A, Clevers H: Wnt signaling, lgr5, and stem cells in the intestine and skin. Am J Pathol. 2009 Mar; 174(3):715-21.

For more on how hair cloning works, visit our page on hair cloning and multiplication.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Hair Cloning Shows Promise in New Stem Cell Study

Alopecia areata is an auto-immune disease that causes hair loss that ranges from small circular areas on the scalp to extensive or even total baldness. When extensive, it can be a socially debilitating disease, and it can be particularly difficult when those suffering are children.

When alopecia areata is localized, i.e. there are a limited number of bald patches, the condition often responds well to cortisone injected directly direct into the scalp. When the condition is more extensive, current treatments do not have a high rate of success. A new study, using hair cloning therapy to regrow hair, shows promise for all individuals suffering from the disease.

The study — conducted by Marwa Fawzi, a dermatologist at the University of Cairo Faculty of Medicine, and reported on Bloomberg.com — used stem cells from the scalps of eight children with alopecia areata to regenerate their own hair:

The Cairo researcher took small amounts of skin from the scalps of the children, isolated the hair follicle stem cells that stimulate hair production, and grew them in the lab, increasing the number of cells. After one month, she put the cells back into the scalps of the children, with numerous injections across the bald areas of their heads. ((Kids Shunned for Hair Loss Get Help From Their Own Stem Cells by Rob Waters. Posted on Bloomberg.com, July 10, 2009))

To read more on how various cloning processes work, view the Hair Cloning Methods page.

Six months after the hair cloning treatment, an evaluation showed a 50% increase in hair in more than half of the subjects. One of them, an 8-year-old boy, grew nearly a full head of hair after being almost completely bald before treatment. The article reports that the boy is grateful that he is now able to lead a more normal life, free from social isolation over his balding scalp.

Dr. Fawzi took new skin samples and examined the hair follicles themselves and could see that the injected stem cells had migrated into the follicles. There, the stem cells stimulated the follicles to transition from a dormant phase to a hair-generating phase.

Further testing is needed and a double-blind study using a larger number of patients in planned, but the study’s success could prove to be a turning point in stem cell cloning for hair restoration. Unlike alopecia areata, where the body’s immune system attacks one’s own hair follicles, in common baldness the culprit is the hormone DHT. In spite of the differences between these two conditions, we appear to be inching closer to the use of stem cell cloning therapy in the treatment of male pattern baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Hair Transplant Graft Depth and How Long After Transplant can Grafts be Dislodged?

Q: How far into the scalp are the grafts placed and is the follicle far enough into the scalp that it will not be damaged? I have heard that the critical time to not touch your scalp is the first 2-3 weeks after the procedure. — M.G., Hillsborough, C.A.

A: The growth part of the follicle is 3-4mm into the scalp. Grafts can be dislodged the first 10 days, so you need to be careful not to scrub your scalp during this period. After that, the grafts are permanent. At 2-3 weeks they can’t be dislodged, even by vigorous scrubbing.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After a Hair Transplant What are the Effects of DHT on Donor Hair?

Q: Hi! I wanted to ask if after hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.

A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).

When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.

Read about Miniaturization

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Laminin-511 Stimulates Dermal Papilla for New Hair Growth

Jing Gao, Mindy C. DeRouen, Chih-Hsin Chen, Michael Nguyen, et. al.
Genes & Development 22:2111-2124, 2008

The growth of a hair follicle from its developmental cell stage to a hair bearing follicle is through an interactive process between epidermal cells and those of the dermal papilla. It was found that Laminin-511 is instrumental in facilitating this process.

It has been felt that the extra-cellular protein Laminin is critical to both adhesion and the signaling process in hair development; however, the mechanism is not fully understood.

Through this study, it was shown that the signaling pathways introduced by the administration of noggin and sonic hedgehog alone were insufficient to develop a hair follicle. When Laminin-511 protein was introduced to the tissue culture, the dermal papilla developed. When the protein was inhibited, hair follicle growth again ceased. This information supports prior studies suggesting that Laminin is critical in the early stages of follicle cell development and is required for continued follicle development and growth.

This study reaffirms in vitro and in vivo studies in mice, the importance of Laminin-511 in the formation of dermal papilla to promote the development of more organized dermal papilla cells and the hair follicle development. It also suggests that there is a reciprocal mechanism between the signaling pathways of noggin and sonic hedgehog with Laminin-511.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Hair Transplant Using Shedded Hair?

Q: Can a hair transplant be done using the hair which has fallen out? — G.O., Gramercy, N.Y.

A: A hair transplant is really a misnomer, since it is the follicle (or root) that is transplanted not the hair itself – although the transplanted follicle usually contains a hair.

Hair, like fingernails, are dead and cannot grow once detached from the root.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Strategies for Follicular Cell Implantation

by Jeff Teumer, PhD
Hair Transplant International Forum, Volume 18, Number 3, May/June 2008

Follicular cell implantation (FCI) is based on the ability of the dermal papilla (DP) cells, found at the bottom of hair follicles, to stimulate new hairs to form. DP cells can be grown and multiplied in a culture so that a very small number of cells can produce enough follicles to cover an entire bald scalp.

In order to produce new follicles, two types of cells must be present. The first is Keratinocytes, the major cell type in the hair follicle, and the second are dermal papillae cells (DP) which lie in the upper part of the dermis, just below the hair follicle. It appears that the DP cells can induce the overlying keratinocytes to form hair follicles. There are a number of proposed techniques for hair regeneration that use combinations of cells that are implanted in the skin. The two major techniques involve either transplanting dermal papillae cells by themselves into the skin or implanting them with keratinocytes. These techniques can be used with or without an associated matrix used to help orient the newly forming follicles.

Implanting Dermal Papillae Cells Alone

  1. Implanting DP cells by themselves into the dermis, with the hope that they will cause the overlying skin cells (keratinocytes) to be transformed from normal skin cells into hair follicles. This method is called “follicular neo-genesis” since new hair is formed where none previously existed.
  2. Cells of the dermal papillae are placed alongside miniaturized follicles. The transplanted cells would induce the keratinocytes of the miniaturized follicles to grow into a terminal hair. A potential advantage of this technique is that the existing miniaturized follicles already have the proper structure and orientation to produce a natural look growth.

Implanting Dermal Papillae with Keratinocytes

  1. A mixed suspension of cultured keratinocytes and DP cells are implanted into the skin.
  2. Keratinocytes and DP cells are cultured together such that full or partial hair formation takes place in a culture dish. These culture-grown hairs, or “proto-hairs,” are then implanted into the patient. The advantage of using a proto-hair is that there would be better control over the direction of hair growth because of the structural orientation of the proto-hair.

Cell Implantation using a Matrix

  1. A variation of the above techniques is to use a matrix to help orient the implanted cells. This could be either an artificial matrix composed of materials such Dacron or it could be a biological matrix composed of collagen or other tissue components. The matrix would act like a scaffold to help cells organize to form a follicle. If the matrix were filamentous (like a hair) it could help direct the growth of the growing follicle. A matrix could be used with dermal papillae cells alone or in combination with cultured keratinocytes.

With all of the varied approaches for FCI, the aim is to combine keratinocytes and DP cells to efficiently and reproducibly generate thousands of follicles for hair restoration. In some cases, cells are combined in vivo and all of the hair formation must take place in the body after implantation, while in others, some hair formation takes place in culture before implantation.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Discusses Hair Transplantation and Densitometry in PRWeb Podcast

Dr. Bernstein took part in a PRWeb podcast about hair transplantation in June 2007. Stream the discussion below or read the transcript:

Announcer: PRWebPodcast.com, visiting with newsmakers and industry experts.

Mario: This is Mario from PRWeb, and today it is a real pleasure to have with us Robert M. Bernstein, M.D. Dr. Bernstein is Associate Clinical Professor of Dermatology at Columbia University, and founder of New York City‑based Bernstein Medical – Center for Hair Restoration. Dr. Bernstein, it’s a pleasure to have you here on PRWeb.

Dr. Bernstein: Nice to be speaking with you.

Mario: Give us some understanding, sir, of your practice, the Bernstein Medical – Center for Hair Restoration. How long have you been around, where you guys are located, what is it you do there, please?

Dr. Bernstein: Bernstein Medical has evolved over the last ten years. It was set it up to do a specific procedure that I pioneered called “follicular unit hair transplantation.”

In this procedure, we dissect out hair follicles from the back of the scalp, exactly the way they grow in nature, so we are now able to perform hair transplants that essentially mimic nature.

This procedure is used by doctors around the world in hair restoration procedures. Our NY Hair Transplant Center is in midtown Manhattan and has been specifically designed for performing this hair transplantation technique.

Mario: You recently co‑authored an article, Dr. Bernstein, that appeared in the “Medical Journal of the International Society of Hair Restoration Surgery”. Now, you are well read and interviewed all over. This must be a bit exciting, something that was positive for you and your clinic. Tell us about the article, what it touched on, and some of the things that would be important for our listeners.

Dr. Bernstein: It sure was very exciting. The hair transplantation procedure has been around for many years, but a lot of it has been too much of an art and not enough of a science. What we’ve found is that doctors sometimes make these very general judgments about how bald the patient is going to become, how much hair they may need for the hair transplant or for the restoration.

We’ve found that by using a procedure called “densitometry”, where the hair is looked at under high magnification, we are able to get much more specific and useful information, both on the extent of how much someone is going to lose their hair, and also whether they are going to be a good candidate for hair restoration surgery.

One of the things that we’ve found is that when people start to thin, the hair first changes diameter before it’s lost, and this change in diameter may not necessarily be seen by the naked eye or be observed by another person.

But if you clip the hair very short and look at the base of the hair follicles under very high power, 30X magnification, you can actually see these very subtle, early changes, and these changes will anticipate future hair loss.

When we’re trying to decide whether a person should have hair transplant surgery, we can actually look at the donor area in the back and sides of the head, and see how stable these areas are. For example, someone that is becoming very bald, if the back and sides of their head show no change in the hair diameter, or no miniaturization, then we know that they may have very good hair for hair transplants; where a person with a similar degree of hair loss, whose sides and back are not stable, may not be a good hair transplantation candidate.

In a sense, by being able to measure things now, we’re able to have a much better sense of whether people are going to become very bald, possibly the rate of change of their hair loss, and then if they do need surgery, such as a hair transplant, we’re able to give much more specific information about what actually might be done.

Mario: We’re speaking to Dr. Robert M. Bernstein, M.D., an Associate Clinical Professor of Dermatology at Columbia University, and founder of New York‑based Bernstein Center for Hair Restoration.

Dr. Bernstein, give us some contact information where we can learn more about your services, and be able to end up taking advantage of them.

Dr. Bernstein: The best information can be found on our web site. The web address is www.BernsteinMedical.com.

Mario: Dr. Bernstein, it’s been a pleasure having you here on PRWeb podcasting with us. The best of luck to you, and congratulations again for that article in the “Medical Journal of the International Society of Hair Restoration Surgery.”

Dr. Bernstein: Thanks a lot, nice talking to you.

Announcer: Produced by PRWeb, the online visibility company.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Summary: Hair Follicle Regeneration in Adult Mouse Skin After Wounding

Dr. Bernstein summarizes an article on stem cells that was published in the journal Nature:

This study demonstrates that after wounding the skin of an adult mouse, an embryonic-like change in the epidermal cells outside of the hair follicle stem cells can be induced to form new hair follicle stem cells. In other words, these cells originate from epidermal skin cells in the wound, but then are able take on the characteristics of hair follicle stem cells and actually produce hair. These regenerated hair follicles establish a stem cell population that can produce a hair shaft and continue through all stages of the follicular cycle. The research suggests that these regenerated hair follicles grow new hair through the introduction of Wnt proteins.

The technology, developed at the University of Pennsylvania School of Medicine, has been licensed by Follica Inc. a privately held medical device company.

Reference: “Hair Follicle Regeneration in Adult Mouse Skin After Wounding,” Ito, M., et al. Nature 447, 316-320, May 17, 2007

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Does the Laser Therapy (LLLT) Hair Loss Treatment Work?

Q: I heard about the laser comb and other lasers for hair loss, how do they work?

A: Low Level Laser Therapy (LLLT) is based on the scientific principle of photobiotherapy. Photobiotherapy occurs when laser light, absorbed by cells, causes stimulation of cell metabolism and improved blood flow.

Although the exact mechanism by which lasers promote hair growth is still unknown, they appear to stimulate the follicles on the scalp by increasing energy production and partially reversing the miniaturization process leading to thicker hair shafts and a fuller look.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Do You Use Sutures or Staples in an FUT Hair Transplant?

Q: Can you please comment on the use of sutures verses staples in hair restoration procedures? — S.S., Prospect Park, NY

A: Sutures are great on non-hair bearing skin and allow perfect approximation of the wound edges, but on the scalp they can cause damage to hair follicles below the skin’s surface. The reason is that a running (continuous) suture traps hair follicles and when the skin swells (as it normally does after hair transplants) the trapped follicles can strangulate and die.

Since staples are placed individually – about ½ cm apart – they don’t strangle the tissue. This allows the blood supply to flow freely to the wound edge permitting the blood’s oxygen to reach the follicles in the stapled area and minimizing the risk of any hair loss. The unimpeded blood flow also facilitates wound healing and can sometimes result in a finer scar, particularly in a tight scalp.

For these reasons, we now use staples in most of our hair transplants.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Do You Treat Hair Loss from Pseudopelade or Scarring Hair Loss on the Scalp?

Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? — T.L., Boston, MA

A: In general, hair transplantation does not work for Pseudopelade (a localized area of scarring hair loss on the top of the scalp) since the condition is recipient dominant rather than donor dominant.

With a donor dominant condition, such as androgenetic hair loss, the tendency to have the condition, or be resistant to it, is located in the hair follicle and moves with the hair follicle when the follicle is transplanted to a new area. Therefore, in androgenetic alopecia, healthy permanent hair taken from the donor area in the back of the scalp will continue to grow in the a new location in the balding part of the scalp.

In a recipient dominant condition, such as Pseudopelade, the problem is in the skin, so if you perform a hair transplant into an affected area of skin, the transplanted hair will become affected by the same process and be lost.

The disease process can often be slowed down with anti-inflammatory agents, such as corticosteriods, applied or injected locally and the bald area can be camouflaged with cosmetics specially made for use on the scalp. See the Cosmetic Camouflage Products page on the Bernstein Medical – Center for Hair Restoration website.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Difference in Hair Cloning Techniques Studied by Aderans and Intercytex?

Q: I know that both Aderans and Intercytex are doing research with cloning hair. Is there any difference in their approaches?

A: Aderans is using the “two-cell” approach. They feel that the best way to produce viable hair follicles is to use a combination of inducer cells and responder cells. Each would be multiplied separately and then injected together into the skin. The inducer cells are follicular fibroblasts and lie at the base of the hair follicle. The responder cells are keratinocytes. They feel that the combination of cells will have the best chance of producing clinically useful hair.

Intercytex prefers a one-cell approach. Their researchers feel that when the cultured inducer fibroblasts are injected into the skin there will be enough existing cells in the skin to produce a cosmetically viable hair. In their experimentation, Intercytex uses a new animal model, termed the “flap graft” model, that involves the implantation of cultured dermal papilla cells with keratinocytes placed under a flap on the back of hairless mice. Later the flap is exteriorized (turned over), allowing the hair to grow normally. Exactly how this will be applied to clinical use in humans is not clear.

A completely different view is held Dr. Ralf Paus at the University of Luebeck in Germany. He feels that there are already enough stem cells in the bald scalp and that the key to hair re-growth is to target key elements in the hair cycle. He feels that topically applied inhibitors of catagen (the resting phase of the hair cycle), exogen (the formation of an empty hair follicle), or inhibitors of the terminal-to-vellus transformation (the process of a hair shrinking in size under the influence of DHT and referred to as miniaturization) will the most effective way to go.

Finasteride and dutasteride are drugs that work in this way, but are clearly not very effective in stimulating new growth. He also feels that an anagen inducer, along the lines of a minoxidil-type medication has a better chance of success then the stem cell targeting strategies described above. In these cases one would, in a sense, rejuvenate dormant hair follicles rather than induce new ones to grow.

Read about Hair Cloning Methods

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After Hair Transplant, What Happens if Transplanted Area is Injured?

Q: I am a patient of yours who had a hair transplantation procedure done mostly in the crown area and in the front about seven months ago. The hair is just starting to come in nicely and is starting to fill in the bald spots. Yesterday I carelessly banged the top of my head against a beam in my attic and cut a nice gash in, you guessed it, a transplanted area. I’d say that the cut is about a good inch. My wife works for a doctor who is certified in facial plastic surgery and I had him suture up the gash. He did not cut any hair, but it took 4 stitches to close the wound. I’m worried about the impact on the transplanted area. Just when it was starting to come in nice I now have a bald spot that I suspect is going to stay as a result of the accident. Please advise. — V.F., Fort Lee, N.J.

A: There is not much you can do at this time. Depending upon the doctor’s suturing techniques; you may or may not have permanent hair loss from the trauma and subsequent suturing. The problem is that if the sutures are placed too far from the wound edge they can strangulate hair follicles, particularly if there is any swelling. Hair loss may be temporary, but if it is permanent, it should be minimal. Additional grafts can be added at your next hair restoration procedure to cover any area of hair loss and the scar from the injury, if it is visible.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

U.K. Invests in Hair Cloning Research

The British government has awarded Intercytex a grant to automate the production of their new hair regeneration therapy. Intercytex is a cell therapy company that develops products to restore and regenerate skin and hair. Intercytex has partnered with a private company, The Automation Partnership (TAP), to develop an automated manufacturing process for their novel hair multiplication treatment.

The hair multiplication product, ICX-TRC, has been submitted as a hair regeneration therapy that uses cells cloned from one’s own scalp. It is intended for the treatment of male pattern baldness (androgenetic alopecia) and female pattern hair loss. The key researcher, biochemist Dr. Paul Kemp, founder of Intercytex, is developing the hair multiplication treatment at their Manchester facility. This investment in hair cloning research is spearheaded by UK Science Minister, Lord Sainsbury.

The government grant will be used mainly to develop a robotic system specifically designed to support the commercial-scale production of their hair cloning product ICX-TRC, at a scale that can handle a large number of people. The company is currently in Phase II clinical testing.

How Intercytex’s Hair Cloning Product Works

Intercytex’s method of hair regeneration involves removing a slice of the scalp, complete with hairs and follicles, from the back of the head. Hair follicles from this area are most resistant to typical hereditary baldness. The sample is taken to a laboratory where the hair producing dermal papilla (DP) cells are extracted and multiplied in flasks. After eight weeks, the DP cells should have cloned into millions of hair cells.

To complete the hair cloning process, the new cells are injected back into the patient’s scalp under a local anesthetic. These cultured cells should then develop into brand new hair follicles.

Intercytex

Intercytex is a 6-year-old company with its main office is in Cambridge, UK and has a clinical production facility and research and development laboratories in Manchester, UK. Additional laboratories are located in Boston, Massachusetts. TAP, founded in 1988, is a private company with headquarters near Cambridge, UK. Intercytex is publicly traded on the London Stock exchange (LSE: ICX).

Additional information about this hair cloning product can be found at www.intercytex.com.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Transplant Society Names Dr. Bernstein ‘Pioneer of the Month’

The International Society of Hair Restoration Surgery (ISHRS) has named Dr. Bernstein the ‘Pioneer of the Month’ in their official publication, the Hair Transplant Forum International.

Below is the article that appeared in the publication announcing Dr. Bernstein as the recipient of the honor. Dr. Bernstein is also a member of the society.

Hair Transplant Forum International
September-October 2006

Pioneer of the Month – Robert M. Bernstein, MD
by Jerry E. Cooley, MD Charlotte, North Carolina

Pioneer of the Month – Robert M. Bernstein, MDThe term “follicular unit transplantation” (FUT) has become so firmly embedded in our consciousness that we often consider it synonymous with hair transplantation in general. Surgeons new to the field may be unaware of its origin and how the concept evolved. In the 1980s, many separate clinics were developing total micrografting techniques to improve the naturalness of hair transplantation. In 1988, Dr. Bobby Limmer began developing a technique consisting of single strip harvesting with stereomicroscopic dissection of the hair follicles within the strip, which he published in 1994.

After observing histologic sections of scalp biopsies, dermatopathologist Dr. John Headington coined the term “follicular unit” in 1984 to describe the naturally occurring anatomic groupings of hair follicles. In 1995, a surgeon just entering the field of hair transplantation became aware of these natural “follicular units” and came to believe that they should be the building blocks for all hair transplants. His name was Bob Bernstein.

From 1995 to 2000, Bob and his colleague Dr. Bill Rassman articulated the rationale and benefits of FUT in dozens of publications and numerous lectures. Doubtlessly, Bob’s extraordinary effort advocating FUT in public forums during that time was critical to FUT’s rapid evolution and acceptance among surgeons.

Bob was born in New York City and raised on Long Island, New York. For college, Bob headed south to Tulane University in New Orleans. Next, he went to medical school in Newark at the University of Medicine and Dentistry of New Jersey. He then went on to a residency in dermatology at Albert Einstein College of Medicine, where he served as chief resident.

Bob performed some punch grafting procedures in residency and a few more when he started his cosmetically focused dermatology practice in 1982. Not liking the results, he didn’t perform another transplant for 12 years. In the summer of 1994, Bob saw a patient of Dr. Ron Shapiro for a dermatologic problem. Impressed with the results of the surgery, Bob began speaking with Ron about the changes in the field. Ron encouraged him to attend the next ISHRS meeting in Toronto, which he did. While there, he saw several of Dr. Rassman’s patients presented and was greatly impressed.

Soon after, he was in Bill’s office observing micrograft “megasessions.” One of the things that caught Bob’s attention was Bill’s use of the “densitometer” to quantify the patients’ hair density. Bob noticed that the hair surprisingly grew in small groups. Bill half jokingly told Bob that he should give up his dermatology practice and go into hair restoration and invited him back for a second visit. On the 5-hour plane ride to Los Angeles, Bob thought about the potential of only transplanting those small groups he saw with the densitometer, and wrote the outline of a paper entitled, “Follicular Transplantation” (published that same year). The second visit with Bill confirmed his interest in hair transplants and, in particular, developing this idea of FUT. He quickly transferred his dermatology practice to a colleague and joined Bill’s group, the New Hair Institute (NHI).

Over the next 10 years, Bob authored and coauthored over 50 papers on FUT addressing issues such as quantifying various aspects of FUs among patients, racial variations, graft sorting, as well as hairline aesthetics, corrective techniques, the use of special absorbable sutures, and FUE and its instrumentation. One of the concepts he emphasized was the recognition of Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA), which were originally described by Dr. O’Tar Norwood. Bob helped raise awareness that patients with DUPA and low donor density are not surgical candidates. For all of his many contributions to the field, Bob was awarded the 2001 Platinum Follicle Award.

Branching out in other directions, Bob decided to go to business school and received his MBA from Columbia University in 2004. He did this to learn how to better streamline the day-long hair transplant sessions and improve general management of his growing staff. In 2005, Bob formed his own practice, Bernstein Medical – Center for Hair Restoration. Looking to the future, Bob says, “I am excited about the accelerated rate of technical changes to the hair transplant procedure. This is due to an increasing number of really clever minds that have entered the field. Almost every aspect of the surgery is being tweaked and improved upon. It goes without saying that cloning will be the next really big thing—but I think it will take longer to develop than some are promising.” On the down side, he notes, “A concern I have is that, as hair transplant practices grow into big franchises with large marketing campaigns, many people are being directed toward surgery rather than being treated as patients with hair loss in need of an accurate diagnosis, medical treatment, emotional support, and surgery only when appropriate.”

Bob met his wife, Shizuka, who was born in Tokyo, when she was opening a dance studio in the East Village section of New York. She now owns a day spa in midtown Manhattan. Bob has three children; two are in college: Michael, 22, is studying mixed martial arts and foreign language; Taijiro, 21, is majoring in theoretical math. His daughter, Nikita, 12, is in 7th grade and plays on the basketball team. In addition to going to Nikita’s games, Bob enjoys skiing, piano, chess, basketball, philosophy, and music history.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Hair Loss Treatment with Avodart Safe?

Q: My friend is taking Avodart, he bought it over the internet. Is it safe to take? — T.G., Denver, Colorado

A: Avodart (dutasteride 0.5mg) was approved by the FDA for the treatment of prostate enlargement in men in 2002. Avodart has not been approved for the treatment of androgenetic hair loss, although physicians can use an approved medication in ways other than for which it was specifically approved. That said, the use of dutasteride certainly requires a doctor’s supervision.

Like finasteride (the active ingredient in Proscar and Propecia), dutasteride blocks the enzyme 5-alpha reductase that converts testosterone to DHT (DHT is a key hormone that causes hair loss). However, unlike finasteride, which only inhibits the Type I form of the enzyme, dutasteride inhibits both the Type I and Type II forms. This combined effect lowers circulating DHT more with dutasteride than with finasteride, but also increases the incidence of its side effects.

The Type II form of the enzyme (blocked by finasteride) is found predominantly in the hair follicle. The Type I form of the enzyme has been found in the scalp and sebaceous glands, and many other parts of the body, but its exact role in hair growth has not been determined. It is felt that dutasteride’s ability to dramatically lower serum levels of DHT is what makes it a more potent medication in hair loss.

When considering the safety of dutasteride, one should consider the following:

  • It acts on other parts of the body besides the hair follicle.
  • Unlike finasteride, where families that had a deficiency of the Type II 5-alpha reductase enzyme were followed for years without any adverse effects, there is no natural biologic model to show the safety of dutasteride.
  • Dutasteride has been approved for prostate enlargement in an older male population. It is not approved for hair loss and, in fact, the clinical trials for hair loss were discontinued, so there is no safety data for its use in younger patients. There is a greater incidence of sexual side effects with dutasteride compared to finasteride.
  • The 1/2 life of dutasteride is 5 weeks compared to 6-8 hours for finasteride. Serum concentrations of dutasteride are detectable up to 4-6 months after discontinuation of treatment.
Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Have a Hair Transplant if My Scalp is Tight from Prior Surgery?

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.

Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.

Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair? — D.D., Highland Park, T.X.

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

Read about Follicular Unit Extraction (FUE)

Read about Follicular Unit Transplantation (FUT)

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

New Instrument for Follicular Unit Extraction Introduced By Drs. Bernstein and Rassman

PRESS RELEASE

World renown hair transplant surgeon introduces a new surgical tool that improves the way hair transplantation can be performed.

New York, NY March 21, 2006

Follicular Unit Extraction (FUE) InstrumentIn a new article appearing on the cover of Hair Transplant Forum International, the official publication of The International Society of Hair Transplant Surgeons (ISHRS), pioneering hair transplant surgeon Robert M. Bernstein MD, along with his colleague Dr. William R. Rassman, recently revealed details about a “New Instrumentation for Three-Step Follicular Unit Extraction.”

Dr. Bernstein is known throughout the world of medicine as author of the landmark publication; “Follicular Transplantation” which described a new hair replacement transplant technique in which he was able to transplant hair exactly as it grows – in naturally occurring groups called follicular units. That paper, together with two dozen other major publications, has revolutionized the way hair transplants are now performed – moving away from “doll’s hair” like plugs and into the realm of natural, undetectable hair patterns.

Follicular Unit Extraction (FUE) is a further refinement of this technique where follicular units are literally removed, one-by-one, directly from the scalp. In the traditional procedure, a strip of tissue is removed from the back of the head and placed under a microscope in order to remove the follicles.

The latest FUE instrument design is based upon Dr. J. A. Harris’ concept of using a blunt tool to prevent damage to hair follicles during extraction. The new device improves on the old method by re-conceiving the shape of the tool’s edge in order to minimize injury to hair follicles. “Our new instrument is made in the shape of a cylindrical tube with a bull-nosed edge. This allows us to capture the entire follicular unit (naturally groups of 1-4 hairs) without damage to the hair bulbs.” We also found that the incidence of buried grafts decreased significantly with the new instrument from about 9% to 1.8% with this new device” said Dr. Bernstein from his Center for Hair Restoration in New York.

In a recent study conducted by Leever Research Services, it is estimated that over 360,000 patients sought help from doctors for their hair loss last year. With ground-breaking work by surgeons like Robert M. Bernstein M.D., the impressive aesthetic results from new hair transplantation techniques are helping men and women who suffer from baldness to get a renewed outlook on their lives.

Posted by Robert M. Bernstein M.D.

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