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Platelet treatment maximizes hair transplant procedure

Article-Platelet treatment maximizes hair transplant procedure

In cosmetic surgery, the degree of patient satisfaction is arguably the most important measure of success. According to David Perez-Meza, M.D., a plastic surgeon and hair transplant surgery specialist, there are several ways to maximize the aesthetic outcomes — and resulting patient contentment — of patients undergoing hair restoration surgery (HRS).

COMBINATION TREATMENTS The follicular unit transplantation procedure is considered by many experts to be the gold standard approach in HRS. In order to boost the "take" of the follicular grafts, hair restoration surgeons use any and all treatments available — including laser treatments, genetic therapies, and pharmacologic approaches such as administration of finasteride (1 mg) and minoxidil 2 percent and 5 percent — often combining them.

In addition, Dr. Perez-Meza also employs autologous growth factors to maximize results. Autologous growth factors, used with success in plastic, orthopedic, dental and cardiac surgeries, have been shown to initiate a positive wound-healing process, wound repair and regeneration by decreasing erythema, edema, pain and infection. Dr. Perez-Meza has found their application to be a very beneficial adjunct to the HRS procedure by accelerating the wound-healing process.

PROCESS HOW-TO First, the patient's own blood (60 cc) is drawn and centrifuged to recover platelets. According to Dr. Perez-Meza, one of the keys to the success of this procedure is using the right centrifuge device as not all centrifuges yield quality platelet product.

"I prefer to use the automated double-spin centrifuge, which produces a much higher platelet quality," he says. "The first spin will give separation and the second will give concentration. Single-spin centrifuges will give you multiple sterile barrier entries, a greater potential product contamination and most importantly, a 30 percent to 70 percent decreased efficiency in platelet recovery versus automated devices."

The centrifuge process takes 13 minutes and provides two types of plasma: platelet-rich plasma (PRP) and poor plasma (PPP). The PRP contains a high concentrate of platelets (four to six times baseline) and several growth factors including platelet-derived, transforming beta 1 and 2, epidermal, and vascular endothelial. The PPP, comprised of fibrinogen, factor XII and fibronectin, does not contain growth factors.

During the hair transplant procedure, the donor hairs are removed from the nuchal area at the back and/or sides of the head. Using a microscope, the donor tissue is cut into single or multiple follicular units and the grafts are then placed in the PRP, which is used as a storage solution.

A few minutes before transplantation begins, the PRP is activated through the addition of thrombin and calcium chloride. This mixture forms a viscous gel, and the grafts are soaked in the activated PRP to release the growth factors. The follicular units are then transplanted into the recipient area.

The platelet gel is also applied to the donor area before closure. At the conclusion of the surgery, the remaining PRP is applied in the transplanted area and the PPP is used as fibrin glue or sealant of both the donor and recipient areas.

MEASURED SUCCESS "I have used this combined technique in my patients and noticed faster regrowth of the transplanted hairs and also some regrowth of the nontransplanted hairs," Dr. Perez-Meza says.

"This regrowth is most likely due to the effects of the autologous growth factor. Post-operative edema and erythema are also noticeably decreased, helping to increase the hair viability, and allowing for a quicker healing and superior all-around cosmetic result."

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