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Hair multiplication, or the act of removing hair follicles and hair follicle stem cells, cloning the follicles/cells, and implanting the cloned follicles/cells into areas of balding scalp, is one of the most anticipated futuristic hair loss treatments. Though several methods of hair multiplication have been proposed, researchers still believe isolation, cloning, and multiplying dermal papilla stem cells from the hair bulb of the follicle represents the greatest chance of true multiplication.

In a new scientific publication, researchers at Harvard Medical School revisited the role of dermal papilla cells in hair follicle function, and confirmed the importance of these cells in the future of hair multiplication treatments. Recently, recommended hair restoration surgeon and hair follicle stem cell researcher Dr. Parsa Mohebi was kind enough to review the new article and share the important scientific information in “laymen’s terms” on his blog. According to Dr. Mohebi:

Hair stem cells and their role in the future of hair restoration has been a hot topic in recent years. It is easy to understand how success in the area of hair multiplication (or hair cloning) would be another quantum leap in hair restoration. People affected by genetic baldness could have the stem cells of hairs from their permanent zone multiplied for hair transplantation.

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.

Dr. Cooley, do you now advise your patients to undertake PRP (platelet rich plasma) + ACell during their hair transplant procedure? If so, please feel free to share more of your observations.

In addition, do you believe oral collagen supplements with low Dalton weight will have a positive impact on the results of a hair transplant in terms of more naturalness and robustness of the grafts?

We now offer and recommend PRP and ACell to anyone undergoing a hair transplant with us who has significant areas of thinning (miniaturization), either in the area to be transplanted or elsewhere. In other words, the purpose is to thicken thinning hair, not necessarily beef up the results of the transplant (for which we use ACell on the grafts and liposomal ATP as a post op spray). My observations were summarized in the update, “Hair Transplant Surgery: The Effects of ACell on Healing and Hair Growth“. In short, we find that on average, we can expect moderate hair thickening in those with significant miniaturization; some get better than average results, some get less than average. I think the degree and duration of benefit likely depends on 2 factors: underlying genetic programming, and what medical maintenance treatments are in place, i.e. better if the patient is on Propecia (finasteride) and Rogaine (minoxidil).

Of all the various topics discussed daily on our hair loss forum, Scalp Micropigmentation (SMP) is highly popular.  Below, Bill Seemiller, managing publisher of the Hair Transplant Network shares his opinion and concerns about scalp micropigmentation.

Since I am very interested in SMP, for the last couple of weeks I’ve been looking at different hair restoration forums and realized some practitioners are now offering temporary SMP. Honestly, I am trying to convince myself that this is the best SMP option, but I simply cannot.

The results appear very “yellow” and the dots are relatively smaller than the real follicles. Also I really don’t get how SMP can achieve a three dimensional appearance. I know several experts have reviewed SMP results from different clinics and they say that the temporary SMP looks most realistic. Also, the good part is that it is non-permanent so this means it’s not there forever.

So Bill, what do you personally think about temporary SMP compared to others, and what are the best SMP results you have seen? Just curious

Bill Seemiller, Managing Publisher of the Hair Transplant Network provides his input below.

Admittedly, I haven’t seen any scalp micropigmentation (SMP) results from any clinic in person at this stage.  In photos, “temporary” SMP looks quite good although an in-person inspection would be highly more accurate in asessing this kind of result, especially given its 2 dimensional (2D) characteristics.

For the past several months, the advantages and disadvantages of scalp micropigmentation or SMP (the process of tattooing the scalp to mimic the appearance of shortly cropped hair on the bald or thinning scalp) has been highly discussed on our hair loss forum.  This procedure is used to promote the illusion of increased hair density in individuals with thinning hair or a “shaved” or “cropped” appearance in those with a completely bald scalp.

Scalp micropigmentation can be compared to topical hair loss concealers such as Toppik, Nanogen and DermMatch because it masks hair loss by creating an illusion of real hair.  Thus, SMP (tattooing) is ideally suited for a very specific type of consumer.

While scalp micropigmentation requires a high level of artistry to mimic the appearance of hair stubble, it’s still only 2 dimensional and isn’t an appropriate solution for men and women who want real, growing hair.  Those who use scalp micropigmentation to sport the “cropped” look on top must be diligent in keeping hair on the sides and back of their head the right length in order to look natural.

Initially, ink associated with scalp micropigmentation (tattooing) was permanent.  However, several clinics and practitioners are now offering non-permanent SMP performed with temporary ink.  Like any other solution for treating or masking hair loss, temporary scalp micropigmentation comes with its own set of advantages and disadvantages.

Advantages

Coalition member Dr. Robert Bernstein is a pioneer in the field of hair restoration and has an outstanding reputation for producing only the best hair transplant results.  Recently, he attended and participated in the annual 2012 ISHRS (International Society of Hair Restoration Surgery) scientific meeting in the Bahamas.  Below, Dr. Bernstein provides this community with his expert insight on Scalp Micropigmentation (SMP), the process of tattooing the scalp to promote an appearance of naturally growing hair.   Visit the “Highlights from the 2012 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting in the Bahamas” for more highlights from the meeting. View Dr. Bernstein’s expert feedback below.

For readers that are not familiar with it, Scalp Micropigmentation (SMP) is a permanent cosmetic tattoo that mimics the very short hairs of a closely shaved scalp.  I think that Scalp Micropigmentation (SMP) is a useful new adjunct to hair transplantation with interesting potential and I am pleased to see that doctors in our field, particularly Dr William Rassman and Dr. Jae Pak, are spearheading the development of expertise in the technique and promoting the technology to make it more widely available to patients.   

 One of the things that was apparent from their presentation at the ISHRS is that SMP is an “art” and that proper technique is extremely important in getting an aesthetically satisfactory result.  This includes: the angle that the instrument is inserted, depth control, the amount of pigmented deposited, and color match – not to mention proper patient selection. 

This question comes from a member of our hair loss social community and discussion forums: 

I’m investigating Scalp Micropigmentation (SMP) for my hair loss, but I’m a bit disappointed with some of the unrealistic/unnatural looking hairlines. In many of the SMP cases I’ve seen online, the hairlines look very harsh and unnatural. Is there anyway to avoid this? How can SMP hairlines look more realistic?

First, and foremost, keep in mind that Scalp Micropigmentation (SMP) is a very specific type of hair restoration treatment, ideally suited for a very small, specific type of hair loss sufferer. Any potential patient considering SMP should conduct detailed research about the treatment and determine beforehand whether or not they are suited for the procedure.

Having said that, I’ve heard patients complain about straight, dark, “harsh” hairlines created during SMP procedures, and how these can result in an unnatural/unrealistic appearance. Because of this, I personally believe there are 3 ways to potentially improve upon SMP hairline design and create a more natural/realistic result:

1. Creating Irregular Hairlines

Although it may not seem so at first glance, hairlines (even in individuals not affected by androgenic alopecia) are naturally irregular. Frontal hairlines are uneven and uniquely shaped, and in order to recreate a truly natural hair restoration result, this imperfect pattern must be replicated.

Although we many not instinctively recognize hairline irregularity as natural, when hairlines appear too straight and too even, it becomes apparent that “something isn’t right.” By mimicking hairline irregularity (like hair transplant surgeons do while recreating a surgical hairline), SMP results can appear more natural and realistic.

In 2008, the U.S. Food and Drug Administration approved the drug Latisse (Bimatoprost) for the cosmetic purpose of lengthening and darkening eyelashes. Because Bimatoprost (a prostaglandin/prostamide analog) seemed to induce new activity in eyelash hair follicles, researchers and hair restoration experts immediately began evaluating the use of the drug on human scalp.

After several years of research, it seemed like Bimatoprost presented some efficacy in regrowing scalp hair and inducing activity in scalp hair follicles (i.e. treating hair loss), but the mechanism and efficiency of the therapy was poorly understood.

However, recently, several hair loss researchers, including Coalition hair transplant surgeons Drs. Nilofer and Bessam Farjo, found an exciting connection between Bimatoprost treatment and new hair growth, and also believe they’ve finally demonstrated how the drug actually works.

In a study published in the FASEB Journal, the hair loss researchers sought to evaluate the effect of Bimatoprost on non-eyelash (scalp) follicles, and found the following:

First, Bimatoprost increased hair synthesis in both scalp follicle origin culture (follicles isolated outside of the body) and in living mouse models. Second, after adding an element that blocked the Bimatoprost-sensitive prostamide receptors in follicles, new hair synthesis ceased (indicating a direct Bimatoprost-to-receptor mechanism in hair follicles). Third, using DNA analysis, the team located  three genes for the Bimatoprost-sensitive receptors, which, according to the team, are likely expressed near the regenerative dermal papilla region of the hair follicle.

Recently, we reported that French cosmetics giant L’Oreal planned the release of a new hair loss treatment called Neogenic. However, as the highly anticipated hair growth product began shipping this month, its debut may have been marred by an unrelated but potentially significant warning issued to Lancôme USA (a unit of L’Oreal) by the FDA regarding the manner in which it promotes cosmetics using language that makes them sound more like drugs.

While Neogenic was not referenced specifically in the FDA warning, anti-aging products, including pricey creams and lotions claiming to “boost the activity of genes” or “stimulate cell regeneration” to reduce signs of aging, were called into question. Per FDA guidelines, any product that is intended to affect the structure or function of the human body is classified as a drug and must therefore pass FDA screening and be proven effective.

Balding men and women should be aware that numerous products exist in the market making false claims to halt hair loss and regrow hair. Though it remains to be seen if Neogenic will deliver on its promises, concerns remain that false advertising claims related to L’Oreal’s anti-aging products could reflect unrealistic claims related to this new hair loss treatment.

Until new and more effective products are clinically proven effective, hair loss sufferers are advised to stick to proven drug treatments like Propecia (finasteride) and Rogaine (minoxidil) in order to maintain and regrow their hair.

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Recently, it seems like hair loss sufferers are enticed by a new “hair loss cure” on a weekly basis. Whether it’s “unlimited donor supply” hair transplant procedures, stem cell therapy, or miracle drugs, researchers and scientists frequently claim they’ve found the cure for genetic hair loss and will offer the treatment “very soon.”

However, researchers from Tokyo, California, and New York may have discovered a far more reasonable and realistic piece in the hair loss cure puzzle: Vitamin D.

Recently, researchers from around the globe began investigating the role of Vitamin D and hair loss, and found the following:

First, a variety of research groups now believe the Vitamin D receptor (the protein receptor in the body where Vitamin D binds) is crucial in activating hair growth.

Next, while conducting additional research on Vitamin D and hair loss, a research team at the University of California, San Francisco discovered a molecule called “MED.” These researchers were able to isolate the gene responsible for creating MED in laboratory mice, and found that “knocking out” (genetically removing the gene from the DNA sequence) the gene drastically decreased hair growth in the mice. Because of this, the researchers believe this gene could be a target for advanced hair loss genetic therapy.

Because of its new and unique nature, scalp micropigmentation (SMP) has become a popular topic on our hair loss discussion forums. Although we personally believe the technique is highly specialized and ideally suited for a small, specific number of patients, hair loss sufferers remain continually interested in the procedure.

Because of this, dedicated hair restoration experts like Dr. William Lindsey, now regularly receive SMP requests from interested patients and started researching the procedure themselves. After investigating the SMP technique and procedure, Dr. Lindsey shared his input on our discussion forums:

Its important for the facts to get out there about SMP. One of my patients essentially thought you could “tattoo on a full head of hair” based on marketing they had seen elsewhere.

SMP will not replace medicine or surgery, but rather is another tool in the armamentarium against hair loss. So far, I think its really ideal for guys seeking scar concealment, and I’m hopeful that it will offer improvement for both thinning crowns (when there is limited donor hair likely to be used elsewhere) and possibly for female hair loss sufferers.

Like any tool, it will have its limitations; you can’t saw with a hammer for example, and its exciting to be on the forefront of this new technology.

Dr. William Lindsey

Dr. Lindsey’s reply both acknowledges some of SMP’s potential benefits while also recognizing its limitations, and we believe this type of analysis truly benefits patients!

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Blake  – aka Future_HT_Doc