Monthly Archives: August 2014

Carlos Wesley, Hair Transplant, PiloFocus, Walter Unger

Dr. Carlos Wesley — PiloFocus Scarless Hair Transplantation

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In 2014, two major trends have become evident in the world of hair transplants:

      1. The realization of the inevitability of FUE hair transplants replacing FUT/strip hair transplants, with the latter slowly almost becoming extinct. Even in 2013, this was not yet entirely obvious. Strip hair transplants will remain a better option than FUE for a minority of patients, so will not entirely go out of fashion.
      2. Increasing adoption of the ARTAS robot system and the inevitable progress in automation of the hair extraction process in hair transplantation. In my opinion, it is also a certainty that hair recipient site creation and hair implantation in those recipient sites will both also see automation in the coming years.

However, if the gifted and highly creative Dr. Carlos Wesley has his way, his PiloFocus scarless hair transplant technique will make both FUE and ARTAS seem blasé and very yesterday, right when both are about to reach peak popularity!

The links in the below paragraphs will  help you understand how PiloFocus works. The basic description of the technique is that it involves extraction of hair follicles from underneath the scalp, something that sounds very freaky, but is actually quite an extraordinary concept. Graft extraction is undertaken via a 1 cm incision in the donor area, through the use of Dr. Wesley’s proprietary Piloscope endoscopic tool. I find the fact that graft survival rates would be 5% – 40% higher with this technique than with FUE much more impressive than the scarless aspect of the technique, which in and of itself is revolutionary. The reason for this higher survival rate is that the grafts when extracted from underneath the scalp are chubbier and include more stem cells and protective tissue.

I have high respect for Dr. Wesley and therefore decided to write this post even before his technique receives FDA approval (expected in 2014). It seems like his invention does not get sufficient respect from most other hair transplant surgeons at present, reminding me of the skepticism that Dr. Woods and FUE were met with just over a decade ago.

My respect for Dr. Wesley derives from his impressive resume;  his years of collaboration with Dr. Walter Unger, a pioneer in the hair transplant and hair loss research world; and his excellent high quality recent presentation on his technique (see Spencer Kobren’s interview with Dr. Wesley in full).

My decision to author this post was also easy after I read this fascinating Verge magazine article on Dr. Wesley and PiloFocus from July 2014.

The biggest disadvantage with the PiloFocus technique is that it seems far more difficult than FUE hair transplantation, especially when you consider that there is no way a robot such as ARTAS can perform the extractions. Consequently, it will require significant training of surgeons by Dr. Wesley, and I would guess that initial costs will be much higher than current average FUE costs. It also seems like there would be a much higher chance of infection with this procedure than with the FUE procedure, although I could be mistaken.

Even if PiloFocus does take off, by the time a decent number of surgeons become experts at it, hair cloning and/or hair multiplication might become a reality. It is too bad that a brilliant mind such as Dr. Wesley’s is utilized in the hair transplantation field rather than in the hair cloning or hair multiplication or hair loss prevention field.

Note: Dr. Wesley currently offers both FUE and FUT hair transplants, and once FDA approval is attained, he will offer PiloFocus.

Ruxolitinib, Alopecia Areata, Angela Christiano, Brett King, JAK Inhibitors, Raphael Clynes

Cancer Drug Ruxolitinib Reverses Alopecia Areata

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For the second time in just two months, the global media has gone beserk over photos that show complete reversal of alopecia areata. This time via ruxolitinib. The first time was two months ago in one of Dr. Brett King’s patients via the rheumatoid arthritis drug tofacitinib.

Ruxolitinib and Alopecia Areata

This time, it is via the bone marrow cancer drug ruxolitinib (approved for sale in the US and EU under brand names Jakafi and Jakavi). It seems like ruxolitinib can cure hair loss in some people suffering from alopecia areata.

These current results are even more significant because:

  1. They occurred in three patients rather than just one.
  2. The research and findings were conducted by the renowned hair loss research expert Dr. Angela Christiano and her team (in particular, Dr. Raphael Clynes) at Columbia University. In 2013, Dr. Christiano had already presented findings that both tofactinib and ruxolitinib reversed alopecia areata in mice. Moreover, these two doctors already filed a patent related to JAK 3 inhibitors in 2012 and are bonafide experts in this field.
  3. These new findings also determine the cellular mechanism (certain set of T cells attack hair follicles) that causes hair loss in people with alopecia areata. This was something that was not completely understood in the past.

The current findings were released in the online edition of Nature Medicine yesterday. All three patients saw excellent results within 4-5 months after taking the twice a day pill, and no adverse side effects were reported.

One of the patient’s images released by Columbia University:

Ruxolitinib Alopecia Areata
Ruxolitinib regrows hair in Alopecia Areata patient.

Video from Columbia University:

JAK Inhibitors

Just as I clarified two months ago when the tofactinib results came out, these results are yet gain unproven to work on the majority of balding people. This is because over 95 percent of hair loss is caused by a hormone driven condition called androgenic alopecia, rather than this less common alopecia areata problem.

However, no decisive study has yet been undertaken that examines the impact of JAK inhibitors such as tofactinib or ruxolitinb on people with androgenic alopecia. So the case is far from closed. I think that there is a good chance of there being an inflammatory immune system attack component to androgenic alopecia for many people, especially those who have significant itching and dandruff associated with their hair loss.

These drugs are expensive, and potential side effects are far more serious than with a drug such as Propecia. So doctors are reluctant to conduct these studies for what they feel is a cosmetic problem. However it is only a matter of time (probably months rather than years) before small-scale studies will be undertaken on all balding people.

Partly due to this development, Mark Blake of The Trichological Society of the UK said the following yesterday:

“It is a matter of time before we find a cure for male pattern baldness as well as alopecia. We know so much more about hair today and how it grows. We would like to think a cure could come within five years, definitely 10.”