Notes from the ISHRS 2009 Conference, Part 2
I just got back from the 17th annual scientific ISHRS meeting (basically a hair transplant doctor’s convention), which went on from July 22-26. Lots of information was presented… lots of lectures, presentations, and discussions. This year’s meeting was in Amsterdam, so I had quite a long flight back to California when it was all over and I was able to do a write up on the plane of what I learned. I thought I’d share…
If you missed yesterday’s post, check out part 1 of my ISHRS meeting notes! Here’s part 2…
Surgical
Hair transplant failures:
Hair transplant failures are often due to undiagnosed scarring (cicatricial) alopecias, so the need to detect them is critically important in advance of the procedure. The skin is often white and shiny and their activity may be in spurts, active at some times and inactive at other times. In my opinion and from my experience, women suffer more undiagnosed scarring alopecias than men and reflecting abnormal patterns of balding may be a clue to their presence. The doctor usually makes the diagnosis when these abnormal balding patterns appear and then the doctor will take multiple skin biopsies in the identified areas. Biopsies are the traditional approach, but the tissues that are taken for biopsy must have some active disease going on to affirm a diagnosis. When the biopsy approach to diagnosis is made, they are made with sizable tools (usually a series of 4 mm punches along the edge of the abnormal balding pattern). Alternatively, test transplants (which are limited procedures) can be done to see if growth occurs at 6-8 months. I have been performing test transplants over the years in such suspicious cases, as this is a more certain way of making the anticipation of success or failure of a traditional hair transplant. Failures of transplants in patients with such scarring alopecias are common.
Hairline design:
This is an area that I find most interesting. My philosophy is very different than most other doctors in the field. I tend to place hairlines in the mature position while most other doctors place the hairlines higher with more recession. There is a belief by many doctors that eventually a traditional mature hairline normally found in a non-balding man will not look normal as a man ages, so the hairline designs offered by many of my colleagues leave portions of the Norwood Class 3 and 4 frontal pattern into the end design of the hairline. Most men, however, want the man that they see in the mirror to reflect the mature hairline, not an “older” looking hairline, so I recommend the mature hairline almost all of the time. This is easily seen at our monthly open house events or online in our Hairline Photo Gallery. As my design of a hairline differs from many of the designs of my colleagues, the art form of a hair transplant surgeon will be evident to all.
Graft trimming:
Graft trimming by the surgeon and his team seems to reflect the robustness of the hair growth. A study was performed by Dr. Michael Beehner, where he trimmed the grafts from chunky to very skinny. The grafts that were made very skinny did not grow as well as those grafts that were made more chunky with more fat surrounding the hair grafts. Dr. Beehner believes that making grafts very skinny seems to:
- Open them up to the damage from drying and being out of the body for any prolonged period.
- Critical elements of the growth centers where stem cells exist, may be trimmed away during graft preparation.
New Hair Institute has always produced chubby grafts for these obvious reasons giving us a good growth track record. There is a direct relationships between the size of the graft and the ability to make recipient sites and place them well. The need to match the graft thickness with the recipient site holes are critical for good graft stability and growth.
FUE:
Four devices were shown to improve the FUE (follicular unit extraction) process. Each claimed that their product was the only one that worked. Every one had a mechanical rotation associated with it one with vibration, others with partial twists of varying diseases. Costs for these devices run as little as $60/each for a disposable device, to as high as possibly $200,000 for robotic controlled FUE soon to be available on the market. Clearly when there are so many options offered, the suggestion is that none really work well. Time will tell which are the best instruments by next year’s ISHRS meeting in Boston.
Saturday morning held a series of sessions called “Breakfast with the Experts”. My session on FUE seemed to have the highest audience. The concerns by the participants were the wild and unsubstantiated claims in performing high numbers of FUEs in a single procedure and a very unrealistic view of damage to the FUE graft from transaction and stripping the grafts in the process of extracting the grafts.
Wound closures:
Would closures from strip surgery were discussed in great detail by many doctors, each promoting their own prejudices. There was clearly no technique that was better than others to prevent scarring. Suggestions on trichophytic closures were one of the few bright spots, but the differences in the techniques used by the various doctors, in my opinion, ranged from effective to completely ineffective. In other words, getting a trichophytic closure is no guarantee of a great result from the technique and a trichophytic closure in one doctor’s hands may be a radically different technique than the same procedure in another doctor’s hands. Results ranged anywhere between wonderful and a complete failure.
Can you discuss using stem cells to cure baldness?
Can you give us your view on Histogen’s progression? The progression they showed after just 1 injection can’t be ignored!
Can you share the results of the Korean dutasteride study in terms of effectiveness?
Please dont take this the wrong way as I respect you immensely, but Doctor havent you still realised all people who come on this blog care about is hearing more about the hair cloning procedures and its development, It’s as if your in denial of its possible success and dont want to share information up on it to us because you are a very successful hair surgeon.
Dr. Rassman:
Thanks for the updates and your insights and opinions. You have a typo up there that I’m sure you would want to correct. In the FUE section, in reference to the FUE devices, you said, “others with partial twists of varying diseases.” I am sure you meant to say “degrees.” Lol.
To Rick who posted a comment above:
I totally disagree with what you wrote. I think very few people come on here to find out about hair cloning. When I was a little kid, I was told that, around the year 2000, everyone would be driving cars that fly. I wonder about hair cloning as much as I wonder if I will ever see those cars really come out.
Dr. Rassman probably doesn’t write about it more because he has already said all there is to say. It’s still a far away reality at this point.
I can’t believe you would think he is holding back on you! If hair cloning actually did come about, who do you think would perform the procedures? Probably the same docs who are now doing hair transplants. Dr. Rassman, and other docs, have nothing to fear from the technology. They would just shift their practice from one thing to another. Plus, there still will be plenty of need for hair transplants because the cost of hair cloning would probably be too high for all but the very wealthy.
Look at the comments above mine. 90% of the time that is all I see. I thought he was holding back because of the way he responds to people asking about hair cloning, his replies are unbelievably linear.
If there was something to report on cloning, you don’t think Dr Rassman or even the mainstream news would report on it? I mean, look at the mainstream media…botox for treating hair loss??! I must’ve seen that story on the news 5 times and all it really was was a press release from one doctor that treated someone with botox after chemo when their hair would’ve likely regrown anyway. In other words, the news will jump on any little nugget that’ll make a good headline.
And when you tell someone to not take something the wrong way, you shouldn’t then go about insulting their integrity. For example…don’t take this the wrong way, but use some common sense.
I’m very surprised that Dr Rassman doesn’t seem to want to discuss the Histogen results. Surely their proto-treatment is one of the most promising areas of investigation? If Histogen is on the cusp of something big, why the silence? If it’s all a crock, Dr Rassman should say so too. What gives?