1. 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

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

3. 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 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

4. Hair loss statistics

5. 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?

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Sustained Growth Factor Release

14. 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

15. 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

17. 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

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

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

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

21. 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

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

23. 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

24. Thank you for your kind attention