Dr. Patrick Mwamba

This young patient, 23 yo, with wavy dark brown hairs, came to our office seeking for a hair transplant surgery. I couldn’t notice any hair loss because he was combing his hairs forward adopting a hairstyle camouflage. Family history of hair loss was negative and the patient was using a shampoo to treat his hair loss. After close examination, we noticed a receded frontal hairline and temples .The pull test for active hair shedding was negative. At this age, we do surgery only if the patient is committed to get on medical therapy .We recommended LED light once per week, Help hair Whey protein and vitamins. For surgery, 1538 grafts FUE by FIT shaven were performed to achieve the patient’s goal: being able to comb his hairs backward. We are presenting his results at 9 months post op and the patient is happy. When building a hairline, we should keep in mind that naturalness and detectability are a paramount. To balance the face, temples points reconstruction must be part of your regular plan .A few thin grafts should be placed there for softness. It is also important to inform our patients that patience is part of the game while waiting for final results .It may take up to one year before you reach your desire goal.

I will rephrase the conclusions about studies that was made in attempt to understand how the level of transection of a follicle can generate or not a new follicle ( Hair transplantation Fifth Edition Walter Unger ,Ronald Shapiro) . MICRODISSECTION studies have demonstrated that both follicular Derma papilla and connective tissue sheet cells in adult hair follicle possess TRICHOGENICITY MONO CULTURED derma papilla cells and CTS LOSE their trichogenic characteristics over time AGGREGATING cultured follicular Derma papilla cells can restore TRICHOGENICITY ABILITY CO CULTURED OF Derma papilla cells and epidermal lineage can PRESERVE trichogenicity Growth factors and MEDIUM conditions can influence trichogenicity in vitro . At the bulge area , you have presence of CTS cells and epidermal cells : that's why you can grow new hair when the cut is under the bulge .You have the presence of the two lineages . The lower part has CTS + DP cells and they are trichogenic . Why are we using GF or are we so interested in media solution? Clinically , when you transect a hair follicle or bissect it , they tend to grow thinner .GF have tendency to proliferate cells , to improve blood supply and therefore the environment of the new follicle to come .They act like fertilizer .At the end the new follicle we are getting are as strong as the mother follicle or even stronger .Certains GF such FGF9 prolongs the anagen phase ;therefore your new follicle will live longer .We have up regulation of protein such as Beta catenin that are anti catagen ( anti apoptosis or cellular death ) . GF promotes proliferation of DP cells and protects them from apoptosis . They could be dangerous of course .That's why we need to be cautious about which one to use and what vehicle to use .Prp seems to be Ok but do not have all the GF .We keep working on safety according to animal model . Media solution are also important to keep the follicle in active phase ;that's why it is so important to use products like ATP , hypothermosol and others GF. Why adding stem cells ? AGGREGATING CULTURED OF DP CELLS can restore trichogenicity When we inject stem cells , they have the tendency to aggregate and stick around the existing follicle of the bisected hairs or miniaturized hairs . Aggregation of stem cells is crucial .Failure of Hair Multiplication came from the inability of human stem cells to aggregate by themselves after in vitro culture .Which is the opposite in mice .

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Fronto temporal recession with diffuse thinning is one of the major characteristic of Female Pattern hair loss. In black woman patient, you need to rule out traction alopecia from braiding or sometimes those two entities coexist. Because of our understanding of medical therapy related to hair loss and hair cycle, we are comfortable to recommend surgery for patients who commit to follow it. Compliance is a key factor for medical therapy success .Of course in our clinic we do recommend the tri therapy : 1.Anti DHT ( Finasteride ) + Anagen stimulator ( Laser light , LED light , or Minoxidil 5 % ) + Catagen onset inhibitor ( Help hair Whey protein + Help hair vitamins ) . In female patients, we do just recommend the bi therapy (anagen stimulators and catagen onset inhibitor). Below you will find an illustration of one female patient with female hair loss pattern who were pushed to use wigs all the time … Look at also the improvement in the donor area from laser and LED light therapy, …And now we have a happy patient free of wigs. Thank you

In hair cycle the resting phase or telogen phase last from 2 to 6 months It means after a surgery you should expect to see the first growth around 3 months up to 6 months.we are within that range. And when hair grows you need to wait up to 12 months before you declare success or not about any procedure It is too early to jump into conclusions We all need to be patient and request informations or update when needed That's why I told people we need at least two years before to get some insight and draw some conclusions Before that it will be just playing games if we are rushing into conclusions Thank you

He is at 5 months post op ( injection of stem cells for hair multiplication ) and so far nothing happened as far as hair growth .

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The patient, 28 years old, with blonde, straight hairs came to visit us to improve his hair line density. He is Norwood 2A in hair loss scale (thinning in frontal hair line). He was on propecia and Rogaine for 5 years to prevent hair loss progression. Dermascopic examination of his scalp didn’t reveal signs of miniaturization on top and vertex .We could lower his frontal hair line with no fear but the patient wanted a conservative approach; just increase the density of the thinning FHL and he wanted something very natural. We grafted at 50 Fu/cm2 a total of 805 grafts. The patient had long hairs .We decided to choose the FUE by FIT patchy shaven technique. Because of his blonde hairs, the contrast skin color/ hair color is low .Therefore we do not have to choose necessarily thin hairs in the lower part of the donor to make a natural, not coarse hair line.

Our patient came to us with two objectives: 1. Fix my Frontal Hair line 2. What can we do for the vertex 3. Don’t want big surgery because of health conditions Beside our tri therapy medical treatment ( finasteride + rogaine foam and/or laser cap + Help Hair Whey protein and Help Hair vitamin ) , I told him that our sight is attracted first to the middle part of our head .When you bring improvement to that part , he usually gives you more flexibility in hair styling .By blocking the flow of lighting from front to back , it gives the impression of fullness of the hair line ( shadow behind frontal hair line ) .Hair length in the middle part can easily cover up the back or vertex if you comb it backward . I recommended to focus our first step in middle front .We choose FUE by FIT patchy shaven for discretion . We are presenting his results 6 months after grafting 704 units in one day at our Brussels clinic . http://imagizer.imageshack.us/v2/xq90/22/m0xo.jpg' alt='m0xo.jpg'> Thank you

We had two patients : The first patient had first surgery with Dr Nigam ( HAir Doubling ) and a regular FUE with technology for hair regeneration in donor area .He came onne month after the surgery .There was no white dot .The patient was supposed to come every month for a follow up but didn't show up for the 2 months and 3 months Fup ( busy with work ).We know that growth after a hair transplant starts to show up from 4 to 6 months ;we are really hoping he will come for the next assessment . The second patient was a Norwood 7 .Dr Nigam performed a small test of Hair doubling ( 30 grafts ) and in December ( 90 days after first surgery ) , he injected stem cells for hair multiplication .He is black and lives in Brussels .So we are checking him every month .What we can tell right now is no signs of surgery in the donor area .It is really a scarless FUE ( compared to what we observed in lots of patients where you can detect the small empty spots of scarring eventhough it is not visible with the naked eye . There is several protocols we have to test now : 1 Scarless FUE with donor hair regeneration . You do perform a regular FUE .And you apply the technology of tissue engineering in donor area .We are now selecting candidate for that study in our Brussels clinic . 2 Hair Doubling The protocol for hair doubling requires extra investments to get a lab in Brussels .We can not offer it so far in our Brussels clinic until we get everything set up .We are thinking of offering that in India to patients who would like me to perform the surgery .We will perform a regular FUE and in one area , we will test the hair doubling technique , possible because Dr Nigam will put his lab in our disposition to get what we need .For this scenario, I have to gather a certain number of patients before to make a trip to India . Dr Nigam is conducting the study for hair doubling in Mumbai and I will be an independant investigator to assess results .We do not have the same surgery protocol ( they do perform classic FUE and not the FIT technique ) . 3 Hair Multiplication will be available only in India because of regulations about hair cells manipulation and culture . I will have to travel to India with the patient to perform it . We need to organize those trips with interested patients knowing is just a trial and results or outcome are not guarantee.And the selected patients have to fit in certain criteria for the sake of standardization of the study .It will not be so easy to organize all of this . At least we want to start with the scarless FUE and the Denovo hair regeneration in donor area .

Patient’s goal is always our first priority .In this case, we had specific requirements from our patient: 1. He wanted to get a good coverage but light 2. He wanted to keep the asymmetry in his frontal hair line 3. He didn’t want a huge change in his look. We grafted his frontal hair line at 30 Fu/cm2 in state of 50 to 60 Fu/cm2 in our regular cases. Behind the frontal hair line the density was 20fu/cm2 .In total we covered 60 cm2 with 1560 grafts.

The patient came to see us one year after a first session surgery in another clinic .He had 2986 grafts by FUT. Results comments: 1. Good growth of Frontal hair line except his left side. 2. Behind the hair line, in frontal zone, regrowth process was not at the RDV.Hairs were looking thins, DE pigmented and couldn’t grow longer .Those are signs of miniaturization in hair loss progress. It created a contrast between the good hair line and the poor density in frontal zone and top (which could be a result of hair loss progression + poor growth from surgery). 3. Scar was unnoticeable in right side and quite big in the left side .Scar from FUT is unpredictable. The patient goal was to increase density so he can be able to comb and create an illusion of coverage. Because of his great hair characteristics ( Calculated density averaging 2.5 hairs per grafts ) , we recommended to graft at low density ( 30 Fu/cm2) a broad area .We end up with 1690 grafts .The technique choose for discretion and fast social reinsertion was FUE by FIT patchy shaven .We will present current status 21 months post op . Hair density ,Calculated density i.e. number of hairs per graft ,hair caliber , hair color and hair pigmentation , contrast skin /hair color , hair length are among the major parameters to consider for hair coverage .

Yes , it was .The patient had a very high calculated density ( i.e. number of hairs per grafts ) averaging 2.2 . We cherry pick the big groups to achieve a better coverage in one pass . Thank you for your comments .

Our patient had a previous strip surgery prior to contact us. During consultation, we noticed poor growth in recipient area with micro scarring and bad angle. In the donor area, he had a thin linear scar of 3mm wide and 13 cm long. He had coarse hairs and good donor density. His goal was to fill in and recreate a new hair line and because he likes short haircut, to hide the donor scar. We recommended grafts both the frontal zone and the scar by FIT shaven technique. Results in the front was still poor and we modify our plan to do small sessions with injections of Acell to improve results .We already did 2 sessions and we will present this case later on if needed . Our focus today is the results we get in the donor from scar grafting. The scar surface was about 3.9 cm2 (13cm long/3mm wide) .Knowing that grafting at low density (beneath 30 Fu/cm2) lead to better yield, we decided to graft at 25 Fu /cm2 .The total number of grafts in the scar was 101 grafts. What lessons do I want to share here? 1. Scar of 3mm is acceptable and it was also flat .But the contrast with the skin color and the anatomy of the scar (linear) attracts our sight and reveals it. At the end it bothers the patient because it doesn’t look natural. 2. Grafting the scar improved the scar color and just with low hair density, we broke the contrast and it looks pretty much invisible. 3. We also noticed FIT /FUE scars also known as white dots .They are present in this case .Their anatomy blends easily with the surrounding area and it doesn’t attract our sight .Therefore it looks natural and normal and no one will pay attention to them .They are present but not noticeable .And our patient can have a short haircut as he wanted.

Hi Crafter , Right now , we are reviewing Dr Nigam's protocols and we are designing the study protocol .There is parameters to follow ( such as hair density , hair caliber ,Cross section trichometry , before and after pictures , number of grafts ,...).Dr Nigam had his own protocol of surgery ;we have our own .We should study how we can put everything together so there is a way to analyse the data objectively . We have also to be aware of intellectual properties about protocols and it should be covered so everybody can be open in the process.While lawyers and administratifs staff are putting all of that together , we are working on establishing protocols . Then we will start the second phase : selection of candidate with specific criteria . We are planning to start in January if we do not find any delay with paper work . From previous experiences , we know it takes about 3 months to start noticing some changes when you do hair transplant .At 6 months , most of the time results start to talk by themselves and it takes about 1 year for full result . If we start in January , our first observations will be available around April . and by July, we will start to see some evidence and by December , the first conclusions .As we can not rely on one or two patients ,we will keep selecting patients from January to June and adjust our protocol as we go .Therefore , the conclusion of this study will be made around June 2015 and we can objectively say if the technique is viable or not . Of course as we progress , we may find new ideas , and hopefully all of this will bring us one step forward in our quest to resolve hair loss and provide cutting edge technique and great ,natural and undetectable results . I will be in India at the end of this month to hopefully finish our paperwork and see how we will move from there . In the meanwhile , let's hope and pray for the best to come ...

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It could be .He has his own records and for sure he should have many pictures to show .As a scientist , I can not rely solely on pictures .That's the purpose for us to conduct a series of trial in the two sites ( Brussels and Mumbai) with the same protocol .If the results are reproducible , it will be a proof of the concept by itself .

He is on tri therapy : Biotin pill ( it takes it by cycle of 3 months ) , Minoxidil 5 % twice a day and propecia , once a day . This is the treatment I recommend to our patient : 1. Anti DHT ( finasteride or dutastaride ) 2 . Anagen stimulators ( luminotherapy such as laser cap and/or Rogaine foam ) 3. Vitamins and proteins .

Our aim with FHL work is to make it look natural. The patient was a Norwood 2 with receding temples .He had a natural asymmetry of his hair line. He wanted to even it up and get a decent density. We recommended medical therapy (to prevent hair loss progression, avoid post op shock loss and improve donor hairs quality). For surgery, we did FUE by FIT shaven technique .We grafted at 60 Fu/cm2.

Everybody should be very careful about any claims made out there . In the meantime , scientific curiosity pushes us to verify any claims and not rejected it based on feelings . Let's put in place a study to proof the concept and let's all be patient as we are moving forward .If it is true , only time will tell us ... I will put my expertise , my effort , my love for patients ,my love for innovations and progress and my hard work to help find a solution .

For ECM , we didn't observe neogenesis as they told you .In theory , we would expect that . Now your point about creating a hole is totally right ;that's why I will suggest a punch of 0.5mm to begin with .And it will be worthy to try it .

Dear Pasquale , I got it now .I am not sure if Dr Nigam tried it .What you are suggesting is creating wounds and apply the cocktail to stimulate neogenesis . It is something I have been doing in my clinic .What we do is to create wounds ( not with big punches ) but with needles .And then ,I was injecting Acell an ECM .The role of Acell is to attract a massive quantity of blood with Adult stem cells ( inactive) and convert them to progenitor cells at the wound site .We did observe on those patients a gain in hair caliber and pigmentation and not statistically significant improvement in density .(neogenesis?) .I was thinking of applying the new cocktail with the same principle .I am just not sure if creating bigger wounds will help favorably . I may try it with even smaller punchs 0.5mm to avoid massive scarring in case of failure .

Hello Bruno , neogenesis means new beginning of a follicle in this case .De novo means new .It is the same thing in our understanding .