Author Bio: Dr. Sanusi Umar MD is the author of this article.
Last Updated on November 17, 2020 by Dr Sanusi Umar MD
Over a decade ago, many clinics began using ACELL, in hair restorations in scenarios that purport that when added to transected pieces of hair follicles, those hair follicle pieces would develop into functioning follicles. A sot of hair multiplication device in other words. Many clinics subscribed to this theory and many patients signed up for it. So what have we learned from that experience? is there a role for Acell in hair restoration?
Curious to see if ACELL could work to support patients undergoing an FUE, follicular unit extraction, hair transplant, Dr. Sanusi Umar of Dr. U Hair and Skin Clinic sought out to find the answer for himself – conducted an informal analysis of the benefits of ACell.
The Dr. U Hair and Skin Clinic Test:
The test had 2 objectives:
- To determine if the grafts survived better after soaking in a solution of Acell before grafting
- To determine if the healing of wounds created by the UGraft FUE techniques benefitted or not from the use of Acell
Methods: In patients undergoing typical hair transplantation with a symmetric recipient site. Grafts implanted in one half of the recipient site were dipped in a solution of Acell before they are implanted into premade slits while grafts going to the other half of the recipient area were not dipped in an Acell solution. All grafts are stored in a chilled lactated ringer’s solution prior to grafting or dipping into Acell solution
Similarly, in the same patients, one-half of the donor areas were coated with a thick solution of Acell before being coated over by bacitracin ointment while the other half was treated with bacitracin ointment and no Acell precoating.
Results: After a waiting period of 1 year, there was no difference in either half of the grafted sites in regrowth count or onset or completion growth. No difference was noted in the recipient healing. Similarly, the donor areas did not show any difference in the rate of healing or quality of the scar.
Conclusion: Acell ECM did not enhance recipient performance nor donor healing when used in this manner. Larger studies would be helpful in confirming these findings
But what is ACELL?
ACell is a wound management medical device/treatment developed with the primary goal of enhancing wound healing using novel concepts in regenerative medicine. It is based on extra cellular matrix (ECM) that is derived from the Porcine urinary bladder matrix and works by forming the framework into which regenerative cells and structural tissue grows. The result is faster healing with less scarring. Scarring is less because the repair is more cellular than cicatricial. In plain language, non-scar-forming cells migrate into the extracellular matrix of Acell to cover the defect rather than conventional scenarios where scar-forming fibroblasts and their ground substances move in to cover the wound defect with a scar (1). But according to Acell’s research, not all acellular products function or respond in the same and vary from person to person (2). The FDA indication for Acell is a device used in wound management.
WHAT IS THE ROLE OF ACELL IN HAIR RESTORATION?
Soon after its emergence over a decade ago, some hair restoration clinics began:
- Using Acell to treat baldness all by itself
- Adding Acell to grafts at the time of implantation with the hope it will increase hair transplant yield/survival
- Applying Acell topically to donor site wounds with the hope that it would optimize wound healing rate and esthetics
- Using Acell as an adjunct in other regenerative methods of hair loss treatment
DOES ACELL TREAT BALDNESS ALL BY ITSELF?
Whether ACell is injected or applied topically, there is no evidence that it will grow new hair or improve pre-existing hair. What’s more, there is not enough theoretical science to support using it in this context.
DOES ACELL IMPROVE GRAFT SURVIVAL IN HAIR TRANSPLANTATION?
Based on Dr. U’s study, this does not occur. Dipping hair transplant grafts in Acell solution before implantation did not increase hair transplant yield
DOES ACELL IMPROVE WOUND HEALING IN HAIR TRANSPLANTATION
Average wounds created by FUE are very small and would typically heal very well with minimal scar formation. Wounds created by UGraft punches called Intelligent punches are optimized further to heal better than typical FUE wounds. Dr. U found no advantage of adding Acell to the FUE wounds created by the UPunch in his study. According to Dr. U, this is likely to be the case in general with FUE wounds of less than 1.12mm diameter. That said, Dr. U believes that Acell will most likely be useful in Follicular unit strip surgery (FUSS) donor wounds which are much larger. According to Dr. U, even in strip surgeries, one has to be careful in using ECM to minimize scar formation as some degree of scar formation is required to create a strong scar that will hold and not stretch. By using ECM such as Acell to minimize the scar-forming process, FUSS practitioners should watch out for the possibility of increased incidence of scar stretching which might manifest as long as 6 months after the surgery.
DOES ACELL ENHANCE THE EFFECT OF OTHER REGENERATIVE MEDICAL TREATMENTS OF HAIR LOSS?
According to doctor Umar, regenerative medicine is playing a prominent role in hair restoration. It is becoming more so as we are beginning to expand our knowledge of the various mechanisms by which hair loss occurs at cellular and autocrine levels. The explosion of research in various aspects of the regenerative science field such as Platelet-derived methods, autologous stem cells derived from fat and blood, use of exosomes as well as allogeneic stem cells derived from placental tissue is already making inroads into the field of hair restoration. The use of platelet based technologies is very rampant and common practice in hair restoration and one of the methods used by many to enhance the efficacy and longevity is a regimen that combines platelets with an extracellular matrix of which Acell is a favorite. Another ECM hyaluronic acid has been used to enhance the effect of Platelet based regenerative procedures in other areas of medicine such as orthopedics. Dr. U has observed enhance effects of adding hyaluronic acid to regenerative medical processes when used in the treatment of hair loss. There is thus a good reason to study the role of ACell, hyaluronic acid, and other ECM in conjunction with platelet-based treatments, stem cell, or exosome-based treatments in hair loss.
Finally, practitioners should be aware that overall, the use of Acell or any ECM for hair restoration is an off-label use and not approved by the federal drug administration (FDA). As a matter of fact, the FDA came down hard on Acell manufacturers with fines and sanctions for alleged claims of approval or topical use. Acell is not approved as a medicine that can be applied topically, rather it is approved as a medical device.
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- Brown BN, Londono R, Tottey S, Zhang L, Kukla KA, Wolf MT, Daly KAReing JE, Badylak SF. Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials. Acta Biomater. 2012 Mar; 8(3):978-87.
- Mulder, Gerit & Wallin,Kelly. (2012) Regenerative Materials That Facilitate Wound Healing. Clinics in Plastic Surgery, Volume 39, Issue 3, July 2012, Pages: 249-267