Coen Gho Follicular Multiplication Method

Coen Gho Follicular Multiplication Method
May 16 04:15 2016 Print This Article

From Dr. Coen Gho:

“Most people know me as the developer of Follicular Multiplication and Hair Multiplication. However, this is only a part of my activities. As you can see, we also have a Pharma division. GHO Pharma which develops new medications for different indications in the field of burns, cardiology and neurology; and GHO clinic which develops new treatments in the field of hair-restoration.

Staining the Cells

In our studies we used several markers. Markers are compounds used to show different characteristics of cells. The goal here was to try and find where stem cells are located in the follicle. If we could locate the stem cells we could see what options we had as far as regenerating new hairs from one existing hair. This is the new technology. So we used markers to do this. Kind of like staining something.

Besides the ones shown on this slide, we used many others:

  • Bcl-2: Stem cells in general have to be protected against apoptosis. Apoptosis is programmed cell death. Therefore, stem cells have to be positive for BCL 2, a well known anti-apoptose marker.
  • CK 19: CK 19 stains specific the follicular stem cells.

Therefore, follicular stem cells have to be BCL-2 as well as CK19 positive. Other markers on the slides are:

  • CK 14 which stains all skin cells
  • CK 16 which stains developing cells, so these cells can not be stem cells
  • Ki 67 is a proliferation markers which stains dividing cells
  • DAPI which stains all cells

Dermal Papilla Cross-Section (a)

When we took a look at the follicle via a longitudinal cross-section of the dermal papilla, we did not find CK19 and BCL-2 positive cells. These cells would have indicated that “Stem Cells” were present in this area of the hair follicle. Our research has shown therefore that there are no follicular stem cells present in the dermal papilla. Some have hypothethized that stem cells are found in the dermal papilla. Our research indicated otherwise, and this was a significant finding. You’ll see why in the following slides…

Dermal Papilla Cross-Section (b)

Bcl-2 is the other stain we used to detect Stem Cells. With this stain we also found *no* stem cells present in this area of the hair follicle. This further established that the all important stem cells needed for cloning are not present in the dermal papilla. This gave us our foundation for what portions of the follicle were and were not important.

Longitudinal Cross-Section of Follicle

Longitudinal cross-section of the entire hair follicle which we got from a hair transplant graft. This is where we found what we were looking for. The markers revealed two main locations (pools) of stem cells in the follicle. One was found in the bulge area, and the other in what is called the “proximal” part of the follicle. Like in the previous slides, there were still no follicular stem cells present in the dermal papilla. These two pools of stem cells gave us our focal points for follicular regeneration.

Plucked-hair Shows Dermal Papilla

On the longitudinal cross-section of a plucked hair, we revealed that follicular stem cells are present in plucked hair.  We took a plucked hair and ran the same tests on it. The hair in the previous slide was a hair transplant graft that was extracted. In this case, the longitudinal cross-section still showed one of the pools of the all-important follicular stem cells.

Cell Culture Shows Dermal Papilla

In a cell culture derived from the attached hair follicle cells from the plucked hair, there are Bcl-2 and CK19 positive cells present. This further validates the presence of Stem Cells.

Summary of Findings

From these fundamental studies we can conclude :

  1. There are two locations in a hair follicle where stem cells are present:  The Bulge and the Proximal area.
  2. Cultured cells derived from plucked hairs also contain follicular stem cells.

Partial Follicles Making New Hairs

Next we did a study to determine whether follicular units (hairs) extracted from someone’s head would still have the potential for follicular regeneration. The significant difference about these types of extracted hairs is that we only extracted the top half of the hair, leaving the original root of the hair in its original location. Since we found two pools of stem cells, we hypothetized that we might be able to remove the top half, extracting the upper stem cell pool for implantation elsewhere, and leaving the lower stem cell pool to let the original hair grow back to full length.

In this study we revealed that partial follicular units smaller than 50% of the original length could actually initiate their own growth into a full hair. This means we are able to implant only a part of a follicle into another portion of someones scalp, and grow an entirely new hair from it, in a new location. This is what Follicle Multiplication is.

What Follicular Multiplication Is

Follicular Multiplication is the name of the procedure, and it consists of three steps :

  1. Extraction of the partial follicular units with a 21G (0.75mm/0.003inch) needle. We remove the top portions of follicles from what is called the “donor area” (place where hairs are taken FROM) and implant them into the front area like a traditional transplant procedure.
  2. Preparing of the recipient area with a same size needle.
  3. Implanting the partial follicular units into the front area of the head to fill in the hairline or reduce thinning.

Healing in Just 1 Day

Because we use the same size needle for the recipient area, the wound healing is very fast and the vascularisation has already been recovered
after one day. This is a significantly faster healing process than with traditional transplants, which typically take several days to weeks for complete healing to occur, and can cause swelling in the face, infection, and extreme discomfort.

No Scarring in Donor Area

Since we are able to extract the particle follicle with such a small needle and create an entirely new hair from it, there are no visible scars like you see above, from a typical hair transplant. As shown in the picture above, traditional transplants actually extract a strip of hair bearing
skin from the back of your head, and then stitch you back up. Many times this leaves scarring and is without a doubt a very painful process  that has a significant recovery time.

With FUE (Follicular Unit Extraction) they extract entire hair follicles from the back of the head and prepare them for implantation up front. Follicular Multiplication differs even from this procedure in that we only extract the top portion of the follicle, leaving the original follicle in place to grow hair. This innovative new procedure causes less trauma to the donor site, and allows for complete regrowth of the donor hair in its original location.

Advantages Over Traditional Hair Transplants

Follicular Multiplication has the following advantages over conventional hair transplantation:

  • Less pain during, as well as after the procedure.
  • Preservation of hairs in the donor area.
  • No scars in the donor area.
  • Better / Faster wound healing.

Difference between FUE and Follicular Multiplication

We don’t extract the whole follicular unit.  In our (fundamental as well as clinical) studies we revealed that we don’t need the whole follicle in order to regenerate hair growth.  If a small portion of the follicle remains in the donor area, it can regenerate a new hair, even when the major part of the follicle is removed. The major part, which has been removed, will also produce a hair when transplanted into the recipient area. So, one hair follicle can produce two hairs.

The rate of multiplication varies between patients, because we sometimes remove too much follicle tissue from the donor area, so only the graft will regenerate a new hair. We also sometimes remove insufficient follicle tissue from the donor area, so only the donor area will continue to produce hairs. These are the reasons why the percentage of “multiplication” varies in each patient. At the moment we have more consistency in the multiplication rate (40 to 80%).

Two Follicles Implanted, Three or Four Hairs Grown

With Follicular Multiplication, we also noticed that although we implant two or three hair follicle parts, sometimes more than three hairs will regenerate. This is already form of hair-multiplication, our other technology. This finding is exactly why we began the research project on Hair Multiplication in the first place.

What is Hair Multiplication?

Hair Multiplication is another technique. It’s not the same as the already existing Follicle Multiplication. Hair Multiplication is a
hair restoration technique which consists of three stages:

  1. Plucking of the hairs.
  2. Culturing of the attached hair follicle cells external from the body.
  3. Injection of cultured cells into a recipient area (front of the head, or areas of thinning hair). These cultured cells then generate new hairs. Like planting seeds.

The benefits will be significant. You will, in effect, have a potentially inexhaustible source of your own hair, which we will generate from only a few of your hairs.

Cultured Cells Derived from Plucked Hair

First we plucked the hair, and cultured the cells derived from the plucked hair. In the cell culture derived from plucked hair, there are cells with different morphologies present. In our fundamental studies we revealed that these cells also represent different cell types.

Challenges with Hair Multiplication

This is a new technology so it is not without challenges. Like other tissue engineering projects, we are facing the issue of inconsistency
of results, due to individual differences. Some of the inconsistency issues relate to the quality of the plucked hairs. Another issue is exactly *where* the number of cells attaches to the plucked hairs. This varies from person to person. As previously mentioned, there are different cell types cultured. Therefore the composition of the cell culture varies between person to person. We think that this may be the cause of inconsistent results. With Hair Multiplication, because we underscibe the importance of the local environment, these cultured cells will be implanted into the existing pores. However, this recipient area varies also person to person.

Conclusion

So there are two types of procedures currently being researched by the Gho clinic which qualify as potential enhancements to standard Hair Transplant procedures and even to the newer Follicular Unit Extraction technique some transplant surgeons are performing.

With any new medical procedure there are checks and balances and studies and data to be published before commercial availability in the United States and other countries. It is also prudent to wait for this data to be available via a published journal article. Dr. Gho has assured us that he plans to follow all the necessary protocols to go about perfecting and publishing his work for the world to benefit from, and we will of course notify you at that time that we feel it is adviseable to look into these procedures.

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