{"id":16516,"date":"2023-05-20T22:22:29","date_gmt":"2023-05-20T20:22:29","guid":{"rendered":"https:\/\/looketmedecine.fr\/?p=16516"},"modified":"2024-10-05T23:27:30","modified_gmt":"2024-10-05T21:27:30","slug":"procedures-therapeutiques-les-innovations-dans-la-medecine-regenerative-des-cheveux-david-poisbleau-md-sophie-menkes-md-byong-seung-cho-ceo-et","status":"publish","type":"post","link":"https:\/\/looketmedecine.fr\/en\/procedures-therapeutiques-les-innovations-dans-la-medecine-regenerative-des-cheveux-david-poisbleau-md-sophie-menkes-md-byong-seung-cho-ceo-et\/","title":{"rendered":"LM N\u00b01 \/ 2023. Hair transplants."},"content":{"rendered":"
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Another look at aesthetic hair health.\nTherapeutic procedures.\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Innovations in hair regeneration medicine.<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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David Poisbleau, MD<\/strong>
<\/strong>Department of Plastic and Maxillofacial Surgery, Henri Mondor Hospital, Cr\u00e9teil<\/span><\/h4>\n

According to the communications from <\/em><\/strong><\/span><\/h4>\n

Sophie MENKES, MD, <\/em><\/strong><\/span><\/h4>\n

Byong SEUNG CHO, MD, CEO of ExoCoBio<\/em><\/strong><\/span><\/h4>\n

Lofti BENSLAMA, MD<\/em><\/strong><\/span><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Platelet-rich plasma (PRP),\u00a0<\/strong><\/span>follicular stem cells and adipocyte-derived stem cells : <\/strong><\/span>what impact does this have on hair regrowth? <\/strong><\/span><\/h4>\n

Sophie MENKES, MD, <\/strong>Switzerland,\u00a0 <\/strong>Pioneer in Aesthetic Gynecology & Internal Medicine.<\/strong><\/span><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Introduction.<\/strong><\/h5>\n
Hair is a symbol of strength and power, and can be a tool of seduction.<\/h5>\n
At his consultation, S. MENKES<\/strong> regularly receives patients who have lost their hair after chemotherapy, often with a strong emotional reaction to the loss of their hair.<\/h5>\n
One of the tools to help hair regrowth is regenerative medicine, via regulation of the hair cycle by increasing vascularization and cellular and nerve regeneration.<\/strong><\/h5>\n
Several genes of interest for the follicular cycle have been identified, in particular the MYB gene, coding for a follicle regulatory protein. It finely regulates the homeostasis of the skin and the hair capital. It has been shown that hyper-expression of this gene in skin cells induces hair loss in mice. Dr. Yuan Hu et al.<\/u><\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Why use adipocyte-derived stem cells?<\/em><\/strong><\/h5>\n
Adipose tissue plays a major role in this cycle: a permanent exchange between the fat cells and the hair takes place, helping follicular growth during the anagen phase.<\/h5>\n
Conversely, the adipose tissue decreases during the catagen phase and accompanies the disappearance of the follicle.<\/h5>\n
This has been demonstrated in mice, with a slowing of follicular growth in individuals treated with an adipocyte growth inhibitor (transcription factor PPARg).<\/h5>\n
The adipose-derived stem cells <\/em>(ADSC) represent 2 to 10% of the stromal vascular fraction (stroma vascular fraction<\/em>SVF). <\/strong>They have a role of differentiation and secretion of signals and growth factors which will regulate tissue homeostasis (growth of the vascular wall, fight against cellular senescence, etc.).<\/h5>\n
All of this secretory product of the ADSC is found in the secretome, which is the set of secretory products transported from cell to cell by microvesicles.<\/h5>\n
The most famous of these transporters is the exosome. Their use via the nanofat<\/em> in hair rejuvenation is of major interest.<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The Nanofat technique<\/em><\/strong><\/h5>\n
S MENKES performs the fat removal with the Hapifat\u00ae kit<\/strong> (1.65 to 2 mm cannula) and then rinse its contents with water (2 or 3 passes).<\/h5>\n
The Tulip\u00ae kit<\/strong> is then used with 30 passes for each connector (2.4 - 1.4 and 1.2 mm).<\/h5>\n
Finally, nanotransfer (400 micron sieve on one side and 600 micron on the other) is used to obtain the nanofat<\/em> <\/strong>and destroy the viable adipocytes likely to bring volume.<\/h5>\n
The injection is performed 4 mm under the skin with a 27G needle, either by hand or with a Lipopen\u00ae.<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The Rigenera\u00ae technique<\/em><\/strong><\/h5>\n
This is a method of obtaining stem cells from the dermis, although in smaller quantities than from fat.<\/h5>\n
Cells are recovered with 3 biopsy punches (2.5 to 3 mm).<\/h5>\n
The grafts containing hair bulbs and the peribulbar space (fat and mesenchymal tissue) are then mechanically ground and filtered to obtain a mesenchymal cell-rich lyophilisate.<\/strong><\/h5>\n
They are diluted in saline and then reinjected with a 33G needle into the scalp under local anesthesia.<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Regen Lab's Platelet Rich Plasma (PRP) technique<\/em><\/strong><\/h5>\n
Another alternative is PRP, which, after centrifugation of the plasma, makes it possible to recover a large quantity of autologous platelets, a natural source of cell growth factors.<\/h5>\n
As many studies have shown, it is also very effective for hair growth.<\/strong><\/h5>\n
The injection technique is done in the same way as the nanofat<\/em>by reinjecting approximately 4 mL into the scalp.<\/h5>\n
S. MENKES performs injections of 0.015 mL per point with a 33G needle, which are spaced 0.5 to 1 cm apart.<\/h5>\n
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Comparison of the three techniques<\/em><\/strong><\/h5>\n
A prospective multicenter study was conducted to compare the Nanofat, Rigenera\u00ae and PRP protocols by AIRMESS (Academy of International Regenerative Medicine and Surgery Societies<\/em>). <\/strong><\/h5>\n
120 patients were included and divided into 3 arms, following these 3 protocols.<\/h5>\n
The main objective was to quantify the evolution of the AGA score (androgenetic alopecia<\/em>) at 9 months of treatment with 4 assessments during follow-up (at baseline and at 3, 6 and 9 months).<\/h5>\n
The evaluation was performed using the TrichoScan\u00ae.<\/strong> in order to obtain objective and quantifiable results via a non-invasive technique based on epiluminescence.<\/h5>\n
Several parameters were collected, such as the number of hairs per cm2<\/sup>of the capillary density, etc.<\/h5>\n
Intermediate results are interesting with thicker, shiny and abundant hair.<\/h5>\n
However, some data are missing to perform the final analyses and the study is not yet published.<\/h5>\n
We present some before and after results in the following illustrations (Nanofat technique).<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Adipose stem cell exosomes\u00a0<\/strong>for hair rejuvenation.<\/strong><\/h3>\n

Byong SEUNG CHO,MD, CEO of ExoCoBio\u00a0<\/strong><\/h3>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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They are increasingly being studied in regenerative medicine and in the field of \"\u00a0cell-free therapy<\/em> \"Dr SEUNG CHO's team has developed a technique for isolating and purifying exosomes from adipose stem cell cultures (ExoSCRT\u00ae by ExoCoBio\u00ae).<\/strong><\/h5>\n
Presented as non-immunogenic and without major side effects, these purified exosomes can be applied transdermally (via CD44 surface markers to penetrate the dermis) or intradermally, possibly combined with Botox or fillers.<\/strong><\/h5>\n
Integrating numerous anti-inflammatory and regulatory organelles, they would be of interest in multiple indications: atopic dermatitis by reducing erythema and scars while reinforcing the skin barrier (the proposed protocol is 5 treatment sessions, spread over 2 weeks), facial rejuvenation, acne scars or even stimulation of hair growth<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Exosomes are transport vesicles measuring 30 to 90 nanometers that are released by a cell into its environment. <\/strong>They contain many signals and cell growth factors, as do the ADSC secretion products discussed above. <\/strong>They allow intercellular communication via messenger RNA and play a role in cellular immunity.<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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They are increasingly being studied in regenerative medicine and in the field of \"\u00a0cell-free therapy<\/em> \"Dr. SEUNG CHO's team has developed a technique to isolate and purify exosomes from adipose stem cell cultures<\/strong> (ExoSCRT\u00ae by ExoCoBio\u00ae).<\/strong><\/h5>\n
Presented as non-immunogenic and without major side effects, these purified exosomes can be applied transdermally (via CD44 surface markers to penetrate the dermis) or intradermally, possibly combined with Botox or fillers.<\/strong><\/h5>\n
Integrating numerous anti-inflammatory and regulatory organelles, they would be of interest in multiple indications: atopic dermatitis by reducing erythema and scars while reinforcing the skin barrier (the proposed protocol is 5 treatment sessions, spread over 2 weeks), facial rejuvenation, acne scars or even stimulation of hair growth<\/h5>\n
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How to optimize the hair transplant procedure.<\/strong><\/h3>\n

Dr Lofti BENSLAM, MD, <\/strong>Maxillo-facial surgeon and stomatologist.<\/strong><\/h3>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u00a0The principles of hair transplantation: two main techniques,\u00a0\u00a0<\/strong><\/span>the FUT (follicular unit transplantation<\/em>)\u00a0<\/strong>and FUE (follicular unit extraction<\/em>).<\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Follicular unit transplantation (FUT)<\/em><\/strong><\/p>\n

This technique involves transplanting hair from the crown region to the deplanted areas, via the removal of a strip of hair under local anaesthetic.<\/h5>\n
From this strip, grafts can be individualized with up to a single hair per grafted unit (called ultramicrografting).<\/h5>\n
These are then inserted into the depleted areas via suitable slots - with as little trauma as possible so as not to compromise the vascularization and quality of the surrounding tissue.<\/h5>\n
This limits fibrotic phenomena that are less conducive to the bedding of future grafts.<\/h5>\n
L. BENSLAMA recommends the use of small, atraumatic Kirchner wires for this purpose.<\/h5>\n
The actual insertion of the graft can be performed manually using ophthalmic forceps, or even robotically.<\/h5>\n
Morphological results were satisfactory, with correct capillary density at the graft site.<\/h5>\n
Normal density is 120 to 130 follicles per cm.2<\/sup>and it is difficult to exceed 80\/cm2<\/sup> with conventional techniques.<\/h5>\n
To optimize graft density, Dr BENSLAMA recommends a second densification session at a distance.<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Follicular unit extraction (FUE)<\/em><\/strong><\/h2>\n
This technique uses a different graft harvesting technique, with direct extraction from the donor zone in a single step using punches. <\/strong><\/h5>\n
However, there is a risk of traumatizing the graft when the blade is inserted - and therefore of a lower yield, with up to 66% of graft loss (known as trans-section of follicular units).<\/h5>\n
This risk can be mitigated by the use of blunt\/hybrid punches or larger punches, but with the consequent risk of a doll's hair appearance.<\/h5>\n
Finally, the graft is highly dependent on the quality of the adjacent skin grafted at the same time as the graft: the implantation technique must therefore preserve it as much as possible.<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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References<\/strong><\/span><\/h2>\n
Hu, Yuan, Zhongya Song, Jiang Chen, and Carlos Caulin. \"Overexpression of MYB in the Skin Induces Alopecia and Epidermal Hyperplasia\". Journal of Investigative Dermatology<\/em> 140, no<\/sup> 6 (June 2020): 1204-1213.e5. https:\/\/doi.org\/10.1016\/j.jid.2019.10.013<\/a>.<\/span><\/h6>\n
Cho, Byong Seung, Jin Ock Kim, Dae Hyun Ha, and Yong Weon Yi. \"Exosomes Derived from Human Adipose Tissue-Derived Mesenchymal Stem Cells Alleviate Atopic Dermatitis\". Stem Cell Research & Therapy<\/em> 9, no<\/sup> 1 (December 2018): 187. https:\/\/doi.org\/10.1186\/s13287-018-0939-5<\/a>.<\/span><\/h6>\n
Ha, Dae Hyun, Hyun-keun Kim, Joon Lee, Hyuck Hoon Kwon, Gyeong-Hun Park, Steve Hoseong Yang, Jae Yoon Jung, et al. \"Mesenchymal Stem\/Stromal Cell-Derived Exosomes for Immunomodulatory Therapeutics and Skin Regeneration\". Cells<\/em> 9, no<\/sup> 5 (May 7, 2020): 1157. https:\/\/doi.org\/10.3390\/cells9051157<\/a>.<\/span><\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Un autre regard sur la sant\u00e9 esth\u00e9tique des cheveux. Proc\u00e9dures th\u00e9rapeutiques. Les innovations dans la m\u00e9decine r\u00e9g\u00e9n\u00e9rative des cheveux. 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