|James Bond Presents:
Interview with Hair Follicle Stem Cell Pioneer, Dr. Coen Gho
November 1, 2005
I've followed the work of Dr. Gho for many years. I have often been intrigued by his original ideas in the field of hair restoration research. In an effort to gain a more in depth understanding of Dr. Gho's remarkable research, I conducted the following interview.
HairStemcell Transplant (HST):
1) Some people believe that a HT-like technique where both the
donor site and the recipient site produce hair is impossible.
Others, who are more scientifically informed, cite that although
such a procedure is certainly possible, consistency in the results
could be an issue. Is there a method that you can use to establish
the hair counts achieved in both the donor and the recipient sites,
and do you plan to offer the public some form of assurance of the
efficiency of your HST procedure (results of your private studies,
future published studies, or etc)?
Dr. Gho: It is almost impossible to count hairs standardized in a certain area. What we have done is to extract many grafts in a defined area and follow that area for a certain period. With this method we can reveal re-growth in the donor area. (See below). At this moment we are preparing a article for a international journal.
Fig 1a. Donor area before extraction of the HairStemcells.
Fig 1b. Donor area directly after extraction of the HairStemcells
Fig 1c. Donor area 1 day after extraction of the HairStemcells. Due to the small dimension of the holes (0.5mm.), the little wounds have already healed. However, there is still no re-growth visible. If there is no re-growth in this area, this area will be left with little scars as seen with Follicle Unit Extraction.
Fig 1d. Donor area 1 week after the extraction of the HairStemcells. The dark spots are places where the grafts have been removed. In these dark spots we see small hairs growing (blue arrows). This shows the re-growth of hairs in the spots where the grafts have been removed. In some dark spots re-growth is not visible, yet, since this picture is taken only one week after the extraction. However, you see already some dark contours coming through the skin.
JB: 2) An often cited study was performed in the past showing that, when follicles were transected longitudinally, the resulting multiplied hairs grew back thinner than the original hairs and had low survival rates ( Swinehart JM. Dermatol Surg. 2001 Oct ;27(10):868-72.). From reading your website, it appears that although you transect hairs longitudinally in HST, the hairs grow back consistently and at normal thickness. You are obviously using a quite different technique than Swinehart. Can you provide some insight as to why your HST technique is not subject to thin hairs and low survival rates?
Dr. Gho: I am familiar with the publication of Swinehart. Besides other little differences, there are two major differences compared to the “ Swinehart technique ” :
1. In our technique and because we use special instruments we don’t dissect / transect the follicle outside the body like Swinehart, but in the skin (in vivo transsection of the hair follicle) Therefore, we don’t have to manipulate the grafts and have therefore (almost) no traumatic damage of the grafts.
2. As published by several authors, grafts in normal saline solution or other Phosphate Buffered Saline solution (PBS) (used in this publication), are very vulnerable to apoptosis (programmed cell death) which results in thinner hairs and lower survival rate. To preserve the hair stem cells and to promote the (stem )cell growth, we use a special preservation and grow medium, designed to enhance the hair stem cells.
Due to these differences, we can guarantee that the hair growth has the same thickness as normal hairs and the survival rate is at least the same as conventional hair transplantation techniques.
JB: 3) You have stated that HST provides more donor re-growth than FM. What is the donor re-growth range in FM, and what is it in HST?
Dr. Gho: The re-growth rate in the donor area of Follicular Multiplication varies between 20 – 70%.
The re-growth rate in the donor area of Hair Stemcell Transplantation is at least 80%.
JB: 4) Longitudinally transecting every follicle in a follicular unit graft using a 0.6mm needle appears to be a difficult proposition because in HST, you transplant FU grafts. Are some of the follicles present in these FU’s not transected, and if so, approximately what percentage of follicles escape longitudinal transection?
Dr. Gho: Follicular Units consists of 2 to 4 hairs. Since one hair follicle has a diameter of at least 0.5 mm . the diameter of a follicular unit is at least 0.8 to 0.9mm. Hairs consists of dead material and have a harder consistency than the hair follicle itself.
Because we use special needles between 0.5 and 0.6mm., depending on the size of the hair follicles, we are able to use the “dead hard hairs” (black arrows as a guidance to obtain the hair stem cells (blue arrows) present in the hair follicles between the “dead hard hairs”.
Because the needle is much smaller than the follicle unit, it is almost impossible to extract to much tissue. Therefore, there is almost total re-growth and there is a major difference in re-growth between the different techniques.
between FUE, FM and HST:
Follicular Unit Extraction
Almost Total Regrowth
5) Several posters at hairsite.com have commented that they believe
survival rates of hair follicle splitting procedures like HST can be
increased by first bathing the split follicles into a medium of
cultured follicular stem cells. Have you attempted this type of
procedure? If so what was the result? If not, do you believe such a
procedure has any merit and why?
Dr. Gho: Of course, we use the same medium used for culturing hair stem cells for HairMultiplication.
The results are the same hair growth and thickness as normal hairs and the survival rate is at least the same as conventional hair transplantation techniques.
The smaller the piece of tissue used with techniques like HairStemcell Transplantation, the more important the medium to increase the survival rate and hair growth.
6) Have you considered using traditional FUE at the hairline to fill
in non-typical problematic areas experienced with HST or is the
consistency of results experienced with HST as good as seen in FUE
(I’ve seen some FUE created hairlines that look very good)?
Dr. Gho: Due to the fact that with HST the grafts are smaller, besides the possibility to create a higher density compared to other techniques like FUE, we are able to create a more natural hairline.
JB: 7) Your website states that with HST, up to 35 grafts can be placed in a cm^2 in a single session, and up to 50 grafts can be placed in a cm^2 when a second session is performed. Does this mean HST results in a maximum of 50 hairs per cm^2 or do the grafts contain more than one hair per graft. If the latter, then what is the maximum hairs per cm^2 achievable in HST?
Dr. Gho: We believe that a natural density is more important than a high density. However, you are right. To create a high density , it is possible to implant 50 grafts per cm 2 Because between 2 to 4 hairs will grow per graft, the maximal density which can be achieved will be around 150cm 2. Of course, in the hairline we will not place these grafts which contain 2 to 4 hairs because this creates a unnatural aspect.
8) While at Gho Clinic , you stated that you would release HM
sometime in 2006 whether the consistency problems were figured out
completely or not. Gho Clinic now claims to have bought the rights
to your HM research. Despite this and other recent setbacks, you
have stated you are still planning on releasing HM at some point in
the future. Approximately when can we expect HM and how effective do
you predict it will be in its initial form (A rough guess is fine,
but please clarify it as such.)?
Dr. Gho: HairMultiplication is just a name for a tissue-engineering technique which contain the culture of Hair Stemcells.
Since technology never stands still, the patent is already almost 10 years old, you can image that new insights are more important than the patents itself. We have filed new patents for HairMultiplication and these will be public I think in 2006/2007.
Because we have started the initial studies this year, let’s hope that we have consistency and therefore a usable technique in 2006. We can not promise this, but we work very hard to accomplish this deadline.
JB: 9) If I recall correctly, you once stated that you believed your HM technique resulted in stimulating miniaturized follicles to re-grow thick hair again. However you also stated that in order to know for certain, you would have to perform more in depth studies. More recently Dr. McElwee showed that existing small follicles take up migrating dermal cells, and this can result in the growth of larger diameter hairs. What are your current views of how your HM technique works regarding stimulation of existing follicles compared to neogenesis?
Dr. Gho: Exactly the same. What we have found is that when we implant the epidermal hair stem cells, we influence the miniaturized follicles to produce s thick hair again. However, when the baldness has been present for more than 5 years, we sometimes can not find the miniaturized follicles anymore.
JB: 10) Two companies— Aderans and Intercytex—are investing millions of dollars and using relatively large teams in an effort to bring DP cell-based HM to market between 2008 and 2010. How has this impacted your own HM research?
Dr. Gho: None, our technology is based on the follicular stem cells and not on the Dermal Papilla cells.
P.s. Let’s hope we are faster………
Optional Bonus questions
11) Are you still actively involved in HM research, and if so, what
sort of progress have you made or are you making?
Dr. Gho: Yes, we have filed new patents for HairMultiplication with the technology of today and these patents will be public I think in 2006/2007.
I hope you understand that this moment we can not disclose any information concerning the results and/or progression.
JB: 12) In what cities are your current clinics open, and how are things progressing in regards to your new venture?
Dr. Gho: At this moment, we are open in Amsterdam , and by the end of this year we will open a clinic in Maastricht , the Netherlands and Madrid , Spain . At this moment we are fully booked for November and December and we are planning in January. So, it is going very well.
JB: 13) What insights or predictions do you have regarding the future of HM research in general?
Dr. Gho: In my opinion HairMultiplication in general, the technique which consists of Tissue Engineering Hairs will be the future of Hair Restoration.
However, if HairMultiplication still involves the stimulation miniaturized follicles, with HairMultiplication it is impossible to create a high density when someone has been bald for a long time. This is because the miniaturized follicles has to be found. In these cases, HM has to be combined with other techniques like HairStemcell Transplantation.
JB: 14) I’m certain that you believe HST is a viable interim alternative while patients await the arrival of HM. HST obviously increases the overall number of harvested donor follicles that are possible. What do you feel the potential range of donor follicles is when performing HST? (IOW, by re-harvesting donor hairs over and over, what range of donor follicles can patients expect to yield in total before their donor site is exhausted?)
Dr. Gho: In theory, it is possible to use the same donor area / donor hair follicles again without any limitation. Practically, our main goal is to achieve a natural result. Therefore, it is not necessary to have more than 2 to 3 treatments for the frontal area and 2 to 3 treatments for the crown.
JB: 15) Do you believe that Intercytex and ARI are on the right track with their DP cell based HM research protocols?
Dr. Gho: Intercytex and ARI are working with Dermal Papilla cells. In my opinion, these cells are able to produce a hair, however, after a period, they will die and will not produce a hair again. Even Colin Jahoda revealed in his studies that human Dermal Papilla cells can not produce a hair but outer root sheath (which contain the follicular (hair) stem cells can produce a hair. However, I think that they do the studies with a combination of both dermal papilla cells and follicular (hair) stem cells and to avoid interference of the current known patents such as ours and/or other research groups, they say that they only use dermal papilla cells.