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Hair Restoration Future, What’s Coming?

In this section I'll be discussing the hair restoration future, which will cover both surgical and non-surgical methods. This is where some conjecture will be injected since the future is really anyone's guess but the information presented is based on current discussions being had in the industry.


The Short Term For Our Hair Restoration Future


The hair restoration future will still include strip surgery.
Donor strip from a FUSS procedure.

Follicular Unit Strip Surgery or FUSS - Regardless of what many people think FUSS will be around for a long time to come, maybe even as long as hair surgery in general is around, until some sort of highly reliable and affordable non-surgical treatment or even a cure comes along. The reason for this is because FUSS is the most efficient and reliable manner in which to target the true sweet spot of the donor zone, where the majority of the best and most healthy hair follicles can be removed for transplantation. FUSS procedures still make up 67.5% (as of 2013) of all surgical hair restoration procedures and while it is in steady decline it still has a long way to go before it becomes extinct. Therefore I predict that FUSS will continue to be the dominant form of surgical hair restoration with a steadily declining dominance until it reaches parity with FUE around 2018 where it will continue to lose ground. The reasons for it's continuing decline involve a few factors. First, I believe FUSS will dwindle simply due to attrition. Many of the "old guard", the doctors and clinics that have been performing FUSS for so long are either switching over to FUE 100% or they are closing up shop due to retirement or moving into other fields of interest. Secondly, the newer doctors coming into the field are not doing so via FUSS. Economic and financial common sense prohibit this. Finally, the general feeling toward strip easily turns patients away from the additional invasiveness associated with the strip removal as opposed to FUE.

The hair restoration future will include FUE for a long time to come.
FUE procedure being performed with a manual punch.

Follicular Unit Extraction or FUE - FUE is going to continue it's rapid growth and I believe the growth will soon be exponential as new statistics data is compiled. As of the end of 2013 there was an average of one new clinic opening worldwide and every one of them was FUE. FUE is much easier for the new or inexperienced doctor to start with as it requires far less staff, equipment, clinic floor space and overall startup costs compared to FUSS and it has a much higher profit ratio as well. It simply makes more economic sense to start a new clinic with FUE and not FUSS. The marketing against FUSS is also turning more doctors toward FUE and even more patients to FUE. Newer and better technologies will become available including improvements to the ARTAS® robotic system and the eventual competitors that it will face in the marketplace. I predict that FUE procedures will reach parity with FUSS procedures around 2018 as the more experienced and committed FUSS doctors retire or change their practice and more and more FUE clinics open and perform surgery. I believe that the marketing will also reach more patients that will see FUE as a more simplistic and easier procedure to undergo.

Pilofocus - This is an innovative technology being developed by Dr. Carlos Wesley in New York. It involves creating a small incision approximately 1.5cm long that allows the doctor to enter under the scalp to perform what could be described as a "reverse FUE" procedure. The result is the presence of only one very small scar but with zero visible scarring from the extraction sites. The potential is big and if Dr. Wesley can refine the procedure enough to make it consistently reliable and cost effective then he'll have a game changer on his hands. I freely admit that in the beginning of hearing the whispers about this secret tech he was working on, I had a strong idea of what it was and I was very skeptical, but he has continued to refine the technique to where I believe he has a strong chance of success. I'll let Dr. Wesley explain more here...

Beyond the surgical options listed above there is absolutely nothing else and for good reason. There is a substantial amount of money and research being poured into alternative restoration procedures that do not involve surgery or involves very little surgery of any sort. I'm talking about playing tackling the problem on the genetic level.


A Hair Restoration Future Without Surgery


The hair restoration future might be dominated by stem cell therapy.
Stem cells have huge potential for all sorts of medical problems.

Stem Cell Treatments - 

Let's get something straight. There is no such thing as stem cell hair transplantation, hair restoration, rejuvenation, etc. It's all absolute lies and deceptions. If anyone tells you different tell them to speak to me because I'll debate them into the ground on the subject. Period. With that said, there is work being done in this field and you see the results of this work all the time when your local news station or newspaper has a fluff article about how some researcher grew three hairs on the back of a mouse with stem cells. It's all fun and exciting but when I see these stories I roll my eyes because they are absolutely useless and even harmful. They are useless, because they only serve to get people excited for nothing because until you see a human head that's got more hair because of a stem cell treatment these result you see on animals mean nothing. It takes years for trials to move from animals to humans and what you're seeing or reading, even at the fastest pace possible, will take a minimum of five years to see the light of day on a human scalp, if at all. These stories can actually be harmful because it gets into the minds of the lay public and so when they see some clinic advertising they use stem cell treatments to revive or restore balding hair (and there are plenty of them out there) the unassuming, uneducated patient off the street believes the claims and they wind up spending many thousands of dollars on snake oil.

So what is a stem cell? Stem cells, to put it plainly, are cells in the body that have yet to receive instructions on what kinds of cells they should be. All cells have a blueprint for how they are supposed to grow and what they are supposed to do but as stem cells the blueprints haven't been finalized. So the trick is to get specific blueprints into these cells so we can make them grow how we want them to. And we want them to grow into hair cells that make more and more and more and more hair! The details of what a stem cell actually is gets far more complicated than what I described but you get the idea of what I'm talking about.

So stem cell hair restoration has a chance of being a real thing in the hair restoration future if even one of the companies working on this get it right. Below are some of the more established and credible companies trying to figure this out.

Histogen results one year into trials. Is this the hair restoration future?
Histogen results one year into trials.


Histogen - Histogen has been around for a while and they have a product they are working on called HSC or "Hair Stimulating Complex". HSC is an injectiable treatment that includes stem cells, proteins, and all manner of ingredients that when injected during trials showed a statistically significant improvement in hair counts even after one year from the starting date. You can see some of the details to the image to the left and the potential for this seems to be quite high.



Kythera Biopharmaceuticals may be on to something with Dr. George Cotsarelis.
Kythera Biopharmaceuticals may be on to something with Dr. George Cotsarelis.

Kythera - This is a company that is making some news as it has just acquired the rights for worldwide distribution of setipiprant which is known as prostaglandin D2 (PGD2) receptor antagonist. This is based on the work of Dr. George Cotsarelis of the University of Pennsylvania where he discovered that prostaglandin D2 is shown in elevated levels in bald or balding men. He theorized that if PGD2 could be blocked or reduced it would allow for cosmetically acceptable new hair growth. Setipiprant has already been through eight clinical trials as an anti-inflammatory. The trials were halted due to a lack of efficacy but the trials noted a very high tolerance level with little to no side effects for over 1000 trial participants. There is a good interview with Dr. Cotsarelis that you can read here...

AADA Interview With Dr. Cotsarelis About PGD2 Blocking Androgenic Alopecia

 Replicel - Replicel came onto the scene relatively late but they made an impact early on with news of their restoration product goals with their product RCH-01 which is a "cell therapy" treatment. I'll let Mr. Voice-Over explain further...

As you can see from the information above the hair restoration future is not in surgery but rather it is in bio-sciences. This is truly exciting because with stem cells and other forms of molecular manipulation we can growth teeth, hearts, lungs, etc. so it is only a matter of time till we can include hair follicles in that same check list of accomplishments. Unfortunately, with all the money and technology being thrown at the problem of hair loss the true fix/cure/treatment that will free us all from this menace is still several years away at best, maybe ten or more at worst. But it IS coming eventually.

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