Hair Multiplication - Bernstein Medical - Center for Hair Restoration
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Two new studies researching a class of drugs called JAK inhibitors have shown that oral treatment results in significant hair regrowth in patients with alopecia areata, an autoimmune condition that causes non-scarring patches of localized hair loss. Currently there is no cure for alopecia areata, so the possibility of a safe, effective medication is welcome news for thousands of affected patients.

Background

Last year we wrote about how the two new FDA-approved drugs tofacitinib and ruxolitinib act as inhibitors of the family of enzymes called Janus kinase (JAK). ((Harel S, Higgins CA, Cerise JE, Dai Z, Chen JC, Clynes R, Christiano AM. Pharmacologic inhibition of JAK-STAT signaling promotes hair growth. Sci Adv. 2015 Oct; 1(9): e1500973.)) By inhibiting the JAK enzymes, the drugs disrupt intracellular communication to white blood cells, called “T lymphocytes,” and are thus useful in treating alopecia areata. The JAK inhibitors prevented the onset of the disease and reversed the condition, enabling hair to regrow in areas previously devoid of hair.

The 2015 study we referenced – led by renowned alopecia areata researcher Dr. Angela Christiano – showed that topical application of tofacitinib and ruxolitinib in mice resulted in the rapid transition of hair follicles from the telogen (resting) phase of the hair cycle to the anagen (growth) phase. The same study found that tofacitinib encouraged hair follicle development in clumped human dermal papilla (DP) cells, stem cells that are critical in the development of hair follicles. [1]

The Studies

The two new studies were published in September 2016 in the journal JCI Insight, a peer-reviewed journal dedicated to biomedical research.

Tofacitinib

The study of oral tofacitinib – by Crispin, Ko, et al – was a 2-center, open-label, single-arm trial; the first to systematically examine the efficacy of JAK inhibitors as a treatment for alopecia areata. ((Crispin MK, Ko J, Craiglow BG, Li S, Shankar G, Urban JR, Chen JC, Cerise JE, Jabbari A, Winge MG, Marinkovich MP, Christiano AM, Oro AE, King BA. Safety and efficacy of the JAK inhibitor tofacitinib citrate in patients with alopecia areata. JCI Insight. 2016;1(15):e89776. doi:10.1172/jci.insight.89776.)) In addition to studying alopecia areata (AA) patients with greater than 50% scalp hair loss, they tested the drug on patients with alopecia totalis (AT), which is the complete loss of scalp hair; alopecia universalis (AU), the loss of scalp and body hair; and ophiasis pattern alopecia areata, hair loss localized to the temporal and occipital scalp. After three months on 5mg tofacitinib citrate, 32% showed up to 50% improvement, and 32% showed greater than 50% improvement. When broken down by subtype of the condition, those with AA improved by 70% on average, those with ophiasis improved by 68%, AT by 11.8%, and AU by 10.5%. They found that following cessation of the treatment, all patients experienced a recurrence of hair loss after an average of 8.5 weeks. Additional trials are necessary to determine the optimal dosage regimen for providing the most long-lasting response.

Ruxolitinib

The study of ruxolitinib – by Mackay-Wiggan, Jabbari, et al – was an open-label clinical trial of 12 patients with moderate to severe alopecia areata. ((Mackay-Wiggan J, Jabbari A, Nguyen N, Cerise J, Clark C, Ulerio G, Furniss M, Vaughan R, Christiano AM, Clynes R. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016;1(15):e89790. doi:10.1172/jci.insight.89790.)) The pilot study tested the use of 20mg oral ruxolitinib twice a day for three to six months; this was followed by three months of monitoring the patients without treatment. Despite the small sample size, the results were striking in that 75% of patients showed a strong response to the medication, with hair regrowth over 50%. After treatment, those who responded to the treatment exhibited a 92% reduction in hair loss. Seven of the nine responders achieved greater than 95% hair regrowth. After stopping treatment hair loss resumed; however, it did not reach the level of hair loss that was present before treatment. This proof-of-concept pilot study showed that ruxolitinib is a safe and effective in reversing the balding effects of alopecia areata.

Conclusion

After showing promise in previous research, scientists have now shown that JAK inhibitors have strong potential to cause substantial hair regrowth in people with alopecia areata; a condition that causes hair loss that can be socially awkward at best and cosmetically disfiguring in severe cases. More studies need to go forward in order to determine which of the two drugs – tofacitinib or ruxolitinib – will be the most effective treatment, and what the proper dosage is for long-term treatment. However, we are hopeful that a medication will be developed for broad use in treating alopecia areata patients.

The other major point of interest following the publication of the series of studies is the potential for JAK inhibitors to treat androgenetic alopecia, or common genetic hair loss. One area that is being discussed is the potential for JAK inhibitors, perhaps in the form of a topical treatment, to stimulate the transition of hair follicles from the resting phase to the growth phase of the hair cycle. Christiano’s research is examining the effects of JAK inhibitors on cultured dermal papilla (DP) spheres. If JAK inhibitors can be used to stimulate DP spheres to grow into mature hair follicles, it may enable hair multiplication techniques to become a viable treatment for common baldness.

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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

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Q: I haven’t seen much new with ACell. Have you been making progress with your research?

A: Thus far, we have not been able to multiply transplanted hairs with ACell, nor have been able minimize the width of the donor scars following FUT. At present, we are not recommending ACell to our patients, but are continuing to explore different ways of using it.

Visit the Hair Cloning News section to read about the latest research on cloning and multiplication
Read about Hair Cloning Methods

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NYT - New Stratagems in the Quest for HairFred R. Conrad/The New York Times

Dr. Bernstein is featured in Douglas Quenqua’s article in the New York Times — “New Stratagems in the Quest for Hair” — about the latest advances in hair restoration. The article mentions Dr. Bernstein’s pioneering research on hair cloning, including his studies on hair multiplication using the breakthrough biotechnology of ACell’s MatriStem® extracellular matrix.

On hair cloning:

Dr. Robert M. Bernstein, clinical professor of dermatology at Columbia University, is now one of several researchers experimenting with [ACell MatriStem].

“It’s just a question of time now” before hair cloning becomes a reality, Dr. Bernstein said. “We keep on moving back that time, but I think there’s absolutely no doubt that it’s going to be done.”

He believes hair cloning will be commercially available within 10 years. This may sound like a long time to wait, but “it’s important to remember that baldness is unlike other conditions where you can progress past the point of being helped,” Dr. Bernstein said. “Once we have a cure for hair loss, everyone will be able to benefit.”

On male pattern baldness:

“Hair has been an evolutionary sign of health and sexuality and youth, and that doesn’t change,” Dr. Bernstein said. “Shaved heads look cool, but not everyone wants one, and not everyone looks good with one.”

The article also discusses interest among hair restoration physicians in researching the use of the eyelash growth medication Latisse for hair regrowth on the scalp.

Go here to read the article at the NYT.

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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.

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ACell, Inc. - Regenerative Medicine TechnologyNew developments in regenerative medicine, presented at the 18th Annual Scientific Meeting of the International Society for Hair Restoration (ISHRS) this past week, may have opened the possibility that a patient’s hair can be multiplied in his own scalp.

ACell, Inc., a company based in Columbia, Maryland, has developed and refined an Extracellular Matrix (ECM), a natural biological material that can be implanted at the site of an injury or damaged tissue in order to stimulate a unique healing response. The ECM stimulates the body’s own cells to form new tissue specific to that site (a process referred to as “Auto-cloning”).

The ACell MatriStem devices have had some preliminary success in allowing plucked hairs that were placed into recipient sites on the patient’s scalp to grow. Although this is a major breakthrough, significant work remains in order for hair multiplication to become a practical treatment for hair loss in men and women.

It is also anticipated that the regenerative properties of Extracellular Matrix will facilitate the healing of the incision in the donor area after a hair transplant. We are currently offering ACell to all patients undergoing follicular unit transplant procedures at no additional charge.

We are currently studying the use of ACell for scalp hair multiplication as well as the facilitation of wound healing in follicular unit transplantation procedures. We are also treating select patients outside the studies. If you are interested in participating, please give us a call.

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She turned me into a newt! I got better…

~ John Cleese, Monty Python and the Holy Grail

Have you ever thought that you want to be more like a newt? You might not have thought about it in those terms, but these tiny amphibians have a physical capability that human beings have dreamed about for eons: the capability of regenerating tissue. If we could tap into this capability, the possibilities for medical treatment are limitless. We could regrow an arm, a leg, a hand, repair a heart after a heart attack, or even regrow hair. Two new avenues of scientific research, discussed in an article in the New York Times, might just help us enable human beings regenerate tissue.

The Stanford Approach

For ages, it has been well known that humans do not possess the regenerative powers of lower vertebrates, such as newts and fish, but the reason has been a mystery. The researchers at Stanford University in California, working with mouse muscle cells, have begun to understand the mechanism behind the capability for certain animals to regenerate tissue.

It seems that lower vertebrates have a genetic makeup that allows their cells to multiply when tissue regeneration is needed. Since unchecked cell multiplication can also lead to tumor (cancer) formation, they also have a tumor suppressor gene known as Rb. This gene is naturally inactivated in newts and fish when they start regenerating tissue.

Mammals possess both the Rb gene and a backup, called the Arf gene, which will close down a cancer-prone cell if Rb fails to do so. […]

The Stanford team shut off both Rb and Arf with a chemical called silencing-RNA and found that the mouse muscle cells started dividing. When injected into a mouse’s leg, the cells fused into the existing muscle fibers, just as they are meant to.

It would appear then, that mammals, including humans, have regenerative capabilities normally programmed into their DNA, but over hundreds of millions of years these capabilities have been suppressed so that the more important function -– that of cancer prevention -– could operate. To clone human tissue, one would theoretically just need to deactivate the suppressor genes, but in a way that would not put the person at an increased risk of developing cancer. Of course, these genes have not yet been identified in man, nor is it known if they even exist.

The UCSF Approach

A second, but very different, approach to tissue regeneration has been taken up by Dr. Deepak Srivastava and his team at the University of California, San Francisco. Based on work by Japanese scientist Shinya Yamanaka, Dr. Srivastava successfully converted ordinary tissue cells (fibroblasts) of the mouse heart into heart muscle cells:

[Dr. Yamanaka] showed three years ago that skin cells could be converted to embryonic stem cells simply by adding four proteins known to regulate genes. Inspired by Dr. Yamanaka’s method, Dr. Srivastava and his colleagues selected 14 such proteins and eventually found that with only three of them they could convert heart fibroblast cells into heart muscle cells.

To make clinical use of the discovery, Dr. Srivastava said he would need first to duplicate the process with human cells, and then develop three drugs that could substitute for the three proteins used in the conversion process.

The drugs could then be injected into damaged areas of the heart to repair the cardiac muscle cells following a heart attack. By using heart fibroblasts to produce cardiac muscle cells, rather than using embryonic stem cells, it is possible that risk of unwanted tumor formation, often noted with stem cell therapies, can be avoided.

It is not a stretch to assume that if scientists can undo the inability of animals to grow heart muscle or limbs, we might someday be able to genetically reverse the inability of a bald person to grow hair.

View more information on hair cloning and hair cloning methods. Also view our hair cloning news and hair cloning glossary pages.

View Nicholas Wade’s NYT article, “Two New Paths to the Dream: Regeneration.” Also take a look at the diagram that accompanies the article.

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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.

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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.

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Q: What is the major obstacle to hair cloning?

A: Although many problems remain, the main one is to keep cloned cells differentiated (the ability to perform a specialized function, like producing a hair). There are certain cells in the skin, called fibroblasts, which reside around the base of the hair follicle. These cells are readily multiplied in a Petri dish. When these cells are injected into the skin, they have the ability to induce a hair to form (they are differentiated). The problem is that when these cells are multiplied in culture, they tend to lose this ability (they become undifferentiated).

A number of methods are being examined to keep these cells differentiated. Among them is the insertion of new genes into the cell’s nucleus to alter the expression of the existing genes. Another method is to change the spatial relationship of multiplying cells. The idea behind the second technique is that all embryonic cells have the same basic genetic material, but grow to have different functions (i.e., grow to form muscle, bone or nerves). One reason is that that the cells have a different physical relationship to one another and thus send different signals to each other based on this relationship. For example, the cells on the outside of a growing ball of cells may act differently than the cells on the inside, etc. If researchers can influence the way cells orient themselves as they multiply in the lab, this may enable them to become differentiated to produce hair and stay that way as the multiplication process continues.

For more on this intriguing topic, see the Hair Cloning and Hair Cloning Methods pages at the Bernstein Medical – Center for Hair Restoration website.

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Q: What is the difference between hair cloning, hair multiplication, and follicular neogeneis? I have read about these terms on the internet and am completely confused.

A: Cloning generally refers to the multiplication of fetal stem cells or embryonic tissues. “Hair cloning”, as the term is generally used, involves the multiplication of adult tissue cells that are used to induce the formation of new hair, so the term is not exactly accurate.

“Hair multiplication” refers to the multiplication of adult hair structures. This model is not actively being pursued since the hair follicle is too complex to be simply cultured in a tube. Instead individual cells called fibroblasts are removed from the scalp multiplied in tissue culture and then these are injected back into the scalp in the hope that they will induce intact follicles to form.

“Follicular neogeneis” is probably the best of these terms, as it describes the formation of new follicles derived from inducer cells that are cultured and then injected into the scalp. It is the preferred term of Ken Washenik at Aderans. Interctyex uses the term “follicular cell regeneration” for its technology.

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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.

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Hair transplantation was introduced in the United States by Dr. Norman Orentreich in 1959. He demonstrated that hair taken from one area of the scalp would continue to grow even if it were transplanted to a balding area of the head.

The problem with this scientific breakthrough was that hair was being transplanted in clumps or “plugs” that did not appear natural. And although patients who had hair transplants were indeed growing hair on what was once a balding pate, the appearance was akin to that of a doll’s head and hardly much of a cosmetic improvement for their baldness.

In 1995, Drs. Bernstein and Rassman presented a paper describing a new procedure surgical hair restoration called Follicular Unit Transplantation or FUT. In this new technique, hair would be transplanted using only naturally occurring, individual units of 1, 2, 3 or 4 follicles. These perfectly intact “follicular units” would be obtained by removing a single, thin strip of skin from the back of the scalp and then using a dissecting stereomicroscope to isolate the tiny naturally occurring groups of hair.

Since the publication of “Follicular Transplantation” hair transplantation has undergone an “extreme makeover” itself, in part due to the incredibly natural results that this powerful procedure can produce. FUT is now considered to be the state-of-the-art in hair transplant surgery and is currently the most widely used surgical hair restoration technique.

Robert M. Bernstein M.D., Clinical Professor of Dermatology at Columbia University in New York City, sat with us for a Q&A on hair transplant surgery and its future.

How are Hair Follicles Removed in Follicular Unit Transplantation?

In order to safely remove and preserve the follicular units without causing any damage to them, the donor tissue is removed in one thin piece. This technique is called Single Strip Harvesting and it is an essential component of follicular unit hair transplants.

How Many Grafts Should be Transplanted at Once?

The average session for a moderately bald person, who has lost most of the hair on the top of his scalp is around 2,500 grafts. Although it is best to complete the hair restoration in as few large sessions as possible, there are limits. When too large a strip is removed, it can cause undue tension in the donor area and cause a stretched scar or loss of hair. Excessively long hair transplants, where the grafts are kept outside the body for an extended period of time, may compromise graft survival.

Another issue with very large sessions is that a hair transplant doctor has less flexibility if problems arise during the surgery. Patient variability is an intrinsic part of hair transplants. In some patients, the grafts tend to pop up above the skin surface as they are inserted into the scalp. Popping also occurs when a graft placed in the skin causes an adjacent one to lift. The closer you put the grafts and the more grafts you transplant at one time, the greater the chance that these problems will occur and the more difficult they will be to manage. The goal is to always maximize what you get from the back and what grows in the front and top. It’s not a race where we have to do 3,000 or 4,000 grafts in every patient. When I hear people say, “Oh, I had 5,000 grafts.” I think “How many of those actually grew?”

Is Hair Transplant Surgery Permanent?

Yes, the hair on the back and sides of the scalp is permanent and it retains this characteristic even when moved to the front and top of the scalp.

Will Transplanted Hair Change Over Time?

The genetic tendency of hair to grow is dependent upon the donor area where the hair comes from. We call this “donor dominance.” However, the character of the hair, the wave, the rate of growth, is affected by the area where it is transplanted into. For example, we discovered that when we take scalp hair and transplant it to the eyebrows, over time, the growth rate actually slows down to match the growth of eyebrows. In this case, the recipient area has an influence on the growth of the eyebrow hair.

Can You Take Hair from Someone Else and Transplant it on Your Own Head?

You cannot perform hair transplants with hair taken from someone else. It has to be your own hair or it will be rejected by the body.

What is the Future of Hair Transplantation?

The next big improvement to the field of surgical hair restoration will be hair multiplication – commonly but erroneously referred to as hair cloning. This technique will dramatically increase a person’s limited donor supply, an issue that frustrates many patients wanting hair restoration.

The mechanism for cloning is based on the multiplication of the cells that surround a hair follicle. These cells, called fibroblasts are readily multiplied outside the body. Once multiplied, the “fibroblasts” could be injected into the skin to induce hairs to form. The problem is that when you multiply these fibroblasts, they lose their ability to stimulate hair to grow – a major roadblock that still needs to be overcome.

Another concern with hair cloning is that if you’re inducing hair to grow, what will it look like? Is it going to be wild and uncontrollably wiry? Will it look like the person’s normal hair? Because the recipient area plays a factor in the way a follicle grows, it’s reasonable to assume that even if you inject these fibroblasts to induce a hair to form, that hair will start to take on the characteristics of a person’s original hair.

It is exciting to think of the possibilities that improvements in the science of hair transplants will afford to those suffering from the effects of hair loss. Perhaps someday any baldness in men and women will be a result of choice and not a genetic constraint, but will unlikely be available for at least 5-10 years.

Watch video Q&A with Dr. Bernstein

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