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IMCAS World Congress 2022
Program

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FOCUS ON S034

Contributing lectures - Hair restoration

Room: Room 241 - Level 2
Date: Friday 3 June 2022 at 16:00 to 17:00
Format: CONTRIBUTED TALKS > session made up of abstract submissions that were carefully reviewed and selected by the Scientific Board

Chairs

Prof Manal BOSSEILA

Dermatologist

Egypt

Dr Rahul PILLAI

Dermatologist

India

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
16:00		Introduction		112432
16:02	Dr Ibrahim ABDELKAREEM	Follicular unit excision hair transplant in cicatricial alopecia	View	113790
16:10	Dr Ana COIMBRA FERNANDES	Effectiveness of Platelet-Rich Plasma for androgenetic alopecia after hair transplant	View	113890
16:18	Dr Miray AL MUSTAFA	PRP is not the first line treatment for hair loss	View	114333
16:26	Dr Mohammed Sajid MUGHAL	Age and stage of a hair transplant - Breaking the barrier of grades	View	114326
16:34	Dr Shameema DAMREE	Exosomes for hair regrowth and against greying	View	115029
16:42	Dr Hudson Alex LAZARO	Modern FUE technique to improve results with wide punchs	View	115116
16:50	Dr Claudia MARCAL	A new protocol for hair regrowth using erbium glass 1565 combined with different techniques	View	114327
16:58		Q&A		114328

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Recommended sessions

Alopecia (hair loss)

Combined treatments

Hair transplants (FUE, FUT)

Platelet-rich plasma (PRP)

Lasers

Introduction

Dr Ibrahim ABDELKAREEM

Dermatologist

Egypt

Other author(s) :

Follicular unit excision hair transplant in cicatricial alopecia

Objectives: Cicatricial alopecia affecting the self-esteem and self-image of the patient. This is where, hair restoration surgery (HRS) comes to restore the aesthetic look of the patient.

Hair restoration surgery in cicatricial alopecia cases is difficult but not impossible. Appropriate selection of the candidates and meticulous planning of the surgery will definitely yield good results.

Introduction: Cicatricial alopecia is a condition wherein the hair follicle is permanently destroyed and replaced by fibrous tissue. Due to permanent damage of the stem cells in the hair follicle bulge.
It can either be primary (lichen planopilaris, discoid lupus erythematosus, folliculitis decalvans, etc.) or secondary (to burns, radiation, trauma, etc.).
Pharmacological treatment in these cases can halt the progression of disease, but it cannot cause regrowth of the hair

Materials / method: As a hair transplant surgeon some challenges facing us during hair restoration in cicatricial alopecia
■ Graft survival
■ Compromised vascular supply of the scarred area
■ May lead to koebnerization, if the disease is active
■ Donor area itself, may be compromised by the disease
■ May need multiple sessions
■ Higher rate of complications
■ Low blood flow can cause infection, tissue ischemia, and necrosis after surgery
■ Unpredictable results
■ Close monitoring after surgery for any signs of relapse of the disease.

Results: Follicular unit excision (FUE) is definitely better than other procedures for Hair restoration in cicatricial alopecia.. A scarred tissue has poor blood supply and scalp oxygenation which is of utmost importance for a good uptake of the grafts. The depth of slit making also varies in the scarred tissue. If the scar is hypertrophic, the slits should be made deeper than normal, and if the scar is atrophic, the slits need to be less deep. The graft survival also depends on the number of grafts/cm2 . It is better if this number does not exceed 30 grafts/cm2 when performing hair transplant

Conclusion: Hair restoration surgery in cicatricial alopecia cases is difficult but not impossible. Appropriate selection of the candidates and meticulous planning of the surgery will definitely yield good results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ana COIMBRA FERNANDES

Cosmetic Surgeon

Portugal

Other author(s) : Paola Halfeld

Effectiveness of Platelet-Rich Plasma for androgenetic alopecia after hair transplant

Objectives: The aim of this study is to study efficacy of Platelet-rich plasma therapy (PRP) in follicular unit extraction (FUE) hair transplant. It is a retrospective study on FUE hair transplant subjects from 1 December 2020 to 31 January 2021. PRP is injected post-operatively during four sessions, one each month immediately after 1 month of surgery. It is known that PRP is beneficial in increasing density and reducing the catagen loss of transplanted hair leading to a fast recovery of the tissue. This study intend to evaluate the clinical effects of PRP in hair growing and density after FUE.

Introduction: It is known that PRP is beneficial in increasing density and reducing the catagen loss of transplanted hair leading to a fast recovery of the tissue. PRP helps to activate and release growth factors with stimulate new follicles and promote blood oxygenation. This study intend to evaluate the clinical effects of PRP in hair growing and density after hair transplant. it is important to study the number of PRP treatments to obtain optimal results after surgery. Also it is important to show that regenerative medicine is the future on tissue repair.

Materials / method: The collected data will be based in surveys and interviews to address the satisfaction score and observation from photograph assessment after 6 months of hair transplant (FUE technique). The inclusion criteria will be patients in the age group of 30–65 years, patients with androgenetic alopecia, patient who had not taken hair transplant in the last 5 years, patients with informed consent. A control group submitted to FUE who did not received a 4 cycle PRP at 1 month interval after and a study group who received a 4 cycle of PRP at 1 month interval. Each subject had 1 month and 6 month review.

Results: 67,9% of the 112 patients reported having good results above the expectation for 6 months after FUE. In PRP group the results after 6 months in frontal and posterior area were statistically significant (p>0.001) suggesting that patients after PRP treatment have better and earlier results comparing to the control group (non-PRP group) after 6 months. More than 50% of the PRP group had results better than expected. This result was statistically significant in PRP group (p<0.001) regarding patient satisfaction. Also a correlation between taking supplements and having earlier results (p=0.024).

Conclusion: Platelet-rich plasma is an effective treatment after follicular unit extraction and should be considered for follow-up after FUE to improve surgery results and treatment for AGA. PRP is effective increasing the anagen phase, improve wound healing time and obtain earlier resultsSeveral strategies have been studied to increase follicle viability and therefore create longer lasting and faster results for the patient. Further studies are needed to study the prevention of androgenic alopecia hair loss after hair transplantation.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Miray AL MUSTAFA

Dermatologist

Norway

Other author(s) :

PRP is not the first line treatment for hair loss

Objectives: As a cosmetic injector one will often encounter patients seeking help for hair loss. It seems to be the norm in the cosmetic field today that injection therapy with platelet rich plasma (PRP) is the first line treatment for every hair loss disorder.
Patients often turn to cosmetic clinics when experiencing hair loss, as the problem is often perceived as cosmetic rather than medical. It is therefore fundamental, before one turns to any injection therapy, to know what kind of hair loss disorder the patient has.

Introduction: There are two main groups of alopecias, scarring and non-scarring alopecias.
In scarring alopecias, the hair follicles ultimately get destroyed. The time it takes from the symptoms start to show until correct treatment is given, is therefore crucial.
When it comes to non-scarring alopecias, there is usually not a permanent destruction of the hair follicles, and the possibility for regrowth of hair is significantly better.

Materials / method: This is a case with histologically verified frontal fibrosing alopecia, a scarring alopecia with a growing incidence, where correct and early treatment introduced regrowth of the hair. The patient received daily topical 5% solution of minoxidil, biweekly topical steroid solution, and 7,5 mg/ml triamcinolone injections every six to eight weeks.

Results: The patient is a prime example where correct and early treatment introduced regrowth of the hair, which would not have been obtained by injections with platelet rich plasma.

Conclusion: To know how to diagnose and treat different types of alopecia correctly, does often not only require a dermatology specialization, but a sub specialization or special interest in trichology, the knowledge in hair loss and scalp disorders.
It is therefore recommended that the patient has been diagnosed by a dermatologist, and if possible, collaborate in the treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Mohammed Sajid MUGHAL

Cosmetic Surgeon

India

Other author(s) :

Age and stage of a hair transplant - Breaking the barrier of grades

Objectives: Understanding the correct stage and age of doing a hair transplant - Using angiogenesis for better nutrient supply to the pre-existing hair follicles and usage of existing blood vessels of already present weaker grafts in combination with VEGF for the prevention of immediate telogen phase after transplant and overall better outcome.

Introduction: Transplants done in early stages of male pattern baldness or FAGA, specially during miniaturisation increases the chances of achieving great results and decreases the chances of pre-existing hair follicles going extinct in the near future. Avoiding PRP and similar therapies therapies in the beginning and instead choosing Hair transplant changes the outcome to a far superior results.

Materials / method: Patients in early stages of male pattern baldness and those during miniaturisation were managed with fue hair transplant. follow-up with growth factor serum therapy was introduced monthly for four months in post hair transplant. face to short in the immediate illusion and achieve the best potential results.

Results: It was observed that if Hair Transplant is done in early stages of balding and in those with miniaturisation get benefited with better results. The angiogenesis boosts the pre-existing miniaturised hair into thicker long-lasting hair follicles. Also the diameter of pre-existing hair was observed to become thicker. Early HTs coupled with the introduction of growth factor serum therapy helped maintain the results for a longer duration and also to prevent further expansion of the balding area. The pre-existing hair fall also got under control with the same combination.

Conclusion: Transplants done in early stages specially during miniaturisation increase the chance of high-density results and decrease the chance of existing hair follicles going extinct in the near future. Patients can observe dreamy results from the correct timing of the transplant in combination with the growth factor therapies.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Shameema DAMREE

United Kingdom

Other author(s) :

Exosomes for hair regrowth and against greying

Objectives: 1.Understand the relationship between hair follicles / hair cycle and adipose cells.
2. Understand the hair follicle ageing process.
3. Understand the functions of the miRNAs and proteins of ASC-exosome for hair regrowth and scalp rejuvenation.
4. Understand the mechanism of action of ASC-exosomes on hair follicles 5.Innovative use of ASC-exosomes in minimally invasive hair regrowth and as a novel treatment against greying.6. Critical evaluation of international clinical cases conducted over the past two years across three continents.

Introduction: Hair follicles are located around adipose stem cells which interact with ASC-exosomes during the hair cycle. Hair ageing involves loss of stem cells, pigment cells, defective immune signals, reduction in regeneration leading to damage in the extracellular matrix. Exosomes have regenerative, anti-inflammatory and anti-ageing effects on dermal papilla cells (DPC). ASC-exosomes has been effectively used as a medical therapy for hair loss across three continents over the past two years and is proving to be a novel therapy against greying.

Materials / method: Scientific Studies:
Ex-vivo, in vitro and in vivo studies were conducted at ExoCoBio Exosome Research Institute investigating the morphology and function of ASC-exosomes on DPC.

International Clinical Case Series:
Across USA, Europe and Asia, after informed consent was obtained, a cohort of 50 patients were treated for male and female pattern hair loss and alopecia with ASC-exosomes +/- low level light therapy.

Results: In Vitro studies of efficacy of ASC-exosomes on DPC showed an increase in growth by 60% and 45% protection against senescence.A series of minimally invasive hair regrowth cases will be presented.a. Combination of ASC-exosomes with microneedling/mesotherapy +/- Low-Level Light Therapy, successful and faster hair regrowth both in male and female alopecia. Successful Hair regrowth in challenging cases using ASC-exosomes: Post multiple failed PRP sessions, post hair transplant surgery, hair regrowth was achieved. Hair regrowth was darker in colour and proof against greying was photographed.

Conclusion: The regenerative, anti-inflammatory and anti-ageing properties of ASC-exosome is highly effective for the treatment of male and female pattern hair loss and it might be a novel therapy against greying. ASC-exosome has superior clinical efficacy that can be confidently as a medical therapy against hair loss. ASC-exosome is a powerful medical therapy in complex hair loss cases. The synergistic effects of ASC-exosomes when used in combination with LLT will yield impressive results. It is novel cell-free therapeutic modality against greying and in the reversal of human dermal papillae.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Hudson Alex LAZARO

Plastic Surgeon

Brazil

Other author(s) :

Modern FUE technique to improve results with wide punchs

Objectives: 1: Provide the best result in inefficient hair growth of previous hair transplant
2: To correct aspects of failure in the anterior hairline
3: Preserve the donor area already damaged by the appearance of withdrawal with large punchs

Introduction: Hair transplantation has been developing a lot over the years. Nowadays this surgery have modern techniques that manage to place the hairs closer to each other using thinnest punchs and doing slits (pre-incisions) to promote the insertion of hairs easier. Also the use of implanters promote better results with less manipulation of grafts and closer insertion of the grafts with more natural looks are possible.

Materials / method: This study refers a male, 35 years old, submitted by a hair transplant surgery in 2015. In this first surgery, the punchs used probably were 4 mm or 5 mm dimensions. The patient presents also scars from a neurosurgery benign tumor extraction. This result demonstrate poor hair growth and big scars in the donor area. The patient was submitted to new hair transplant surgery in 2019, jan, 14. To collect in donor area was used coverage value calculation to avoid overharvesting. The punch used was 0,95 mm,

Results: After eighteen months, the final result of the second hair transplant was considered satisfactory by him, presenting improvement of the anterior hairline, better filling of the entire recipient region. Almost without harm to the donor area thanks to applying concepts of the coverage value calculation formula. This carefull harvesting proportionated preservation of the hairs of donor area. The use of less than 1 mm punchs are obligatory to this type of reapproach surgery. In this case, the option was to use 0,95 mm serrated punchs.

Conclusion: The Coverage Value calculation is obtained by this formula- number of follicular unit by square cm times the number of hair per follicular unit times the diameter of the hairs. 0,95 mm punch sizes gives less risk of visible scar, faster recovery of donor area, better hair grafts that proportionate best results. The use of pre incisions in recipient area and implanters to put the hair grafts into the scalp proportionate high density surgeries with natural results.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Claudia MARCAL

Dermatologist

Brazil

Other author(s) :

A new protocol for hair regrowth using erbium glass 1565 combined with different techniques

Objectives: This lecture will demonstrate the possibility to treat different conditions of hair loss, regardless of the gender and age of the patient, using a customized protocol, composed by NAFL (density = 100 and energy = 20 J/ cm²), intra-dermal therapy with PRP and drug delivery with topical sterile formulations rich in vitamins, oligo minerals, botanical extracts, mainly high level of sillicium, combined with oral prescription of minoxidil, finasteride and dutasteride, when necessary. This study will show the safety and efficacy of these synergic techniques and technologies.

Introduction: Nowadays it is known that hair loss is a medical condition that can affect females and, mainly, males. Its most common cause is called Androgenetic alopecia, and it is known that approximately 50% of female and 80% of male experience significant hair loss during their lifetime. However, factors like stress, bad nutrition, hormones alterations, lack of sleep, smoking, menopause, post pregnancy and other disorders, such as Alopecia Areata, Telogen Effluvium, Senescent Alopecia, Female Pattern Hair loss, and Frontal Fibrosing Alopecia, can also provoke hair loss and shaft hair miniaturization.

Materials / method: The treatment, performed in more than 100 volunteers, consists in the application of LED/LLLT during twenty-five minutes, followed by NAFL 1565nm (100 spots/cm2 and 20 mJ) applied in horizontal, vertical and oblique lines on the scalp hair, between shaft hair, one centimeter apart each other. This protocol requires from five to ten sessions, with an interval of fifteen days. A blend of extracts, vitamins, amino acids, antioxidant and minerals was applied immediately after the laser or PRP by pneumatic platform or intradermal therapy with syringe.

Results: Pull test, biopsies of the affected area (pre and pos treatment) and polarized light microscopy were used to measure the thickness of the shaft hair, terminal vellus ratio, improvement of the miniaturization of the follicles and analysis of hair cycle using trichoscopy. It is possible to observe that all patients demonstrated an improvement after the treatment with this specific protocol, since the density of the hair shaft was 0.3mm, and after over 4 months of the procedure the analyzed structures became terminal hair with 0.6 mm big.

Conclusion: The main NAFL 1565 mechanisms of action for hair growth are based on the inducement and increase of blood flow, reduction of cytokines and changes of grow factors. It’s also possible to observe direct stimulation of dermal papilla. The key factors of hair growth and hair cycle are connected to the action of FGF family (VEGF, IGF and others grow factors), which are included in the wound healing process. The main factor for hair growth stimulation and hair cycle progress is the WNT-B-CATENIN-LEF1 signaling. No adverse effects were observed and the biopsies confirms the efficacy of the procedure.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS World Congress 2022 Program

FOCUS ON S034

Contributing lectures - Hair restoration

Chairs

Lectures of the session

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IMCAS World Congress 2022
Program