Dermal Sheath Cup Cells, Shiseido

Shiseido Phase 3 Trial Results

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I have covered Japanese cosmetics behemoth Shiseido for almost ten years across over a dozen posts. My last post about them became too confusing, as I was regularly appending it with brief new updates. I was awaiting the correct time to restart. This company also makes the popular Shiseido Adenovital Shampoo.

Shiseido’s work on a hair loss cure based on the injection of cultured autologous dermal sheath cup cells (DSCs) is promising and safe. While the company has no problems with fundraising, thay have had some issues with their partnership with Replicel (Canada). I will not repeat that story here, but readers can check out my past posts on those two companies for more details.

Shiseido Dermal Sheath Cup Cell Hair Growth.
Shiseido’s hair growth treatment with the injection of autologous dermal sheath cup cells. Includes work from Replicel.

Shiseido Phase III Study Results Published

Earlier this month, Shiseido released the results of its “Phase III equivalent” study. The actual work was published in “The Journal Of Dermatology” Volume 50, Issue 10, in December 2023. In that same second link above, it also says “First published: 26 September 2023”, which might mean date of original Japanese submission.

No-one seems to have noticed it on Reddit as far as I can tell. I only learnt about it due to someone e-mailing me and asking me to check the end of the first PubMed link above where it says: “Grants and funding: Shiseido Group.”

It is not surprising that this development went through without notice. For one, the title of the paper does not even mention Shiseido’s name:

“Efficacy of autologous dermal sheath cup cell transplantation in male and female pattern hair loss”.

Even causing more confusion is the fact that they call this a “Phase III equivalent clinical study.” And only 36 volunteers participated in this trial. Not even remotely close to what you expect in a proper large-sized Phase 3 trial. The Shiseido website’s Hair Regenerative Medicine page has no new updates either.

In any event, this is clearly Shiseido’s trial for its DSC injections. After culturing dermal sheath cup cells (the source of dermal papilla cells) from the scalp skin of the hair loss patient, they are implanted (injected) into the same patient’s balding scalp skin to rejuvenate damaged hair follicles and promote healthy hair growth.

Among the paper’s many co-authors are the renowned Shiseido-affiliated Dr. Ryoji Tsuboi and Dr. Manabu Ohyama. All of the co-authors are also associated with at least one of the folllowing four entities in Japan:

  1. Department of Dermatology, Tokyo Medical University, Tokyo.
  2. Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo.
  3. Department of Dermatology, Toho University Ohashi Medical Center, Tokyo,.
  4. Regenerative Medicine Research & Business. Development Department, Yokohama.

Results

Keeping in mind the small size of the study, the results while positive, are a bit underwhelming. Thirty-six male and female participants with pattern hair loss (PHL) were injected with dermal sheath cup cells. These DSCs were harvested from non-affected occipital hair follicles twice in quarterly intervals.

On global photographic assessment, 30% of the participants showed improvement.

The phototricogram data analysis showed increases in the:

  • Cumulative hair diameter of 107.6 ± 152.6 μm/cm2. This was a +1.4% increase versus baseline.
  • Hair cross-sectional area of 3069.1 ± 10960.7 μm2 /cm2. This was a +3.4% increase versus baseline.
  • Mean hair diameter of 0.9 ± 0.9 μm. This was a +2.2% increase versus baseline.

The female and high terminal hair ratio groups achieved better outcomes. It is not clear if any new hair growth occurred from the above breakouts. But stronger and denser existing hair after 12  months is a positive. And could imply better future protection against dihydrotestosterone (DHT) spurred follicle miniaturization.

Another confusing statement:

Of the total participants, 62.9% noted some degree of improvement.

It seems like this 62.9% figure is based on patient feedback rather than any kind of measurement. And per the math, this would imply that 22 of 35 patients gave a positive response, while 1 dropped out before the 1-year mark.

I have not tried to find any long version of this report, as overall it leaves much to be desired. I hope a far lengthier Phase 3 clinical trial is still going on.

And I also hope that Shiseido will be able to remain fully transparent, in spite of any pending legal issues with Replicel.

Hair Transplant, Hair Transplant Turkey

Hair Transplant Industry in Turkey Worth $2 Billion in 2022

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Turkey Hair Transplant

Turkey hair transplant patients in a Turkish Airlines flight.The most frequent automatic news alerts from Google that I have received over the past ten years are about hair transplants in Turkey. Most of these articles still refrain from using the country’s new name “Türkiye”. I will use both in this post.

I almost renamed this post to “Turkish Hairlines” after reading the following quote in a recent Forbes article on hair transplants in Turkey:

“The national flag carrier Turkish Airlines is jokingly called “Turkish Hairlines” and the (Istanbul) airport is plastered with hair transplant advertisements.”

A video on TikTok that showed this phenomenon in a Turkish Airlines airplane went viral in 2022.

Turkish Hair Transplant Industry Worth $2 Billion

According to TRT World, the Turkish Health Tourism Association head recently announced that:

The Turkish hair transplant tourism industry was worth $2 billion in 2022. Moreover, one million patients from abroad received hair transplants in Türkiye in 2022.

The above numbers are probably estimated and have a wide error margin. However, there is no doubt that Turkey has become the global epicenter for hair transplant related cosmetic tourism.

$2,000 Hair Transplants in Turkey

If we go by the above data, the average cost of a hair transplant in Türkiye would then come out to be $2,000 per procedure. Extremely cheap by western standards, even if each transplant only consists of 1,000 to 2,000 grafts on average.

The one million hair transplant patient count estimate just in Turkey clearly indicates that the ISHRS global data is wildly off. The organization estimates their global hair transplant total (703,000 in 2021) based on member surveys that are then extrapolated. My gut feeling is that the Turkish number is a lot closer to the truth.

Now the Japanese and Africans are Coming

When it comes to hair transplant tourism, Türkiye has always benefited from its proximity to Europe and the Middle East. The cost of a hair transplant in Türkiye is less than half what you would find in Western Europe or Dubai. More surprisingly, in recent years, hair loss sufferers from as far away as Japan and sub-Saharan Africa have started to come to Turkey.

  • An increasing number of Japanese patients have started getting hair transplants in Türkiye per Nikkei, benefitting from a favorable exchange rate due to the weak Turkish Lira. According to one person quoted in the article: “The price of a hair transplant in Istanbul is one-sixth of that in Japan and one-half of that in South Korea.”
  • A recent article in the Jersusalem Post covered how Turkey is becoming the go-to destination for Israelis desiring hair restoration procedures. Among the reasons cited included affordability, medical expertise, advanced technology and safety measures. Besides the low cost, all of these will significantly vary depending on clinic of course.
  • Another recent article in Essence covered a clinic where 30 percent of patients were from Africa. Note that the kinkier and curlier African hair necessitates going to a surgeon who is experienced in transplanting that type of ethnic scalp hair grafts.

Unfortunately, the tremendous mostly positive publicity for Turkey’s low-cost hair transplant tourism industry has also resulted in hundreds of subpar unregistered hair restoration clinics in Turkey. In a similar manner to what you see in India where both good and bad quality proliferates rapidly. Make sure to read my posts on hair transplant abroad and hair transplant gone wrong.

Quality Clinics

Do note that there are dozens of quality clinics in Türkiye. Some of them impress me tremendously with what they show on social media. Some have plenty of great reviews, but also seem like factories with numerous physicians moving along at breakneck speed.

Some of the work that impressed me include this recent video from ASMED and Dr. Koray Erdogan. Another surgeon named Dr. Emrah Çinik has a large online following and stellar reviews. Almost all the well known surgeons seem to operate in Istanbul. Several lesser known ones are based in Ankara, but I am not mentioning them here for now.

Among the larger clinics with many surgeons, “Hair of Istanbul” has over 4 million followers on Instagram. Cosmedica and Smile Clinic both have over 1 million followers. Vera Clinic has 400,000 followers. Do note that many businesses can easily purchase followers and artificially increase their importance.

All the reputable surgeons should be able to perform the more popular follicular unit extraction (FUE) procedure. Some may still offer the strip (FUT) procedure depending on patient request and suitability,

Thousands of Unmonitored Hair Transplant Clinics in Türkiye

Suppose 1 million foreigners really do get a hair transplant in Türkiye each year; and suppose that each hair transplant clinic in the country performs a crazy high 1,000 procedures per year; you would then still have 1,000 hair restoration clinics being present in the country. Most likely there are at least several thousand hair transplant clinics in Türkiye. And I would not be surprised if the majority are unmonitored and maybe even unregistered.

Even more surprising:

  • On the ISHRS website, there are currently only 16 Turkish surgeons listed as members. Note that the ISHRS has around 1,000 hair transplant surgeon members from across the world. So it is not that hard to get on their list.
  • On the IAHRS website, there are currently 6 Turkish surgeons listed as members.
  • The Turkish society of Hair Restoration Surgeons was supposedly established on March 1st, 2020. However, I do not see any website for the organization that lists surgeon member names.

So it is absolutely imperative that you conduct thorough research before going to Turkey for a hair transplant. Even if most of the 1 million people who go there each year fail do so and take a major gamble with their long-term appearance. Do not do what GQ writer Alex Hawkins did (even if he got lucky and ended up satisfied):

“I flew to Turkey and visited a clinic where a vaguely mysterious doctor cut 4,250 holes in my head.“