Skin Regeneration, Wound Healing and Hair Growth

The most “natural” way of regrowing lost hair is via wounding or intentional injury. Hence the massive popularity of at-home microneedling and dermarolling for hair growth.

However, no-one truly understands the biology of wound healing spurred new hair follicle growth. We have been waiting for 15 years for Follica to come through.

Update: March 2023 — In vivo reprogramming of wound-resident cells generates skin with hair.

Update: February 2022 — Another interesting new study titled “Cellular Memories: More Than Skin Deep.” Co-author is Dr. George Cotsarelis.

June 21, 2021

Hair Follicle Mesenchymal Activity During Wounding Healing

I am updating this post because an important new study on wound healing and hair follicle mesenchymal stem cell activity was published in June 2021. The Israeli researchers behind this paper concluded the following:

“During wound healing, dermal papilla (DP) and dermal sheath (DS) cells move towards the wound, but do not directly participate in follicle neogenesis.”

They further elaborate that follicle neogenesis during wound healing is a genuine de-novo process. The new follicle formation does not rely on any preexisting components from preexisting follicles.

October 24, 2020

Wound Healing and Hair Follicle Growth

Two recent papers published important new findings in regards to wound healing and skin regeneration.

Wound healing via skin regeneration is often accompanied by hair follicle regeneration. Or even by brand new hair follicle neogenesis (e.g., Follica). Note that this hair growth after wounding phenomenon was even being researched in the 1950s and 1960s.

Thousands of hair loss sufferers around the world are trying out at-home microneedling and dermarolling. Many of them have seen significant success, although one has to be careful with this type of scalp self-injury. On our hair loss chat, the most interesting recent discussion is around wounding depth levels.

Human embryonic and neonatal skin has the potential to regenerate after wounding. This includes fully functioning hair follicles. However, adult skin no longer has such regenerative capabilities. Researchers have been trying for years to find ways to coax salamander-like regenerative powers in humans. If not for whole limbs, at least for hair growing skin to cover baldness for our sake.

New Studies on Skin Regeneration and Wound Healing

1) In September 2020, a team that included Dr. Jeff Biernaskie published a study on the regenerative potential of dermal fibroblasts during wound healing. They identified a specific population of progenitor cells that reside within the dermis and which aid in wound healing. I covered Dr. Biernaskie and his University of Calgary team in detail in 2020.

Skin Regeneration Regulators
Skin Regeneration Regulators. Source: Bernaskie Lab GitHub.

This latest research is shared on GitHub. Also see Biernaskie Lab. According to the findings, Runx1, retinoic acid, and Hic1 control mesenchymal regenerative capabilities.

According to this summary, Dr. Biernaskie said that they have shown the following:

“You can alter the wound environment with drugs, or modify the genetics of these progenitor cells directly. Both are sufficient to change their behavior during wound healing. And that can have really quite impressive effects on healing that includes regeneration of new hair follicles, glands and fat within the wounded skin.” 

“It suggests that the adult wound-responsive cells do in fact harbor a latent regenerative capacity, it just simply needs to be unmasked.”

2) Also in September 2020, a new study from the University of Washington identified Wnt transcription factor Lymphoid enhancer-binding factor 1 (LEF1) as the key factor in adult skin regeneration.

LEF1 gene expression in fibroblasts has the potential in adult skin to repair itself like the skin of a newborn baby. This skin can also grow new hair follicles.

In an interview with lead author Dr. Ryan Driskell (link no longer working), he said the following:

“We identified a genetic factor that allows adult skin to repair itself like the skin of a newborn baby.”

Skinregeneration.org

The authors of the above study have started a new site called skinregeneration.org. The site’s mission is to provide a platform for scientists to easily query large datasets that focus on skin wounding and scarring repair.

For further information, see the Driskell Laboratory site at Washington State University.

Update: July 8, 2022 — A WSU research team led by Dr. Ryan Driskell is researching how to regenerate skin without scarring. This would be done by reactivating Lef1 expression in adult fibroblasts. In effect, this would turn adult skin into more youthful young skin.

Hair, Skin and Wounds all Interconnected

While researching for this post, I could not believe the number of diverse past posts that I have written on this blog that have focused on skin regeneration, wound healing and hair formation.

Regenerating hair follicle after wounding.
Wound induced single hair follicle neogenesis in a bald old man.

Renowned hair loss researchers such as Dr. George Cotsarelis, Dr. Luis Garza, Dr. Elaine Fuchs and Dr. Mayumi Ito have all also conducted frequent research on skin regeneration. I have discussed their work in past posts if you search for their names.

My gut feeling is that whenever there is a fully effective cure for hair loss, there is a strong likelihood that there will also be a cure for quality skin regeneration.

Skin Gun and Spray-On Skin

It seems like the technology to repair skin has improved significantly during the past decade. There is an especially unmet need when it comes to treating skin that has been burnt badly.

One of the technologies that I used to very curious about is the skin gun that was widely hyped in 2011. I have not heard much about this in recent years. RenovaCare acquired the technology in 2013. The company’s skin gun and spray-on stem cells for wound healing are trademarked under the names SkinGun™ and CellMist™.

Alma TED (TransEpidermal Delivery) for Hair Growth

Alma TED System
Alma TED™ System.

Over the past year, I have kept hearing about the Alma TED™ ultrasound-based system for hair growth. The TED stands for “TransEpidermal Delivery”, meaning past the epidermis upper skin layer.

This device is made by Alma and it improves medication and growth factor delivery to the hair follicles. It was only in March 2022 that the company announced the launch of its new ultrasound based system Alma TED.

The device benefits hair growth via improving drug delivery as well as blood flow. On a somewhat related note, even sound therapy by itself can benefit hair growth per some findings.

Alma TED for Hair Loss

I decided to finally write this post after seeing that there is a presentation on Alma TED at this week’s AAD2023 meeting.

Alma TED Presentation
Alma TED Presentation at AAD2023.

I covered a few of these American Academy of Dermatology (AAD) conferences in the past. This time, I leave it up to the readers to go through the various hair related sessions.

The above presenter Lady Christine Cheng Dy, MD has been at the forefront of using this technology. On her website, she has a video of herself getting the painless non-invasive Alma TED treatment. It works by “using acoustic sound waves and air pressure to drive active components deeper into the skin”. This leads to better and greater absorption.

Dr. Alan Bauman, another pioneer in the use of this technology has some great videos of this treatment on his site. He is upfront that Alma TED will not grow new hair follicles, but can make existing ones stronger. He uses a growth factor serum in combination with the ultrasound delivery.

Alma TED comes with a propriety tip that is engineered with Impact Delivery™ patented technology. Unlike PRP, this non-invasive, non-traumatic treatment does not require the use of injections or needles.

Better Drug Delivery

A few weeks ago, Dr. John Cole (see his site’s section on TED), mentioned something interesting to me:

“I am very curious about using Alma TED to deliver dutasteride and finasteride. TED opens a 3 micrometer channel in the skin. According to their chief scientific director, anything up to 800 daltons should go in. Finasteride is around 400 daltons and dutasteride is 500 plus daltons.”

Dr. Cole says that he has seen great patient results from TED. On his site, he elaborates that cavitation from the ultrasound separates the skin’s collagen network of fibers. This enables the delivery of a hair care formula at up to 4mm depth into the skin via the air pressure.

He further elaborates that TED is a two step process:

  1. First you open the channels.
  2. Then, at a higher intensity, you deliver the product.

Update: It seems like Dr. Cole did a self-experiment and used Alma TED to deliver Dutasteride, Latanoprost and Minoxidil to his scalp. I did not know this when I wrote this post.

Make sure to also read my past post on topical finasteride delivery mechanisms.