Brazilian pioneer advances hair restoration

Philadelphia - Growth factors concentrated from a patient's own bloodaccelerate hair regrowth while prod-ucing up to 35 percent more folliculardensity, says Carlos Oscar Uebel, M.D.

"Normally it takes three months for hair to start growing. For some patients this is very problematic. Grafts fertilized with platelet-rich plasma start to grow in a few weeks," says Dr. Uebel, associate professor of plastic surgery at Pontifícia Universidade Católicado Rio Grande do Sul in Porto Alegre, Brazil. Prior to surgery, technicians take 80 cc of blood, centrifuge it, then concentrate the plasma into a gel. Dr. Uebel then places donor follicles in the gel for 15 minutes, much in the same way a horticulturalist inoculates roots tohasten propagation.

Dr. Uebel uses agriculture as a metaphor for hair restoration. After treating follicles, he "plants" them (using the micrograft megasession approach he pioneered 18 years ago) "like onions."

Prior to surgery, Dr. Uebel collected 80 cc of blood in eight vacuum flasks, using sodium citrate as an anticoagulant. He centrifuged the flasks for 10 minutes, condensed the resulting plasma into four new flasks and centrifuged another 10 minutes. After removing floating plasma, the residual concentrate was treated with calcium chloride, transforming fibrinogen into fibrin and producing a gel.

Follicles harvested from skin-bearing flaps taken from the posterior of the neck were separated into two groups. Half were maintained in a humid saline solution prior to implantation. The other half sat in the plasma-rich gel for 15 minutes before implantation.

Following surgery, patients returned for evaluation once a month for seven months. By counting the number of successful grafts under a magnifying glass, Dr. Uebel determined that the platelet gel treatment improved their survival rate by 15 to 35 percent. Using a digital camera to take images under standardized conditions and software to analyze density, he calculated that the gel enhanced density by 20 to 35 percent.

"The procedure also works with women," the surgeon notes. "Although baldness is rare, some experience thinning after onset of menopause, and they suffer psychologically more than men."

Science of growth factors Indigenous to the bulge area, growth factors (PDGF, TGF beta and VEDGF) interact with matrix and stem cells, giving rise to the follicular unit (hair shaft, sebaceous glands, erectus pilus muscle and the perifolliculum) and activating the proliferative phase of hair growth.

Upon harvesting and implantation, follicular units enter a latency period of three to four months.

"Sprouting is slow and progressive up to the seventh month, when all hair follicles will have germinated," Dr. Uebel says. "In normal implantations, yield is around 85 percent due to apoptosis of some follicular units."

Treatment with platelet-rich plasma increases the survival rate of grafts, hastens activation of the proliferative phase and improves density of regrowth.