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posted by drnigam, 28.02.2013, 16:22


This post is for the comparison between Dr. Nigam’s and Dr. Gho’s technique for the forum members & HT Doctors for the critical discussion and sharing of experiences for mutual benefit of all. This is a professional, healthy discussion post and is not for any personal criticism against any one, would appreciate if Dr. Gho and other Hair transplant Doctors participate in this thread, specially inviting Dr. Cole, Dr. Ziering, Dr. Bernstein, Dr. Umar, Dr. Arvind, Dr. Gho and many more respected colleagues including Ironman, GC, Neversay, Didi, Boldy, Freddie and the other forum members.

As you know it took 10 years for 50 % of Doctors to move from Strip method to FUE and FUE itself is 10 years old, now it’s time to move to Hair Doubling with activated Stem Cells and Isolated Dermal Papilla cells and newer ideas which will be coming through esteemed colleagues and forum members.

I wish to present my studies in San Francisco, USA in OCT 2013. Hopefully there I will be meeting all the above mentioned doctors and other respected colleague from Hair Transplant industry.


Our friend Dr. Gho’s - Donor doubling & Dr. Nigam Hair Doubling with activated Stem Cells and DP cells:-

1G. Dr. Gho bisects the follicular unit and not single follicle longitudinally in Vivo (when the follicle already exist in the scalp), hence it is a blind technique. (As per Dr. Gho’s published paper he himself mentioned there are unsuitable or damaged grafts at the donor area. He bisects using a inner diameter, 0.6 mm triple waved tipped partially blunt FUE punch (he calls it triple wave punch). Since Dermal Papilla is embedded in sub-cutaneous fat cells hence it is unlikely Dermal Papilla cells would be present in the extracted bisected follicular unit or maybe he is able to extract part of Dermal Papilla. As per Dr. Cole’s website Dr. Gho tries to bisect the follicle at the line of Auber which he found difficult and was worried about loss or damage caused to the grafts. Although even if 1/3 proximal that is a root with outer root sheath and 2/3 distal which contains bulge stem cell and part of outer root sheath stem cells, generate hair up to 60% to 70% which has been shown in the earlier studies of Toscani, Rossi, Erjin, Jahoda, Roy and Micali. This also shows that if there is such a partial FUE or transacted FUE with proximal and distal stem cells it can still grow both the bisected follicles. Although the character and diameter of the hair may differ. Remember Dr. Gho is not cutting follicle unit into two but a folliclular unit(refer to his histo slide in his paper and not the picture mentioned in his paper) into two. Kindly refer his article donor hair follicle preservation by partial follicular unit extraction a method to optimize hair transplantation.

1N. Dr. Nigam bisects the hair follicle / follicular unit transversely in vitro under 50x magnification with special fine blades and also collects the spilled out approximately 1000 to 1200 DP cells and injects it back in to the bisected follicles along with autologus activated epithelial and dermal papilla cells, outer root sheath, stem cells through 25 to 50 separately extracted follicular units in Vitro (when the follicle is not existing in the scalp but the cutting is done under microscope with full vision hence there is no chance for unsuitable or damaged grafts). The bisection is done at the particular level on the follicle wherein the Dermal Papilla cells & outer root sheath cells are present in both the bisected parts of the follicle. Due to patent pending neither Dr. Nigam nor Dr. Gho has not mentioned that at what level they bisect the follicle.

2G. Dr. Gho’s technique utilized only preservative media which does not have stem cell or isolated stem cell for boosting and survival of bisected follicle & no growth factor, no stem cells were utilized. Dr. Gho claims in his website that stem cell is been extracted from the donor area and implanted in the recipient area which is false and misleading because bisected follicle unit is extracted and implanted in the recipient area.

2N. Dr. Nigam’s technique involves addition of isolated activated stem cells with growth factors isolated Dermal Papilla cells injections extra cellular matrix and 250 arterial PRP, Epidermal growth factor, follistation,, KGF, FGF and other (can’t disclose all as patent is under process)

3G. Dr. Gho claims that since he keeps the bisected follicular unit in the preservative medium (The medium is composed of the following ingredients: sodium chloride, potassium chloride, magnesium sulphate, sodium phosphate, calcium chloride, glucose, sodium bicarbonate, sodium lactate, sodium pyruvate, human serum albumin, insulin, bis(maltolato)oxovanadium (BMOV) and
a-tocopherol (vitamin E)) of nutritional factors hence this technique should not be claimed as stem cell hair transplant (Because no isolation of stem cell is done in a regenerative lab, hence the technique cannot claim any manipulation of stem cells. Although it is true even in a normal hair fall when a new hair grows it is because of the inherent multiplication of the stem cell present in the hair follicle. Any isolation or multiplication of stem cell is possible only in a FDA or European authority certified lab which our friend Dr. Gho does not have at present.

3N. Since Dr. Nigam has his own Lab he can extract few grafts from the body or from the donor area and isolate stem cell from the grafts, Dermal Papilla and Dermal Sheath cells, plus isolate and cultured with inducible Dermal Papilla cells and inject the solution into both the bisected units so that they are nourished with the required nutrition to develop.

4G. Unfortunately regulation in Europe are very strict for isolation, multiplication, activation of even adult stem cells not to mention embryonic stem cell or allogeneic stem cell, the use of which is legally 25 years away. Hence our dear Dr. Gho has shifted his lab and opened one unit in Indonesia to catch up fast and may be introduced activated stem cells into his present techniques.

4N. Luckily in India for Dr. Nigam research and therapy on adult autologus stem cell with minimal manipulation is legal and cleared by 3 regulatory authorities in India (Dr. Nigam has a clearance from these 3 authorities in India) and since he utilizes the activated stem cells in his medical procedure with monthly follow up with his all patients with a special consent form. Dr. Nigam’s technique is only be legal in few countries as on today across the globe including India.

5G. Dr. Gho has patented his process of longitudinally bisection of donor hair follicle, preservation by partial follicular unit extraction a method to optimize hair transplantation (kindly confirm the same with the patent authority and through his published paper in journal of Dermatological Treatment, 2010, 21:337-349. Since Dr. Gho himself calls his technique partial follicular extraction it is misleading to named it as stem cell hair transplant. This nomenclature of stem cell hair transplant is not usually objected by patent authorities but can be objected very well by European authorities of stem cells because claiming of stem cells therapy or its used is not legal in Europe. The word stem cell for hair transplant can only be used if it is isolated in FDA certified regenerative lab and / or activated and then injected back into the scalp. Unfortunately this is not the case of in Dr. Gho. Hence if this will come to the notice of Stem Cells authority they might take action against it but patent authority will not object for the same. Infact it is the inherent property of the existing stem cells in a hair follicle to denovo on its own to get activated and multiply to regenerate a bisected hair follicle if all the different type of stem cells is present in the bisected the follicle to regenerate a new hair follicle. Dr. Gho bisected graft are minimal outside the scalp by 4 to 5 hrs including 2 hrs in the preservative medium.

5N. Since Dr. Nigam has his own FDA licensed regenerative Lab in Mumbai (the license is already posted on the forum) Dr. Nigam’s Bio-Techs first isolate the adult hair stem cells present in a hair follicle, sorted out by magnetic beading system and then they activate (not multiplied which takes one and half a month) with serum free growth factors within 4 hrs of time and then they inject it into the bisected follicles. This hair doubling has been trademarked in India and Patent application is under process. We believe this is a actual stem cell Hair Doubling. At Dr. Nigam’s we do not keep the follicles outside the scalp for more than 50 min in any of the hair transplant procedure including Hair Doubling.
We make Patient lie-down in a lateral position and one Doctor extract and other Doctor implants the grafts simultaneously (most of the transplant elsewhere are done in supine or prone position where the surgeon has to first extract the graft which takes few hours and then implant the grafts except in DHI technique. We use PRP growth factor and extra cellular matrix to increase the graft survival. We make recipient incisions prior to the extraction of grafts to promote granulation of tissues and minimizing scalp.

6G. Dr. Gho’s technique of Donor Doubling or preservation can transform the NW7 to NW2 in 2 years of time and that also at a very high cost because on an average 1500 grafts can be replicated only after 6 to 7 months.

6N. Dr. Nigam’s technique of Donor Doubling or Hair Doubling are effective because in this technique both the bisected part of the grafts can be implanted at the recipient area hence through this technique NW7 can be transformed to NW2 in 10 – 15 days from the procedure.

7G. The cost and time to transform NW7 to NW2 (10000 grafts) through Dr. Gho’s technique will cost very high (approximately USD $13000 for 2000 Grafts which means US $50000 for 10000 Grafts) and this transformation will take atleast 5 years.

7N. The cost for 10000 Grafts with Dr. Nigam’s Hair Doubling technique for 2000 Grafts in one day is USD $5000 and USD $10000 (All Inclusive) for 10000 Grafts. The total time period required for 10000 Grafts is 10 – 15 days.
You must be wondering that the NW7 patient can donate only 2000 to 3000 follicular unit maximum. We can extract 3000 follicular unit from NW7 and we can double it to 6000 follicular units and can be implanted into the recipient scalp. The Balance 2000 / 3000 grafts can be taken from the body or beard and similarly can be doubled to 4000 /6000 grafts as body hair are single follicular Graft.

8G. Both Dr. Gho is using surrounding tissues with the bisected follicular unit

8N. Dr. Nigam is also using surrounding tissues with the bisected follicle

9G. Dr. Gho is using 0.6 mm inner diameter which means 0.7 mm FUE punch of outer diameter. Although his punch is triple waved tipped, which is partially blunt.

9N. Dr. Nigam uses the same 0.6 mm inner diameter which means 0.7 mm FUE punch.

10G. Blindly longitudinal bisection in vivo has a disadvantage since the hair follicles angles at the skin surface is different from the placement angles of the bottom part of the hair follicle with the root. Hence higher number of transected or unsuitable grafts are possible and it’s a time consuming process

10N. Since at Dr. Nigam’s the bisection of follicle / follicular unit is done under high magnification in vitro which is outside the scalp, negligible chances of transected or unsuitable grafts. Kindly go through Dr. Cole explanation of the same in his post on the forum

11G. Healing of the donor area with Dr. Gho’s technique is also better than traditional FUE.

11N. Healing of the donor area is exceptionally fast in Dr. Nigam’s technique due to the use of activated stem cells, growth factors, isolated DP cells, extra-cellular matrix and PRP. Some of the forum member has already commented that they have not seen such exceptionally fast healing of both donor as well as recipient area with complete healing bring the scalp to the normal state without dot marks.

Challenges for both Dr. Gho & Dr. Nigam:-
Dr. Gho and Dr. Nigam both have to get their documentation of Donor Doubling / Hair Doubling atleast on 5 patients independently by informed and computer skilled consumer or by a independent hair transplant Doctor and / or by independent editor of top credible hair loss forum. Dr. Nigam has already agreed for the above procedure for free of cost in Mumbai and similar response from Dr. Gho is awaited. Both these techniques are promising and can change the hair loss industry in better way before the real Hair Multiplication, Dermal Papilla implantation or macro follicle Organoid hair implantation becomes a reality in next 1 to 5 years as it is the next and may be the final breakthrough in the HT industry for MPB. Neither of their technique can claim multiplication but it can be classified as Donor Doubling & Hair Doubling respectively.

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