Platelet lysate promotes hair growth: In vitro and in vivo mechanism and randomized, controlled trial.

BACKGROUND: Platelet lysate (PL), a novel platelet derivative, has been widely used in regenerative medicine and is a potential therapy for improving hair growth. It is necessary to fully clarify the potential mechanism and evaluate preliminary clinical effect of PL on hair growth. METHODS: We used the C57BL/6 model, organ-cultured hair follicles, and RNA-seq analysis to explore the mechanisms of PL regulating hair growth. Then, we performed a randomized, controlled, double-blind study of 107 AGA patients to verify the therapeutic efficacy of PL. RESULTS: The results confirmed that PL improved hair growth and accelerated hair cycling in mice. Organ-cultured hair follicle evaluation confirmed that PL prolonged anagen remarkably and down-regulated IL-6, C-FOS, and p-STAT5a. Clinically, diameter, hair counts, absolute anagen counts and changes from baseline in the PL group showed a significant improvement at 6 months. CONCLUSIONS: We elucidated the specific molecular mechanism of PL action on hair growth and proved equal changes in hair follicle performance after PL vs PRP in AGA patients. This study provided novel knowledge of PL, making it ideal for AGA.

Efficacy of Platelet-Rich Plasma plus Basic Fibroblast Growth Factor on the Treatment of Androgenic Alopecia.

BACKGROUND: Studies have identified platelet-rich plasma (PRP) as a novel adjuvant therapy in androgenetic alopecia (AGA). However, the efficacy of PRP still needs to be improved. The purpose of this study was to assess the efficacy of PRP plus basic fibroblast growth factor (PRPF) for the treatment of AGA. METHODS: This was a prospective randomized, double-blind, placebo-controlled, half-head study. Eighty patients whose AGA was staged Norwood-Hamilton stages III to VII or Ludwig stages I to III were enrolled in the study from February of 2019 to September of 2019. Patients were divided randomly into two groups of 40 patients each and were given the following treatment: group 1, PRPF was injected in the right half and the left half with placebo; group 2, PRPF was injected in the right half and the left half with PRP. The treatment was processed three times, 1 month apart. Hair growth parameters were evaluated by trichoscope monthly until the sixth month of the study. Patient satisfaction, hair pull test, and side effects were recorded during follow-up. RESULTS: Of the 80 patients included in the study, 47 were men and 33 were women with a mean age of 28.96 ± 4.82 years (range, 21 to 46 years). Both PRP and PRPF showed positive improvement ( P < 0.05) on hair count, terminal hair, and anagen hair after the treatment. Efficacy of PRPF revealed a significant improvement ( P < 0.05) in hair count, terminal hair, vellus hair, and anagen hair versus PRP. There was no statistical difference among any of the parameters in the placebo group. CONCLUSION: PRPF can be a safe and valuable form of AGA treatment, and has proven to be more effective than PRP. CLINICAL RELEVANCE STATEMENT: Hybrid therapy of PRP with relative growth factors, such as basic fibroblast growth factor, have prominent efficacy on treatment of AGA. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Modeling human gray hair by irradiation as a valuable tool to study aspects of tissue aging.

As one of the earliest and most visible phenomenon of aging, gray hair makes it a unique model system for investigating the mechanism of aging. Ionizing radiation successfully induces gray hair in mice, and also provides a venue to establish an organ-cultured human gray hair model. To establish a suitable organ-cultured human gray HF model by IR, which imitates gray hair in the elderly, and to explore the mechanisms behind the model. By detecting growth parameters, melanotic and senescence markers of the model, we found that the model of 5 Gy accords best with features of elderly gray hair. Then, we investigated the formation mechanisms of the model by RNA-sequencing. We demonstrated that the model of organ-cultured gray HFs after 5 Gy irradiation is closest to the older gray HFs. Moreover, the 5 Gy inhibited the expression of TRP-1, Tyr, Pmel17, and MITF in hair bulbs/ORS of HFs. The 5 Gy also significantly induced ectopically pigmented melanocytes and increased the expression of DNA damage and senescence in HFs. Finally, RNA-seq analysis of the model suggested that IR resulted in cell DNA damage, and the accumulation of oxidative stress in the keratinocytes. Oxidative stress and DNA damage caused cell dysfunction and decreased melanin synthesis in the gray HFs. We found that HFs irradiated at 5 Gy successfully constructed an appropriate aging HF model. This may provide a useful model for cost-effective and predictable treatment strategies to human hair graying and the process of aging.

Relieving postoperative pain using tumescent solution with ropivacaine in follicular unit excision.

BACKGROUND: Local tumescent anesthesia relieves postoperative pain. OBJECTIVE: The objective of the study was to compare the effect of injecting a tumescent solution with/without ropivacaine on postoperative pain. METHODS: A randomized, double-blind control study was conducted in 314 patients who underwent first follicular unit excision after obtaining informed consent and ethics committee approval. The patients were randomly divided into three groups: intra-groups (group 1, injected with tumescent solution with ropivacaine; group 2, without ropivacaine) and inter-group (group 3, right-head/left-head side with/without ropivacaine). Postoperative pain was recorded using the 5-point Wong-Baker Faces Pain Scale. No preoperative analgesic was administered to any patient. The survival rate of hair follicles was measured using dermoscopy during follow-up. Data were statistically analyzed. RESULTS: Of the 314 patients included in the study, 166 were men and 148 were women with a mean age of 32.15 ± 4.58 (range, 25-45) years. Postoperative pain with ropivacaine was significantly more relieved compared with that without ropivacaine in both groups (p < 0.05). There was no significant difference between sex and survival rate of hair follicles in the intra- or inter-group. CONCLUSION: A tumescent solution with ropivacaine has proven to relieve postoperative pain and is a safe and valuable form of local anesthesia in follicular unit excision.

Emerging Role of Dermal White Adipose Tissue in Modulating Hair Follicle Development During Aging.

Hair follicle stem cells are extensively reprogrammed by the aging process, manifesting as diminished self-renewal and delayed responsiveness to activating cues, orchestrated by both intrinsic microenvironmental and extrinsic macroenvironmental regulators. Dermal white adipose tissue (dWAT) is one of the peripheral tissues directly adjacent to hair follicles (HFs) and acts as a critical macroenvironmental niche of HF. dWAT directly contributes to HF aging by paracrine signal secretion. However, the altered interrelationship between dWAT and HF with aging has not been thoroughly understood. Here, through microdissection, we separated dWAT from the skin of aged mice (18 months) and young mice (2 months) in telogen and depilation-induced anagen for transcriptome comparing. Notably, compared with young dWAT, aberrant inflammatory regulators were recapitulated in aging dWAT in telogen, including substantial overexpressed inflammatory cytokines, matrix metalloproteinases, and prostaglandin members. Nonetheless, with anagen initiation, inflammation programs were mostly abolished in aging dWAT, and instead of which, impaired collagen biosynthesis, angiogenesis, and melanin synthesis were identified. Furthermore, we confirmed the inhibitory effect on hair growth of CXCL1, one of the most significantly upregulated inflammation cytokines in aging dWAT. Besides this, we also identified the under-expressed genes related to Wnt signaling fibroblast growth factor family members and increased BMP signaling in aging dWAT, further unraveling the emerging role of dWAT in aging HFs malfunction. Finally, we proved that relieving inflammation of aging dWAT by injecting high-level veratric acid stimulated HF regenerative behavior in aged mice. Concomitantly, significantly decreased TNF-a, CCL2, IL-5, CSF2, and increased IL10 in dWAT was identified. Overall, the results elaborated on the complex physiological cycling changes of dWAT during aging, providing a basis for the potential regulatory effect of dWAT on aging HFs.

Effect of De-epithelialization on Graft Survival Rate After Follicular Unit Extraction.

BACKGROUND: To achieve a natural postoperative appearance, hair grafts are often de-epithelialized from the epidermis during follicular unit extraction (FUE). However, the effect of de-epithelialization on the survival rate of transplanted hair follicles (HFs) has not been investigated. OBJECTIVE: To investigate the effect of de-epithelialization on the survival rate of transplanted HFs. METHODS: A total of 64 male patients with androgenetic alopecia were included in this study. They were randomly divided into de-epithelialization and control groups. Organ culture was performed to assess the elongation of hair shaft and the percentage of anagen HFs in both groups. Patients were followed up postoperatively to evaluate complications, postoperative shedding, survival rates, and satisfaction. RESULTS: No significant difference in hair shaft elongation and percentage of anagen HFs was observed between both groups. The immediate postoperative satisfaction in the control group was much lower than that in the de-epithelialization group (71.25% and 100%, respectively). No significant differences in shedding rate, graft survival rate, and complications were noticed between both groups. CONCLUSION: Follicular de-epithelialization does not affect the survival rate of graft in FUE. Based on these data, de-epithelialization may improve immediate postoperative appearance and lead to a more pleasing cosmetic outcome.

Comparison of low-level light therapy and combination therapy of 5% minoxidil in the treatment of female pattern hair loss.

This study was conducted in order to compare the safety and efficacy of LLLT, 5% minoxidil, and combination therapy in the treatment of FPHL. A randomized controlled trial was developed to study the effect of LLLT on FPHL using a device called iHelmet®, which is equipped with 200 5mW laser diode source (650 nm) arrays. Ninety Ludwig's types II-III FPHL patients were randomly divided into 3 groups: LLLT group (A), 5% minoxidil group (B), and combination group(C). Hair density, hair diameter, and scalp oil-secretion were detected to evaluate the treatment effect. Significant improvement of hair density and hair diameter was observed in all stages of FPHL after treatment. Oil-secretion of the three groups was decreased after treatment. The effectiveness of reducing oil-secretion in LLLT group and combination group was higher than minoxidil group (P < 0.05). For improving hair diameter and hair density, combination group was better than LLLT and minoxidil groups. No side effects were reported. Our study illustrated that LLLT is a safe and effective treatment for FPHL. Besides, LLLT can significantly improve its efficacy when used in combination with 5% minoxidil.

Extensive Scarring Alopecia Treated Through a Single Dense-Packing Follicular Unit Extraction Megasession.

BACKGROUND: Follicular unit extraction (FUE) is becoming more popular in hair restoration. However, its potential for treating extensive scarring alopecia is unknown. METHODS: Patients with scarring alopecia larger than 100 cm2 were enrolled from 2015 to 2018. After assessing scar quality regarding vascularity, pliability, and thickness, dense-packing megasession (DPM)-FUE was performed on high-quality recipient sites. Patients were followed up at 1 week and 12 months postoperatively to evaluate complications, survival rates of grafts, and patient satisfactions. Cases of nonscarring alopecia were reviewed as controls. RESULTS: Fifty-two scarring alopecia and 55 nonscarring alopecia patients were enrolled. The mean scar area was 120 cm2, and the procedure required an average of 8 operative hours, with no difference between groups (p > .05). Graft amount and postoperative complications were similar as well (p > .05). The survival rate in scarring alopecia was lower than that in the control but was still 85% (p < .05). Follow-up photographs showed effective scar camouflage after DPM-FUE. Most patients were very satisfied with the final results (p > .05). CONCLUSION: DPM-FUE is a safe and effective treatment for extensive scarring alopecia.

The effect of hyperbaric oxygen therapy combined with hair transplantation surgery for the treatment of alopecia.

BACKGROUND: Transplanted hair follicles suffer from various injuries, which are difficult to prevent. Hyperbaric oxygen therapy (HBOT) was reported to be an excellent procedure to promote capillary regeneration and reduce ischemia-reperfusion injury. AIM: To evaluate the clinical efficacy of HBOT as an adjuvant therapy for hair transplantation surgery. METHODS: Thirty-four patients with II-IV alopecia were divided into the control group and HBOT group randomly. The control group was treated with routine FUE procedure, while HBOT group combined with HBOT. Patients were treated with 100% oxygen under 2.0 atmospheres absolute pressure for 60 minutes through a facemask during HBOT and take the therapy daily for 7 days continuously after operation. Satisfaction and clinical improvement were evaluated at the fourth week and the sixth month postoperatively. RESULTS: Itching and folliculitis were significantly decreased in HBOT group (11.8% vs 35.3%). In addition, HBOT resulted in a lower postoperative shedding rate (27.6 ± 2.6% vs 69.1 ± 2.4%); nevertheless, the survival rate at 9 months showed no significant difference between HBOT (96.9 ± 0.5%) and control (93.8 ± 0.6%). The early postoperative satisfaction in control group was much lower than HBOT group (52.9% vs 88.2%), whereas all patients showed satisfaction with the final result. CONCLUSION: Hyperbaric oxygen therapy is able to minimize the postsurgical follicle shedding and lead to less folliculitis and itching, which provides evidence for HBOT to act as an adjuvant therapy for hair transplantation surgery.

Clinical experience on follicular unit extraction megasession for severe androgenetic alopecia.

BACKGROUND: Severe androgenetic alopecia has significant impact on patients' self-image and emotional health. As the most advanced way to achieve the growth of a full head of hair in shortest period of time, the megasession hair transplant procedure is a promising treatment for severe androgenetic alopecia. AIMS: To introduce the procedure and technical details of follicular unit extraction megasession and to evaluate the surgery outcome. METHOD: A total of 273 male patients undergoing follicular unit extraction (FUE) megasession between 2016 and 2018 were included in our study. The extraction was performed using 1.0 mm punch. The BASP classification degree of patient hair loss, the number of extracted hair, surgery consuming time, and graft survival rate were recorded. We finally evaluated patients' satisfaction with surgery outcomes. RESULTS: Ages of patients ranged from 28 to 53 years, with a mean of 42 years (SD, 8.42). All of them were at C3 and U1 degree of BA type hair loss according to the BASP classification. The number of follicular units transplanted was between 3000 and 6000, with surgery duration range from 6 hours to 12 hours and graft survival rate varies from 93.5% to 96.6%. A total of 81% of them were satisfied with the outcomes, 19% of them had a second procedure performed to provide further hair density. None of them had infection after the surgery. CONCLUSION: Compared with multi-stage hair transplantation, FUE megasession has the advantages of reducing operation frequency and overall surgery duration. Thus, FUE megasession is an appealing treatment option for severe AGA patients, who expect to a more desirable natural and esthetically pleasing result in a one-stage operation.

Large-Scale Beard Extraction Enhances the Cosmetic Results of Scalp Hair Restoration in Advanced Androgenetic Alopecia in East Asian Men: A Retrospective Study.

INTRODUCTION: Beard hair serves as an important additional donor supply to support hair transplantation in hirsute patients with extensive alopecia and lacking sufficient occipital hair. However, the efficacy and safety of large-scale beard hair extraction have not been studied extensively in the East Asian population. METHODS: Data obtained from hirsute patients with extensive alopecia who underwent hair transplantation between March 2017 and December 2018 at Nanfang Hospital were analyzed. Occipital and beard hair were evaluated separately during the pre-, intra-, and post-operative periods. Individual beard hair follicular units (FUs) were harvested under tumescence using a hollow punch with an outer diameter of 0.8-0.9 mm. Follow-up examinations were scheduled at 3-5 days, 1 month, and 9 months postoperatively to check for complications, determine the survival rate of mixed, transplanted FU grafts, and assess patient satisfaction. Data were collected and analyzed statistically. RESULTS: A total of 36 hirsute, male patients with advanced androgenetic alopecia (AGA) (Norwood-Hamilton V-VI) were included in this study. The density of the occipital and beard areas was 78.6 ± 4.6 and 48.4 ± 9.3 FU, respectively. It took 3.1 ± 0.9 h to harvest 3135 ± 863 FUs from the occipital area and 2.1 ± 0.6 h to harvest 2352 ± 599 FUs from the beard area. The transection rate for occipital FUs and beard FUs was 3.7 ± 0.4 and 3.9 ± 0.2%, respectively. Completion of the operation took approximately 10.0 ± 0.9 h, and no serious complications were reported 5 days after the procedure. An FU survival rate of 95.7 ± 1.6% was observed at 9 months after transplantation, with no visible hypopigmented scars observed in the bare areas. All patients were satisfied with the resulting cosmetic appearance. CONCLUSION: Large-scale beard extraction, when combined with occipital hair extraction, is a safe and effective treatment to enhance the cosmetic appearance of East Asian men with advanced AGA.

Evaluating the Satisfaction of Patients Undergoing Hair Transplantation Surgery Using the FACE-Q Scales.

BACKGROUND: It is necessary to evaluate a successful cosmetic procedure from the patients' perspective. FACE-Q is a patient-reported outcome scale for patients undergoing cosmetic procedures. However, currently there are no FACE-Q scales used in the field of hair transplant surgery. This article aims to apply FACE-Q scales to evaluate the satisfaction of patients undergoing hair transplantation surgery. METHODS: FACE-Q scales were modified to contain both preoperative and 6-month postoperative self-assessment, including baseline preoperative information of patients (such as age, family history of alopecia, Hamilton' alopecia grade),preoperative self-assessment (satisfaction with appearance, the preoperative visual age, expected visual age) and postoperative self-assessment (satisfaction with appearance, postoperative visual age, satisfaction with decision, psychological well-being and social function). Besides, early life impact and recovery early symptoms were also re-evaluated. RESULTS: The mean difference between the 6-month satisfaction with appearance and baseline scores showed a significant increase of 29.62 (baseline, 46.97; 6-month, 76.59; P < 0.001) and patients perceived they appeared 5.81 years younger after surgery (P < 0.001). Postoperative satisfaction with appearance has no significant relevance with gender (P = 0.460), age (P = 0.529), marriage (P = 0.811) or family history of alopecia (P = 0.641). However, income (P = 0.003), educational level (P = 0.003), the purpose of hair transplantation (P = 0.018) and early life impact (P = 0.002) were shown to have a significant impact on satisfaction with appearance. CONCLUSIONS: The FACE-Q scales are a valid and reliable patient-reported outcome tool for patients undergoing hair transplantation and can be widely used to evaluate the satisfaction of patients undergoing such surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

As a carrier-transporter for hair follicle reconstitution, platelet-rich plasma promotes proliferation and induction of mouse dermal papilla cells.

Morphogenesis of hair follicles during development and in hair reconstitution assays involves complex interactions between epithelial cells and dermal papilla cells (DPCs). DPCs may be a source of cells for hair regeneration in alopecia patients. Reconstitution of engineered hair follicles requires in vitro culture of trichogenic cells, a three-dimensional scaffolds, and biomolecular signals. However, DPCs tend to lose their biological activity when cultured as trichogenic cells, and scaffolds currently used for hair follicle regeneration lack biological efficiency and biocompatibility. Platelet-rich plasma (PRP) gel forms a three-dimensional scaffold that can release endogenous growth factors, is mitogenic for a variety of cell types and is used in model tissue repair and regeneration systems. We found that 5% activated PRP significantly enhanced cell proliferation and hair-inductive capability of mouse and human DPCs in vitro and promoted mouse hair follicle formation in vivo. PRP also formed a three-dimensional gel after activation. We used PRP gel as a scaffold to form many de novo hair follicles on a plane surface, showing it to be candidate bioactive scaffold capable of releasing endogenous growth factors for cell-based hair follicle regeneration.

Evaluation Indicators of Aesthetic Effects on Hair Transplantation.

Hair transplantation involves the transplantation of hair, beard, eyebrows, eyelashes, and pubic hair. Based on our experience, the aesthetic result of hair transplantation mainly relies on 4 indicators, including selection of the donor site, direction and angle of grafted hairs, density, and survival rate of implanted hair follicles. We believe that good results can be achieved as long as attention is paid to the above 4 points.

Cytokine loaded layer-by-layer ultrathin matrices to deliver single dermal papilla cells for spot-by-spot hair follicle regeneration.

The dermal papilla cell (DPC) is a type of highly specialized mesenchymal cells located in hair follicles (HF). Due to the primary role in the epithelial-mesenchymal interaction that enables hair-follicle morphogenesis and hair cycling, DPC has become an attractive cell source for hair regeneration to treat alopecia patients. However, DPCs tend to lose their function during in vitro culture. Hence, there exists a clear need to develop a microenvironment that can recapitulate the interactions within the native milieu of DPCs. Since layer-by-layer (LBL) nano-coating with biocompatible materials on the cell surface displays the versatility with tunable loading and release properties, which can provide a remodeled microenvironment for regulating cell function. Here, we developed a LBL self-assembly technique to single DPCs to create a nano-scale ultrathin extracellular matrix (ECM). We studied that the single cell-based LBL-encapsulation would not impact the viability, morphology, proliferation and intrinsic properties of DPCs using Western blot and mRNA expressions of ß-catenin, ALP and α-SMA. We then included fibroblast growth factor-2 (FGF-2) into the LBL nano-structure to regulate the DPC function. Finally, we performed in vivo hair reconstitution assays using LBL-encapsulated DPCs combined with freshly isolated epidermal cells (EPCs) and found this strategy can treat hair loss.