A Brief Clinical and Basic Science Primer
When tissues are deprived of their blood supply, even briefly, the damage to the cells comes not so much from the lost blood supply, but from the RE-PERFUSION! Perfusion is blood flow, so reperfusion means that the formerly oxygen-deprived tissues suddenly experience a flood of blood in their midst. This can cause tissue damage. On a biochemical level, what happens is this: free radicals are formed. What are free radicals? Well, they are usually highly charged, highly energetic oxygen species, like OH- (hydroxyl), H2O2 (peroxides), O- (superoxides), and others. These free radicals act as “little bullets”, if you will, and can damage cell membranes, and contents of the nuclei of cells. Of these, superoxide specifically is known to break down nitric oxide and to inhibit hair follicle cell growth. Interestingly, nitric oxide is also a “free radical”; however, in small amounts, it exerts a positive effect. Only when its production is out of control, such as in septic shock, is it damaging to the body. Now, these free radicals are also part of normal metabolism and are often used by certain white blood cells to destroy viruses, bacteria, and other invaders. But as is often the case, it’s a matter of balance. Too many of them are bad and in too concentrated an area. This is a major way that heart muscle is damaged after coronary occlusion (blockage), brain tissues killed after occlusive stroke, and so on. These Hair Cycle products are physician-formulated, safe, and naturally based, delivered in a vehicle that is gentle and effective and leaves the hair soft and manageable. The products are ideal for those undergoing hair transplant surgery and for the millions of men and women worldwide experiencing hair loss. So, how is this pertinent to our field of hair transplant surgery? Well, our follicular unit grafts are tissues deprived of perfusion (they are ischemic). What ameliorates reperfusion injury and free radical formation? Cold for one thing (we use chilled saline as a storage solution, right?), and brevity of ischemic time (minimal time out of the body). Certain substances like tetrahydrobiopterin (BH4), which we have yet to figure out how to apply to our work, can protect cells from ischemia-reperfusion injury. There are also fascinating studies that show that ischemic pre-conditioning (IPC) can protect tissues in remote locations from ischemia-reperfusion injury (IR). Thus, using IPC on a limb, like a forearm, may help protect tissues elsewhere in the body (possibly follicular unit grafts?). One of the things that we can do is to use various antioxidants to shift the balance in the tissue’s favor. Our product line contains many antioxidants. Any antioxidant “quenches” free radicals, i.e., it allows itself to be oxidized rather than the cellular structures at risk. Our bodies have a very sophisticated antioxidant system; ascorbic acid (vitamin C), tocopherols (vitamin E), glutathione, glutathione synthetase, carotenoids (vitamin A-like substances), and many more. With our product line, we are placing these and others topically, that is, directly on the scalp and hair.
The products also are rich in anti-inflammatories, generally of the natural persuasion. Again, as with free radicals, it’s a matter of balance. Too much inflammation is deleterious to tissues and cells. Think of rheumatoid arthritis or atherosclerosis. These are inflammations out of control. It is well known that androgenetic alopecia (pattern baldness) is associated with markedly increased numbers of inflammatory cells around the follicles. If we diminish inflammation in the scalp after transplant, there is less pain, less swelling, and possibly a higher likelihood of graft survival. And we have also included cell proliferates, anagen stimulators, and nitric oxide (NO) stimulators. A cell proliferant is any substance that stimulates an increase in cell division, and it is cell division at and around the hair’s bulb that drives the growth of the hair shaft. Cell proliferation is also mandatory during the healing process. An anagen stimulator is any substance that increases the amount of time the follicle is in the anagen or active growth phase. Conversely, this would diminish the amount of time spent in telogen, or resting stage. What about nitric oxide stimulators? Nitric oxide, or NO, is a small, gaseous molecule that plays an important role in an astounding number of metabolic processes. It is a signaling molecule and is produced by several enzymes collectively known as NO synthases. Among other things, NO is involved in immune system functioning, exerting an antimicrobial effect, decreasing inflammation in blood vessels, increasing blood flow (NO is intimately involved in mediating the effect of Viagra and other such drugs), and in stimulating hair cell growth. It has been proposed that deficient production of scalp nitric oxide is related to baldness. We also know NO is essential for proper wound healing such as after hair transplant surgery, and is an anagen stimulator.
Now, a quick word about androgens. It is well known that androgens (“male” hormones) are part of the hair loss equation in both men and women. Specifically, testosterone and other androgens may be converted, by an enzyme called 5-alpha-reductase, to a much more potent androgen called dihydrotestosterone (DHT). Propecia (finasteride) and Avodart (dutasteride) are 5-alpha-reductase inhibitors and therefore decrease levels of DHT in the body and scalp. Pattern baldness, or androgenetic alopecia, as the name implies, depends on a combination of a genetic predisposition to hair loss, the presence of androgens, especially DHT, and the passage of time.
The Science Behind HairCycle
The Hair Cycle product line contains topical inhibitors of 5-alpha-reductase and inhibitors of the action of DHT at the androgen receptor. So, to reiterate, we have included: anti-inflammatories, antioxidants, cell proliferants, DHT inhibitors and androgen blockers, anagen stimulators, and nitric oxide precursors. These Hair Cycle products are physician-formulated, safe, and naturally based. All this and more, in a vehicle that is gentle and effective, and renders the hair soft and manageable. The products are ideal for those undergoing hair transplant surgery and for the millions of men and women worldwide experiencing hair loss.
Here is a good video that explains the hair cycle growth phase:
