Alan J. Bauman, M.D.Diplomate, American Board of Hair Restoration Surgery

PRP LifeLift™ Certification & TrainingSeptember 13, 2014

PLATELET RICH PLASMAFOR HAIR REGROWTH

ABHRS

CONFLICTS OF INTEREST• The following conflicts of interest

pertain to this presentation: NONE

ALAN J. BAUMAN, M.D., A.B.H.R.S.• Diplomate, American Board of Hair Restoration Surgery• Member, International Society of Hair Restoration Surgery• Recommended, American Hair Loss Association• Member, American Academy of Anti-Aging Medicine (1998)

• New York Medical College• Beth Israel Medical Center NY – General Surgery• Mt. Sinai Medical Center NY – General Surgery

• Bauman Medical Group (est. 1997) - Boca Raton, FL• >17,000 patients treated, >7,000 hair transplants

VIDEO: PRP HAIR REGROWTH ON ABC

http://hai.rs/hairprp-placenta

OVERVIEW

• Hair Follicle & Growth Cycles

• Hair Loss & Treatments

• PRP & Growth Factors

• PRP in Hair Restoration

• Role of Extracellular Matrix (ECM)

• ACell/Matristem & BioD-Restore

• Hair Evaluations & Measurements

• How to Prepare & Apply Scalp PRP

• Additional Educational Opportunities

HAIR & SKIN ANATOMY: THE PILOSEBACOUS UNIT

HAIR GROWTH CYCLE

HAIR FOLLICLESTEM CELL SIGNALING

• Epithelial Wnt/β-catenin signaling is required for hair matrix cell proliferation. Wnt/β-catenin signaling is a central regulator of adult stem cells.

• LRP inhibition permits stem cell survival; blocks hair growth reversibly

• β-catenin is required in bulge stem cells for their proliferation, but not survival indicating the persistence of functional progenitors so follicles will continue to proliferate even without β-catenin.

• Hair Follicle ~ Fibroblast “Cousin”

HAIR:

Beauty &

Youth

• Fear/anxiety ~ Sickness or Illness• Low Self-Esteem/Self-Confidence• Feel Older / Less Attractive• Camouflage/Compensate• Avoid Social Situations

Hair Loss

HAIR LOSS: ANDROGENETIC ALOPECIA (AGA)• Genetic Male and Female Pattern Hair Loss – most common type• Affects nearly 100 Million Americans (est. 60M men, 40M women)

NORMAL MINIATURIZED

60X & 30X “HAIRCAM” DERMOSCOPY

SEVERE DEPLETION: HAIR TRANSPLANTATION

HAIR LOSS: ALOPECIA AREATA (AA)

• Autoimmune• Small / Circumscribed• “Spot baldness”• 1-2% of cases spreads

to the entire scalp• Standard Tx’s:

• Steroid injections• Microtrauma

MEDICAL HAIR LOSS TREATMENTS:PRESERVE AND ENHANCE HAIR FOLLICLE FUNCTION

MODAL ITY TX MECHANISM

Oral Finasteride blocks Dihydrotestosterone production [♂AGA]

Topical Minoxidil K+ channel opener, vasodilator [AGA, AA]

Phototherapy LLLT, LaserCap ↑ mitochondrial membrane potential [AGA, AA]

Nutraceutical Biotin, Marine Protein Metabolic/Nutritional [AGA, AA]

Cell Therapy Platelet Rich Plasma Growth Factors, Cytokines [AGA, AA]

PLATELET RICH PLASMA FOR HAIR REGROWTH

GROWTH FACTORS, CYTOKINES AND MORE…• platelet-derived growth factor - PDGF

• transforming growth factor beta - TGF-B

• fibroblast growth factor

• insulin-like growth factor 1 - IGF1

• insulin-like growth factor 2 - IGF2

• vascular endothelial growth factor - VEGF

• epidermal growth factor - EGF

• nerve growth factor - NGF

• interleukin-1 – IL1-B

• Interleukin-8 – IL8

• keratinocyte growth factor

• connective tissue growth factor

GROWTH FACTORS & HAIR FOLLICLE CYCLING

• PDGF – stimulate growth of dermal mesenchyme, epidermis-follicle interaction (5)

• VEGF – mitotic & endothelial cells, increases vascular permeability (Yano-6)

• EGF – mitosis of epithelial cells, fibroblasts. Inhibits catagen, promotes anagen(10/11)

• IGF – anti-apoptosis (12)

• FGF – proliferation & differentiation of keratinocytes and endothelial cells. Anagen (13)

• NGF – hair cycle modulator. Stimulates hair growth (NGF-TrkA) via proliferation of keratinocytes, NGF-p75NTR promotes apoptosis and hair follicle regression. Stress mediator, may play a role in neurogenic inflammation, hair follicle apoptosis & premature catagen.

PLATELET RICH PLASMA STAND-ALONE TREATMENT FOR HAIR REGROWTH

• Autologous (or Allograft)

• Bedside

• Out-patient

• Quick; “lunch-hour”

• Non-Invasive

• Painless Local Anesthesia

• No Downtime

• Low risk

• Hair Growth www.HairCoach.netYesPRP at Bauman Medical

VEGFVASCULAR ENDOTHELIAL GROWTH FACTOR

Bouhanna/Amgar

LITERATURE REVIEW:USE OF PRP IN HAIR RESTORATION

• Graft-storage media in Hair Transplantation (Bouhanna/Amgar)

• Wound healing accelerator in Donor and Recipient Areas (R Reese, J Cole, J Cooley)

• Improvement of ‘take-rate’ & growth in hair transplantation (R Reese, C Uebel)

• Stand alone treatment for androgenetic alopecia or alopecia areata. (J Greco, Amgar, Bouhanna, Rinaldi)

Bouhanna/Amgar

PRP FOR ANDROGENETIC ALOPECIA

Bouhanna/Amgar

PRP FOR ALOPECIA AREATAPreTx 8 weeks

4 months

PRP FOR ALOPECIA AREATA

PreTx 8 weeks 4 months

PRP HAIR REGROWTH IN 38YO FEMALE AGABEFORE & AFTER 9MOS

PRP HAIR REGROWTH 36YO MALE AGABEFORE & AFTER 9MOS

EXTRACELLULAR MATRIX (ECM)• Extracellular part of multicellular

structure

• Structural & Biochemical support

• Injury Repair & Tissue Growth

• Wound healing / fibrosis

• Regulates intracellular communications

FUNCTIONS during injury or tissue regeneration:• Prevents inflammation & scar tissue formation• Facilitates tissue repair

WHY USE EXTRACELLULAR MATRIX (ECM) W/ PRP?

PROLONG & ENHANCE!

• Without ECM: PRP effects last ~90 days, requiring repeat treatments

• With ECMs

• PRP hair growth effects may last for up to 2 years

• PRP hair growth effects appear to be stronger

ACELL/MATRISTEM ECM• Porcine Bladder Matrix

• Micronized powder

• Collagen

• Basement membrane

• Bio-scaffold

BIOD-RESTORE - PLACENTAL TISSUE ECM

• Immune privileged - Rarely evokes immune response

• Provides cells, structure and signals for repair/regeneration

• Natural scaffold / ECM for cell migration & proliferation

• Proteins, cytokines, carbohydrates, hyaluronic acid, growth factors, chemical compounds and multipotent cells naturally inherent in placental and amnionic fluid

• Anti-inflammatory / Anti-microbial / Anti-scarring / Anti-adhesive

BioD-Restore™ is a cryopreserved amnion allograft from the placenta of live, healthy donors.

BIOD-RESTORE• Multipotential Tissue Matrix

• Structural allograft derived from human amnion

• Chemical compounds, growth factors, residual cells

• Regeneration

• Immune privileged

• Multipotent cells

BIOD-RESTOREPROCUREMENT & PROCESSING:

• Prescreened donors

• Medical review

• Prenatal testing

• Behavioral risk assessment

• Blood tests

• Medical history

• Disease testing

• Aseptic recovery / sterile cesarean section

• FDA-registered tissue bank

• FDA-registered processing center

GROWTH FACTORS FOUND IN AMNION• Platelet-Derived Growth Factor (PDGF)

• Transforming Growth Factor Beta (TGF-β)

• Vascular Endothelial Growth Factor (VEGF)

• Fibroblast Growth Factor (FGF)

• Epidermal Growth Factor (EGF)

• Insulin-like Growth Factor (IGF-1)

HAIR MEASUREMENTS & EVALUATIONS• “HairCheck” – Cross-Section Hair

Bundle Trichometry

• HMI – Hair Mass Index

• Sensitive, scientific, repeatable, accurate

• “HairCam” Dermoscopy – identifies miniaturization

• Global Photos – medical ‘mugshots’ HairCam – ABC Good Morning America

HairCheck at Bauman Medical

HOW TO PREPARE AND APPLY PRP+ECM• Patient Selection, treatment area identified & measured.

• Phlebotomy is performed.

• Scalp prepped w/ antiseptic shampoo and local anesthesia.

• PRP is prepared using centrifuge & YesPRP™ kit.

• If used, BioD-Restore is thawed.

• PRP is mixed gently with ECM (Acell/Matristem or BioD-Restore)

• PRP+ECM is injected intradermally into the scalp

• Mechanical (MicroPen) microneedling creates microtrauma

• Scalp is cleansed, 15min LLLT applied

• instructions given prior to discharge

Dr. Bauman performs PRP on ABC Palm Beach

SIDE EFFECTS / SEQUELAE / FOLLOW-UP

• Tenderness / Swelling is rare

• Follow-ups can be performed monthly to track hair growth improvements.

• Monitor hair growth using HairCheck and HairCam to observe peak and plateau.

UPCOMINGPRP HAIR GROWTH & HAIRCHECK™ WORKSHOPS

Friday September 19th -or- Friday November 14th 9am-5pm Boca Raton

• Hair Loss Diagnosis & Evaluations, Treatments & Tracking

• Hands-on HairCheck Measurements and Hands-on PRP+ECM hair regrowth procedure

• Course Director: Alan J. Bauman, M.D.

• Certificate & Starter Kit

• Email: andres@baumanmedical.com

• www.HairCoach.net for info/registration and future events

REFERENCESMarx, R.E. , et al, “Platelet-Rich Plasma Growth Factor Enhancement for Bone Grafts,” Oral Surg Oral Med Oral Patrhol, 1998;85:638-646.Antonaides, H.N., et al,”Human Platelet-Derived Growth Factor: Structure and Functions”, Federation Proceedings, 1983;42:2630-2634.Pierce, G.F., et al,”PDGF-BB,TGF-β 1 and Basic FGF in Dermal Wound Healing: Neovessel and Matrix Formation and Cessation Repair”, Am J Pathology, 1992;140:1375-1388.ELISA Immuno Assay For PDGF-A, Human VEGF, TGF-β 1, and Human EGF, R&D Systems, Mpls, MN 1999.Bauman AJ, The use of cross-sectional hair bundle trichometry in the diagnosis, evaluation and tracking of hair loss. Poster Presentation. ISHRS ASM October 2012 Nassau, Bahamas.Gruss, J., et.al., Human amniotic membrane: a versatile wound dressing. CMA Journal 1978; Vol.118:1237-1246De Coppi, P. et.al., Isolation of amniotic stem cell lines with potential for therapy. Nature Biotechnology 2007; Vol.25,No.1:1274-1280

PRP VIDEO PLAYLIST

http://hai.rs/prphairgrowthvids

Thank You!!

Alan J. Bauman, M.D.Bauman Medical Group

Boca Raton, FL USA

doctorb@baumanmedical.combaumanmedical.com

linkedin/in/alanjbaumantwitter.com/DrAlanBauman

facebook.com/alanjbauman