Senior Member Drnigam Posted February 21, 2013 Senior Member Share Posted February 21, 2013 Dr. Nigam's 1st Case Studies of 2013 on Hair Doubling Mr. Dhanesh Makwana, Age : 24 Hair Doubling Day 0 (11th Jan, 2013) Link to comment Share on other sites More sharing options...
Senior Member JustOne Posted February 22, 2013 Senior Member Share Posted February 22, 2013 Nice presentation Dr Nigam . We look forward to your continued updates on your case studies . Personally I would like my case to be as detailed as this patient here. Thanks :cool: Link to comment Share on other sites More sharing options...
Regular Member Gary1911A1 Posted February 24, 2013 Regular Member Share Posted February 24, 2013 Looks promising. Please keep us advised. Link to comment Share on other sites More sharing options...
Senior Member Blake Bloxham Posted February 26, 2013 Senior Member Share Posted February 26, 2013 Dr. Nigam, Great case! Thank you for sharing. Altogether, I find your donor doubling technique very interesting. I understand the advantage of not "blinding" removing bulge stem cell partial grafts, but I was wondering if the full removal and re-implantation of the inferior portion of the follicle results in decreased regrowth in the donor region? I may have missed it in the presentation, but do you have any statistics on donor regrowth rates? Additionally, if so, are you seeing a decreased shaft diameter in the re-implanted follicles like Dr. Gho noted in his donor doubling study? Thanks again for sharing. Look forward to discussing this further. "Doc" Blake Bloxham - formerly "Future_HT_Doc" Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician. Link to comment Share on other sites More sharing options...
stifler Posted March 7, 2013 Share Posted March 7, 2013 Can someone please explain in layman's term what this is? Thanks! Link to comment Share on other sites More sharing options...
Senior Member Blake Bloxham Posted March 8, 2013 Senior Member Share Posted March 8, 2013 Can someone please explain in layman's term what this is? Thanks! Sure: Hair follicles have two confirmed areas of stem cell activity: one near the arrector pili muscle in the isthmus region of the follicle and one in the inferior 1/3rd of the follicle. Most experts seem to believe the stem cells in the superficial portion of the hair follicle are located in the bulge region and the stem cell activity in the deeper portion of the follicle likely comes from the dermal papilla (though this part is a bit more complex). In other words, there are two areas of stem cell activity in a hair follicle: one in the deep part of the follicle, and one in the more superficial part of the follicle. Research has demonstrated that both areas of stem cell activity in the follicle are capable of re-creating functional hair follicles that undergo cycling and produce terminal hairs. This means that, in theory, you can take a hair follicle, divide it into two portions and create two follicles from it. This is the idea behind "donor doubling" procedures: using an FUE process to extract the superficial stem cells in a hair follicle (the bulge stem cells), implanting this partial graft in balding scalp, leaving the deeper area of stem cell activity (the dermal papilla stem cells) in the donor scalp, and creating two follicles from one. By doing this, you've (in theory) created an unlimited supply of donor hair. Some physicians achieve this by using modified FUE punches to remove - and subsequentially implant - bulge stem cell grafts. Because the depth (and in some cases, the necessary width) of this splitting process is unknown, some refer to this as "blind" extraction and do not believe it's overly precise. To combat this, Dr. Nigam proposes something slightly different: extract the entire follicle via an FUE punch, dissect it in half under a microscope, implant the bulge stem cells into the balding scalp, and place the dermal papilla portion back into the donor scalp. He also uses several different serums to help aid in this process, but that's basically what's going on. Hope this helps! "Doc" Blake Bloxham - formerly "Future_HT_Doc" Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician. Link to comment Share on other sites More sharing options...
Regular Member gambler Posted March 8, 2013 Regular Member Share Posted March 8, 2013 Nice summary - Thanks Link to comment Share on other sites More sharing options...
stifler Posted March 8, 2013 Share Posted March 8, 2013 Ahhh, that is a great summary! Thanks! I'm assuming the serum acts as a growth medium. Dr. Nigam, what has been the success rate so far for this (also, if you could specify how you are defining success, that would be great)? For me, success would be that you actually get new hair (doubling) that grows in a sustainable manner. Who are the best candidates for this? Link to comment Share on other sites More sharing options...
Senior Member Shyguy Posted March 8, 2013 Senior Member Share Posted March 8, 2013 Great summary Future HT Doc! Using Propecia since 1997 Using Rogaine Foam once a day since 2012 Using Niazoral 2% once a week since 2012 Link to comment Share on other sites More sharing options...
Senior Member Drnigam Posted March 9, 2013 Author Senior Member Share Posted March 9, 2013 Stifffler, When a graft is doubled into two,this is when we call it 100% success as far as the question of doubling is considered (Jahoda and others have conducted hair doubling studies without addition of stem cellls and growth factors with 70%regrowth in both the bisected follicles.Since we add progenitor stemcells and growth factors our success rate is 90 to 95% as on today). When the diameter or the thickness of these bisected two follicles is not less than the original thickness of the follicle,than we can claim to achieve 100% success rate, as far as the quality or character of the follicle is concerned. Rate of growth of these bisected follicles is also a parameter to watch for. These bisected follicles tend to skip the shedding phase after implantation probably due to injury to the follicle and addition of stemcells, hence enters repair phase rather than shedding phase, seen commonly after traditional FUT and fue hair transplant. As you can see in the above case study, the doubling as per as the number is concerned is not an issue, The quality/diametre of hair in our last 6months experience( as we started with hair doubling since last 6 months) is not any different from the thickness achieved by follicles after traditional FUT/FUE transplant, the exact diameter we be measured after 6 months ,when our cases reach 1year growth, as in any transplant the final thickness of the follicle is achieved at 1 to 11/2 year of transplantation. Any case which is an indication for FUT/FUE is fit for hair doubling, specially the MPB patients with poor donor availability at the safe donor zone. We are in the process of converting NW6/7 to NW2 with hair doubling which is not possible with FUT/FUE except with body to hair transplant. 10000 grafts required for the same can be created by 5000 donor grafts doubling(in cases with availability of good donor or the body/ beard grafts need to be used). Hair doubling will also help in giving higher density than FUT/FUE thus more natural result. stuyQUOTE=stifler;2339084]Ahhh, that is a great summary! Thanks! I'm assuming the serum acts as a growth medium. Dr. Nigam, what has been the success rate so far for this (also, if you could specify how you are defining success, that would be great)? For me, success would be that you actually get new hair (doubling) that grows in a sustainable manner. Who are the best candidates for this? Link to comment Share on other sites More sharing options...
Senior Member Drnigam Posted March 9, 2013 Author Senior Member Share Posted March 9, 2013 Blake,Before me ,the well known research scientist Jahoda and others have shown in several studies that 70% growth of the bisected follicular units after bisection and reimplantation.As we add to the bisected follicular units progenitor stemcells on day 0 and multiplied stemcells at 6 weeks +dp cells +ecm+prp+growth factors, We started hair doubling 6 months back. We have seen, in last 6 months regrowth of bisected follicular units to be around 90 to95%. Regarding the shaft diameter ,we will measure the same after 6months, as it takes 1 to 11/2 year for even FUT/FUE transplanted hair to achieve full thickness In our 6 months observation the shaft diameter is comparable to traditional FUT/FUE hair around this time.We have the advantage of stemcells and other factors as mentioned above.I will post the pic of 28 days followup of a patient on monday, for whom we have doubled 1150 grafts to 2300 grafts. In another forum i have opened my clinic to FREE patch test for forum members with 30 to 50grafts, for the month of march and april 2013 to those patients who are ready for semi permanent tattoo and are ready to document the same with hair counts,as an independent observer. Dr. Nigam, Great case! Thank you for sharing. Altogether, I find your donor doubling technique very interesting. I understand the advantage of not "blinding" removing bulge stem cell partial grafts, but I was wondering if the full removal and re-implantation of the inferior portion of the follicle results in decreased regrowth in the donor region? I may have missed it in the presentation, but do you have any statistics on donor regrowth rates? Additionally, if so, are you seeing a decreased shaft diameter in the re-implanted follicles like Dr. Gho noted in his donor doubling study? Thanks again for sharing. Look forward to discussing this further. Link to comment Share on other sites More sharing options...
Noah Posted June 15, 2013 Share Posted June 15, 2013 Dr nigam any updates on this? Link to comment Share on other sites More sharing options...
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