The popularisation of hair transplantation as a cosmetic procedure began after the description by Dr. Norman Orentreich  (Ann N Y Acad Sci 83:463–479, 1959) in 1959 of the principle of donor dominance. To this day, hair transplantation is the only permanent/long-lasting treatment for androgenetic alopecia, but it is severely limited by the availability of donor hair. In the lighter-skinned Asian populations, the hair characteristics are coarse straight black hair with a lower density compared to other races  (Pathomvanich, Hair Transplantation, Elsevier, Amsterdam, 2006). Notwithstanding the larger calibre hairs in this population, both the high hair to skin colour contrast and the lower density of the donor hair mean that there are severe limitations to the amount of scalp coverage that can be accomplished by standard transplantation. Scientific research in hair biology in recent years has yielded the possibility of stem cell therapy/tissue engineering as an alternative treatment for this rate-limiting step. This concept is based on the knowledge that hair follicles (HFs) are self-renewing organs [3, 4] (Blanpain, Cell 118:635–648, 2004; Botchkarev, J Exp Zool B Mol Dev Evol 298:164–80, 2003), so the possibility of artificially inducing the natural HF regeneration in a similar manner to embryogenesis is an enticing prospect.
The idea with cell therapy is that small numbers of hair follicles are extracted from the donor region; cells are isolated and cultured in the lab to produce thousands or millions of cells, which are placed into the balding areas to produce many more hairs than were originally extracted. These hair-forming cells could work in a number of ways: they could either organise into new hair follicles or stimulate the transformation of a vellus hair into a terminal hair. Experiments in mice models have shown that isolated follicular dermal papilla, cultured dermal papilla cells, dermal connective tissue sheath cells and bulge epidermal stem cells all can regenerate hair follicles.
In this chapter I will discuss the research behind attempts at follicular regeneration, from cell culturing to potential delivery methods.
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