Saturday, 16 December 2017 , 02:28:03

  • Site map
  • Contacts

Sensational discovery of Georgian Professor

Sensational discovery of Georgian Professor

11 Jan, 2011

Cause of Pattern Alopecia has Finally Been Discovered.

Hair Transplant Business is Still in Demand.

Tamaz Tamazashvili, M.D., Ph.D. ScD, Professor of Surgery, Tbilisi, Georgia, New York, USA, drtamazashvili@gmail.com

Abstract

The assumption of androgen's leading role in the development of pattern hair loss was a scientific mistake, which, dominating almost 6 decades, mislead patients, physicians, and pharmaceutical companies. As a result, the baldness still remains as the most prevalent condition in our society. The breaking news is that solar radiation has been discovered as a direct cause of patten alopecia which is expected to make a cardinal changes in the management of hair loss problem in the future. How the new discovery can effect hair transplant business? This is the main topic of the given article.

Pattern hair loss loss is one of the burning problems in our society. It affects millions of people in all countries and has a serious impact on people's life. Every single person, especially young, is in danger in terms of the high possibility to go bald regardless of all attempts to stop hair loss and avoid baldness.
The danger is over! Cause of pattern hair loss is finally discovered and it is not androgens as it was assumed before, but solar radiation (1). We are going to have significant changes in hair business- generally and hair transplant business- particularly.  Those changes are expected because hair loss becomes avoidable now if people pay proper attention to their exposure to solar radiation.
I am a hair transplant surgeon working in this field successfully more than 15 years, and, of course, worry about the future of the hair transplant business.
Scientific process, however, is an uncontrollable event which usually interferes with our medical activities and require sometimes to make even unwilling changes in order to keep our business going properly and successfully in the future.
This is the situation we have now. It requires maximum solidarity of hair transplant specialists to make more clear what are we going to loose and what we are going to gain in this new situation?
 First of all, what we need to do is to recognize the reality and not ignore it. The reality is that pattern hair loss is not a mystery any more, it is fully disclosed and presented in the book “New Concepts in Physiology of the Hair Follicle and  Etio-Pathogenesis of Pattern Alopecia (1).
   
Can this new discovery beneficially effect the hair transplant business, and if yes, how?
First of all, it should significantly increase the consent rate of patients for hair transplant procedure.
What does it mean?
Based on new concepts in hair physiology, the main role of the scalp hairs is protection from solar radiation (1). That is why since hair loss starts it does not stop but progresses gradually to baldness. So only transplanted hairs are natural protection for bald people from solar radiation which avoids further action of radiation on the scalp skin and hair follicles situated therein.
This all means that hair transplantation procedure is not only a cosmetic issue like it was assumed before, but a serious protection of remaining hair follicles from solar radiation, and hence, essential remedy against further progression of hair loss. So hair transplantation becomes from optional to a necessary procedure to stop progression of baldness.
Since October 5, 2010, when new discovery in hair physiology and pathology was officially announced we got an increase in consent rate for hair transplant procedure from 48% to 74.4%. You can also easily get the same result if you are able to explain to the patients how important the transplanted hairs are for them and delay of procedure increases significantly their chance to loose the remaining hairs. Besides that, hair restoration, if delayed,  becomes more difficult and less effective. Conviction of our patients is not hard to achieve because most of them are already familiar with the results of all kind of treatment, they come to see us for new and well-founded explanation of what happened with them,  what is the cause of their hair loss problem, and what is the new approach to treatment. Many of them are even able to remember when they exactly got their critical solar radiation. This kind of consultation is always very helpful to convince them the necessity to restore hair coverage as soon as possible and thereby decrease the chance of progression of hair loss in the future. 
There is another very important benefit from hair transplantation. It has been  confirmed in many research that hair follicles contain multi-potent stem cells (2,3,4), which can be transformed in a certain situation into different type of cells: vascular cells (5,6), smooth muscle cells (7,8), neural progenitor cells (9,10,11,12).
Based on this data, transplanted hairs are not only physical protection of remaining hair follicles from solar radiation, but they are a very important source of stem cells capable to fill the depleted reserve potential of existing hair follicles and makes them more resistant to the further cation of solar radiation (1).     
Hair transplantation is a very effective procedure in terms of regrowing of transplanted hairs, but there are some cases when hairs fail to grow after follicular transplantation. This phenomenon is referred to
“X-Factor.”
Referring to the new discovery now it becomes obvious that to increase survival of transplanted grafts the recipient site needs to be prepared for follicular transplantation, because long term action of solar radiation on bald scalp created the situation when all stem cells of transplanted follicles are used for maintenance of the integrity of skin first. It deprives transplanted follicles of stem cells which are necessary to provide steady hair growth after transplantation (1).
Thus, knowledge about the cause of hair loss allows to increase effectiveness of hair transplantation through increasing the survival rate of transplanted follicles.
Follicular survival depends to a great degree on their preservation during a period from dissection to implantation. For this reason I have developed container-protective method which preserves follicular grafts from dehydration during their implantation into recipient area . It was reported at an annual meeting of International Society of Hair Restoration Surgery in New Orleans (1998). Colleagues from my clinic have refined that method facilitating grafts countability and preservation (13).
At that time, we were worrying only about graft dehydration and had no idea about possible photo-damage of dissected grafts.
Now it becomes absolutely obvious that follicular grafts need protection not only from dehydration but from photo-damage as well during donor strip harvesting, grafts dissection, preservation and implantation. This requires to create a special environment, which preserves follicular grafts from possible photo-damages.
 As we see, the new discovery opens the “secret” of many previously unknown events, which had negative influence on final results of hair transplantation and gives impulses to different associated companies for development of new devices.
I had personal communication with the president of Robbins Instruments Inc., Mr. George Mulvaney who got very interested in this idea and expressed his willingness and readiness to participate in the development of special optical devices allowing to perform the whole hair transplant procedure in a special light-free environment.
Progression of hair loss is one of the undesirable results of hair transplantation, because not only existing hairs shed gradually but the transplanted hairs as well which seriously discredits the hair transplant procedure.
I have observed many patients in my practice, who had experienced thinning of transplanted hairs after a while. It is actually against our promise given  to the patients before the procedure that transplanted hairs never shed. Now we know that transplanted hair follicles need protection from solar radiation as well which avoids hair loss problem in the future.
Thus, knowledge about the cause of pattern alopecia allows to prevent hair loss from transplanted follicles which should improve the long term results of hair transplantation.
Summarizing all the above, we can conclude that discovery of solar radiation as a direct cause of pattern hair loss should basically have a beneficial effect on hair transplantation itself.
   
The question arises: since many people will be able to protect themselves from solar radiation, can the pool of patients for hair transplantation be diminished?
Yes and No.
Yes – because  people will get a real chance to protect themselves from solar radiation and avoid onset or progression of hair loss. This is an inevitable benefit for our society from discovery of the cause of baldness.
To reach this goal, however, is not very easy. It requires systematic monitoring over outdoor solar radiation. Loss of control even one day may become critical for the safety of hair follicles.
So the common pool of people experiencing hair loss will be diminished worldwide but at the same time, the pool of patients for hair transplantation is expected to increase significantly.
What does it mean?
Hair transplantation is going to become from an optional procedure designed to correct existing cosmetic defects- bald spots, to the necessary procedure. Necessity of hair transplantation is dictated by the fact that only transplanted hairs can create a reliable protective barrier against solar radiation.
So the only way to protect the remaining hair follicles naturally from solar radiation is restoration of lost hairs. That is why we should expect an increase in demand for hair transplantation in the future.
Free Society From Baldness- this is our goal. This slogan includes not only protective measures that allows people to prevent hair loss, but treatment as well using both hair transplantation and/or different medications.
So, dear colleagues, there is no reason to panic, just look straight to the reality. Get familiar with the  new book which allows us to work out the necessary strategies for our business in the future.
Based on all prognoses, from new discovery in hair physiology and pathology all sides win: patient's, physician's and pharmaceutical companies'.
Most important for us should be victory of the patients whose treatment will be more effective and successful.

Conclusion:

1. Based on new discovery hair transplantation is no longer only cosmetic issue. It becomes a necessary procedure to protect existing hair follicles from solar radiation and prevent the progression of baldness.
2. Because of necessity to create a protective hair layer we should expect a significant increase in consent rate for hair transplant procedures in the future.

References:

1. Tamazashvili, T. New Concepts in Physiology of the Hair Follicle and Etio-Pathogenesis of Pattern Alopecia. Morris Publishing, 2010, 237 p.
2. Ma DR, Yang EN, Lee ST: A review: the location, molecular characterisation and multipotensy of hair follicle epidermal stem  cells. Ann Acad Med Singapore 2004;33:784-788.
3. Hoffman RM: The pluripotency of hair follicle stem cells. Cell Cycle 2006;5:232-233.
4. Hoffman RM: The potential of nestin-expressing hair follicle stem cells in regenerative medicine. Expert Opin Biol Ther 2007;7:289-291.
5. Yano K, Brown LF, Detmar M: Control of hair growth and follicle size by VEGF-mediated angiogenesis. J Clin Invest 2001;107:409-417.
6. Amoh Y, Li L, Yang M, Moossa AR, Katsuoka K, Penman S, Hoffman RM: Nascent blood vessels in the skin arise from nestin-expressing hair follicle cells. Proc Natl Acad Sci USA 2004;101:13291-13295.
7. Drewa T: Using hair-follicle stem cells for urinary bladderwall regeneration. Regenerative Med 2008;3:939-944.
8. Liu JY, Peng HF, Andreadis ST: Contractile smooth muscle cells derived from hair-follicle stem cells. Cardiovas Res 2008;79:24-33.
9. Li L, Mignone J, Yang M, Matic M, Penman S, Enikolopov G, Hoffman RM: Nestin expression in hair follicle sheath progenitor cells. Proc Natl Acad Sci USA 2003;100:9958-9961.
10a. Amoh Y, Li L, Campillo R, Kawahara K, Katsuoka K, Penman S, Hoffman RM: Implanted hair follicle stem cells  form Schwann cells that support repair of severed peripheral nerves. Proc Natl Acad Sci USA 2005;102:17734-17738.
10b. Amoh Y, Li L, Katsuoka K, Penman S, Hoffman RM: Multipotent nestin-positive, keratin-negative hair-follicle bulge stem cells can form neurons. Proc Natl Sci USA 2005; 102:5530-5534.
11. Amoh Y, Li L, Katsuoka K, Hoffman RM: Multipotent hair follicle stem cells promote repair of spinal cord injury and recovery of walking function. Cell Cycle 2008;7:1865-1869.
12. Amoh Y, Kanoh M, Niiyama S, Hamada Y, Kawahara K, Sato Y, Hoffman RM, Katsuoka K: Human hair follicle pluripotent stem (hfPS) cells promote regeneration of peripheral-nerve injury: an advantageous alternative to ES and iPS cells. J Cell Biochem 2009;107:1016-1020.
13. Bebiashvili, I., Mulvaney, G., Tamazashvili, T. Container-Protective Method of Follicular Graft Preservation in Hair  Transplantation. Hair Transplant Forum International, 2008; 18,6: 229-230.