Alan J. Bauman, M.D. Diplomate, American Board of Hair Restoration Surgery

YES PRP Certification & Training May 30th, 2015

PLATELET RICH PLASMAFOR HAIR REGROWTH

ABHRS

CONFLICTS OF INTEREST• The following conflicts of interest

pertain to this presentation: NONE

ALAN J. BAUMAN, M.D., A.B.H.R.S.• Diplomate, American Board of Hair Restoration Surgery • Member, International Society of Hair Restoration Surgery • Recommended, American Hair Loss Association • Member, American Academy of Anti-Aging Medicine (1998)

• New York Medical College • Beth Israel Medical Center NY – General Surgery • Mt. Sinai Medical Center NY – General Surgery

• Bauman Medical Group (est. 1997) - Boca Raton, FL • >17,000 patients treated, >7,000 hair transplants

Alan J. Bauman, M.D.

VIDEO: PRP HAIR REGROWTH ON ABC

http://hai.rs/hairprp-placenta

OVERVIEW• Hair Follicle & Growth Cycles • Hair Loss & Treatments • PRP & Growth Factors • PRP in Hair Restoration • Role of Extracellular Matrix (ECM) • ACell/Matristem & BioD-Restore • Hair Evaluations & Measurements

• How to Prepare & Apply Scalp PRP • Additional Educational Opportunities

HAIR & SKIN ANATOMY: THE PILOSEBACOUS UNIT

HAIR GROWTH CYCLE

HAIR FOLLICLESTEM CELL SIGNALING

• Epithelial Wnt/β-catenin signaling is required for hair matrix cell proliferation. Wnt/β-catenin signaling is a central regulator of adult stem cells.

• LRP inhibition permits stem cell survival; blocks hair growth reversibly

• β-catenin is required in bulge stem cells for their proliferation, but not survival indicating the persistence of functional progenitors so follicles will continue to proliferate even without β-catenin.

• Hair Follicle ~ Fibroblast “Cousin”

HAIR:

Beauty

&

Youth

• Fear/anxiety ~ Sickness or Illness • Low Self-Esteem/Self-Confidence • Feel Older / Less Attractive • Camouflage/Compensate • Avoid Social Situations

Hair Loss

HAIR LOSS: ANDROGENETIC ALOPECIA (AGA)• Genetic Male and Female Pattern Hair Loss – most common type • Affects nearly 100 Million Americans (est. 60M men, 40M women)

NORMAL MINIATURIZED

60X & 30X “HAIRCAM” DERMOSCOPY

SEVERE DEPLETION: HAIR TRANSPLANTATION

SEVERE DEPLETION: MEDICAL HAIR PROSTHESIS

HAIR LOSS: ALOPECIA AREATA (AA)

• Autoimmune • Small / Circumscribed • “Spot baldness” • 1-2% of cases spreads to

the entire scalp • Standard Tx’s:

• Steroid injections • Microtrauma

MEDICAL HAIR LOSS TREATMENTS:PRESERVE AND ENHANCE HAIR FOLLICLE FUNCTION

M O D A L I T Y T X M E C H A N I S M

Oral Finasteride blocks Dihydrotestosterone production [♂AGA] Topical Minoxidil K+ channel opener, vasodilator [AGA, AA] Phototherapy LLLT, LaserCap ↑ mitochondrial membrane potential [AGA, AA] Nutraceutical Biotin, Marine Protein Metabolic/Nutritional [AGA, AA] Cell Therapy Platelet Rich Plasma Growth Factors, Cytokines [AGA, AA]

PLATELET RICH PLASMA FOR HAIR REGROWTH

GROWTH FACTORS, CYTOKINES AND MORE…• platelet-derived growth factor - PDGF • transforming growth factor beta - TGF-B • fibroblast growth factor • insulin-like growth factor 1 - IGF1 • insulin-like growth factor 2 - IGF2 • vascular endothelial growth factor - VEGF • epidermal growth factor - EGF • nerve growth factor - NGF • interleukin-1 – IL1-B • Interleukin-8 – IL8 • keratinocyte growth factor • connective tissue growth factor

GROWTH FACTORS & HAIR FOLLICLE CYCLING

• PDGF – stimulate growth of dermal mesenchyme, epidermis-follicle interaction (5) • VEGF – mitotic & endothelial cells, increases vascular permeability (Yano-6) • EGF – mitosis of epithelial cells, fibroblasts. Inhibits catagen, promotes anagen(10/11) • IGF – anti-apoptosis (12) • FGF – proliferation & differentiation of keratinocytes and endothelial cells. Anagen (13) • NGF – hair cycle modulator. Stimulates hair growth (NGF-TrkA) via proliferation of

keratinocytes, NGF-p75NTR promotes apoptosis and hair follicle regression. Stress mediator, may play a role in neurogenic inflammation, hair follicle apoptosis & premature catagen.

PLATELET RICH PLASMA STAND-ALONE TREATMENT FOR HAIR REGROWTH

• Autologous • Bedside • Out-patient • Quick; “lunch-hour” • Non-Invasive • Painless Local Anesthesia • No Downtime • Low risk • Hair Growth

www.HairCoach.netYES PRP at Bauman Medical

VEGF VASCULAR ENDOTHELIAL GROWTH FACTOR

Bouhanna/Amgar

LITERATURE REVIEW: USE OF PRP IN HAIR RESTORATION

• Graft-storage media in Hair Transplantation (Bouhanna/Amgar)

• Wound healing accelerator in Donor and Recipient Areas (R Reese, J Cole, J Cooley)

• Improvement of ‘take-rate’ & growth in hair transplantation (R Reese, C Uebel)

• Stand alone treatment for androgenetic alopecia or alopecia areata. (J Greco, Amgar, Bouhanna, Rinaldi) Bouhanna/Amgar

PRP FOR ANDROGENETIC ALOPECIA

Bouhanna/Amgar

PRP FOR ALOPECIA AREATAPreTx 8 weeks 4 months

PRP FOR ALOPECIA AREATA

PreTx 8 weeks 4 months

PRP HAIR REGROWTH IN 38YO FEMALE AGABEFORE & AFTER 9MOS

PRP HAIR REGROWTH 36YO MALE AGABEFORE & AFTER 9MOS

EXTRACELLULAR MATRIX (ECM)• Extracellular part of multicellular structure • Structural & Biochemical support • Injury Repair & Tissue Growth • Wound healing / fibrosis • Regulates intracellular communications

FUNCTIONS during injury or tissue regeneration: • Prevents inflammation & scar tissue formation • Facilitates tissue repair

WHY USE EXTRACELLULAR MATRIX (ECM) W/ PRP?

PROLONG & ENHANCE!

• Without ECM: PRP effects last ~90 days, requiring repeat treatments • With ECMs

• PRP hair growth effects may last for up to 2 years • PRP hair growth effects appear to be stronger

ACELL/MATRISTEM ECM• Porcine Bladder Matrix • Micronized powder • Collagen • Basement membrane • Bio-scaffold

BIOD-RESTORE - PLACENTAL TISSUE ECM

• Immune privileged - Rarely evokes immune response • Provides cells, structure and signals for repair/regeneration

• Natural scaffold / ECM for cell migration & proliferation • Proteins, cytokines, carbohydrates, hyaluronic acid, growth

factors, chemical compounds and multipotent cells naturally inherent in placental and amnionic fluid

• Anti-inflammatory / Anti-microbial / Anti-scarring / Anti-adhesive

BioD-Restore™ is a cryopreserved amnion allograft from the placenta of live, healthy donors.

BIOD-RESTORE• Multipotential Tissue Matrix • Structural allograft derived from

human amnion • Chemical compounds, growth

factors, residual cells • Regeneration • Immune privileged • Multipotent cells

BIOD-RESTOREPROCUREMENT & PROCESSING:

• Prescreened donors • Medical review • Prenatal testing • Behavioral risk assessment • Blood tests • Medical history • Disease testing • Aseptic recovery / sterile cesarean section • FDA-registered tissue bank • FDA-registered processing center

GROWTH FACTORS FOUND IN AMNION• Platelet-Derived Growth Factor (PDGF) • Transforming Growth Factor Beta (TGF-β) • Vascular Endothelial Growth Factor (VEGF) • Fibroblast Growth Factor (FGF) • Epidermal Growth Factor (EGF) • Insulin-like Growth Factor (IGF-1)

HAIR MEASUREMENTS & EVALUATIONS• “HairCheck” – Cross-Section Hair

Bundle Trichometry • HMI – Hair Mass Index • Sensitive, scientific, repeatable,

accurate • “HairCam” Dermoscopy – identifies

miniaturization • Global Photos – medical ‘mugshots’

HairCam – ABC Good Morning America

HairCheck at Bauman Medical

HOW TO PREPARE AND APPLY PRP+ECM

• Patient Selection, treatment area identified & measured. • Phlebotomy is performed. • Scalp prepped w/ antiseptic shampoo and local anesthesia. • PRP is prepared using centrifuge & YesPRP™ kit. • If used, BioD-Restore is thawed. • PRP is mixed gently with ECM (Acell/Matristem or BioD-Restore) • PRP+ECM is injected intradermally into the scalp • Mechanical (MicroPen) microneedling creates microtrauma • Scalp is cleansed, 15min LLLT applied • instructions given prior to discharge

Dr. Bauman performs PRP on ABC Palm Beach

SIDE EFFECTS / SEQUELAE / FOLLOW-UP

• Tenderness / Swelling is rare • Follow-ups can be performed monthly to track hair growth improvements. • Monitor hair growth using HairCheck and HairCam to observe peak and plateau.

UPCOMING PRP HAIR GROWTH & HAIRCHECK™ WORKSHOPS

Friday June 19th -or- Friday Septembe 25th 9am-5pm Boca Raton • Hair Loss Diagnosis & Evaluations, Treatments & Tracking • Hands-on HairCheck Measurements • Hands-on PRP+ECM hair regrowth procedure • Course Director: Alan J. Bauman, M.D. • Certificate, Starter Kit & Ongoing Support • andres@baumanmedical.com or www.HairCoach.net for info/registration and future events

REFERENCESMarx, R.E. , et al, “Platelet-Rich Plasma Growth Factor Enhancement for Bone Grafts,” Oral Surg Oral Med Oral Patrhol, 1998;85:638-646. Antonaides, H.N., et al,”Human Platelet-Derived Growth Factor: Structure and Functions”, Federation Proceedings, 1983;42:2630-2634. Pierce, G.F., et al,”PDGF-BB,TGF-β 1 and Basic FGF in Dermal Wound Healing: Neovessel and Matrix Formation and Cessation Repair”, Am J Pathology, 1992;140:1375-1388. ELISA Immuno Assay For PDGF-A, Human VEGF, TGF-β 1, and Human EGF, R&D Systems, Mpls, MN 1999. Bauman AJ, The use of cross-sectional hair bundle trichometry in the diagnosis, evaluation and tracking of hair loss. Poster Presentation. ISHRS ASM October 2012 Nassau, Bahamas. Gruss, J., et.al., Human amniotic membrane: a versatile wound dressing. CMA Journal 1978; Vol.118:1237-1246 De Coppi, P. et.al., Isolation of amniotic stem cell lines with potential for therapy. Nature Biotechnology 2007; Vol.25,No.1:1274-1280

PRP VIDEO PLAYLIST

http://hai.rs/prphairgrowthvids

Alan J. Bauman, M.D. Bauman Medical Group

Boca Raton, FL USA

doctorb@baumanmedical.com baumanmedical.com

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Thank You!!