Dr. Nigam: Action plan for pure HM ??

[Broken2013]

Hey Dr. Nigam, its been a while since we got any update regarding your HM studies. What's goin on. Over there at BTT, all we can see is doubling updates(good job by the way).. However, you should know that we haven' t seen any concrete independent forum member HM updates. What is current protocol for HM??

[moopookoo]

If doubling is working fine I don't think there is need to rush into HM,

im impressed with Toms(French guy) donor regeneration so far, all we need to do is wait

 

it would be good to see more guys(Europeans/americans) to visit dr nigam and get procedure done just as Tom is doing

 

imo procedures should be FREE

[Broken2013]

I got your point moopookoo, but what about diffuse thinners. IMHO, doubling would be a bad option for them especially for early thinners. For them HM is the real deal. Moreover, HM would be cost effective, less time consuming. doubling only caters to well defined bald areas whereas HM has the potential to help both slick bald as well as diffuse thinners.

 

what's your take, Dr nigam??

[Blake Bloxham]

Broken,

 

Last time I spoke with Dr. Nigam, he was waiting on the material to start culturing dermal papilla stem cells in 3-D spherical matrices. At a recent conference, a researcher noted that some of the downfalls with extracting, multiplying, and reinjecting dermal papilla stem cells (i.e. hair multiplication) may be related to the fact that aren't cultured and matured in a sphere-like environment. When switching from a standard culture environment to a spheroid one, the dermal papilla cells seemed to have an easier time inducing and creating legitimate follicles. Dr. Nigams also injects a variety of other factors that mimic the natural scalp environment, and this is supposed to help as well.

 

However, please keep in mind that at this point in time, neither the efficacy or the safety of this procedure have been proven. In my opinion, culturing stem cells and injecting non-organic entities with unlimited growth potential into the scalp with no guarantee that they will stay in the scalp presents with serious potential for complication. While I feel like a regulatory body (like the US FDA) would review this potential THOROUGHLY, they have not had the chance to do so thus far, so all patients should be aware.

 

Like moopookoo said, I really think "donor doubling" is very promising and exciting at this point in time. What's more, unless you suffer from serious diffuse unpatterned alopecia (DUPA), I don't see why you'd be completely neglected as a candidate for this type of procedure (once it is proven and effective as well). As I'm sure you've seen, Histogen just released an update of it's phase IIa trials as well, and Follica announced some news last week, so there are some potential (no guarantees) things "in the works" as well.

 

As of now, I think it's best to remain cautiously optimistic and hopeful toward these new treatments, but also keep in mind that they are mostly theoretical or still in the research and development stages at this point in time.

 

Hope this helps!

[Broken2013]

Hey future,

 

Thanks for the info, i appreciate. No doubt, doubling has got some real potential to turn nw7 to nw2. I am just concerned for some thinners who still have appreciable ammount of hairs and are just starting to thin. A hair transplant wont be such a good idea in those cases or would it be? Anyways, ive exchanged some emails with dr, nigam. I must appreciate dr. Nigam for taking some time out of his busy schedule to address my queries. So far so good, but i am still waiting like you all for some good solid evidence, both in doubling and pure hm. I am sure the way this doctor is working, we will soon have some groundbreaking evidences ....fingers crossed

 

Thanks again future !

[Spanker]

I wonder what this will cost if it ever comes to being available on a larger scale. Regular FUE is almost 8 dollars per graft so there is no telling what it will cost. It seems like balding may be cured in the future, but only the rich and genetically lucky will have full heads of hair.

[Broken2013]

Spanker,

 

I agree with you totally. these treatments are not for everyone. Only, rich can afford. It is very painful to see that diseases don't discriminate between rich and poor, but treatments do. Anyways, theoretically, Dr. Nigam has cured this menace with his doubling- HM combo. Just need solid good evidence. I admit it will be reassuring to see that finally someone is able to give us our hairs back, but at the same time everything comes down to money. I just dont understand if you have something near to a cure, why would you charge such a high amount. Just make it affordable and it shouldnt be a problem as whole freakin bald world would be running to you....

 

"Baldness should be a choice"

[Gary1911A1]

I would like to think with time the cost would come down, but I'll be the first to admit I don't understand the procedure.:confused:

[Blake Bloxham]

Gary,

 

Which aspect do you not understand? The hair multiplication or the donor doubling?

[Noah]

Future,

 

You say dr nigams procedure we dont know the safety of it, do you know anymore as to the unsafe aspect of it and wh\at could possibly go wrong, im very close to going to Mumbai, the products he injects would they be legal in say USA or Europe?

 

Noah

[Questionmark]

Gary,

 

Which aspect do you not understand? The hair multiplication or the donor doubling?

 

Future, thanks for your effort in educating us

 

Me too, I have to confess that I am a little confused about the appearently two different procedures. As I am not a native speaker, it is quite difficult for me to be in the know of even the main principle of the methods used.

 

It would be highly appreciated if you could give me/us a quick, clearly arranged overview that can be understood also by simple men as me, just like f.e. principle of the method, chances, risks, how many patients are treated by now and when do we can expect meaningful results.

 

Thank you so much!

[Questionmark]

Sorry, double post. Arrrrgh!

[KO]

I wonder what this will cost if it ever comes to being available on a larger scale. Regular FUE is almost 8 dollars per graft so there is no telling what it will cost. It seems like balding may be cured in the future, but only the rich and genetically lucky will have full heads of hair.

 

 

Remember, if it works, ANYBODY should be able to do it, so competition will drive the price down, and India will likely lead the way due to huge labor supply.

 

If you're talking about HM, then I suspect it will be very cheap. All you need to do is extract, culture and inject, no manual moving of follicles, it can be automated and mechanised.

[Blake Bloxham]

Hi Guys,

 

A few things:

 

1. I'm not sure what this type of procedure would cost. I think it really depends on how it unfolds, and how much it ends up costing the physician.

 

2. Noah - while I don't want to prematurely label a procedure as "unsafe" I've shared my reservations before about injecting cultured stem cells and growth factors. Both of these entities, simply put, have the ability to expand, multiply, and grow wildly, and it is difficult to know precisely what will happen when this is all injected into a human being. What's more, I don't think we've really seen any conclusive proof yet that the injected cells would stay in the scalp. In theory, this means that cells with the potential to continually grow could end up in other areas of the body.

 

Please keep in mind that this is all theoretical. However, researching these theories and ensuring they won't happen is the job of regulatory bodies like the US FDA. Because these theories and many of the growth factors have not been evaluated, I do not believe this procedure could be performed in the US/Europe (at this point in time).

 

3. The differences between donor doubling and multiplication:

 

1. Donor doubling - hair follicles have two identified regions of stem cell activity: the hair bulge (which contains hair bulge stem cells) and the hair bulb (which contains, among other things, dermal papilla stem cells). Studies have shown that both these areas can be separated and induce growth of a fully functional follicle on their own (though communication between the different "niches" of stem cell activity in a hair follicle is proving to be very important).

 

Because of this, it's possible to extract one area of follicle stem cell activity (the bulge) and implant this into balding scalp and leave the other area (dermal papilla) in the donor region. Because both areas can induce new follicle growth, you've created a functional hair follicle in both the donor region (which can, in theory, be used again for future procedures) and the recipient scalp. In other words, you've turned one follicle into two - aka: "doubling."

 

2. Hair Multiplication - involves the isolation and extraction of hair follicle stem cells (usually the dermal papilla stem cells), culturing and multiplication of these cells outside of the body, and implantation (usually by injection) of these newly cultured cells back into the scalp. Because these cells are responsible for follicle growth and normal follicle functioning, injecting them into the scalp is supposed to create new hair follicles (or possibly allow the cells to enter inactive follicles and make them function again).

 

Again, this is a VERY broad/vague description of the theory behind these two techniques, so I apologize if I missed some details.

 

Hope this helps!

[Questionmark]

Thank you so much, Blake! Because this topic is so interesting, I have two more questions, if you don`t mind:

 

1. Does Dr. Gho do the same as Dr. Nigam now?

 

2. How many patients have yet been treated with each of the methods and when can we expect meaningful results?

 

Again, thanks in advance!

[Blake Bloxham]

Thank you so much, Blake! Because this topic is so interesting, I have two more questions, if you don`t mind:

 

1. Does Dr. Gho do the same as Dr. Nigam now?

 

2. How many patients have yet been treated with each of the methods and when can we expect meaningful results?

 

Again, thanks in advance!

 

I don't mind at all!

 

1. Dr. Gho and Dr. Nigam both practice a type of donor doubling (though I believe Dr. Nigams plans on fully moving to hair multiplication in the future). However, their respective approaches are slightly different:

 

Dr. Gho uses a very fine (0.5 mm) FUE punch to remove the necessary components of the hair bulge from the back of the scalp. He does this in a manner that looks nearly identical to an FUE procedure. The hair bulge is located in the inner (an area call the outer root sheath) and mid portion of the follicle, so the thin punch is able to extract this area while still leaving behind enough of the dermal papilla components to cause donor regrowth.

 

Dr. Nigams uses a method called invitro follicle bisection. Dr. Nigams extracts the entire follicle via a normal sized FUE punch, then he cuts (bisects) the graft into the bulge cell portion and dermal papilla portion under magnification. Afterwards, he implants the bulge portion into the recipient scalp and re-implants the dermal papilla region back into the donor scalp.

 

Although both methods are unique, they still achieve the same goal.

 

2. Although he doesn't have as many cases presented on his website, Dr. Gho has treated patients with his procedure (sometimes called the "hair stem cell transplant" or "Gho procedure") for a number of years. Dr. Nigams only recently started his donor doubling (9 months ago, I believe), so it has not been performed on as many patients, nor have we really seen a matured result yet.

 

Because hair multiplication is still in the highly experimental phases, I couldn't really even guess how many (or few) people who have undergone the procedure.

[Questionmark]

Thanks again, you`re the best

 

So I suppose the error probability, at least theoretically, is lower with Dr. Nigams technique, as he sees the follicle while cutting it, hence he can work much more precise than Dr. Gho, who has more or less to work blindly with his 0.5 mm punch?

 

I also think I once read that Dr. Nigam is using medical ultrasonics to get a better picture of the direction the follicle grows, in order to keep the damage as low as possible. Do you think that this technique will establish one day in other clinics, also with "normal" FUE, or isn`t there really need to, as skillful FUE docs anyway are able to keep the transection rate so low that it wouldn`t make a significant difference?

 

However, if Gho is succesful with his method, he deserves lots of kudos for his skills. This may be the most challenging fine mechanical work being done in the field. Still I wonder why he doesn`t publish a representative amount of results to prove them.

[Gary1911A1]

Thanks for the very informative post Blake.

[james84]

Future_HT_Doc thanks for the great info as always:)

 

I really hope these methods come to fruition, as at the minute they is not enough evidence to prove otherwise.