Dr. Jerry Cooley

Spanker The result from PRP/ACell appears over the same time course as a transplant, ie 6-12 months. Some shedding may occur, but I take this to be a Rogaine like effect where telogen hairs are pushed into anagen. I have tried it on a couple patients with DUPA or diffuse thinning, not on finasteride, and the results were not good. I would not recommend it for this type of patient.

Haircut Yes, we use PRP/ACell (without a transplant) to try and thicken hair. The degree of improvement will depend on whether the patient is on finasteride, how much miniaturizing hair there is, and individual variation. Attached are three patient examples of PRP/ACell in the crown without a transplant and without confounding effect of finasteride (ie first 18 months of treatment).

This patient is in his early 60's and has been on finasteride for many years. He had a hair transplant about 10 years prior of about 2500 grafts. His donor was not that great. We performed FUT of 3,315 grafts (6,252 hairs) and PRP/ACell. He is shown 15 months later. His grafts grew in well and there was a nice thickening effect from the PRP/ACell. He may come back to fill in the fronto-temporal corners a little. As usual, we did not shave so the patient could return to work in 7-10 days.

Thanks for the feedback. The patient is 90% happy with it and plans to let some time go by. The crown can be a black hole for grafts so I recommended he wait another 6 months and see how he feels about it then. Some camouflaging fibers like Toppik can make a big difference here.

This patient has the vertex pattern of MPB where the frontal hairline is generally preserved over time. Thinning starts at the top and spreads outward over time. He had started finasteride a year previously with stablization of the loss. We performed FUT 3,342 grafts. He is shown 11 months post op, with overall great improvement. Depending on lighting, there is still some scalp showing through, but under most conditions its not really noticeable.

Thanks for your comments and question. In regard to PRP, neither he nor I thought the PRP was wearing off. There are no black and white rules as to how often PRP should be repeated. There are numerous variables here such as genetic rate of loss and use of medications. In this case, the patient wanted to do another PRP to see if additional thickening, particularly in the crown, would occur.

Not sure I understand the question, sorry. Can you rephrase it?

Thanks for the comments. We performed another PRP at followup. He may try a low dose finasteride and see how he does. I find that patients who thought they had low libido at 1mg per day often do not have a problem at 0.5mg every other day.

This patient is in his late 40's and wanted to mainly address recession of the hairline. He has baby fine hair. He had tried finasteride in the past but discontinued due to possible side effects. We performed FUT of 3120 grafts (6,255 hairs) as well as PRP/ACell. He is shown 10 months later.

This woman is in her early 30's and has been experiencing hair loss for almost 10 years. She has been on spironolactone and minoxidil for 7 years but there was still some progression in her hair loss despite medical therapy. In addition, she is a long distance runner and in my opinion she had inadequate protein intake. We advised a better diet and she began using Help Hair protein shake. Her donor density was low and we were only able to harvest 1,538 grafts (2,454 hairs), which we focused in the frontal core. We performed PRP/ACell at the time of the FUT and at 6 months. She is shown at 12 months.

I appreciate all the comments. I would certainly like for him to have started finasteride as well. However, I never try to talk anyone into taking it. We know there is a significant placebo effect when it comes to finasteride side effects. The chance of side effects is therefore much higher for someone who starts out with a negative attitude about the drug and is worried about it. Given that he is in his 50's and has been on a slow downward slide, he will likely not need to have PRP/ACell yearly. For someone in their 20's, that may certainly be the case. I believe the ACell makes the PRP effect last longer than PRP alone. I have found that for myself, PRP/ACell lasts about two years before it starts to wear off. Regarding the expense, it all depends on exactly what the clinic is doing. If the clinic is using a cheap centrifuge that wasn't designed for PRP, it should not be expensive. But it will not produce good platelet concentrates and the results will not be that good. We use a system that produces >5X platelet concentrates and the cost of each disposable kit is significant. Furthermore, there is almost $500 worth of ACell in each of our treatments. I've developed a rough sense for who will benefit and who will not, so I try to be careful about who we perform it on to make sure the expense is justified.

This patient is in his 50's and wanted to address his crown, midscalp, and receding hairline. We performed FUT 4,317 grafts (9,688 hairs) as well as PRP/ACell. He is shown one year later. He did not take finasteride. As hair loss progresses in the future, he will do more PRP and/or transplants as needed; he preferred that approach to taking medication (despite my recommendation).

This lady is in her early 70's but looks much younger, except for the frontal hair loss. We performed FUT of 2217 grafts ((1-843, 2-1077, 3-278, 4-19; 3,907 hairs). Her donor area was typical for many of the females I see, which is much lower density and far fewer hairs/graft compared to the men I see. It is necessary to pack the hair in at a good density. In addition, we usually combine the single hair grafts to increase the number of 2 and 3 hair grafts. This looks better than placing them singly and means fewer incisions in the scalp. She is shown one year after the procedure.

We used about 1,000 grafts in the back. Thanks for all the comments.

This patient is in his early 40's. He had been taking finasteride with good results and no further hair loss. He wanted to primarily restore the front, but also add some to the crown. We performed FUT 4,399 grafts (1-1136, 2-2129, 3-1113, 4-21) to the front, midscalp, and crown. We did not shave his hair, allowing him to return to work in a week. He is shown one year later.

Over 100cm2 of area was covered. In some areas, over 40 grafts/cm2 was achieved but over most of the area, it was more like 30. Thanks for the comments.

Yes, he came back for a consult for a second, smaller procedure.

This patient is in his mid 40's and wanted restoration emphasizing the front but with some coverage in the crown. He did not want to take finasteride so we planned a conservative restoration that would continue to look good even with ongoing loss of non-transplanted hair. We performed FUT of 3,595 grafts (1-973, 2-1864, 3-591, 4-167; 7,142 hairs). He is shown 3 years later.

This lady is in her late 30's and has traction alopecia. We performed FUT of 2,042 grafts (3391 hairs) to restore the frontal hairline. We harvested the maximum amount of hair but were unable to get enough to restore all the way down to the original hairline. However, she was happy with the improvement, shown at 10 months.

David I did not take your post to be in any way offensive. In fact, my thought when I read it was, "Right on!". I have a significant number of men and women in their 60's and 70's who come in for hair restoration. My oldest patient ever was 83 and he continued to enjoy his new hairline until he was 95 when I last saw him. Older patients have the same motivation as younger patients (ie look better and restore self image) and they usually have more realistic expectations. Some of the issues in dealing with older patients include working with gray/white hair which can be challenging and they are often on several prescription medications for health issues, so we have to sometimes do things a little differently and monitor closer to make sure we keep our procedure safe. But otherwise, they heal just as well and have the same graft growth. I enjoy seeing a diversity of patients including age, gender, racial backgrounds, types of alopecia, etc.

This patient is in his mid 60's and wanted to restore his frontal hair, as well as thicken the crown. We started finasteride and performed FUT: 3,801 grafts (1-779, 2-1626, 3-1010, 4-386; 8,605 hairs), placing mostly in the front but also some in the mid scalp and crown. He is shown 10 months post op. In patients with gray/white hair, we dye the hair to make dissection and placement easier.

This patient is in his mid 40's and has type III/IV hair loss. We performed FUT with 3,781 grafts with half going to the frontal area. The other half went towards filling in the crown and mid-scalp. We started him on finasteride as well. He is shown 3 years later.

Spanker Yes, he came in wanting to reverse all the old work so he could shave his head. Attached are photos of the recipient. Dr Cooley

This patient had several strip surgeries in the 1990's with unsatisfactory results. He has very fine hair and his loss progressed over the years. His goal was to repair the donor scars and remove the grafts so he could shave his head. We performed a series of procedures combining FUE (1,583 grafts), plug removal, PRP/ACell, and dermabrasion. He is shown 5 months after his last procedure. While not perfect, he feels comfortable shaving his head now.

This patient is in his mid 40's and wanted to fill in his crown and reinforce his hairline. He had had a prior FUE procedure elsewhere with somewhat disappointing results. We started him on finasteride and performed FUT of 4,197 grafts (about 7,500 hairs). We also performed PRP/ACell. He is shown 18 months post op. He has extremely fine hair which is always challenging in terms of creating density.