PracticalDermatology

Chytra V. Anand, MBBS, MSc, Jeannette Graf, MD, Neil Sadick, MD

While there is still no cure for hair loss, researchers are making impressive strides in treating androgenetic alopecia, and Cosmetic Surgery Forum faculty members are on the front lines of many of these advances, including Progenitor Cell Therapy and platelet-rich plasma (PRP) injections, which can be used alone or in combination with other modalities to address hair loss and thinning.

Progenitor Cell Therapy

Progenitor Cell Therapy, which involves taking micrografts from the hair line and re-injecting them into the scalp, is commonly performed in India and may soon find its way to US shores, says dermatologist and CSF faculty member Chytra V. Anand, MBBS, MSc, founder and CEO of Kosmoderma Skin, Hair & Body Clinic, with offices throughout India.

These micrografts are rich in progenitor (stem) cells, growth factors, and an extracellular matrix and produce a more noticeable effect than PRP, which only contains growth factors, Dr. Anand explains. To perform the procedure, she uses a 27-gauge needle with an injection depth of approximately 3mm. Next, she prepares the micrografts by placing them into a machine that turns the tissue into a solution. Because there is no blood extraction, it’s fairly painless, and results are often seen within four to six months, she says.

Patient selection for Progenitor Cell Therapy is critical. The ideal hair loss patient for Progenitor Cell Therapy is experiencing mild-to-moderate thinning and hair loss, has a healthy scalp and a healthy diet, she says. Importantly, visible signs of hair miniaturization are mandatory to ensure the micrografts are viable. The procedure itself takes approximately 45 minutes, doesn’t require extensive aftercare, and can be repeated on a yearly basis, she says.

Dr. Anand sometimes combines PRP with progenitor cells. “I perform the progenitor cell procedure and after six months I perform PRP [on a] quarterly basis. This has enhanced my results,” she says.

That’s not all that she is excited about in the hair restoration arena. “Hair Genesis with stem cells is new and here to stay,” she says. To perform this procedure, Dr. Anand makes 3mm punch biopsies at the hairline then splices the biopsy with saline at high speed using a special 600-blade splicer to create a solution that is immediately injected into the scalp. “This works for androgenetic alopecia with hair micronization, and only if there is visible hair thinning,” she says.

Micropigmentation of the scalp with hair transplantation can also give a fuller look and better coverage, she says. “This is an increasing trend.”

PRP in Practice

PRP, when used alone, is producing impressive results for patents with androgenetic alopecia, says Jeannette Graf, MD, an assistant clinical professor of dermatology at the Mount Sinai Hospital in New York City. “For best results, PRP treatments can be performed every four to six weeks,” she says. “Maintenance treatments can be spaced by giving a treatment every four months after.”

New York City dermatologist Neil Sadick, MD, a Clinical Professor of Dermatology at Weill Cornell Medical College, achieves better outcomes when he combines PRP with microneedling or fractional lasers. “We are now beginning to work on a new PRP product that combines hyaluronic acid as the stabilizing agent in conjunction with PRP to help the PRP to be more potent and to last for a longer period of time,” he says.

He is also impressed with improvements in robotic hair transplants. “The ARTAS robot is not only able to harvest donor micrografts or follicular units from the donor part of the scalp, but now for the first time the robot is able to implant those grafts as well,” he says.

Pro Tips on Navigating the Hair Loss Supplement Aisle

Supplements are playing an increasing role in treating hair loss, CSF faculty members agree. Dr. Anand favors oral supplement alternatives to finasteride, including saw palmetto and anagain. “The combination of these two natural dihydrotestosterone inhibitors is gaining traction across the globe,” she says. “In India, we use this combination in all androgenetic alopecia cases.”

Dr. Graf is a fan of Nutrafol Hair supplements. “These highly researched and studied complexes of natural ingredients block the inflammatory and micro-inflammatory processes that play a role in hair loss,” she says. “Many patients have noticed hair thickening and diminished hair loss. I have several patients who are breast cancer survivors who noted that areas of chemotherapy-related hair loss that had been present for years showed regrowth.”

The hair restoratiom pipeline

There are other exciting areas of research in hair loss, including JAK inhibition and the development of drugs that target the sonic hedgehog signaling pathway.

At present, six JAK inhibitors are either approved for various conditions or under development, adds Dr. Schlessinger. “Tofacitinib (Xeljanz) has been investigated both in clinical trials and off-label for the treatment of alopecia areata and had positive improvement in Severity of Alopecia Tool (SALT) scores in various trials,” he says. “This area has great promise also for the treatment of nail dystrophy associated with alopecia areata. Trials are ongoing for this condition and we will look forward to more data in the future.”

Dr. Graf adds that the sonic hedgehog gene pathway may activate signals that stimulate hair growth and regeneration. “It is an interesting research topic. Stay tuned.”

Cosmetic Surgery Forum 2021 will be held December 1-4 in Nashville. Register online or get more information at CosmeticSurgeryForum.com.