Thank you for your question.
You submitted a question without a photo. And you’re asking in this question is adipose
derived stem cell treatment for hair loss better than PRP and Acell. You state in your
question that you have female pattern hair loss or androgenetic alopecia. And you’re
aware that the adipose derived stem cell treatment is more expensive than PRP and Acell and you
want to know is it better.
Well, I can certainly share with you my perspective on this question which is certainly something
that comes up in our practice fairly frequently. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. I am also the founder of
TrichoStem™ Hair Regeneration Centers. This is a system used by us, developed by us for
the past 7 years of using PRP with Acellular matrix and having developed systems and algorithms
of dosing and intervals that are unique to the methods that we employ using this system
for both men and women with hair loss, androgenetic alopecia.
So to begin with, the concept of what are we doing when we’re treating female pattern
hair loss, we have to begin with what is the cause of female pattern hair loss. And the
reality is, besides the genetics, there is no known associated factor as opposed to male
pattern hair loss where there is at least the awareness of something called dihydrotestosterone
or DHT that’s a variable that Is potentially treatable in male pattern hair loss.
Female pattern hair loss essentially, the only pharmaceutical intervention is minoxidil
5% foam, relatively recently approved. Otherwise, there has been nothing else. When we were
starting doing Acell and PRP combination over 7 years ago, we were doing it for transplants
and transplant surgery. And it was done for the purpose of improving the healing and yield
of the hair grafts as well as the healing of the donor area. A side-effect in some patients
was that thinning hair became thicker. So it became an opportunity for me to look into
the feasibility of using this as a way to treat hair loss.
Now we also have to understand that there is no cure for hair loss. What we are essentially
doing is we’re managing hair loss. And what have we learned from our clinical experience?
With a specific concentration of Acellular matrix, platelet-rich plasma injected in a
specific way, we can reactivate hair that isn't growing. Now what does that mean? Essentially,
when hair is thinning, the growth cycles get shorter and the resting phases get longer.
By definition, that means that there are fewer hairs which is greater than the normal percentage
which is usually 8-10% of hairs that are not actively growing because of the prolonged
resting phase. Stimulation of hair growth is observed by the reactivation and growth.
What else do we see? We see thinning hairs becoming thicker. So therefore hair quality
improves. You add numbers with quality and then you get better coverage.
Now what we have learned over time is that patients come with different lengths of hair
growth cycles depending on a lot of variables which we have ultimately created into an algorithm
and this algorithm is based on gender, age of onset, duration of hair loss, rate of progression
of hair loss and degree of hair loss. In addition for women, looking at other hormonal factors.
With that being said, with TrichoStem™ Hair Regeneration, we have been able to get consistent
improvement with the overwhelming majority of women with female pattern hair loss. Now
sometimes, there is a mixed picture. Sometimes a female pattern hair loss patient will also
have some hormonal irregularities even though it may not be detected by the blood tests.
And there are some patients who also happen to have some degree of chronic telogen effluvium.
There can be also patients who happen to have telogen effluvium or shedding due to stressors.
So that being said, when we think of what it is that we are accomplishing, the mechanism
of action is still unclear. But one variable that I think is probably contributing to this
is based on the work that has been done using fat and this is where we also look at the
adipose derived stem cells. What essentially is the premise is that with liposuction and
then processing of what’s known as stromal vascular fraction or SVF, you can inject fat
cells into the scalp and get essentially a fat grafting effect.
So what is essentially a common thread between the two procedures? Well basically, as is
observed when we use PRP and Acell into the skin is that the fat cells improve and this
has been shown in study after study in histology. Basically, stimulating the fat cells has benefit
to skin. We can therefore transfer that idea into better and more stem cell activity in
the scalp resulting in probably some positive benefit in the fat cells which thereby affects
the hair growth cycles.
So then the question is, what is better? Well, I am a cosmetic surgeon and liposuction has
been a very big part of my practice so harvesting fat is no problem. My objection to fat transfer
or fat grafting compared to Acellular matrix and PRP is that first, is it worthwhile to
put a patient through the harvesting of the fat and this placement? Placement of fat in
the scalp is more traumatic than injecting Acellular matrix and PRP. With that trauma,
comes a certain degree of risk related to inflammation as well as potential for bleeding.
A recent study done I believe in behalf of a particular medical processing unit, a device
to process fat was done in a small group. I believe it was 10 people, in that group
where fat was harvested and processed, they were able to show some benefit in a handful
of those patients. Of the I believe 9 patients that were on the study, only 6 of them remained
in the study and several were lost to follow-up. The numbers are too small to make significant
comparison. What we can conclude is that fat transfer has some benefit in hair growth in
some patients according to that study.
When we look at our own history of treating patients with Acellular matrix and PRP and
developing Hair Regeneration in the algorithm, it has been my decision throughout this time
and it may change if we find something better with adipose derived stem cells is my decision
that essentially, there is no advantage that I can see of using fat grafting over the injection
of Acell and PRP.
In addition, when we think of the management of hair loss, we have to think of growth cycles.
We have to think of longevity and maximizing sustainability. That means timing of injections
when there is more than one injection necessary. I think it’s very difficult for patients
to undergo multiple fat grafting sessions as well as go through the risk and the trauma
and the amount of swelling that is associated. One patient in that small study had a hematoma.
That means there was a lot of bleeding under the scalp and that is a complication that
is in my opinion avoidable by using Acellular matrix and PRP.
So I think that you should look into the options because as far as Acell and PRP is concerned,
all practitioners are not equal. I think it’s important that you find a practitioner who
has extensive experience with female pattern hair loss, the use of Acellular matrix and
PRP who have been doing this treatment for years and not the overwhelming group of people
that are joining the parade and doing it for only a relatively short period of time and
are still learning. I think it’s important to understand that there is a necessity for
customization in order to get the best outcome in managing hair loss whether it’s for women
or for men.
Again, in conclusion, thus far, I would not recommend adipose derived stem cells over
Acellular matrix and PRP. Learn more and hopefully this was helpful to you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.