Upload
bauman-medical-group-hair-restoration-for-men-and-women
View
1.732
Download
5
Tags:
Embed Size (px)
Citation preview
Alan J. Bauman, M.D.Diplomate, American Board of Hair Restoration Surgery
PRP LifeLift™ Certification & TrainingSeptember 13, 2014
PLATELET RICH PLASMAFOR HAIR REGROWTH
ABHRS
CONFLICTS OF INTEREST• The following conflicts of interest
pertain to this presentation: NONE
ALAN J. BAUMAN, M.D., A.B.H.R.S.• Diplomate, American Board of Hair Restoration Surgery• Member, International Society of Hair Restoration Surgery• Recommended, American Hair Loss Association• Member, American Academy of Anti-Aging Medicine (1998)
• New York Medical College• Beth Israel Medical Center NY – General Surgery• Mt. Sinai Medical Center NY – General Surgery
• Bauman Medical Group (est. 1997) - Boca Raton, FL• >17,000 patients treated, >7,000 hair transplants
VIDEO: PRP HAIR REGROWTH ON ABC
http://hai.rs/hairprp-placenta
OVERVIEW
• Hair Follicle & Growth Cycles
• Hair Loss & Treatments
• PRP & Growth Factors
• PRP in Hair Restoration
• Role of Extracellular Matrix (ECM)
• ACell/Matristem & BioD-Restore
• Hair Evaluations & Measurements
• How to Prepare & Apply Scalp PRP
• Additional Educational Opportunities
HAIR & SKIN ANATOMY: THE PILOSEBACOUS UNIT
HAIR GROWTH CYCLE
HAIR FOLLICLESTEM CELL SIGNALING
• Epithelial Wnt/β-catenin signaling is required for hair matrix cell proliferation. Wnt/β-catenin signaling is a central regulator of adult stem cells.
• LRP inhibition permits stem cell survival; blocks hair growth reversibly
• β-catenin is required in bulge stem cells for their proliferation, but not survival indicating the persistence of functional progenitors so follicles will continue to proliferate even without β-catenin.
• Hair Follicle ~ Fibroblast “Cousin”
HAIR:
Beauty &
Youth
• Fear/anxiety ~ Sickness or Illness• Low Self-Esteem/Self-Confidence• Feel Older / Less Attractive• Camouflage/Compensate• Avoid Social Situations
Hair Loss
HAIR LOSS: ANDROGENETIC ALOPECIA (AGA)• Genetic Male and Female Pattern Hair Loss – most common type• Affects nearly 100 Million Americans (est. 60M men, 40M women)
NORMAL MINIATURIZED
60X & 30X “HAIRCAM” DERMOSCOPY
SEVERE DEPLETION: HAIR TRANSPLANTATION
HAIR LOSS: ALOPECIA AREATA (AA)
• Autoimmune• Small / Circumscribed• “Spot baldness”• 1-2% of cases spreads
to the entire scalp• Standard Tx’s:
• Steroid injections• Microtrauma
MEDICAL HAIR LOSS TREATMENTS:PRESERVE AND ENHANCE HAIR FOLLICLE FUNCTION
MODAL ITY TX MECHANISM
Oral Finasteride blocks Dihydrotestosterone production [♂AGA]
Topical Minoxidil K+ channel opener, vasodilator [AGA, AA]
Phototherapy LLLT, LaserCap ↑ mitochondrial membrane potential [AGA, AA]
Nutraceutical Biotin, Marine Protein Metabolic/Nutritional [AGA, AA]
Cell Therapy Platelet Rich Plasma Growth Factors, Cytokines [AGA, AA]
PLATELET RICH PLASMA FOR HAIR REGROWTH
GROWTH FACTORS, CYTOKINES AND MORE…• platelet-derived growth factor - PDGF
• transforming growth factor beta - TGF-B
• fibroblast growth factor
• insulin-like growth factor 1 - IGF1
• insulin-like growth factor 2 - IGF2
• vascular endothelial growth factor - VEGF
• epidermal growth factor - EGF
• nerve growth factor - NGF
• interleukin-1 – IL1-B
• Interleukin-8 – IL8
• keratinocyte growth factor
• connective tissue growth factor
GROWTH FACTORS & HAIR FOLLICLE CYCLING
• PDGF – stimulate growth of dermal mesenchyme, epidermis-follicle interaction (5)
• VEGF – mitotic & endothelial cells, increases vascular permeability (Yano-6)
• EGF – mitosis of epithelial cells, fibroblasts. Inhibits catagen, promotes anagen(10/11)
• IGF – anti-apoptosis (12)
• FGF – proliferation & differentiation of keratinocytes and endothelial cells. Anagen (13)
• NGF – hair cycle modulator. Stimulates hair growth (NGF-TrkA) via proliferation of keratinocytes, NGF-p75NTR promotes apoptosis and hair follicle regression. Stress mediator, may play a role in neurogenic inflammation, hair follicle apoptosis & premature catagen.
PLATELET RICH PLASMA STAND-ALONE TREATMENT FOR HAIR REGROWTH
• Autologous (or Allograft)
• Bedside
• Out-patient
• Quick; “lunch-hour”
• Non-Invasive
• Painless Local Anesthesia
• No Downtime
• Low risk
• Hair Growth www.HairCoach.netYesPRP at Bauman Medical
VEGFVASCULAR ENDOTHELIAL GROWTH FACTOR
Bouhanna/Amgar
LITERATURE REVIEW:USE OF PRP IN HAIR RESTORATION
• Graft-storage media in Hair Transplantation (Bouhanna/Amgar)
• Wound healing accelerator in Donor and Recipient Areas (R Reese, J Cole, J Cooley)
• Improvement of ‘take-rate’ & growth in hair transplantation (R Reese, C Uebel)
• Stand alone treatment for androgenetic alopecia or alopecia areata. (J Greco, Amgar, Bouhanna, Rinaldi)
Bouhanna/Amgar
PRP FOR ANDROGENETIC ALOPECIA
Bouhanna/Amgar
PRP FOR ALOPECIA AREATAPreTx 8 weeks
4 months
PRP FOR ALOPECIA AREATA
PreTx 8 weeks 4 months
PRP HAIR REGROWTH IN 38YO FEMALE AGABEFORE & AFTER 9MOS
PRP HAIR REGROWTH 36YO MALE AGABEFORE & AFTER 9MOS
EXTRACELLULAR MATRIX (ECM)• Extracellular part of multicellular
structure
• Structural & Biochemical support
• Injury Repair & Tissue Growth
• Wound healing / fibrosis
• Regulates intracellular communications
FUNCTIONS during injury or tissue regeneration:• Prevents inflammation & scar tissue formation• Facilitates tissue repair
WHY USE EXTRACELLULAR MATRIX (ECM) W/ PRP?
PROLONG & ENHANCE!
• Without ECM: PRP effects last ~90 days, requiring repeat treatments
• With ECMs
• PRP hair growth effects may last for up to 2 years
• PRP hair growth effects appear to be stronger
ACELL/MATRISTEM ECM• Porcine Bladder Matrix
• Micronized powder
• Collagen
• Basement membrane
• Bio-scaffold
BIOD-RESTORE - PLACENTAL TISSUE ECM
• Immune privileged - Rarely evokes immune response
• Provides cells, structure and signals for repair/regeneration
• Natural scaffold / ECM for cell migration & proliferation
• Proteins, cytokines, carbohydrates, hyaluronic acid, growth factors, chemical compounds and multipotent cells naturally inherent in placental and amnionic fluid
• Anti-inflammatory / Anti-microbial / Anti-scarring / Anti-adhesive
BioD-Restore™ is a cryopreserved amnion allograft from the placenta of live, healthy donors.
BIOD-RESTORE• Multipotential Tissue Matrix
• Structural allograft derived from human amnion
• Chemical compounds, growth factors, residual cells
• Regeneration
• Immune privileged
• Multipotent cells
BIOD-RESTOREPROCUREMENT & PROCESSING:
• Prescreened donors
• Medical review
• Prenatal testing
• Behavioral risk assessment
• Blood tests
• Medical history
• Disease testing
• Aseptic recovery / sterile cesarean section
• FDA-registered tissue bank
• FDA-registered processing center
GROWTH FACTORS FOUND IN AMNION• Platelet-Derived Growth Factor (PDGF)
• Transforming Growth Factor Beta (TGF-β)
• Vascular Endothelial Growth Factor (VEGF)
• Fibroblast Growth Factor (FGF)
• Epidermal Growth Factor (EGF)
• Insulin-like Growth Factor (IGF-1)
HAIR MEASUREMENTS & EVALUATIONS• “HairCheck” – Cross-Section Hair
Bundle Trichometry
• HMI – Hair Mass Index
• Sensitive, scientific, repeatable, accurate
• “HairCam” Dermoscopy – identifies miniaturization
• Global Photos – medical ‘mugshots’ HairCam – ABC Good Morning America
HairCheck at Bauman Medical
HOW TO PREPARE AND APPLY PRP+ECM• Patient Selection, treatment area identified & measured.
• Phlebotomy is performed.
• Scalp prepped w/ antiseptic shampoo and local anesthesia.
• PRP is prepared using centrifuge & YesPRP™ kit.
• If used, BioD-Restore is thawed.
• PRP is mixed gently with ECM (Acell/Matristem or BioD-Restore)
• PRP+ECM is injected intradermally into the scalp
• Mechanical (MicroPen) microneedling creates microtrauma
• Scalp is cleansed, 15min LLLT applied
• instructions given prior to discharge
Dr. Bauman performs PRP on ABC Palm Beach
SIDE EFFECTS / SEQUELAE / FOLLOW-UP
• Tenderness / Swelling is rare
• Follow-ups can be performed monthly to track hair growth improvements.
• Monitor hair growth using HairCheck and HairCam to observe peak and plateau.
UPCOMINGPRP HAIR GROWTH & HAIRCHECK™ WORKSHOPS
Friday September 19th -or- Friday November 14th 9am-5pm Boca Raton
• Hair Loss Diagnosis & Evaluations, Treatments & Tracking
• Hands-on HairCheck Measurements and Hands-on PRP+ECM hair regrowth procedure
• Course Director: Alan J. Bauman, M.D.
• Certificate & Starter Kit
• Email: [email protected]
• www.HairCoach.net for info/registration and future events
REFERENCESMarx, R.E. , et al, “Platelet-Rich Plasma Growth Factor Enhancement for Bone Grafts,” Oral Surg Oral Med Oral Patrhol, 1998;85:638-646.Antonaides, H.N., et al,”Human Platelet-Derived Growth Factor: Structure and Functions”, Federation Proceedings, 1983;42:2630-2634.Pierce, G.F., et al,”PDGF-BB,TGF-β 1 and Basic FGF in Dermal Wound Healing: Neovessel and Matrix Formation and Cessation Repair”, Am J Pathology, 1992;140:1375-1388.ELISA Immuno Assay For PDGF-A, Human VEGF, TGF-β 1, and Human EGF, R&D Systems, Mpls, MN 1999.Bauman AJ, The use of cross-sectional hair bundle trichometry in the diagnosis, evaluation and tracking of hair loss. Poster Presentation. ISHRS ASM October 2012 Nassau, Bahamas.Gruss, J., et.al., Human amniotic membrane: a versatile wound dressing. CMA Journal 1978; Vol.118:1237-1246De Coppi, P. et.al., Isolation of amniotic stem cell lines with potential for therapy. Nature Biotechnology 2007; Vol.25,No.1:1274-1280
PRP VIDEO PLAYLIST
http://hai.rs/prphairgrowthvids
Thank You!!
Alan J. Bauman, M.D.Bauman Medical Group
Boca Raton, FL USA
linkedin/in/alanjbaumantwitter.com/DrAlanBauman
facebook.com/alanjbauman