ISHRS 20th Abstract Book 2012 Bahamas Final

A B S T R AC T B OO K

OCT 17-20

2012

New Trends in Hair Restoration: Surgery and Science

2012 Ann uAl Scientific Mee ting

coM M it te e Francisco Jimenez, MDChair

Advanced/Board Review Course Chair

Rober t H. True, MD, MPH Jonathan L. Ballon, MDBasics Course Chair

Workshops & Lunch Symposia Chair Live Patient Viewing Chair Live Patient Viewing Co-Chair

Marcelo Pitchon, MD

Nicole E. Rogers, MD

Ber tram M. Ng, MBBS

Glenn M. Charles, DO Jean M. Devroye, MD Neil S. Sadick, MD Melvin L. Mayer, MDImmediate Past-Chair

Surgical Assistants Chair Newcomers Program Chair

Brandi Burgess

Paul C. Cotterill, MD

How to read this bookAbstracts are included for General Session oral presentations and poster presentations. The abstracts are listed in this book in the order they are scheduled to present in the General Session. Posters are listed behind the Poster tab. There is an author index and topic index behind the Index tab. The indices reference the abstract numbers. The oral presentations are numbered in the order they are presenting starting with 001. The posters are numbered starting from P01. The abstract format is as follows:Abstract Number

001 Program Chair Welcome & AnnouncementsFrancisco Jimenez, MD NA, Las Palmas Gran Canaria, Spain

Title of Presentation Author Block The bold name is the presenting author. Biography of Presenting Author

Dr. Jimenez is a dermatologist and hair transplant surgeon. Trained in Dermatology in Madrid, in Dermatopathology at the University of Miami, in Mohs surgery at Duke University and in Hair Restoration Surgery with Dr. Dow Stough in Hot Springs, Arkansas. Currently working in private practice in Gran Canaria, Canary Islands, Spain. Author of 44 publications in peer review journals and past Editor of the Hair Transplant Forum (2008-2010). Dr. Jimenez received the 2011 ISHRS Platinum Follicle Award. F.Jimenez: None. ABSTRACT: Not applicable.

Disclosure of Conflict of Interest Block Abstract

Presenters were given the opportunity to submit their PowerPoint presentations in addition to their abstracts. Where applicable, the presentation is included immediately after a presenters abstract. Disclosures of conflict of interest are included in the introductory pages as well as next to each presenters abstract throughout this book.

DisclaimerRegistrants understand that the material presented at the Annual Meeting has been made available under sponsorship of the International Society of Hair Restoration Surgery (ISHRS) for educational purposes only. This material is not intended to represent the only, nor necessarily the best, method or procedure appropriate for the medical situations discussed, but rather is intended to present an approach, view, statement or opinion of the faculty which may be of interest to others. As an educational organization, the ISHRS does not specifically approve, promote or accept the opinions, ideas, procedures, medications or devices presented in any paper, poster, discussion, forum or panel at the Annual Meeting. Registrants waive any claim against ISHRS arising out of information presented in this course. Registrants understand and acknowledge that volunteer patients have been asked to participate in the Annual Meeting sessions for educational and training purposes. Registrants shall keep confidential the identity of, and any information received during the Annual Meeting regarding, such volunteer patients. Registrants further understand and agree that they cannot reproduce in any manner, including, without limitation, photographs, audiotapes and videotapes, the Annual Meeting sessions. All property rights in the material presented, including common law copyright, are expressly reserved to the presenter or to the ISHRS. The sessions may be audio, videotaped, or photographed by the ISHRS. Registrants also understand that operating rooms and health care facilities present inherent dangers. Registrants shall adhere to universal precautions during any Course, Workshop, or Session that they attend that may utilize cadaveric specimens, cadaveric material or sharps, and that any contact they may have with cadaveric specimens or cadaveric material shall conform to all proper medical practices and procedures for the treatment of patients for whom no medical history is available. In the event that one incurs a needle stick injury, cut, or other exposure to blood borne pathogens, the person shall immediately notify the Course, Workshop, or Session Director and the ISHRS and take such other follow-up measures as deemed appropriate. By attending this program, in no way does it suggest that participants are trained and/or certified in the discipline of hair restoration surgery. All speakers, topics, and schedules are subject to change without prior notification and will not be considered reasons for refund requests. Registrants agree to abide by all policies and procedures of the ISHRS. Registrants waive any claim against ISHRS for injury or other damage resulting in any way from course participation.

2012 International Society of Hair Restoration Surgery

ABSTRACTS20th Annual Scientific Meeting of the International Society of Hair Restoration Surgery

October 17-20, 2012 Atlantis Conference Center The Bahamas

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Continuing Medical Education Mission StatementCME PurposeThe purpose of the International Society of Hair Restoration Surgerys (ISHRS) CME program is to meet the educational needs of its members and close the gap that exists between current and best practices by providing practice-oriented, scientifically-based educational activities that will maintain and advance skills and knowledge as well as promote lifelong learning for its members. CME activities will result in improvement of physician competence and performance in practice.

Content AreasThe curriculum of the ISHRSs CME program includes but is not limited to hair transplantation, alopecia reduction surgery, hair biology and physiology, congenital and acquired alopecias, other hair and scalp related ancillary procedures and disorders, and risk and practice management. (ISHRS Core Curriculum of Hair Restoration Surgery and Core Competencies of Hair Restoration Surgery). Content is determined by the integration of various sources of needs, including gaps in knowledge and/or performance of hair restoration surgeons, national guidelines, emerging research, and expert opinion.

Target AudiencesThe target audiences of the ISHRS are as follows: - The primary target audience is its physician members with varying medical specialty backgrounds from around the world. - Secondary audiences for the CME program include non-member physicians, as well as residents, nurses, surgical assistants and other allied health personnel. The ISHRS recognizes the importance of and encourages international and interdisciplinary exchange of medical knowledge and practice through calls for papers, and invitations to interdisciplinary and international speakers with special expertise.

Types of ActivitiesThe activities that support the CME mission are diverse and multifaceted, in order to provide multiple approaches for knowledge acquisition. CME offerings include the following: - Annual Meeting, which may include didactic and hands-on courses, live surgery workshops, seminars, scientific sessions, and poster presentations. - Other activities include regional live surgery and didactic workshops, enduring materials, and Internet CME. All CME activities will be cost-effective and will meet the criteria for continuing medical education of the ACCME and the AMA Physicians Recognition Award.

Expected ResultsThe CME program will result in improved performance in practice (such as surgical skills) and competence (medical knowledge and ability) among its participants. All participants will be expected to provide written feedback following all educational activities, and the CME Committee will rely on this feedback as well as other methods to assess the effectiveness of educational efforts and direct changes in its CME Program.

Learning ObjectivesThe learning objectives are listed on the adjacent page as well as by each General Session listing within this Abstract Book.

Continuing Medical Education (CME) CreditThe International Society of Hair Restoration Surgery is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The International Society of Hair Restoration Surgery designates this live activity for a maximum of 34.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The International Society of Hair Restoration Surgery Annual Scientific Meeting (program #611100) is recognized by the American Academy of Dermatology for 34.25 AAD Recognized Credits and may be used toward the American Academy of Dermatology's Continuing Medical Education Award.

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Learning ObjectivesUpon completion of the General Sessions, you will be able to:

THURSDAYOpening Session o Demonstrate understanding of basic biology of follicular stem cells. o Identify the role of these cells in hair cycle regeneration. o Formulate ideas for the role of HF stem cells in applications of hair regeneration, wound healing, and in regenerative medicine. Research Presentations o Describe various research projects on the subject of hair and how they may impact therapies or treatments for hair loss. Advanced Surgical Techniques I o Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure. o Discuss the surgical approaches to hair transplantation in special situations. Finasteride Symposium o Review the latest studies on the efficacy and safety of finasteride 1 mg in androgenetic alopecia. o Discuss possible adverse events relating to the use of finasteride, including claims of persistent sexual dysfunction, and concerns relating to prostate cancer. o Develop guidelines for use of finasteride in a hair restoration practice: best candidates for finasteride, type of information that should be delivered to the patient about side effects, combination therapy of finasteride with other FDA approved medications. Operation Restore and Repair Cases o Discuss the surgical approaches to several repair cases, including several that were supported by the ISHRSs Operation Restore pro bono program. Coffee with the Experts o Discuss various hair restoration surgery topics in-depth in small groups. Advanced Surgical Techniques II o Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure. o Discuss the surgical approaches to hair transplantation in special situations.

FRIDAYNorwood Lecture o Explore the contribution of the follicular cells in dermal repair and re-epithelialization of cutaneous wounds. o Demonstrate the influence of the hair follicle cycle in the acceleration or retardation of the wound healing response. o Discuss the possible effects of cutaneous wounding on hair follicular neogenesis. o Understand the importance of the hair follicle in the biological mechanisms involved in the wound healing response. Emerging Therapies: Different Strategies to Induce Hair Growth o Describe ongoing studies involving pharmacologic agents being tested for treatment of androgenetic alopecia. o Discuss various research projects on the subject of hair and how they may impact therapies or treatments for hair loss.

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FRIDAY (continued)Non-Surgical Free Papers o Discuss the diagnosis and therapy of several non-androgenetic alopecias. o Discuss different non-surgical alternatives to hair transplantation. Poster Review Session o Review key points relating to a variety of studies and surgical pearls regarding hair restoration surgery. How I Do It Videos: Practice Tips and Surgical Gems o Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure.

SATURDAYBreakfast with the Experts o Discuss various hair restoration surgery topics in-depth in small groups. Controversies and Hot Topics in Hair Restoration Surgery o Recognize and discuss a variety of hot topics as indentified by ISHRS membership, including donor area safety in FUE, hair graft survival in FUE compared with FUT, and robotic hair harvesting. Food for Thought o Critically analyze how certain scientific presentations make us think twice about basic concepts that are taken for granted. o Understand how new tools and new surgical approaches oblige us to perform a critical revision of assumed dogmas. o Discuss new methods to objectively evaluate the outcome of HRS, and where the future of HRS is heading. Advanced Surgical Videos o Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure. Live Patient Viewing o Assess the results of real live patients from a variety of cases that utilized different approaches and techniques.

Learner Bill of RightsThe International Society of Hair Restoration Surgery (ISHRS) recognizes that you are a life-long learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge or skill; and to attain or enhance a desired competency. As part of the ISHRSs duty to you as a learner, you have the right to expect that your continuing medical education experience with the ISHRS includes: Content that: Is driven and based on independent survey and analysis of learner needs Promotes improvements or quality in healthcare Is current, peer-reviewed and evidence-based Offers balanced presentations that are free of commercial bias Is vetted through a process that resolves any conflicts of interests of planners and faculty Is driven and based on learning needs, not commercial interests Addresses the stated objectives or purpose Is evaluated for its effectiveness in meeting the identified educational need

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A learning environment that: Is based on adult learning principles that support the use of various modalities Supports learners ability to meet their individual needs Respects and attends to the special needs of learners with respect to the ADA Respects the diversity of groups of learners Is free of promotional, commercial, and/or sales activities Disclosure of: Relevant financial relationships that planners, teachers, and authors have with commercial interests related to the content of the activity Commercial support (funding or in-kind resources) of the activity Anecdotal contentApproved by CME Committee, 03/02/05 Approved by Board of Governors, 06/20/05

The ISHRS gratefully acknowledges the following corporate supporters of the 20th Annual Scientific Meeting for their generosity.

GoldJohnson & Johnson Healthcare Products, Division of McNEIL-PPC, Inc.

SilverBosley Cytomedix, Inc. Hair Club Medical Group Ziering Medical Worldwide

BronzeCole Instruments Restoration Robotics, Inc.

In-KindA to Z Surgical Ellis Instruments, Inc. HSC Development Robbins Instruments

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Summary of Disclosures of Conflict of InterestThe International Society of Hair Restoration Surgery (ISHRS) assesses conflict of interest with its faculty/instructors, planners and managers of CME activities. Conflicts of interest that are identified are thoroughly vetted by management and the CME Committee via the Content Review and Validation Teams of peer-physicians, for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. The ISHRS is committed to providing its learners with high quality, unbiased and state-of-the-art education. All faculty were required to disclose both via our online abstract submission system and at the podium or on their posters. The disclosures are listed below as well as next to each abstract in this book.

The following faculty have reported real or apparent conflicts of interest that have been resolved through a peer-review process. (Listed in alpha order by last name.)Part of Meeting Lunch Symposium Poster Publishing Title Lunch Symposium 311 - Business Development: Marketing The Mythical FUE Learning Curve- Observations After Training 75 Doctors In FUE Methods How I Do FUE Using a New Extractor Punch Breakfast with the Experts, Table Leader on the Topic of "Ischemia-reperfusion injury and Hair Follicle Viability" Finasteride: So Tell Me Doctor - Are There Any Side Effects? Coffee with the Experts, Table Co-Leader on the Topic of "Finasteride" How I Do Eyebrow HT: Pearls for Succes Workshop 202: High Tech HT: The Best High Technological Devices in My Practice - See your workshop director for specifics and format of this workshop Coffee with the Experts, Non-CME Table Leader on the Topic of "SAFE System" FUE Hands-On Course faculty Coffee with the Experts, Table Leader on the Topic of "Minoxidil: Use It or Lose It and Other Facts that Patients Need to Know" Lunch Symposium 213 - FUT versus FUE: Personal preference and how to explain advantages and disadvantages to patients Denovo Hair Follicle Formation: Possible Applications in Clinical Situations Disclosure Block R. Baxter: Employment; Surgeons Advisor, Inc.; Our firms provide services to aesthetic physicians. T. Bhatti: Ownership Interest (owner, stock, stock options); My center runs a training program for which doctors are charged a fee for training. P. Boudjema: Ownership Interest (royalty, patent, or other intellectual property); royalty, patent, or other intellectual property. W.D. Ehringer: Employment; Energy Delivery Solutions. Ownership Interest (owner, stock, stock options); Founder, Energy Delivery Solutions. Ownership Interest (royalty, patent, or other intellectual property); Inventor, VitaSol US Pat# 7056529. S. Freedland: Research Grant (principal investigator, collaborator or consultant); GSK. S. Freedland: Research Grant (principal investigator, collaborator or consultant); GSK. R.S. Haber: Ownership Interest (royalty, patent, or other intellectual property); Haber Spreader- Ellis Instruments. R.S. Haber: Ownership Interest (royalty, patent, or other intellectual property); Haber Spreader, Ellis Instruments.

General Session Breakfast with the Experts

General Session Coffee with the Experts General Session Workshop

Coffee with the Experts FUE Hand-On Course Coffee with the Experts

Lunch Symposium

General Session

General Session

Scalp Injection of Active Embryonic-like Cellsecreted Proteins and Growth Factors

Lunch Symposium General Session

Lunch Symposium 311 - Business Development: Marketing Refinement of the Rose Tissue Spreader

J.A. Harris: Ownership Interest (owner, stock, stock options); HSC Development - producer of FUE device. J.A. Harris: Ownership Interest (owner, stock, stock options); Owner of company producing an FUE device. R.T. Leonard: Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); JOHNSON AND JOHNSON. Consultant/Advisory Board; JOHNSON AND JOHNSON. Other; LASERCAP INC. R.T. Leonard, DO: Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); JOHNSON AND JOHNSON. Consultant/Advisory Board; JOHNSON AND JOHNSON. Other; LASERCAP INC. G. Lindner: Ownership Interest (owner, stock, stock options); I am a co-founder of TissUse GmbH. Under agreements between the Technische Universitt Berlin (TUB), TissUse GmbH is entitled to a share of the royalties received in future by the TUB.. Ownership Interest (royalty, patent, or other intellectual property); The technology for generating hair-follicle-like organoids is the subject of a patent from the Technische Universitt Berlin that includes me (Gerd Lindner) as an inventor.. G.K. Naughton: Employment; Histogen, Inc. C. Ziering: Consultant/Advisory Board; Histogen Scientific Advisory Board member. M. Hubka: Employment; Histogen. D. Ehrlich: Employment; Histogen. M. Zimber: Employment; Histogen. M. Ramsey: Employment; I disclose that I am a partner with PAI Medical Nashville and have been so for 17 years.. P. Rose: Ownership Interest (royalty, patent, or other intellectual property); Developed the design of the instrument with Cutting Edge Instruments in Canada.

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(continued from previous page)Part of Meeting Coffee with the Experts General Session FUE Hand-On Course Breakfast with the Experts Publishing Title Coffee with the Experts, Non-CME Table CoLeader on the Topic of "The Role of Vitamins & Supplements in Hair Loss and HRS" How I Do Body Hair Transplants FUE Hands-On Course - faculty Breakfast with the Experts, Table Leader on the Topic of "Prerequisites for a New Hair Transplant Practice" Disclosure Block L. Shapiro: Ownership Interest (owner, stock, stock options); Owner of Help Hair line of nutritional products. S. Umar: Ownership Interest (royalty, patent, or other intellectual property); UGraft, Upunch. S.H. Umar: Ownership Interest (royalty, patent, or other intellectual property); Patent applications on FUE device. S.A. Vasa: Ownership Interest (owner, stock, stock options); Vasa Innovations, Vasa Surgiart Pvt Ltd, Vasa Hair Academy. Ownership Interest (royalty, patent, or other intellectual property); intellectual property rights like patent, design registry, trade marks, copy rights for 10 patents. K. Washenik: Employment; Aderans Research Institute/Bosley. Research Grant (principal investigator, collaborator or consultant); Allegran, Johnson and Johnson. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); Merck. Ownership Interest (owner, stock, stock options); Aderans Research Institute/Bosely. Ownership Interest (royalty, patent, or other intellectual property); Aderans Research Institute/Bosley. K. Washenik: Employment; Bosley/Aderans. Ownership Interest (owner, stock, stock options); Bosley/Aderans. Ownership Interest (royalty, patent, or other intellectual property); Bosley/Aderans. K. Washenik: Employment; Aderans Research Institute/Bosley. Research Grant (principal investigator, collaborator or consultant); Allergan, Johnson and Johnson. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); Merck. Ownership Interest (owner, stock, stock options); Aderans Reserach Institute/Bosely. Ownership Interest (royalty, patent, or other intellectual property); Aderans Research Institute/Bosley.

General Session

Finasteride Persistent Sexual Dysfunction Controversy: Update

Coffee with the Experts General Session

Coffee with the Experts, Table Co-Leader on the Topic of "Research Challenges in Hair Biology" Update on Cell Based Regeneration Studies

Planners and managers who have reported real or apparent conflicts of interest:Name of Planner or Manager Robert S. Haber, MD James A. Harris, MD Position CME Committee CME Committee, Webinars Chair Reported Areas of Conflict Ownership interests (owner, stock, stock options), Ellis Instruments, Inc. - Transdermal Light Cap, Inc. Ownership interests (owner, stock, stock options), HSC Development, Restoration Robotics; Consultant/Advisory Board, Restoration Robotics. Ownership interests (owner, stock, stock options), Dermagenoma; Consultant/Advisory Board, Dermagenoma. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness), Allergan; Ownership Interest (royalty, patent, or other intellectual property), A-Z. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness), ParaPro-Natroba head lice medication, and WebMD-hair & skin expert; Other, JNJ via Ink & Roses PR/interviews Research Grant, Allergan; Speakers Bureau/Honoraria, Histogen; Ownership Interests (owner, stock, stock options), Histogen; Consultant/Advisory Board, Allergan, Histogen. K. Washenik: Employment; Aderans Research Institute/Bosley. Research Grant (principal investigator, collaborator or consultant); Allergan, Johnson and Johnson. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); Merck. Ownership Interest (owner, stock, stock options); Aderans Reserach Institute/Bosely. Ownership Interest (royalty, patent, or other intellectual property); Aderans Research Institute/Bosley.

Sharon A. Keene, MD Matt L. Leavitt, DO

CME Committee CME Committee, LSW Committee Chair CME Committee, Live Patient Viewing Chair CME Committee, 2012 ASM Cmt

Nicole E. Rogers, MD

Neil S. Sadick, MD

Ken Washenik, MD, PhD

CME Committee

In addition, the ISHRS reports the following relationships with commercial interests associated with this activity:Name of Commercial Interest Johnson & Johnson Healthcare Products, Division of McNEIL-PPC, Inc. Bosley Type of Financial Relationship Provided unrestricted educational grant Provided unrestricted educational grant

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(continued from previous page)Cytomedix Hair Club Medical Group Ziering Medical Worldwide Cole Instruments Restoration Robotics, Inc. A to Z Surgical Cole Instruments Ellis Instruments HSC Development Robbins Instruments Provided unrestricted educational grant Provided unrestricted educational grant Provided unrestricted educational grant Provided unrestricted educational grant Provided unrestricted educational grant Provided in-kind support Provided in-kind support Provided in-kind support Provided in-kind support Provided in-kind support

The ISHRS is not owned by an organization with any interests in product manufacturing.

Planners and managers that have reported no conflicts of interest:Name of Planner or Manager Jonathan L. Ballon, MD Marco Barusco, MD Brandi Burgess Victoria Ceh, MPA Glenn M. Charles, DO Paul C. Cotterill, MD Jean Devroyre, MD Francisco Jimenez, MD Melvin L. Mayer, MD Bertram M. Ng, MBBS Marcelo Pitchon, MD Carlos J. Puig, DO Melanie Stancampiano Robert H. True, MD, MPH Bradley R. Wolf, MD Position CME Committee, Basics Course Chair CME Committee CME Committee, Surg Asst Chair Executive Director, CME Director (planner and manager) CME Committee, 2012 ASM Cmt CME Committee Chair CME Committee, 2012 ASM Cmt CME Committee, 2012 ASM Cmt CME Committee, 2012 ASM Cmt CME Committee, Live Patient Viewing Co-Chair CME Committee, Workshops & Lunch Symposia Chair CME Committee Program Manager (planner and manager) CME Committee, Advanced/Board Review Course Chair CME Committee Reported Areas of Conflict No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report. No COI to report.

OFF-LABEL OR OTHER NON-FDA APPROVED, INVESTIGATIONAL USEAdditionally, speakers are also required to know and disclose to their audiences the FDA approval status of all medical devices and pharmaceuticals for the uses discussed, described or demonstrated in their educational presentations. Listed below are those who indicated that their presentation will include discussion of an offlabel or other non-FDA approved, investigational use of a medical device or pharmaceutical product:Part of Meeting General Session Publishing Title Safety and Efficacy of Finasteride 2.5 mg in Postmenopausal Women with Androgenetic Alopecia: Pilot Study in 52 Patients Panelist for Finasteride Symposium Updated Clinical Experience With Hair Duplication Breakfast with the Experts, Table Leader on the Topic of "Ischemia-reperfusion injury and Hair Follicle Viability" Presenting Author Abdulmajeed Alajlan, MD Robert Bernstein, MD Jerry Cooley, MD William Ehringer, PhD Off-label Disclosure Finasteride from MSD

General Session General Session Breakfast with the Experts

propecia made by merck MatriStem, ACell VitaSol, Hypothermosol (Energy Delivery Solutions), UW Solution (BTL), DMEM (Sigma-Aldrich, Gibco), Normal Saline (Braun) finasteride, Merck ROGAINE FOAM; JOHNSON AND JOHNSON Acell

General Session Coffee with the Experts

General Session

How Finasteride Should be Used in a Hair Transplant Practice Coffee with the Experts, Table Leader on the Topic of "Minoxidil: Use It or Lose It and Other Facts that Patients Need to Know" Preliminary Results Using ECM in a Split-Body Fashion

Edwin Epstein, MD Robert Leonard, DO

Jose Lorenzo, MD

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(continued from previous page)Part of Meeting Workshop/Course Faculty General Session General Session General Session Publishing Title Peri-surgical Drug Management and Safety Treatment of Eyebrow Hypotrichosis with ACellMatriStem + PRP Finasteride in the Long Run - Surprising Data from the Sato Study How I Do Body Hair Transplants Presenting Author Robert Niedbalski, DO Robert Niedbalski, DO Akio Sato, MD Sanusi Umar, MD Off-label Disclosure MatriStem MicroMatrix from ACell, Inc. MatriStem MicroMatrix Propecia Minoxidil

Listed below are those who answered that they DO NOT have a financial interest or other relationship with the manufacturer(s) of any of the products(s) or service(s) they intend to discuss:Publishing Title Breakfast with the Experts, Table Leader on the Topic of "Donor Harvesting for Asian Patients" Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice Safety and Efficacy of Finasteride 2.5 mg in Postmenopausal Women with Androgenetic Alopecia: Pilot Study in 52 Patients Breakfast with the Experts, Table Co-Leader on the Topic of "Eyelash HT: Pearls & Pitfalls" The New Wave of Complications in the Follicular Unit Era Poster Review Session, Posters 16-30 Basics Course in FU Hair Restoration Surgery - Chair Photographic Review of Factors That Make FUE Cases Difficult Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Dissecting Station) Ergonomics Tips and Resources to Design, Conduct and Publish a Scientific Study in Hair Restoration Medical Treatments: OTC's Graft Preparation and Survival Workshop 202: High Tech HT: The Best High Technological Devices in My Practice (Workshop Director) Breakfast with the Experts, Table Leader on the Topic of "Leveraging Social Media for Patient Relations" Lunch Symposium 311 - Business Development: Marketing The Use of Hair Bundle Cross-Section Trichometry to Confirm Success in the Medical Management of Hair Loss Lunch Symposium 213 - FUT versus FUE: Personal preference and how to explain advantages and disadvantages to patients Lunch Symposium 311 - Business Development: Marketing Recipient Site Angulation and Follicle Survival Anesthesia Panelist for Finasteride Symposium Coffee with the Experts, Table Leader on the Topic of "Robotic FUE" W-Trichoplasty Closure For Better Strip Scars- A New Technique Does FUE Technique Grow Better Hair? - Anagen Selective FUE Traction Alopecia In Sikh Males- A Review of 213 Cases Managed With Hair Transplant FUE Hands-On Course faculty The Role and the Placement for the Robotic Arm in Hair Transplants- Our Initial Experience Ethics in Hair Restoration Surgery Welcome and Introductions Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Workshop Director) Welcome & Workshop Details Advance Technologies Panel Discussions: Graft Placement Techniques Workshop 202: High Tech HT: The Best High Technological Devices in My Practice Application and Evaluation of the Cross Section Trichometer, Follicular Density, Hair Density, Hair Shaft Diameter and Surface Area Measurement to Predict Suitability of Candidates for Hair Transplantation, as Well as to Predict Results From Hair Transplantation Follicular Density Comparison by Reticule Surface Area Size Hair Mapping: A Comparison of Caucasian and Korean Hair Density, Follicular Density and Calculated Density; A Three Year Follow Up Using New Methods. Coffee with the Experts, Non-CME Table Leader on the Topic of "Cole FUE Device" How I Do FUE: Tips to Maximize Speed & Efficiency Breakfast with the Experts, Table Leader on the Topic of "How to Manage Big FUE Cases" Lunch Symposium 213 - FUT versus FUE: Personal preference and how to explain advantages and disadvantages to patients Panelist for Controversies and Hot Topics in Hair Restoration Surgery FUE Hands-On Course faculty Updated Clinical Experience With Hair Duplication 10 Disclosure Block G. Abbasi: None. M. Kwack: None. J. Ahn: None. Y. Sung: None. A. Alajlan: None. B.A. Arocha: None. M.R. Avram: None. M.R. Avram: None. J.L. Ballon: None. J. Bang: None. D. Barron: None. D. Barron: None. M.N. Barusco: None. M.N. Barusco: None. M.N. Barusco: None. M.N. Barusco: None. M. Batt: None. M. Batt: None. A.J. Bauman: None. A.J. Bauman: None. A.J. Bauman: None. M.L. Beehner: None. M.M. Behnke: None. R.M. Bernstein: None. R.M. Bernstein: None. T. Bhatti: None. T. Bhatti: None. T. Bhatti: None. C.N. Bisanga: None. M.A. Bishara: None. K. Rodriguez: None. R. Green: None. S.A. Boden: None. B.J. Burgess: None. D. Carmona Baez: None. D. Carmona Baez: None. G.M. Charles: None. B. Cohen: None. J.P. Cole: None.

J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.P. Cole: None. J.E. Cooley: None.

Publishing Title Graft Survival Panelist for Operation Restore and Repair Cases Session Breakfast with the Experts, Table Leader on the Topic of "Hair Transplantation in Women: How to Choose the Candidate and Surgical Planning" Frontal Fibrosing Alopecia: a Variant of Lichen Planopilaris or Distinct Clinical Entity? Comparative Study of Ten Cases Untouched Strip Technique, A Procedure Combining FUE and Strip Surgery While Preserving an Untouched Area: Analysis of 18 Cases Combination of Strip Surgery and Follicular Unit Extraction to Improve the Number of Follicular Units Harvested in Primary and Secondary Hair Transplantation Asymmetric Two-Layer Closure in Trichophytic Closure for Wide Donor Wound Advance Technologies Panel Discussions: Donor Removal Techniques (strip) FUE Hands-On Course faculty A Split Comparison Study of Trichophytic Versus Non-Trichophytic Closure of Donor Site in Follicular Unit Hair Transplantation (FUT) Female Hair Loss Work Up & Non Androgenetic Hair Loss Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Dissecting Station) Panelist for Operation Restore and Repair Cases Session Breakfast with the Experts, Table Leader on the Topic of "My Experience with Different FUE Devices" Scalp Burning and Tenderness: How Important is it to Ask During the Consultation? Lichen Planopilaris Following Hair Transplantation The Initial Consultation: Androgenetic vs. Non-AGA Hair Loss Workshop 203: To Transplant or Not to Transplant: How Not to Get into Trouble with Mimickers of Androgenetic Alopecia (Workshop Director) FUE Evaluation in Patients with Previous HT Procedure FUE Hair Transplant in Traction Alopecia in Sikh Population Advance Technologies Panel Discussions: Recipient Sites How Finasteride Should be Used in a Hair Transplant Practice Panelist for Operation Restore and Repair Cases Session Hairline Advancement in Women: Surgical Hairline Advancement Versus Hair Grafting Eyebrow Transplantation: Techniques and Outcomes of Over 350 Cases Advanced Practice Management Techniques for the Established Hair Transplant Surgeon Hair Transplants to the Beard, Chest and Other Areas- A Review of Over 400 Procedures Workshop 204: Eyebrow HT Lunch Symposium 211 - Business Development: Practice Management (Lunch Symposium Director) Lunch Symposium 311 - Business Development: Marketing Moderator Introduction, Advanced Surgical Techniques II Cell Therapy and Hair Genetics Lunch Symposium 211 - Business Development: Practice Management Coffee with the Experts, Table Co-Leader on the Topic of "Hair Transplantation in Young Patients: My Personal Approach" Workshop 204: Eyebrow HT Breakfast with the Experts, Table Co-Leader on the Topic of "Eyelash HT: Pearls & Pitfalls" Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Video Presentation of Slivering and Follicle Dissection Under Stereo Microscope, and Innovative Technique to Train Staff Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Dissecting Station) The Latest Discovery: Is PGD2 the Real Target to Cure Androgenetic Alopecia? Breakfast with the Experts, Table Co-Leader on the Topic of "Advances in Hair Biology: PGD2 and Other Stories" Scarless Galeal Closure Temporal Peaks Aesthetic Implication Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Breakfast with the Experts, Table Leader on the Topic of "Spanish Speaking Table: Tips for FUE, Manual and Power, Indications" FUE Hands-On Course faculty The Method of Direct Hair Implantation Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Slivering Station) Panel of Pearls Panelist Moderator Introduction, Poster Review Session Advance Technologies Panel Discussions: FUE Breakfast with the Experts, Table Leader on the Topic of "Getting Strarted with Adding FUE to Your Practice" Anatomy of the Hair Follicle for the Surgical Assistant Intrapatient Graft Length Differences Influencing Depth Controlled Incisions A Case of Trichorrhexis Nodosa After Hair Transplantation Coffee with the Experts, Table Leader on the Topic of "Hairline Design for Asian Patients" 11

Disclosure Block J. Cooley: None. P.C. Cotterill: None. P.C. Cotterill: None. M. Crisstomo: None. D. Tomaz: None. M. Crisstomo: None. E. Andrade: None. K. Nogueira: None. M. Crisstomo: None. M. Crisstomo: None. D. Tomaz: None. M. Crisstomo: None. M. Crisstomo: None. D. Tomaz: None. A. Afonso: None. M. Crisstomo: None. K. Dae-young: None. M.S. Dauer: None. J. Devroye: None. N. Dhepe: None. K. Prabhune: None. N. Bhalerao: None. D. Didocha: None. M.Dieta: None. M.S. DiStefano: None. M.S. DiStefano: None. J.C. Donovan: None. J.C. Donovan: None. J.C. Donovan: None. J.C. Donovan: None. J.C. Donovan: None. A. Dua: None. K. Dua: None. K. Dua: None. A. Dua: None. V.W. Elliott: None. E.S. Epstein: None. E.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. J.S. Epstein: None. B. Farjo: None. N.P. Farjo: None. S.P. Gabel: None. V. Gambino: None. M. Gandelman: None. M. Gandelman: None. M. Gandelman: None. A.K. Garg: None. S. Garg: None. J.A. Garner: None. L.A. Garza: None. G. Cotsarelis: None. L.A. Garza: None. J.I. Gaviria: None. J.I. Gaviria: None. M. Morales De Bournigal: None. J.D. Gillespie: None. A. Ginzburg: None. A. Ginzburg: None. C.P. Giotis: None. L. Gorham: None. L. Gorham: None. R.S. Haber: None. J.A. Harris: None. J.A. Harris: None. J. Hoffman: None. P.C. Cotterill: None. S. Hwang: None. S. Hwang: None. S. Hwang: None.

Publishing Title Breakfast with the Experts, Korean-Speaking Table: How to Reduce Folliculitis after Hair Transplantation Multiple Scar Extractions "Plugged" by FUE Grafts - A Reliable Way to Improve Scars in the Scalp Lunch Symposium 211 - Business Development: Practice Management Hair and the Psyche: Arm and Beard Hair Implant Program Chair Welcome & Announcements Moderator Introduction, Norwood Lecture Current Status of Research and Therapy to Prevent Chemotherapy Induced Alopecia Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Comparing the Graft Survival and Growth Keeping in PRP to the Saline in Hair Transplantation Social Media for Business Scientific Evidence that Environment, Diet and Lifestyle Contribute to Epigenetic Regulation of Hormones and are Likely to Influence Hair Growth Beyond Finasteride Side Effects: Alternate Risks for Sexual Dysfunction and Spermatic Abnormalities via Genetics, Physiology, and Environment Poster Review Session Panelist for Controversies and Hot Topics in Hair Restoration Surgery Commentary On, "Updated Clinical Experience with Hair Duplication" The Study of Storage Solutions for Hair Follicle Protection During Hair Transplantation Surgery Moderator Introduction, Advanced Surgical Videos Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Lunch Symposium 213 - FUT versus FUE: Personal preference and how to explain advantages and disadvantages to patients Lunch Symposium 211 - Business Development: Practice Management Protection of Human Hair Follicles Viability by Coculture with Mesenchymal Stem Cells Coffee with the Experts, Table Leader on the Topic of "Adding HT to a Cosmetic Practice or Adding Costmetic Procedures to a Hair Transplant Practice" Lunch Symposium 211 - Business Development: Practice Management Lunch Symposium 311 - Business Development: Marketing (Lunch Symposium Director) Receipient Site Anesthesia and Tumescence Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Implanting Station) Assistants Role in FUE I Workshop 204: Eyebrow HT Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners (Lunch Symposium Director) Preliminary Results Using ECM in a Split-Body Fashion Implantation With Implanter Pen II Live Patient Viewing Case Coffee with the Experts, Table Leader on the Topic of "Spanish Speaking Table: FUE" FUE Hands-On Course faculty Advance Technologies Panel Discussions: Tissue Expansion & Flaps Panelist for Operation Restore and Repair Cases Session Coffee with the Experts, Table Co-Leader on the Topic of "Flap Surgery and Use of Expanders & Operation Restore" Hair Transplantation Into Scars President's Address Advance Technologies Panel Discussions: Trichophytic Closures Moderator Introduction, Controversies and Hot Topics in Hair Restoration Surgery Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Basic Principles of Donor Anesthesia & Donor Harvesting Moderator Introduction, Research presentations Panelist for Operation Restore and Repair Cases Session Medical Treatments: Medical Therapies Moderator Introduction, Non-Surgical Free Papers Overview of BLS with AED The Effects of Delay in Extracting Follicular Units on the Viability of FUE Grafts Harvesting Hair From Temporal Area - Limitations and Advantages Oral/IV/IM Sedation Workshop 202: High Tech HT: The Best High Technological Devices in My Practice Follicular Unit Transplantation: Comparison of Three Cuttings Techniques From Stem to Hair: Deciphering and Exploiting the Instruction Set That Guides Follicle Regeneration Coffee with the Experts, Table Co-Leader on the Topic of "Research Challenges in Hair Biology" Panelist for Emerging Therapies Session Case Report: Treating an Extensive Burn Injury of the Scalp in a Child Coffee with the Experts, Table Co-Leader on the Topic of "Flap Surgery and Use of Expanders & Operation Restore" 12

Disclosure Block S. Hwang: None. M.G. Ingers: None. M. Sjorin: None. A. Tallaaker: None. L.E. Ishii: None. K.I. Jebai: None. F. Jimenez: None. F. Jimenez: None. J.J. Jimenez: None. S.S. Kabaker: None. H. Kahnamuee: None. M. Kearney: None. S.A. Keene: None. S.A. Keene: None. S.A. Keene: None. S.A. Keene: None. S.H. Khan: None. M. Kim: None. J. Oh: None. J. Kim: None. R.G. Knudsen: None. R.G. Knudsen: None. G. Koher: None. G.M. Kuka: None. M.F. Kulahci: None. S.M. Lam: None. S.M. Lam: None. S.M. Lam: None. S. Lam: None T. Lardner: None. T. Lardner: None. B.L. Limmer: None. B.L. Limmer: None. J.F. Lorenzo: None. J.F. Lorenzo: None. J.F. Lorenzo: None. J.F. Lorenzo: None. J.F. Lorenzo: None. E. Mangubat: None. E. Mangubat: None. E. Mangubat: None. J.H. Martinick: None. J.H. Martinick: None. M. Marzola: None. M. Marzola: None. M. Marzola: None. M.L. Mayer: None. M.L. Mayer: None. M.L. Mayer: None. P.J. McAndrews: None. P.J. McAndrews: None. W.M. McKenzie: None. P. Mohebi: None. P. Mohebi: None. P. Mohebi: None. P. Mohebi: None. M.H. Mohmand: None. D. Ahmed: None. B.A. Morgan: None. B.A. Morgan: None. B.A. Morgan: None. F.G. Neidel: None. K.B. Leonhardt: None. F.G. Neidel: None.

Publishing Title Where to Put the Grafts When Not Enough - Frontal Core vs. Parting Side Approach The Simplest Way to Prevent and Manage Postoperative Follicultis Moderator Introduction, "How I Do It" Videos: Practice Tips and Surgical Gems Breakfast with the Experts, Table Leader on the Topic of "Donor Harvesting for Asian Patients" Peri-surgical Drug Management and Safety Treatment of Eyebrow Hypotrichosis with ACell-MatriStem + PRP Workshop 203: To Transplant or Not to Transplant: How Not to Get into Trouble with Mimickers of Androgenetic Alopecia Commentary On, "Application and Evaluation of the Cross Section Trichometer, Follicular Density, Hair Density, Hair Shaft Diameter and Surface Area Measurement to Predict Newly Developed Hair Transplanter OKT (Optimally Kept Transplanter) That Improves the Hair Survival Rate No Temporal Point Peak, 2 Peak Sideburns and No Peak S-line Hairline Design in Woman Golden Rules to be Observed for Enhancing the Survival Rate in Hair Transplant Using a Choi-Hair Transplanter Workshop 201: Scalp Micro-Pigmentation FUE Hands-On Course faculty The Effects of Williams E Media on Follicular Unit Graft Survival Compare to Normal Saline as a Storage Solution Hair Transplantation in Frontal Fibrosing Alopecia: A Report of Two Cases FUE Hands-On Course faculty Camouflaging the Posterior Zygomatic Arch Protrusion After Zygoma Reduction Surgery Using Hair Transplantation in Infratemple Area Both-Hand Slit Technique ( Both-Hand No-Touch Technique) Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Slivering Station) The History of Hair Transplantation for the assistant Workshop 202: High Tech HT: The Best High Technological Devices in My Practice Scarring Alopecia (Chemical Burns) Secondary to Hair Highlighting: An Under Reported Entity Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Commentary On, "Personal Hair Growth Index" Trichoschisis: an Uncommon Complication from Hair Transplantation Does Epinephrine Influence Post-Surgical Effluvium?, A Pilot Study Workshop 204: Eyebrow HT (Workshop Director) The Hair Follicle - Wound Healing Connection Moderator Introduction, Emerging Therapies; Different Strategies to Induce Hair Growth Breakfast with the Experts, Table Co-Leader on the Topic of "Advances in Hair Biology: PGD2 and Other Stories" Moderator Introduction, Operation Restore and Repair Cases Personal Growth Index: Transforming the Unknown Variable Element of the Hair Transplant's Quality Equation into a Stable Constant Expanding Needle Concept For Better Extraction of Body Hair Grafts Impossible Hair Transplant Repair - A Different Approach to Treat a Difficult Repair Patient When FUE Goes Wrong Use of Body and Beard Hair as Additional Donor in Extensive Hairloss Moderator Introduction, Food for Thought Moderator Introduction, Advanced Surgical Techniques I Evaluation of Body Dysmorphic Disorder in Hair Loss Patients and Benefit After Hair Transplant Accurate & Error Free Counting of Recipient Sites and Grafts Using Novel Electronic Counter Update on Recipient Site Staining, Better Stain Formulation Viscosity Improves Sites Visibility by 100 % Scalp Micropigmentation as a Complement and an Alternative to Hair Transplantation Workshop 201: Scalp Micro-Pigmentation (Workshop Director) Panelist for Controversies and Hot Topics in Hair Restoration Surgery FUE Hands-On Course faculty The Initial Consultation: Patient Selection Commentary On, "Scientific Evidence That Environment, Diet and Lifestyle Contribute to Epigenetic Regulation of Hormones and Are Likely to Influence Hair Growth" Pre and Post-op Management Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Implanting Station) The Role of the Assistant in Hair Transplantation How I Inject PRP in Patients with Hair Loss and HRS Coffee with the Experts, Non-CME Table Co-Leader on the Topic of "The Role of Vitamins & Supplements in HairLoss and HRS" Workshop 203: To Transplant or Not to Transplant: How Not to Get into Trouble with Mimickers of Androgenetic Alopecia Micro-Incisonal Graft Removal Technique Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Slivering Station) Sales vs. Education Higher Temporal Recession - Why? When? and How to Convince Patients 13

Disclosure Block B.M. Ng: None. B.M. Ng: None. B.M. Ng: None. B.M. Ng: None. R.P. Niedbalski: None. R. Niedbalski: None. B.P. Nusbaum: None. B.P. Nusbaum: None. K. Oc: None. K. Oc: None. K. Oc: None. J. Pak: None. J.P. Pak: None. R. Panchaprateep: None. R. Panchaprateep: None. E. Papanikolaou: None. J. Park: None. J. Park: None. J. Moh: None. M.W. Parsley: None. M.W. Parsley: None. W. Parsley: None. W. Parsley: None. W. Parsley: None. W. Parsley: None. D. Pathomvanich: None. D. Pathomvanich: None. D. Pathomvanich: None. R. Paus: None. R. Paus: None. R. Paus: None. D. Perez-Meza: None. M. Pitchon: None. A. Poswal: None. . Poswal: None. A. Poswal: None. A. Poswal: None. A. Poswal: None. C.J. Puig: None. H.N. Radwanski: None. R.J. Rajput: None. M.N. Rashid: None. M.N. Rashid: None. W. Rassman: None. W.R. Rassman: None. W.R. Rassman: None. W.R. Rassman: None. W.H. Reed: None. W.H. Reed: None. R.J. Reese: None. F. Reynoso: None. F. Reynoso: None. F. Rinaldi: None. N.E. Rogers: None. N.E. Rogers: None. P. Rose: None. B. Nusbaum: None. A.W. Russell: None. A.W. Russell: None. A. Ruston: None.

Publishing Title Pitfalls for the Beginner: Panel Discussion and Audience Q&A - Panelist Finasteride in the Long Run - Surprising Data from the Sato Study Re-innervation and APM Formation of FU after HT Lunch Symposium 311 - Business Development: Marketing Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Implanting Station) Guide to Photo Documentation of HT Results Low Anabolic Profile in Assessing a Patient's Overall Hair Loss Program Advance Technologies Panel Discussions: Hairline Design Breakfast with the Experts, Table Leader on the Topic of "How to Design a Correct Hairline" Workshop 203: To Transplant or Not to Transplant: How Not to Get into Trouble with Mimickers of Androgenetic Alopecia Pitfalls for the Beginner: Panel Discussion and Audience Q&A - Panelist Moderator Introduction, Finasteride Symposium Coffee with the Experts, Table Co-Leader on the Topic of "Finasteride" Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Commentary On, "The New Wave of Complications in the Follicular Unit Era" Creating a Natural and Pleasing Hair Transplant Ergonomics Stamp for the Operation Planning How I Do FUE at 2,000 Extractions/Hour Advanced/Board Review Course - Chair Test Taking Strategies Lunch Symposium 213 - FUT versus FUE: Personal preference and how to explain advantages and disadvantages to patients Commentary On, "FUT vs FUE What is the Future?" Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Slivering Station) Graft Preparation I Coffee with the Experts, Table Co-Leader on the Topic of "Hair Transplantation in Young Patients: My Personal Approach" Lunch Symposium 212 - If I knew then what I know now - Experts share the wisdom they wish they'd been told when they were beginners Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Dissecting Station) Staff Training Big FUE Sessions, Evaluation of the Donor Site Workshop 205 - Surgical Assistants Dissecting & Implanting Workshop (Implanting Station) Graft Preparation II Ryan Welter Hair Loss Classification Coffee with the Experts, Chinese-Speaking Table: Pearls for Asian Hair Transplants FUE Hands-On Course faculty VIDEO: Neograft: Personal Experience, Capabilities and Limitations Quantifying the Perception of HairAmount: An Analysis of Hair Diameter and Density ChangesWith Age in Caucasian Women A Case Study Follow Up: Graft and Hair Counts at One Year: Side by Side FUE/Strip FUT Transplants in a Frontal Scalp Genomics Comparison of Hair Follicles from Punch Biopsies, Follicular Unit Extraction (FUE) Hands-On Course: Manual and Motorized (Course Chair) How I Repair Wide Donor Scars Using FUE and 0.75mm Punches FUT vs FUE What Is The Future ? Can We Do DFUs On Asians? Atrial Fibrillation and Guidelines for Perioperative Antithrombotic Therapy High Density Implantation for Secondary Cicatricial Alopecia How I Make Recipient Sites Usng Micropunches Donor Closure Technique Using Both EdgesTrichophytic Closure: A Video Presentation Asian Female Hairline Surgery Using Follicular Unit Extraction Principles of Choosing the Follicles During the Surgery Intend to Increase the Density A 4*100 Relay system of surgery consulting Coffee with the Experts, Table Leader on the Topic of "Zones for Surgical Planning in Men and Women According to Their Degree of Alopecia" Lunch Symposium 211 - Business Development: Practice Management Scar Repair For A 16 Year Old Male Patient Using FUE How the Outgrowth Angle of Hair Follicles Infuences the Injury of the Skin of the Donor Area in FUE. A Mathematical Approach of the Problem

Disclosure Block A.S. Ruston: None. A. Sato: None. A. Takeda: None. A. Sato: None. K. Toyoshima: None. A. Takeda: None. T. Tsuji: None. D. Seigel: None. J. Shafer: None. J. Shafer: None. L. Shapiro: None. R. Shapiro: None. R. Shapiro: None. M.K. Singh: None. D.B. Stough: None. D.B. Stough: None. D.B. Stough: None. D.B. Stough: None. D.B. Stough: None. E. Suddleson: None. P. Tafoya: None P. Tesauro: None. L.R. Trivellini: None. R.H. True: None. R.H. True: None. R.H. True: None. R.H. True: None. A. Ullrich: None. A. Ullrich: None. W.P. Unger: None. W.P. Unger: None. S. Vadachkoria: None. S. Vadachkoria: None. J.F. Lorenzo: None. X. Vila: None. A.D. Watts: None. A.D. Watts: None. R. Welter: None. W. wen yi: None. K.L. Williams: None. K.L. Williams: None. B.R. Wolf: None. T. Dawson: None. B. Wolf: None. B. Wolf: None. T. Dawson: None. B. Hulette: None. P. Hu: None. B. Wolf: None. B. Wolf: None. W. Wu: None. W. Wu: None. K. Yagyu: None. K. Yagyu: None. K. Yamamoto: None. K. Yamamoto: None. S. Yi: None. J. Zhang: None. C. Zhao: None. C.L. Ziering: None. C.L. Ziering: None. G. Zontos: None. C. Davies: None. G. Zontos: None.

The views and techniques of the presenters are not necessarily those of the International Society of Hair Restoration Surgery (ISHRS), but are presented in this forum to advance scientific and medical education.

14

day-by-day PrOGraM I Thursday

Thursday I OcTOber 18, 20126:30AM-6:00PM 7:00AM-6:00PM 7:00AM-8:00AM 7:30AM-8:30AM 7:30AM-7:30PM 7:30AM-7:30PM 8:15AM-6:00PM 8:15aM-9:15aM registration speaker ready room Newcomers Orientation breakfast(invitation only)

9:22AM-9:32AM 10 how to critically evaluate research and esearch Tips and resources to design, conduct 005 and Publish a Scientific Study in Hair restoration Marco N. Barusco, MD 9:32AM-9:39AM006 7 The effects of Williams e Media used

continental breakfast exhibits Poster Viewing GeNeraL sessION 9:40AM-9:47AM007

as a storage solution to enhance Graft survival in comparison to Normal saline aline Ratchathorn Panchaprateep, MD survival Michael L. Beehner, MD

7 recipient site angulation and Follicle

Opening SeSSiOnModerator: Francisco Jimenez, MDLeARning obJecTiveS Demonstrate understanding of basic biology of follicular stem cells. Identify the role of these cells in hair cycle regeneration. Formulate ideas for the role of HF stem cells in applications of hair regeneration, wound healing and in regenerative medicine.

9:47AM-9:57AM 10 Q&a 9:57AM-10:04AM008 7 Quantifying the Perception of hair

amount: an analysis of hair diameter and density changes with age in caucasian Women Bradley R. Wolf, MD Effluvium? Damkerng Pathomvanich, MD reticule surface area size John P. Cole, MD

10:04AM-10:11AM009

7 Does Epinephrine Influence Post-Surgical

8:15AM-8:20AM001

5 Program chair Welcome

Francisco Jimenez, MD8 Presidents address

10:12AM-10:19AM010

7 Follicular density comparison by

8:20AM-8:28AM002

Jennifer H. Martinick, MBBS

10:20AM-10:30AM 10 Q&a 10:30AM-10:45AM coffee breakGenerously suppor ted by a grant from Johnson & Johnson Healthcare Products, Division of McNEIL-PPC, Inc.

8:30AM-9:05AM 35 adVaNces IN haIr bIOLOGy LecTurer From stem to hair: deciphering and 003 exploiting the instruction set that guides follicle regeneration Featured Guest Speaker: Bruce A. Morgan, PhDAssociate Professor, Department of Dermatology, Harvard Medical School; Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USAThe Advances in Hair Biology Lectureship is generously suppor ted by a grant from BOSLEY.

10:45aM-12:00PM

advanced SuRgical techniqueS iModerator: Henrique N. Radwanski, MDLeARning obJecTiveS Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure. Discuss the surgical approaches to hair transplantation in special situations.

9:05AM-9:15AM 10 Q&a 9:20aM-10:30aM

10:45AM-10:47AM011

2 Moderator Introduction

ReSeaRch pReSentatiOnSModerator: Melvin L. Mayer, MDLeARning obJecTive Describe various research projects on the subject of hair and how they may impact therapies or treatments for hair loss.

Henrique N. Radwanski, MD haiRline deSignand

SuRgical planning

10:47AM-10:54AM012

7 hairline advancement in Women:

9:20AM-9:22AM004


surgical hairline advancement versus hair Grafting Jeffrey S. Epstein, MD When? And How to Convince Patients Antonio S. Ruston, MD

Melvin L. Mayer, MD

10:54AM-11:01AM013

7 Higher Temporal Recession Why?

THURS15


11:02AM-11:09AM014

7 No Temporal Point Peak, 2 Peak

sideburns and No Peak s-Line hairline design in Women Kun Oc, MD

2:18PM-2:38PM 20 Finasteride: so tell me doctor are there any side effects? 022 Featured Guest Speaker: Stephen Freedland, MDAssociate Professor of Urology and Pathology; Vice Chief of Research, Urological Surgery; Associate Director of Clinical Research, GU Program, Duke Cancer Institute; Editor-in-Chief, Prostate Cancer and Prostatic Diseases; North American Editor, European Urology; Durham, North Carolina, USA

11:10AM-11:20AM 10 Q&a d OnOR a Rea h aRveSting 11:20AM-11:27AM015 7 harvesting hair from the Temporal area

Limitations and advantages Parsa Mohebi, MD Paul T. Rose, MD, JD

11:27AM-11:34AM016

7 Refinement of the Rose Tissue Spreader 7 use of body and beard hair as additional

2:38PM-2:48PM 10 Q&a 2:48PM-2:58PM 10 Finasteride in the Long run surprising data from the sato study 023 Akio Sato, MD, PhDDirector of Tokyo Memorial Clinic Hirayama (invited speaker)

11:34AM-11:41AM017

donor in extensive hairloss Arvind Poswal, MBBS

11:42AM-12:00PM 18 Q&a 12:00PM-12:30PM 12:30PM-1:45PM break for hotel to set the room for lunch, attendees can visit exhibits Ishrs General Membership business Meeting Luncheon and service awardsFor all registered attendees (except exhibitors). Included with paid registrations.

2:58PM-3:05PM024

7 Safety and Efficacy of Finasteride

2.5mg in Postmenopausal Women with androgenetic alopecia: Pilot study in 52 Patients Abdulmajeed Alajlan, MD hair Transplant Practice Edwin S. Epstein, MD

3:06PM-3:13PM025

7 how Finasteride should be used in a

2:00PM-3:30PM019

FinaSteRide SympOSiumModerator: Dow B. Stough, MD Panelist: Robert M. Bernstein, MDLeARning obJecTiveS Review the latest studies on the efficacy and safety of finasteride 1mg in androgenetic alopecia. Discuss possible adverse events relating to the use of finasteride, including claims of persistent sexual dysfunction, and concerns relating to prostate cancer. Develop guidelines for use of finasteride in a hair restoration practice: best candidates for finasteride, type of information that should be delivered to the patient about side effects, combination therapy of finasteride with other FDA approved medications.

3:13PM-3:30PM 17 conclusions by dr. stough and audience Q&a 3:30PM-3:55PM027 028 029, 030 031

OpeRatiOn ReStORe and RepaiR caSeSModerator: David Perez-Meza, MD Panelists: Paul C. Cotterill, MD, Mark S. DiStefano, MD, E. Antonio Mangubat, MD, Edwin S. Epstein, MD and Melvin L. Mayer, MDLeARning obJecTive Discuss the surgical approaches to several repair cases, including several that were supported by the ISHRSs Operation Restore pro bono program.

2:00PM-2:02PM018


3:30PM-3:50PM 20 Ishrss Operation restore 026 David Perez-Meza, MD and panelists 3:50PM-3:55PM032 5 Treating an extensive burn Injury of the

Dow B. Stough, MD7 Finasteride Persistent sexual dysfunction

2:03PM-2:10PM020

controversy: update Ken Washenik, MD, PhD

scalp in a child Frank G. Neidel, MD

2:10PM-2:17PM021

7 beyond Finasteride side effects:

alternate risks for sexual dysfunction and spermatic abnormalities via Genetics, Physiology and environment Sharon A. Keene, MD

16


4:00PM-4:45PM

or Visit the exhibits

cOFFee with the e xpeRtSLeARning obJecTive Discuss various hair restoration surgery topics in-depth in small groups. No extra fee. Open to all attendees on a first-come, first-served basis. This is an informal session for small groups to discuss a specific topic. Come with your questions. Round banquet tables will be set in the back of the General Session room. Each table will be labeled with a topic and experts name. Get your coffee and then sit at the table of your choice to have coffee with an expert.

4:45PM-6:00PM

advanced SuRgical techniqueS iiModerator: Bessam K. Farjo, MBChBLeARning obJecTiveS Compare and contrast different surgeons approaches to various aspects of the hair transplant procedure. Discuss the surgical approaches to hair transplantation in special situations.

4:45PM-4:47PM053


Bessam K. Farjo, MBChB R ecipient a Rea

4:47PM-4:54PM033 034 051 035 036 037 038 039 040 041 042 043 044 1) robotic Fue Robert M. Bernstein, MD 2) spanish-speaking Table: Fue Jose F. Lorenzo, MD 3) chinese speaking Table: Pearls for asian hair Transplantation Wen Yi Wu, MD 4) research challenges in hair biology Bruce A. Morgan, PhD & Ken Washenik, MD, PhD 5) Finasteride Stephen Freedland, MD & Dow B. Stough, MD 6) Minoxidil: use It or Lose It and Other Facts that Patients Need to Know Robert T. Leonard, Jr., DO 7) hair Transplantation in young Patients: My Personal approach Walter P. Unger, MD & Vincenzo Gambino, MD 8) Flap surgery and use of expanders & Operation restore E. Antonio Mangubat, MD & Frank G. Neidel, MD 9) hairline design for asian Patients Sungjoo Tommy Hwang, MD, PhD 10) Zones for surgical Planning in Men and Women according to Their degree of alopecia Craig L. Ziering, DO 11) adding hT to a cosmetic Practice or adding cosmetic Procedures to a hair Transplant Practice Samuel M. Lam, MDNON-CME TABLES

7 The Influence of Intrapatient Graft

054

Length differences on depth controlled Incisions Sungjoo Tommy Hwang, MD, PhD

4:55PM-5:02PM055

7 Where to Place the Grafts When There

are Not enough Frontal core vs. Parting side approach Bertram M. Ng, MBBS Muhammad N. Rashid, MD

5:02PM-5:09PM056

7 Making recipient sites the Fast Track Way

5:10PM-5:20PM 10 Q&a h aiR t RanSplantatiOn 5:20PM-5:27PM057in

S pecial S ituatiOnS

7 hair Transplant to the beard, chest and

Other areas: review of 400 Patients Jeffrey S. Epstein, MD

5:27PM-5:34PM058

7 hair Transplantation into scars

Jennifer H. Martinick, MBBS7 Micro-incisional Graft removal Technique

5:35PM-5:42PM059

Paul T. Rose, MD, JD7 eyebrow Transplantation: Techniques and

5:42PM-5:49PM060

045

Outcomes of Over 350 cases Jeffrey S. Epstein, MD

5:50PM-6:00PM 10 Q&a 6:00PM-7:30PM Welcome reception (in Exhibit Hall)

046

047 048 049 050

12) saFe system for Fue James A. Harris, MD 13) cole Fue device John P. Cole, MD 14) The role of Vitamins & supplements in hair Loss and hrs Lawrence J. Shapiro, MD & Nicole E. Rogers, MD 15) assistants Issues Brandi Burgess, Margaret Dieta & Lil Carr

THURS17

1618

001 Program Chair Welcome & AnnouncementsFrancisco Jimenez, MD NA, Las Palmas Gran Canaria, Spain Dr. Jimenez is a dermatologist and hair transplant surgeon. Trained in Dermatology in Madrid, in Dermatopathology at the University of Miami, in Mohs surgery at Duke University and in Hair Restoration Surgery with Dr. Dow Stough in Hot Springs, Arkansas. Currently working in private practice in Gran Canaria, Canary Islands, Spain. Author of 44 publications in peer review journals and past Editor of the Hair Transplant Forum (2008-2010). Dr. Jimenez received the 2011 ISHRS Platinum Follicle Award. F. Jimenez: None.

002 President's AddressJennifer H. Martinick, MBBS Salvado Medical, Nedlands, Australia. Dr Martinick is a past Program Chair of the ISHRS, past editor of Cyberspace Chat and currently serves as President of the ISHRS. She is deeply committed to its mission of promoting the highest ethical standards in professional hair restoration. In 2003 she received the Platinum Follicle award, the societys highest award for her contributions to the hair transplantation industry. She has gained international prominence for her studies on transected hair and devising the very natural looking snail track hairline. Dr Martinick has developed a Technician Training System. She is renowned for her restorative work. J.H. Martinick: None. ABSTRACT: President's Address for 20th Annual Scientific Meeting Bahamas October 17-20, 2012

19

003 From Stem to Hair: Deciphering and Exploiting the Instruction Set That Guides Follicle RegenerationBruce A. Morgan, PhD Harvard Medical School, Boston, MA, USA. Dr. Morgans laboratory studies the development and regeneration of cutaneous appendages in model organisms. Recent work has focused on the role of the dermal papilla (DP) in guiding hair morphogenesis and follicular regeneration. Mouse models that allow manipulation of gene expression specifically in the DP after the follicle has formed have been exploited to probe the role of specific signals between follicular keratinocytes and the DP. This work with model systems is integrated with a collaborative effort to understand the genetic variation driving the diversity in cutaneous appendage form and function within different human populations. B.A. Morgan: None. ABSTRACT: Much research on the mechanisms that regulate hair growth and cycling has focused on keratinocyte stem cells and their progeny, in part because of the powerful genetic tools available to study this compartment in vivo. More recently, we have developed analogous tools and methods to analyze the role of the follicular papilla (DP) in these processes in the mouse. In humans, a correlation between DP size and hair shaft size has been noted both during normal growth and in the follicular decline observed with aging or progressive alopecia. However, whether this was the cause or an effect of follicular decline remains controversial. Using mouse genetic models that allow manipulation of DP cell numbers in otherwise healthy follicles in vivo, we show that DP cell number dictates both hair follicle size and hair shaft morphology. DP cell number also regulates the frequency of re-entry into the anagen phase of the hair cycle. Although the mechanism by which the DP is damaged in this mouse model may differ from that in, for example, androgenetic alopecia in humans, the downstream mechanisms that mediate follicular decline are likely to be conserved. Our experiments with this mouse model of hair thinning and loss have also revealed mechanisms that act to restore DP cell number and hair size after further damage to the DP is prevented. Related work during normal development and cycling has identified genetic pathways that act in the DP to specify DP cell number and hair morphology. While this talk will focus on mechanisms that regulate DP size and activity in the context of normal development and cycling and the response to DP damage in vivo, their potential application in hair restoration efforts will also be briefly discussed.

004 Moderator Introduction, Research presentationsMelvin L. Mayer, MD Bosley Medical, San Diego, CA, USA.

20

He has served as an Examiner and Past President of the ABHRS and member of many committees in the ISHRS through the years. He has been awarded research grants by the ISHRS. Areas of interest include follicular regeneration of bisected follicles, graft yield at varying densities, classification and surgical techniques of the temporal points, scalp elasticity scale and understanding its importance in maximizing donor width and minimizing donor scars, and techniques to maximize the quality of transplants in Black patients. He was awarded the Platinum Follicle Award in 2004. San Diego is home. M.L. Mayer: None.

005 How to Critically Evaluate Research and Tips and Resources to Design, Conduct and Publish a Scientific Study in Hair RestorationMarco N. Barusco, MD Tempus Hair Restoration, PA, Port Orange, FL, USA. Marco N. Barusco, MD Founder & Medical Director - Tempus Hair Restoration, PA Chairman & Trustee - American Society of Hair Restoration Surgery (ASHRS) Chairman of the Written Exam Committee - American Board of Hair Restoration Surgery (ABHRS) Chief Section Editor for Hair Restoration - The American Journal of Cosmetic Surgery (AJCS) Member of the Board of Trustees - American Academy of Cosmetic Surgery (AACS) Member of the Board of Directors - American Board of Hair Restoration Surgery (ABHRS)Member of the Live Surgery Committee - International Society of Hair Restoration Surgery (ISHRS)Port Orange Office: 5537 S. Williamson Blvd, Suite 752 Port Orange, FL 32123 Phone: 1-877-877-5200 - Fax: 1-888-877-5200 M.N. Barusco: None. ABSTRACT: As a member of the Editorial Board of the American Journal of Cosmetic Surgery and as a Consultant for REUTERS Insight I am often asked to review scientific studies submitted for publication in the area of hair restoration surgery.

Over the years I have participated in many scientific studies involving different aspects of hair restoration surgery including, among others, studies on hair growth and survival, hair density studies, graft angulation studies and donor

21

area healing studies. My experience has taught me that it is exceedingly difficult to produce scientifically-sound studies in hair restoration surgery, particularly when it involves hair growth and survival. Accurate hair counts and hair measurements are exceedingly difficult tasks to perform accurately and consistently, leaving room for error and criticism if not done properly.

Another issue with hair studies reside on the fact that most of the time photographs are used at least in part to demonstrate results. What I see very often is that pictures of hair growth may be very misleading To accurately prove or refute a clinical hypothesis using photographs, the investigator must adhere to strict rules of consistency to ensure that adequate visual interpretation of results is afforded, making the data obtained trustworthy. These mistakes and inconsistencies may make an excellent study invalid and unfit for publication in a major peerreviewed journal.

In this presentation I intend to highlight these and some other issues and provide participants with an insight on how to avoid these pitfalls so that more consistency may be obtained when drafting and conducting a study protocol. Also, insights will be given as to protocol writing and use of an IRB.

22

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26

006 The Effects of Williams E Media on Follicular Unit Graft Survival Compare to Normal Saline as a Storage SolutionRatchathorn Panchaprateep, MD Chulalongkorn University/ DHT Clinic, Bangkok, Thailand. Ratchathorn Panchaprateep, MD Division of Dermatology Department of Medicine Faculty of Medicine King Chulalongkorn Memorial Hospital Rama 4 Road Bangkok 10330 Thailand Email Address: [email protected], [email protected] Education - Medical degree (First Class Honours), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand - Dermatology,Division of Dermatology, Department of Medicine, Chulalongkorn University, Bangkok, ThailandClinical fellow in Laser and Dermatologic Surgery, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand - Phd. Study in skin and hair stem cell\, Chulalongkorn University, Bangkok, Thailand - Fellowship in Hair Restoration Surgery (ISHRS), DHT Clinic, Bangkok, Thailand. Academic Appointment: 2008Now: Instructor in Dermatosurgery, Chulalongkorn University, Bangkok, Thailand Hospital Appointment: 2011-Now: Dermatologist, hair transplantation surgery, Bumrungrad General Hospital R. Panchaprateep: None. ABSTRACT: Introduction: Until now, there have been several attempts to look at the best storage solution for holding the grafts during hair restoration procedure. There is still controversy regarding its usage. Currently, most hair surgeons use normal saline or ringer lactate. This has led to the development of new storage solutions that have been shown to support hair growth after transplantation eg. Platelet rich plasma (PRP), Hypothermasol, ACell, etc. Successful hair follicle organ culture has been established for more than 20 years, the isolated human scalp follicles can grow up to 10-14 days. The Williams E media has been used as a standard culture media in hair organ culture and also as a transported media in hair biologic research. This media contains the glucose, amino acids, vitamins, salts, buffers and antioxidants that tissue requires. So our study used Limmers 1992 study as a model for testing the survival of follicular unit (FU) graft holding in Williams E media solution compared to standard normal saline at various period of time. Objective: To study the survival of follicular unit grafts preserved in Williams E media compared to saline over a period of time. Materials and methods: A-47-year-old Norwood type VI male Asian, who had few miniaturized hairs scattered on the top of his head was

27

chosen for the trial. He was generally healthy, non-smoking/drinking and not on any hair loss medication. Five separated 1x1cm study boxes were marked off in each half of scalp with total of 10 study boxes and the corner of each boxes were tattoo. After strip harvesting, half the number of grafts were stored in normal saline and another half in Williams E medium (Gibco BRL, Paisley, Scotland) supplement with 10 g of insulin, 10 ng/ml of hydrocortizone and 200 mmol/L Lglutamine at 4C. The grafts were placed at 2, 4, 6, 24 and 72 hours out of body, at the density of 30 grafts per square meter. The scalp was split into half, NSS on the right side and William E medium on the left side of the patient (as shown in picture). For the front row, 30 grafts contain of 15 FUG of 1 hair and 15 FUG of 2hairs. The back row, 27 FUG of 2 hairs and 3 FUG of 3 hairs were inserted per box. Wiliams E NSS 0.9% Each of the study boxes were photographed pre-operative, immediately after insertion, then at 4, 6, 8, 10 and 12 months after surgery. The hair count was done at each visit by counting both full terminal hairs and slightly thin hairs, but extremely vellus hairs were not included. The hairs diameter was measured by micrometer (Mitutoyo Corp, Japan). Results: Preliminary report of the hair counts at 4 and 6 months is showed in table 1. The grafts survival in William E media was significantly superior to those in saline except at 72-hours showed poor growth in both groups. Table 1: Percentage of growing hairs at 4 and 6 months post transplant Saline (n = 108) William E media Time 4 mo 2 hr 64.8 6 mo 4 mo 6 mo 97.2% 98.1% 93.5% 100% 5.5%

74.1% 88.9%

4 hr 49.1% 58.3% 98.1% 6 hr 54.6% 67.8% 88% 24 hr 31.5% 37.9% 94.4% 72 hr 6.5% 6.5% 5.5%

We also observed most of the hairs growing at William E side were coarser than in saline. At 6 months, the mean hair diameter of William E and saline group was 60.4 compared to saline 52 m. Conclusion: The preliminary data showed that William E solution as a storage solution can significantly improve graft survival comparing to the standard normal saline at 2, 4, 6 and 24 hours time point. We still wait for the final hair counts at 12 months after surgery.

28

29

DisclosuresThe effects of Williams E media as a holding solution on the follicular unit graft survival comparing to normal salineRatchathorn Panchaprateep Division of Dermatology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand Damkerng Pathomvanich DHT Clinic, Bangkok, Thailand.

I have no relevant financial relationships or conflicts of interest to declare.

Introduction Until now, there have been several attempts to look at the best storage solution for holding the grafts during hair restoration procedure. There has not been a conclusion on the type of medium to use. Several studies of efficacy of storage solution in vitro via elongation study it remains unclear whether elongation is truly a good indicator of graft viability. Currently, most hair surgeons use normal saline or ringer lactate.

Introduction Successful hair follicle organ culture has been established for more than 20 years, the isolated human scalp follicles can grow up to 10-14 days. The Williams E media has been used as a standard culture media in hair organ culture and also as a transported media in hair biologic research. This media contains the glucose, amino acids, vitamins, salts and buffers that tissue requires.

Objective To study the viability of hair follicular unit grafts preserved in Williams E media compared to saline over a period of time via using box study (Limmers 1992 study).

Materials and methods A-47-year-old Norwood type VI male patient with few miniaturized hairs scattered on the top of his head He is generally healthy non-smoking/drinking not on any hair loss medication

30

Materials and methods Williams E medium (Gibco BRL, Paisley, Scotland) supplement with 200 mmol/L L-glutamine 10 g of insulin 10 ng/ml of hydrocortizone

The grafts were placed at 5 different time points as 2, 4, 6, 24 and 72 hours out of body at the density of 30 grafts per square meter.NSS Williams E media

Materials and methods 10 separated 1x1cm study boxes were marked off in each half of scalp with total of 20 study boxes and the corner of each boxes were tattooed.

Density = 30 FUG/cm2

Front role

Back role

6 rolls

15FUG x 1h 15FUG x 2h

27FUG x 2h

5 columns

3FUG x 3h

Immediate post-op

Evaluation Each study boxes were photograph before, immediate after transplant and at 4, 6, 8, 10 and 12 months follow-up period. The hair count was done at each visit by counting both full terminal hairs and slightly thin hairs, but extremely vellus hairs were not included by 2 blinded hair transplant surgeons and 1 registered nurse. The hair diameter was measured by micrometer (Mitutoyo Corp, Japan).

72hr

72hr

72hr 24hr 6hr 4hr 2hr 2hr 4hr 6hr

72hr 24hr

NSS

Williams E

31

Immediate post-op

P/O 1 mo

P/O 10 mo

P/O 12 mo

P/O 4 mo

P/O 12 mo

P/O 12 mo

P/O 12 mo

Post-operativeTime 2 hr 4 hr 6 hr 24 hr 72 hrP/O 6 mo P/O 10 mo P/O 12 mo

ResultPercentage of growing hairs at 4 and 12 months post transplant Saline (n =108)4 mo 12 mo

William E (n =108)4 mo 12 mo

64.8% 49.1% 54.6% 31.5% 7.4%

72.2% 65.7% 66.7% 46.3% 8.3%

97.2% 98.1% 93.5% 100.0% 3.7%

97.2% 98.1% 91.7% 100.0% 1.9%

Comparison of graft survival across 72 hours12 months follow up120.0% 97.2% 100.0% 98.1% 91.7% 100.0%

Results At 12 months follow-up period, the graft survival in William E media was significantly superior to those in saline except for at the 72-hours insertion. At 72-hours time point shows poor growth of the FU graft in both groups.

Growth Rate (percentage)

80.0%

72.2% 60.0% 65.7% 66.7% 46.3%

40.0%

20.0% 8.3% 0.0%NSS WE

1.9%2h 72.2% 97.2% 4h 65.7% 98.1% 6h 66.7% 91.7% 24h 46.3% 100.0% 72h 8.3% 1.9%

32

2 hrs2 hour insertion100.0% 97.2% 88.9% 90.0% 80.0% 80.0%Growth Rate (percentage) Growth Rate (percentage)

4 hrs4 hour insertion110.0% 101.9% 100.0% 90.0% 98.1% 96.3% 101.9% 98.1% 95.4% 93.5%

97.2%

70.0% 60.0% 50.0% 40.0% 47.2% 30.0% 20.0% 10.0% 0.0%NSS WE

72.2% 73.1% 64.8% 45.4% 37.0% 72.2% 72.2%

70.0% 60.0% 48.1% 50.0% 40.0% 30.0% 33.3% 20.0% 10.0% 0.0% 30.6% 38.0% 49.1% 58.3% 68.5% 65.7% 66.7%

43.5%

1 mo 47.2% 45.4%

2 mo 43.5% 37.0%

4 mo 64.8% 88.9%

6 mo 73.1% 97.2%

8 mo 72.2% 93.5%

10 mo 72.2% 95.4%

12 mo 72.2% 97.2%

1 mo 33.3% 38.0%

2 mo 30.6% 48.1%

4 mo 49.1% 101.9%

6 mo 58.3% 98.1%

8 mo 68.5% 96.3%

10 mo 66.7% 101.9%

12 mo 65.7% 98.1%

NSS WE

6 hrs6 hour insertion100.0% 90.0% 80.0% 70.0%Growth Rate (percentage)

24 hrs24 hour insertion100.0% 91.7% 91.7% 100.0% 91.7% 95.3% 90.0% 80.0% 70.0% 97.2% 97.2% 100.0%

93.5% 88.0%

67.6% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%NSS WE

66.7% 63.0%

Growth Rate (percentage)

66.7%

54.6% 54.6%

60.0% 50.0% 46.3% 40.0% 30.0% 25.2% 31.5% 17.8% 38.0% 45.4% 31.5%

28.7% 37.0% 27.8%

20.0% 25.9% 10.0% 12.0% 0.0%NSS WE

1 mo 37.0% 54.6%

2 mo 27.8% 28.7%

4 mo 54.6% 88.0%

6 mo 67.6% 93.5%

8 mo 66.7% 91.7%

10 mo 63.0% 91.7%

12 mo 66.7% 91.7%

1 mo 25.9% 25.2%

2 mo 12.0% 17.8%

4 mo 31.5% 95.3%

6 mo 38.0% 100.0%

8 mo 45.4% 97.2%

10 mo 31.5% 97.2%

12 mo 46.3% 100.0%

72 hrs72 hour insertion100.0% 90.0% 80.0% 70.0%Growth Rate (percentage)

2hr FrontWE NSS

60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%NSS WE

40.7%

11.1% 33.3% 7.4% 3.7% 10.2% 2 mo 10.2%11.1%

3.7% 6.5% 2.8% 4.6% 8 mo 4.6%3.7% 10 mo 6.5% 2.8%

7.4% 1.9% 12 mo 7.4%1.9%

1 mo 33.3% 40.7%

7.4% 4 mo 7.4%7.4%

6.5% 6 mo 6.5%3.7%

33

4hr FrontWE NSS WE

6hr FrontNSS

6hr FrontWE NSS WE

24hr FrontNSS

72hr FrontWE NSS

Results We also observed most of the hairs growing at William E side were bigger than saline. At 12 months, the mean hair diameter of William E and saline group was 65 and 56.5 m

34

Discussion Graft preservation is critical in hair growth and survival There are different solutions for graft preservationIntracellular storage solutions (Hypertonic) Hypothermasol Viaspan Vitasol (liposomal ATP) Custodiol Extracellular storage solutions (isotonic) Normal saline Ringers lactate Tissue culture media BSS PRP

Comparison of graft survival in different chilled storage solutionsWilliam E2 hr 4 hr 6 hr 8 hr 24 hr 48 hr 72 hr 96 hr 97 % 98 % 91 % -100 % -1.9 % --

NSS73 % 66 % 67 % -46 % -8% --

Hyp/ ATP90 % 90 % 92 % 122 % 82 % 84 % 76 % 40 %

Comparison of graft survival when stored in chilled salineLimmer 19962 hr 4 hr 6 hr 8 hr 24 hr 48 hr 72 hr 96 hr 95 % 90 % 86 % 88 % 79 % 54 % ---

Hair follicle viability depends on a variety of factors1. 2. 3. 4. 5. 6. 7. 8. Energy charge: calcium vs anions Osmotic agents: mannitol, sucrose pH levels Specific nutrients Oncotic proteins: colloid/ dextran 40 Growth factors Hormones Others: amino acids, antioxidants, electrolytes

Beehner 2011 Our study 201274 % 64 % 90 % 90 % 74 % 68 % 20 % 12 % 73 % 66 % 67 % -46 % -8% --

Williams' Medium E Buffer pH remains constant since it contains NaHCO3 as (neutral)

Conclusion William E solution as a storage solution can significantly improve graft survival and graft diameter comparing to the standard chilled normal saline at 2, 4, 6 and 24 hours time point.

Antioxidants Contains glutathione cellular antioxidant and hydroxyl radical scavenger help metabolize lipid peroxides and H2O2 both are potent free radicals reperfusion injury

Ascorbic acid (vit C) and alpha-tocopherol (vit E) free radical scarvengers

Amino acids Hormone: insulin important growth factor

Hydrocortisone reduce inflammation

reperfusion injury

35

Limitation This is only box study in one subject These grafts were placed in study boxes, so they might not be simulate the real-world results that a large number of grafts are transplanted

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007 Recipient Site Angulation and Follicle SurvivalMichael L. Beehner, MD Saratoga Hair Transplant Center, Saratoga Springs, NY, USA. Michael Beehner, M.D. has practiced hair transplant surgery in Saratoga Springs, New York since 1989. He obtained his M.D. from the University of Illinois and has residency training in family practice and general surgery. He was co-editor of the Forum from 2002-2005, Platinum Follicle Award recipient in 2001, Manfred Lucas lifetime achievement award recipient in 2007, recipient of 4 Research Grant Awards, and a member of the ISHRS Board of Directors. He is a past diplomate of the American Board of Family Practice (1976-2003) and a current diplomate of the ABHRS. He served as ABHRS President in 2005. M.L. Beehner: None. ABSTRACT: Introduction: This study was designed to see if there was a difference in survival between grafts placed at three different angles Objective: As stated in introduction Materials/Methods: Three study boxes were used in the anterior crown region of a 46 y/o Norwood VI male's scalp. Boxes measure 1.1cm x 1.1cm (1.21cm2) in square area. 25 x 2-hair FU's placed in each box. (50 follicles/hairs per box) Recipient sites made with 19g solid core needle Grafts within the three study boxes placed in sites made at 90 degrees (perpendicular), 45 degrees, and very acute (approximately 10-15 degrees). Study count performed 11 months later. Results: PERPENDICULAR BOX: 55 hairs counted, but two FU sites had 3 hairs exiting. These extra 2 hairs taken off results. 5 of the hairs were slt. miniaturized. Thus, 53 of hairs from the 2-hair FU's present. 106% present 40 DEGREES BOX: 54 hairs present, including one FU exit site with 4 hairs. 6 of the hairs were slightly miniaturized. Thus, 2 hairs subtracted from result. 52 hairs present with 50 having been placed. 104% present ACUTE ANGLE BOX: 42 hairs counted. No 3 or 4-hair FU's. 1 miniaturized hair. 84% present Discussion: In 2000 Dr. Dow Stough conducted a similar study with the three study boxes having recipient sites made at 10, 45, and 60 degrees respectively. The count was performed at 8 months. The results showed 82% survival for the 10 degree box, 76% survival for the 45 degrees box, and 77% survival in the 60 degree box. These three percentages are virtually statistically the same with no significant advantage shown in any of the boxes. They placed 50 x 2-hair FU's in 18g needle sites in 1.5cm x 1.5cm boxes (2.25cm2). Thus the densities of planting in the two studies are almost identical.

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Our study seemed to show a small but discernible advantage in survival for the 90 and 60 degree boxes, as compared with the acute angle box. The only differences in our studies were the slightly smaller needle sites in our study, the count being done at 11 months ins

ISHRS 20th Abstract Book 2012 Bahamas Final

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