Dr. Wendel calls PRP her go-to treatment “for women with androgenic alopecia or alopecia areata, not alone but in combination with minoxidil and LLLT. We have the larger devices in our practice but often use the LaserComb (Hair-Max) or LaserCap (LCPro). We have more experience with these devices and don’t believe that bigger is always better.”
“PRP is an awesome way of enhancing healing and growth after transplantation,” adds Dr. Giannotto. “We use it on every patient undergoing a restoration procedure. PRP can also be used to prevent or slow down the progression of hair loss. Several of our patients have noticed good hair growth beginning several months after the procedure. It is important to counsel the patient undergoing just PRP (no surgery) so that they understand that this is not a permanent solution to hair loss and usually requires maintenance sessions every four to six months.”
Dr. Epstein doesn’t use PRP as a stand-alone procedure but he does find it useful for some patients to provide additional treatment of their hair loss. “We combine the PRP with ACell MatriStem, which is a regenerative matrix that seems to improve outcomes,” he says. Dr. Weiss and Dr. Urato do not offer PRP, saying there isn’t enough evidence to support its efficacy.
“Surgical hair restoration techniques have certainly progressed, especially in the last five years. When I started performing hair restoration surgery, we were in the era of mini-grafts and micro-grafts,” says Dr. Giannotto. “This technique was replaced by follicular unit transplantation (FUT) in which a strip of donor hair with follicles intact was removed. This strip was dissected under microscopy and the grafts were isolated and implanted into the donor area. Using microscopic studies, this technique was refined by dissecting follicular units from the strip— defined as a group of one to four or more hairs—and the glands that supply them. Splitting follicular units down further destroyed their growth potential. The advantage of the FUT method was that a variety of follicular unit sizes could be isolated mimicking natural hair growth patterns.”
The downside to FUT is that, while it offers good results in the transplant area, it is painful and often leaves a troublesome scar in the donor area. “We prefer FUE (follicular unit extraction), which leaves no linear scar, causes less discomfort and allows for quicker recovery,” says Dr. Weiss. “We use the ARTAS robotic system to aid follicular extraction with all of our patients now. We have found it to be better than handheld automated devices because of its computer algorithms, precision and accuracy—all of which facilitate a better quality procedure.”
When describing the benefits of ARTAS to his patients, Dr. Weiss likens it to a baseball pitcher who will inevitably tire during a long game. “The pitcher eventually gets tired and his accuracy and precision decline. A robot is not subject to such fatigue and continues to produce high quality grafts for the duration of the procedure,” he says. “The ARTAS robot allows me to improve the quality of care I can offer patients.”
About half of hair restoration surgeons are now using some type of automated system for FUE. Dr. Epstein uses several handheld, powered FUE devices, including the NeoGraft Automated Hair Transplantation System and a custom-designed E-Fue System. “We don’t use ARTAS at this time because our current systems are providing outstanding results and the technology is still undergoing improvements. Surgical technique is the most important aspect of the transplant procedure,” he says.
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