M1A1

I.m curious, why was my last question edited and removed? Thank you,

Dr. Vories, Thank you for posting this case, as the improvement appears to be a nice cosmetic outcome thus far, can you clarify as to why the hairs are standing straight-up as they exit his scalp? Thank you.

Patriot, I have been observing my hair for a while now and as someone who has taken Propecia since 1998 and has had 2 transplants- I know the difference between placebo and real results...For me, the results are real... In hindsight, I wish I started using this device earlier. Unfortunately, I followed the herd and did not even bother to try-big mistake on my part. But, that is water under the bridge. I am happy with my results after using this device now for about 9 months-Actually, and based on the study, I too started seeing the results around the 6 month mark. Ultimately, we all have a choice whether or not we choose to use this device, Propecia, supplements, 5%Foam or use a multi-modal approach or not. Patriot, you do what you think is best for you.

As someone, who has had two HT's, the laser has taken my somewhat unnatural hairline and overall hair density to a new level. What I mean by this is that my HT hairline now looks natural... Is it super dense-no. But, it looks good...No more roving eyes at my hairline. And honestly, I still can't believe how much better my hair looks. 8 minutes on Mon, Wed, & Friday that's it... On a side note, you will shed some to a lot of hair when you first start using this device. I know I did in my hairline-did not look good. In addition, it is best to use the device in a completely dark environment, like your bathroom and go very slow per the instructions. I also take collagen supplements with a very low Dalton weight, that in my opinion, have helped me. Make sure to speak to your doctor first before embarking down this road. In closing, I hope this device helps you as much as it has helped me. Best,

Ritwick, According to the study it was done once a week with a 1.5mm dermaroller. In addition, the day of microneedling, the participants in the study did not apply minox. Unfortunately, the study did not specify the type of roller. As far as using this after your transplant, it would be in your best interest to speak to your doctor. Hope this helps.

Slickers, At this time i do not have the other links, however, other forums provide some very good information on dermarolling/microneedling-I hope my spelling is O.K. aND ONE PICTURE OF A SLICK BALD HEAD WITH WHAT APPEARS TO BE VERY GOOD EARLY GROWTH-ALMOST TO HARD TO BELIEVE.

Dr. Charles, Thank you for your response. At first when i read the study i was somewhat concerned as it was from India and alot of medicine from India is dubious at best. But keeping an open mind and after further review of the study, it seemed at least on its own, fairly scientificaly process driven. With that said, what is your thoughts concerning the hair counts? Do they seem high? So, according to my math, this technique or modality was able to generate about the equivalent of 45 FU'S per sqaure centimeter? I look forward to your response...Your time is greatly appreciated Best,

You can find the study in The International Journal of Trichology- Volume : 5 | Issue : 1 | Page : 6-11 The results are very strong-Enjoy Ninety four of the 100 subjects completed the 12 week study period of which 50 were treated with both Microneedling and 5% Minoxidil lotion (Microneedling group) and 44 were treated with only 5% Minoxidil lotion (Minoxidil group) (6 subjects lost to follow-up and they were not considered for efficacy evaluation). Patients demographic and hair loss features at base line were similar among the both groups. Demographic characteristics The mean age of the population was 28.6 years. Patients had hair loss for a mean average of 4.5 years (range: 3-10 years). In Microneedling group, 23 had grade III vertex and 27 had grade IV hair loss. Similarly, in the Minoxidil group, 21 had grade III vertex and 23 had grade IV hair loss. A total of 94 patients, 20 had been treated with Finasteride and Minoxidil in the past for 6 months to 1 year duration and had reported no improvement, of which twelve were randomized to the Microneedling group and eight to the Minoxidil group. Efficacy assessment Hair count Change from baseline hair count at 12 weeks was a primary efficacy variable. There was steady increase in target area hair count over 12 weeks in subjects of Microneedling group. The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs. 22.2 respectively, P = 0.039) [Figure 5] and [Table 1]. Figure 5: Mean hair counts at baseline and at end of 12 weeks in the Microneedling and Minoxidil treated group Click here to viewTable 1: Change from baseline hair count at 12 weeks Click here to view Investigator evaluation Investigator evaluation of hair growth at week 12 was a primary efficacy variable. Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group [Table 2], [Figure 6] and [Figure 7]. Figure 6: Grade 3 response on 7‑point evaluation scale in the Microneedling treated group Click here to viewFigure 7: Grade 0 response on 7‑point evaluation scale in patient no. 1 and grade + 1 response in patient no. 2 in the Minoxidil treated group Click here to viewTable 2: Investigator evaluation of hair growth at week 12 Click here to view Patient evaluation Patient subjective evaluation of hair growth at week 12 was a primary efficacy variable. In the Microneedling group, 41 (82%) patients versus only 2 (4.5%) patients in the Minoxidil group reported more than 50% improvement [Table 3]. Table 3: Patient subjective evaluation of hair growth at week 12 Click here to view There was no significant adverse effect in both Microneedling and Minoxidil group. Other notable findings during the study period were Initiation of new hair growth was noticeable by around 6 weeks in Microneedling group and by 10 weeks in Minoxidil group. Rapid growth in the existing hair was seen at week 1 in the Microneedling group than Minoxidil group [Figure 8]. Figure 8: Earlier and faster hair re‑growth at 1 week noted in Microneedling treated group Click here to view Twelve men, unsatisfied with Finasteride and Minoxidil in the past, had +1 and +2 responses (4 and 8 men respectively) in Microneedling group on investigator's evaluation. Similar eight unsatisfied men to the previous treatment, showed no change after 12 week study period in the Minoxidil group. Discussion Minoxidil and Finasteride are the only FDA approved treatment modalities for AGA. Minoxidil is a potassium channel blocker, which leads to new hair growth by causing vasodilatation of scalp blood vessels. In animal studies, topical Minoxidil shortens telogen, causing premature entry of resting hair follicles into anagen, and it probably has a similar action in humans. Minoxidil may also cause prolongation of anagen and increases hair follicle size. [7] Minoxidil and Finasteride show their greatest efficacy in reducing loss of hair with small percentage of new hair growth seen after at least 4 months of daily usage. [8],[9] Efficacy of Minoxidil varies from 20% to 40% as per various studies. Patients using monotherapy continue to go bald in spite of therapy. Insignificant cosmetic effect of Minoxidil causes discontinuity of treatment in majority of patients. [10] DP is the site of expression of various hair growth related genes and a major target for androgen mediated events. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. [11] Mechanisms of hair re-growth induced by Microneedling include: [5],[6],[12] Release of platelet derived growth factor, epidermal growth factors are increased through platelet activation and skin wound regeneration mechanism Activation of stem cells in the hair bulge area under wound healing conditions which is caused by a dermaroller Overexpression of hair growth related genes vascular endothelial growth factor, B catenin, Wnt3a, and Wnt10 b. Studies on repeated Microneedling stimulation by Jeong et al. [5] and Kim et al. [6] showed the enhanced expression of hair related genes and stimulation of hair in mice. Kim et al. [6] also noted earlier and faster hair re-growth with more shiny texture of the hair in micro needle treated group than the untreated mice group. The authors also suggested that micro needle roller could be useful to treat hair loss refractory to Minoxidil therapy. The present 12-week study showed that dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair count and patient/investigator assessment of hair growth/scalp coverage. On retrospective questioning of patients after 8 months of completion of the study, at the time of writing the manuscript, all patients in the Microneedling group reported a sustainable response. The results of this study show that Microneedling is a safe and a promising tool in hair stimulation both for male and female AGA and also is useful to treat hair loss refractory to Minoxidil therapy. We opine that Microneedling procedure should be offered to patients with AGA along with the existing therapeutic modalities for faster hair re-growth and better patient compliance. However, issues regarding Microneedling viz; different sizes of needles of the dermaroller, frequency, duration and end point of the procedure are yet to be answered. This is the first study of use of Microneedling in male AGA. References 1.Kwack MH, Sung YK, Chung EJ, Im SU, Ahn JS, Kim MK, et al. Dihydrotestosterone-inducible dickkopf 1 from balding dermal papilla cells causes apoptosis in follicular keratinocytes. J Invest Dermatol 2008;128:262-9. 2.Chen D, Jarrell A, Guo C, Lang R, Atit R. Dermal β-catenin activity in response to epidermal Wnt ligands is required for fibroblast proliferation and hair follicle initiation. Development 2012;139:1522-33. 3.Reddy S, Andl T, Bagasra A, Lu MM, Epstein DJ, Morrisey EE, et al. Characterization of Wnt gene expression in developing and postnatal hair follicles and identification of Wnt5a as a target of Sonic hedgehog in hair follicle morphogenesis. Mech Dev 2001;107:69-82. 4.Plikus MV, Mayer JA, de la Cruz D, Baker RE, Maini PK, Maxson R, et al. Cyclic dermal BMP signalling regulates stem cell activation during hair regeneration. Nature 2008;451:340-4. 5.Jeong K, Lee YJ, Kim JE, Park YM, Kim BJ, Kang H. Repeated microneedle stimulation induce the enhanced expression of hair-growth-related genes. Int J Trichology 2012;4:117. 6.Kim BJ, Lim YY, Kim HM, Lee YW, Won CH, Huh CH, et al. Hair follicle regeneration in mice after wounding by microneedle roller. Int J Trichology 2012;4:117. 7.Messenger AG, Rundegren J. Minoxidil: Mechanisms of action on hair growth. Br J Dermatol 2004;150:186-94. 8.Tosti A, Duque-Estrada B. Treatment strategies for alopecia. Expert Opin Pharmacother 2009;10:1017-26. 9.Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: A systematic review. Arch Dermatol 2010;146:1141-50. 10.Schweiger ES, Boychenko O, Bernstein RM. Update on the pathogenesis, genetics and medical treatment of patterned hair loss. J Drugs Dermatol 2010;9:1412-9. 11.Zimber MP, Ziering C, Zeigler F, Hubka M, Mansbridge JN, Baumgartner M, et al. Hair regrowth following a Wnt- and follistatin containing treatment: Safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol 2011;10:1308-12. 12.O'Toole1 EA, Mellerio JE. Wound healing. In: Burns TB, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology 8 th . Blackwell Publishing. 2010. p14.1-27. Figures [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8] Tables [Table 1], [Table 2], [Table 3]

Mick, This result is AWESOME-so, this is from his clinic in Madrid? In addition, any videos or outside pics? Plus what is the hair count breakdown? By the way the pictures are very clear... Moreover, the naturalness, density and softness of the hairline is so stellar. I mean the scalp contrast is not even exisistant-WOW... Best

I'm glad that a picture was posted of a devastated harvesting procedure via FUE. It just goes to show you, at the end of the day, it comes down to the Doctor and his team-even more so for FUE...Honestly, a lot of doctors do not have the skillset to execute this type of surgery and do it consistently well. I am still blown away at Dr. Lorenzo's YouTube vide results. Clear Bright Light, combed wet, top view, & close up of hairline... I mean it's like he goes out of his way to show AND VIDEO the worst angles. Never mind combing post result with wet hair. I have never seen that before by a doctor on this forum or frankly any other forum. I usually don/t make blanket statements, but this should be the standard for all HTN Docs...and for that matter, the rest of the HT industry. Instead of dark light, no top downs, blatant over exposure of flash from the side and front with very little use of videos. On that note, I would like to applaud Dr. Lorenzo FOR PUSHING THE ENVELOPE WITH COMING WET POST OP HAIR and not hiding behind comical before and after photographs. I have to be fair and also give much deserved credit to H&W for their stellar video work too.

Actually, I am having some moderate success on it after 9 months. It has definitely naturalized my hair transplanted hairline especially in the transition zone. Though, I have been on Propecia since 1998... My understanding of Rogaine and the comb are that they are both Anagen inductors, however, they have different mechanisms at play that ultimately achieve somewhat of a cosmetic improvement-it's all relative...

Mickey, Something else that is of interest to me is that some of the FUE doctors in Europe, Turkey, & Belgium tell their patients to use the Laser Comb after their procedure- any thoughts on that???

Whoops, I meant FUE-LOL...

Mickey, I have read the complete thread and I have to say, I am impressed with your representation of FUE & FIT and their advantages and disadvantages...You seem to provide a logical perspective. What I find fascinating is that you have opened the eyes of many readers on JUST this forum about FUE and lets just say that, well, the BEST FUE doctors in the world will be incredibly busy. It's simple, the market demands it-supply side econ 101. You know when I first saw the results of the Turkish doctors, Dr. Lorenzo, and the others from Belgium, I couldn't believe it, NO- the truth of the matter is that I didn't want to believe it. Now I know, the best FUE doctors in the world are in EUROPE. And the BEST FUE doctor arguably may currently be in Spain. North American doctors on average have a long way to go to equal their FUR peers in Europe and Turkey. Keep up the good work...

Dr. Cooley, Great Job... The hairline looks very natural...And the crown, well as the Visa commercials state-Priceless..Did this patient have PRP & ACEL with his procedure?