Experimental suggestions.

[S Foote.]

In my opinion, the most important future experiments in male pattern baldness, would be those designed to `re-test' the current donor dominance assumptions.

The current notion is that because follicles transplanted by `plug grafting', tend to retain their existing growth characteristics, this means an `in-built' difference in how follicles react to androgens.

The problem with the current interpretation is that other experimental evidence just doesn't fit this!

I have argued here previously that experiments show that direct exposure to androgens, does `NOT' change normal follicle cells into male pattern baldness follicle cells. So where's this alledged `in-built' growth restriction response to androgens?

Like most people here, my own hair loss effected me badly. So in the early 80's, i had a number of transplantation procedures. This comprised of four scalp reductions finished off by 4mm plug grafts.

In those days, the stretching of hair bearing tissue upwards from the sides of the head by scalp reduction, was being hailed as a major breakthrough in hair transplantation. This procedure done properly covered the larger part of the crown area, and left the plug graft donor area at the back of the head intact. Plug grafts were then used to fill in the front and the remaining central scar on the crown left by the scalp reductions.

My procedures were done by a leading clinic, and the results were very good, i had no complaints about the clinical competence. However, over the same kind of time scale as i had lost my original hair, the hair moved by scalp reduction also receeded back. My natural recession point at the sides was well established before the scalp reductions, and over time the scalp reductions made no difference to this!

The long term results of the 4mm grafts were better, but the only follicles that survive are those right on the edge of the grafts. This is recognised as the `doughnutting' effect. http://www.hairtransplantadviser.org/fallacies.htm

According to the current theory, scalp reduction should be permanent. The biggest problem with research in transplantation is the vested interests of the transplantation `industry'!! But anyone with any common sense should ask why a procedure that was once hailed as a major breakthrough, has been quietly dropped by the industry?

It seems to me that the only terminal hair producing follicles that survive long term in the balding area, are those that were in terminal mode when transplanted, and have experienced a healing process around them. All modern transplantation procedures that survive long term are `plug' grafts. Call these FUE or anything you like, but they are just `smaller' versions of the original plug grafts.

My interpretation of the plug graft effect ,is that a fibrose `scaffold' is formed around the transplanted follicles during the healing process. This scaffold then acts as a template for the regrowth of future anagen follicles, reducing the tendency of the surrounding tissue to influence follicle size through normal contact inhibition.

This scaffold `principle' has been discussed in relation to the latest hair multiplication research. http://www.hairsite4.com/dc/dcboard.php ... 2515&page=


In my opinion, there are already existing studies that support either an effect of the local tissue conditions, or the healing process in how plug grafts `work'. The studies that note a tendency for transplanted follicles to `adapt' to the local conditions, completely go against the current theory. http://www.ncbi.nlm.nih.gov/entrez/quer ... s=12269871 http://www.hairsite4.com/dc/dcboard.php ... c_id=15123

Perhaps the most relevant study here is about the recovery of balding follicles, when transplanted to immune deficient mice. http://www.ncbi.nlm.nih.gov/entrez/quer ... s=12734505 These are immune deficient mice where the immune system related healing, and so any `scaffold' effect is reduced. They are `NOT' androgen deficient mice, so why the recovery?

The most important experiment relating to the donor dominance issue, would be the independent study of the long term effects of scalp reduction. In my experience, such a study would completely blow the current donor dominance theory out of the window! Then we could all move on from a situation that is not helping anyone as it stands.

I personally think that the current hair multiplication research is a good thing, because a lot of the same kind of issues will have to be contended with, and so we may see some progress.

S Foote.

 

[Old Baldy]

Stephen: Your experience with the scalp reduction supports your argument quite a bit.

Please remember back when you had the operation.

The areas that were stretched to the top of your scalp eventually went bald. Think back - where were those areas beforehand? Were they in areas "high" on the scalp to begin with? In other words, were those "stretched" areas that went bald in areas that could have been in the "MBP" zone to begin with?

Did your final balding zone end up where you thought the horseshoe pattern would have occured anyways? In other words, did the predictable horseshoe pattern express itself the same way, regardless of any scalp reduction in your opinion (i.e., with or without the scalp reduction you ended up with the "same" horseshoe pattern you were worried about in the first place)?

 

[Bismarck]

Old Baldy,
If I remember correctly, scalp redection is not longer used becaused of the "stretch back" effect. So maybe Stephen hasn't lost these "new" hair hair on top - they jsut went back where they were before.

bis

 

[Old Baldy]

Oh, now that's a thought. Thanks Bis.

http://216.109.117.135/search/cache?p=s ... 1&.intl=us

 

[S Foote.]

Stephen: Your experience with the scalp reduction supports your argument quite a bit.

Please remember back when you had the operation.

The areas that were stretched to the top of your scalp eventually went bald. Think back - where were those areas beforehand? Were they in areas "high" on the scalp to begin with? In other words, were those "stretched" areas that went bald in areas that could have been in the "MBP" zone to begin with?

Did your final balding zone end up where you thought the horseshoe pattern would have occured anyways? In other words, did the predictable horseshoe pattern express itself the same way, regardless of any scalp reduction in your opinion (i.e., with or without the scalp reduction you ended up with the "same" horseshoe pattern you were worried about in the first place)?

Hi Old Baldy.

In my personal experience, this notion of `stretch back' in scalp reduction is just one of the excuses made by the transplantation industry for why this procedure was dropped. The other excuse i have heard before, is that scalp reduction reduces the donor supply from the back of the head.

The `whole' reasoning behind scalp reduction in the first place, was to `also' make use of the hair at the sides of the head, that is not normally used in hair transplantation.

The shape of the tissue cut out from the balding area, is designed so that when the loosened sides are streched up and stitched together, the hair from the sides moves up to cover the crown. This has no effect `At all' on the normal graft donor supply at the back of the head.

In fact, this was the central claim made by the transplant clinics for scalp reduction at the time!!

Just what is this `stretch back' claim? Are they trying to claim that the hair bearing tissue some how moves back down? If this was so, you would just end up with a `very' wide central scar. This just doesn't happen!

This sort of `psuedo technical' bulls**t, is a necessary excuse for the transplantation industry, in order to avoid misrepresentation law suits!

As i said, i had no issues with the technicalities of my scalp reductions, and these combined with the grafts provided `full' coverage for a while.

Like most people here who are concerned about their hair loss, i was very familiar with my recession points. We look at these closely every day don't we!

My natural recession point at the sides, was the same before the scalp reductions, as it is today! The scalp reductions `fixed' my problem for a while, but this `natural' recession point was not ultimately changed.

I know that a lot of `alledged' DHT resistent hair was moved above this point by the scalp reductions, because the remaining hair at the sides was, and is today thinned out considerably! This wouldn't happen if the stretch back excuse was valid!

There is certainly no doubt in my mind based on personal experience, that scalp reductions disprove the current donor dominance theory.

These excuses for the failure of scalp reduction, made by the transplantation industry, should be a lesson to everyone interested in scientific `truth'. We are just not going to get the truth when vested interests of any kind are involved!

Good luck.

S Foote.

 

[Old Baldy]

Boy Stephen, now this is food for thought! Thanks for the reply.

 

[michael barry]

s foote, good points made

I totally agree with the assertion that hair docs cant be trusted. The past 4 years of my life have been stolen by the 100 old hair transplants I had back in 95. Im a Norwood 3. My temple hair receeded and the plugs are visible now. Propecia, when it came out, was thought to keep a man's hair in the front and regrow hair on the top and back. I thought Id be safe to get transplants behind my hairline to buff up my temples. The salesman at the transplant mill thought this was an excellent idea and thought I could even lower my hairline a tad. The doctor, who no doubt had read the info on propecia only blocking 65 percent of your DHT serum levels, proboably suspected that this drug would only delay the inevitable there. Now Im having to electrolysis out these plugs and dermabrate my temples. I'll have to wear a little make up on my temples for the rest of my life if I have any kind of tan because the scar holes (they are small , but visible) wont tan. Ive visited a few more doctors over the years in consultations. Ive been lied to each visit. When Ive asked in the past if there was any way other than surgery to get them out (surgery will make the scars larger and more obvious), Ive ALWAYS been lied to and told no. Both lasers and electrolysis can remove hair (although lasers may take about 3 treatments to do so). One salesman even claimed that "you must have been reading the internet, there is no way to remove transplanted hairs, your only option is to get more work done". I really got fed up with how a man is so manipulated when visiting hair docs......you know, they play on fear, having improboably good looking women working there WORK you to get surgery, the psychological sales gimmicks they pull there are legion. Im, like you, hoping that someday either a genetic therapy that shuts the androgen receptors more or less off to DHT or a stem cell regenerative method becomes available so unfortunate decent men -like us- dont continue to be mislead by these would be millionare docs who will happily lie to a guy and damage his life brutally just to get another ten thousand.....

 

[Bismarck]

Stephen, why is transplanted hair (via FUE or so) not lost ? I remember you said that it is protected from the "environment" by some kind of scar tissue. But how it is possible for body hair to look like scalp hair after it is transplanted to the head ? This does imply that there are hormonal influences from the tissue around the transplanted grafts doesn't it ?

 

[Armando Jose]

Mr. Foote,

I agree with you. Probably scalp reductions disprove the current donor dominance theory.

But, a question: After your scalp reduction you lost, again, the hair, but how was this process? Beginning in the top and front of the head and then moved forward to the sides or diffussely?

Armando

 

[S Foote.]

Stephen, why is transplanted hair (via FUE or so) not lost ? I remember you said that it is protected from the "environment" by some kind of scar tissue. But how it is possible for body hair to look like scalp hair after it is transplanted to the head ? This does imply that there are hormonal influences from the tissue around the transplanted grafts doesn't it ?

I think the latest hair transplantation experimental results are very interesting, and again there is no way the current donor dominance theory can explain these.

http://www.hairsite4.com/dc/dcboard.php ... c_id=15123

The current theory is very clear about it's implication, and this is that the growth potential of androgen affected follicles, is dictated from `within'. Hence the phrase `donor dominance'. The growth characteristics of `androgen dependent' chest hair for example, is `not' supposed to change when transplanted according to the current theory, but it does!

http://www.hairsite8.com/woods/chest1.htm

It should be perfectly clear from the latest research, that the conditions `around' the follicles, are dictating their `actual' growth potential. The question is what conditions are important here?

In my experience scalp reduction doesn't last while conventional grafts do, so whats the difference?

I think scalp reduction is the `purest' test of the current donor dominance theory. In scalp reduction, hair is being moved to the balding area without any other induced changes. So there is nothing else in scalp reduction that could influence the result. On the other hand, conventional grafts create significant changes in the tissue around the follicles. So logic dictates it is one or all of these changes that ensure the survival of follicles in the male pattern baldness area.

In conventional grafting, there is a healing process around the follicles, and a significant change in the circulation within the graft. If hypoxia (a lack of oxygen) can exist in grafts as small as 4mm diameter, there can be no active circulation in `plug' grafts of any size. http://www.hairtransplantadviser.org/fallacies.htm Hypoxia is claimed to be the reason for the non survival of follicles in the larger grafts.

However, there is a contradiction here in the fact that a general induction of hypoxia in the scalp, has been shown to improve the condition of hair follicles. http://www.geocities.com/bryan50001/artery_ligature.htm

So, we are left with the healing process. On consideration, i think it is this that ensures the long term survival of large follicles in conventional grafts.

I think there are three factors involved here. First, transplant surgeons take follicles that are already `large' anagen follicles. Secondly, the healing process itself can induce above `normal' cell multiplication. Scar tissue is above normal cell multiplication. Thirdly, healing produces fibrose tissue.

If normal contact inhibition is the major player in anagen follicle size, the formation of a fibrose `scaffold' around transplanted follicles can effectively `protect' the space required for these transplanted anagen follicles. The advantages of a biological scaffold, are recognised in the generation of biological structures, and have been discussed in regard to HM research. http://www.hairlosshelp.com/hair_clonin ... henik3.cfm

So why not a `naturaly' formed scaffold in conventional grafts?

I personaly think that the current research in HM, is going to identify the realities in follicle survival in conventional graft transplantation.

In my opinion, the sooner the better!

S Foote.

 

[S Foote.]

Mr. Foote,

I agree with you. Probably scalp reductions disprove the current donor dominance theory.

But, a question: After your scalp reduction you lost, again, the hair, but how was this process? Beginning in the top and front of the head and then moved forward to the sides or diffussely?

Armando

Hi Armando.

The scalp reductions were designed to move hair from the sides upwards into the crown area, saving the normal donor area at the back of the head for frontal grafts.

Whilst the scalp reductions worked for a time, the hair `moved up' from the sides, receeded downwards over time in the same way, and rate as the original. The frontal grafts are left as an `island' that looks completely unatural.

S Foote.

 

[michael barry]

S. Foote, a question about donor dominance.....

S. Foote,
Ive looked hard at horseshoe bald men in the past few years and have noticed (especially on men with buzz cuts) that their hippocratic wreath hair is thinner than it obviously once was, even in the back.

Its evident to me that the hippocratic wreath hair thins by (just guesstimation) 10-20% by the time a guy is in his 60's and 70's. This I suppose would give a bit of crecedence to your idea that the "donor dominance" theory is at least partly untrue.

Ive seen you state that it is perhaps the local conditions and perhaps pressure around the follicles that influence hair to miniaturize. Do you have any ideas on "stop-gap" measures a fellow might take now to help with this? Im always looking for ways to "keep what I got" ...thanks, M

 

[Fallout Boy]

If donor dominance isnt true than why do transplanted hairs not fall out???

 

[michael barry]

I think what S.Foote was intimating was that transplanted follicles have been moved and have went through fibrosis around the recipient site. Fibriosis, the bodys scarring and healing process around a cut of some kind apparently produces extra fast cell growth around the new implanted hair follicles that shields them from the effects of androgen hormones. So in essence, those little white scars around hair plugs and the skin healing from the punch hole beneath represent the real reason the new plugs survive.

He noted in his first post that miniaturizing hair from people transplanted to androgen sensitive mice not only grow, but grow back to full terminal size. When hair from terminal areas (regular back of the head donor areas) are moved to these androgen sensitive (or bald) mice, the also grow and stay terminal size. This suggests that the front of your scalp has something wrong with it and is killing perfectly good follicles off instead of those individual follicles having a "dna clock" telling them to stop producing terminal hairs.

If this is true, dermatologist may be able to come up with a rememdy for baldness that would be more skin based than follicle based. Im not putting a bunch'a little holes in my frontal lobe to test it however.

I definitely agree with S.Foote on one thing however, I dont trust the hair transplant industry to be honest with us if they find that the cure for pattern baldness isnt what will get them paid big time.

 

[Bryan]

The scalp reductions were designed to move hair from the sides upwards into the crown area, saving the normal donor area at the back of the head for frontal grafts.

Whilst the scalp reductions worked for a time, the hair `moved up' from the sides, receeded downwards over time in the same way, and rate as the original. The frontal grafts are left as an `island' that looks completely unatural.

I want every person reading this to understand that what Stephen wrote above is NOT documented in the medical literature. It is based ENTIRELY on his own personal anecdote.

Bryan

 

[Fallout Boy]

I definitely agree with S.Foote on one thing however, I dont trust the hair transplant industry to be honest with us if they find that the cure for pattern baldness isnt what will get them paid big time.

But Intercytex the company going into Phase II trials for HM isnt even a hair trainsplant company or in the industry... they will get paid EXTREMELY Big time if they find the cure for male pattern baldness

 

[michael barry]

Then Im pullin' for Intercyclex right along with ya' man. Im hoping there is an answer for pattern baldness that is not just stopping natural hormones via some drug or surgically implanted to tell you the truth.

I WOULD really rather NOT be some pill you have to take everyday. There is a psychological consequence to knowing if you stop taking some pill or if it becomes unavailable, that your appearance will drastically change in a year or so. I couldnt fully comprehend this back when I got on propecia.

 

[S Foote.]

The scalp reductions were designed to move hair from the sides upwards into the crown area, saving the normal donor area at the back of the head for frontal grafts.

Whilst the scalp reductions worked for a time, the hair `moved up' from the sides, receeded downwards over time in the same way, and rate as the original. The frontal grafts are left as an `island' that looks completely unatural.

I want every person reading this to understand that what Stephen wrote above is NOT documented in the medical literature. It is based ENTIRELY on his own personal anecdote.

Bryan

Yes thats right Bryan, my opinion is based on my personal experience.

Have you got any `personal' experience of transplantation techniques???

Based on my personal experience, i question the donor dominance theory you support Bryan. In my experience, the only follicles that survive long term in transplantation are those that have had a healing process occour around them.

From this `personal' observation, i am suggesting that these follicles survive because of the formation of a fibrose matrix around these follicles.

Surgeons extract large anagen follicles to transplant in these `plug' grafts. You can call these FUE or anything else, but they are transplanted as `mini' plug grafts. If a fibrose matrix is forming around these large anagen follicles, it will form a structure that will in the future `conserve' this anagen space, and therefore the large anagen follicle.

Such natural or artificial `scaffolds' or tissue templates, are recognised as giving protection and direction to growing cells. http://www.surgicenteronline.com/articles/331feat6.html
http://www.pubmedcentral.nih.gov/articl ... tid=400485
http://www.nibib1.nih.gov/eAdvances/012805.htm

Matrix formation is also known to protect growing cells against the influences of contact inhibition Bryan!!
http://www.pubmedcentral.nih.gov/articl ... tid=122571


If this is what is happening, if you then transplant follicles from the normal donor area that are in the natural telogen phase, (miniaturised), these will `NOT' then grow in the male pattern baldness area because the matrix will be small and prevent this!

This would be an important test in my opinion, and i asked Dr Limmer who was interviewed on HairLossTalk.com if this had been tried. He said that as far as he was aware, this hadn't been studied.

I think it should be, because if these transplanted `normal' follicles in telogen `didn't' enlarge, the current theory would have yet another problem!

By the way Bryan, I am not the only one who is questioning the current donor dominance theory, Dr Limmer and his associates are as well!

http://www.hairlosstalk.com/newsletter/article181.htm

Quote:
"We've always believed that the recipient area where you plant the hair has very little or nothing to do with how the hair grows. There is some new information out of the Oriental research group that indicates more of an influence by the recipient area than we'd first thought. "

S Foote.

 

[Fallout Boy]

if they realy felt that this could be a big problem why the hell dont they do some kind of test / study on it?? doesnt seem like it would be that hard actually

 

[Bryan]

If this is what is happening, if you then transplant follicles from the normal donor area that are in the natural telogen phase, (miniaturised), these will `NOT' then grow in the male pattern baldness area because the matrix will be small and prevent this!

This would be an important test in my opinion, and i asked Dr Limmer who was interviewed on HairLossTalk.com if this had been tried. He said that as far as he was aware, this hadn't been studied.

I think it should be, because if these transplanted `normal' follicles in telogen `didn't' enlarge, the current theory would have yet another problem!

So what is the approximate success rate of transplanted hairs? Let's be clear about what I'm asking: what is the percentage of TOTAL hairs which, when transplanted into balding areas of scalp, continue to grow normally afterwards?

Here's some BAD NEWS for you, and it comes from Orentreich's original "autograph" study from 1959: he apparently had a higher success rate than the 90% predicted by your theory! :wink: He transplanted hairs in a total of 52 subjects with male pattern baldness (multiple graphs per subject), and here's what he says in the "Results" section (the emphasis in bold text in a couple of places is my own):

"Donor dominance was observed in all of the cases of alopecia prematura. 'Hair to hair' grew hair; 'hair to bald' grew hair; 'bald to bald' remained bald; and 'bald to bald' remained bald.

"The grafts containing hair continued to grow hair in the area of alopecia that was of the same texture and color and, apparently, at the same rate and with the same period of anagen that governed the nature of the hair of the donor site (after 2 1/2 years' follow-up it was still growing)...Moreover, the hair growth of the grafts appeared unimpaired."

How do you explain THAT, Stephen?? At any one time in normal non-balding subjects, about 10% of scalp hairs are in telogen (even HIGHER percentages of scalp hairs are in telogen in balding subjects), so several of the follicles that Orentreich transplanted MUST have been in telogen at the time! And yet he said that in EVERY CASE of the male pattern baldness grafts, full donor dominance was observed, with the grafts continuing to grow normally afterwards. If your theory were correct, several of them (the 10% or more which were in telogen at the time they were excised) would never have enlarged from the miniaturized condition they were in, while in that telogen phase!! I know, I know: you think that just from sheer luck, Orentreich excised only follicles that just happened to be in anagen, right? That would be the usual ad hoc explanation that you always come up with, wouldn't it? :wink:

It's "Strike 3" for your theory! YOU'RE OUT!!

By the way Bryan, I am not the only one who is questioning the current donor dominance theory, Dr Limmer and his associates are as well!

http://www.hairlosstalk.com/newsletter/article181.htm

Quote:
"We've always believed that the recipient area where you plant the hair has very little or nothing to do with how the hair grows. There is some new information out of the Oriental research group that indicates more of an influence by the recipient area than we'd first thought. "

Yes, I know. There's no need to belabor that point. I've already acknowledged that there _may_ be an unexplained 10% of the hairgrowth equation. But frankly, I'd like to see some corroboration for even THAT claim from the "Oriental research group", before I believe it fully...

Bryan