Use of platelet-rich fibrin matrix for hair growth in males and females Richard M. Goldfarb, M.D. FACS President/CEO of Center for Smartlipo and Plastic Surgery

Disclosures Medical Director for Factor Medical - Distributor of Selphyl Off label use of PRFM (Selphyl) will be discussed

Hair loss Hair loss in males is considered a normal process of aging. Hair loss in females is not considered a normal process of aging. The average adult has 100,000-150,000 hairs and losses up to 100 per day. Each follicle has its own cycle divided into 3 phases: Anagen- active phase 2-6 years Catagen-transition phase 2-3 weeks Telogen-resting phase, 2-3 months, hair sheds and a new hair replaces it There are two types of hair on the body Vellus Androgenic Hair

Hair loss statistics

Hair loss patient consultation Evaluate for: Shedding Gradual or sudden Family history Systemic diseases Medications Physical Exam Local or generalized Scarring or non-scarring Work-up Biopsy?

Most common Types of hair loss Involutional Alopecia- comes with age, thinning of hair Androgenetic Alopecia- hair loss from the scalp Alopecia Universalis- complete loss of hair on scalp and body Telogen Effuvium-hair loss due to stress Traction Alopecia- hair loss from a pulling source Alopecia Areata- sudden hair loss starting with bald patches Scarring Alopecia- rare disorders that replace hair with scars

Pathology of androgenic alopecia Balding hair has increased androgen receptors and 5-alpha reductase in men and women Leading to progressive diminution of dermal papilar cells Leads to eventual hair loss

Hair growth cycles Anagen “Growth phase” Begins in papilla Lasts 2-6 years The longer in this phase, longer the hair will grow 85% of hair on the head is in this phase Catagen “Transition Phase” 1% of all hair Lasts 2 weeks ? Of melanin production in the hair bulb Hair shaft is pushed upwards despite not having growth Telogen “Resting Phase” Hair is in this phase for 10-15% of your life. Despite the name, epidermal cells living in the follicle continue to grow This phase also includes ”shedding” Within two weeks, the new hair shaft will begin to grow

Current treatment of androgenic alopecia (Fda approved) Hair transplant (does not address on going hair loss) Minoxidil Increases duration of anogen phase Increases follicular size and duration Takes 6-9 months for effect Goal is to re thicken hair and stop progression (85-90% success rate) Finasteride Blocks dihydrotesterone Stops progression in 90% Regrowth approximately 65% Minoxidil and Finasteride Synergistic effect Low level light therapy Unsure of effectiveness

Platelet-rich Fibrin Matrix (PRFM) FDA Cleared Medical Device with CE Mark (EU) Kit allows physician to: Draw a small amount of blood Spin to make PRFM (platelet-rich fibrin matrix) Prepare for injection Procedure takes <30 minutes from start to finish Best-in-Class Technology in Regenerative Medicine

Platelets Release Growth Factors KGF (Keratinocyte growth factor) Growth and new generation of keratinocytes Platelets PDGF (Platelet derived growth factor) Cell growth, new generation and repair of blo od vessels, collagen production FGF (Fibroblast growth factor) Tissue repair, cell growth collagen production EGF (Epidermal growth factor) Promotion of epithelial cell growth, angiogenesis, promotion of wound healing VEGF (Vascular endothelial growth factor) Growth and new generation of vascular endothelial cells TGF – B (Transforming growth factor beta1) Growth of epithelial cells, endothelial cells, promotion of wound healing

Platelets and Fibrin Matrix Platelets release growth factors New blood vessels Angiogenesis stimulated Fibroblasts & Stem Cell Migration Fibrin Matrix Scaffold to support sustained GF release

Sustained Growth Factor Release

PRFM vs. PRP Fibrin Matrix essential to: Platelets (1) release significant amounts of growth factors (2) while retained in fibrin matrix Fibrin Matrix essential to: • Calcium chloride in a closed-system to allow for controlled fibrin polymerization • Scaffold is a biologic connector that supports stem cell migration • Platelet remain viable and localized • Sustained cytokine/growth factor release

PRFM - Next Generation PRP Platelets in plasma Activation is immediate Alpha granules release growth factors quickly (bolus) Short-term tissue signaling Minutes - hours PRFM Platelets in fibrin matrix CaCl2 binds to Na Citrate 1:1 Clotting cascade resumes (Fibrinogen - Fibrin) Platelets remain viable with controlled GF release Hours - days 15

Mechanism for prFM use in hair loss Stimulates stem cells Prolongs Dermal Papillar cell survival Fibroblast growth factor to extend Anagen hair cycle Increases vascularity in release of platelet- derived growth factor

Before and after photos 63 yr old male-5 months after 3rd treatment with PRFM

Before and after photos 55 yr old male- 3 months after 3rd treatment with PRFM

Before and after photos 56 yr old female 6 months after 3rd treatment with PRFM

Alopecia Totalis failed intralesional steroids x 1 year 6 weeks post- injection with PRFM 42 yr old male 6 weeks after 1 treatment with PRFM

My treatment protocol Three treatments about six weeks apart Additional use of Finesteride, monoxidil and biotin

summary Preliminary data are encouraging and warrant further investigation Studies are ongoing to achieve FDA approval Possible synergy with other products A-Cell Aminocytes Minoxidil, Finasteride PRFM vs PRP - differences are scientifically and clinically meaningful

Thank you for your kind attention