The Importance of Using State-of-the-Art Storage Media

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I just finished preparing a lecture that I was asked to prepare for the basics course this falls, international society of hair restoration surgery, lecture series. And I thought that this lecture would be something appropriate for a podcast as well. The topic is on storage media. So what is storage media? Storage media refers to, what you place the grafts into before they go into the scalp? So for example, if I’m harvesting something with fue, those grafts come out, they must be placed into an appropriate storage media and then eventually placed into the, into the scalp FUT. The same thing when the grafts are removed, when the strip is removed, that must be dissected into grafts. And during that process, the grafts must be in a storage medium before they place into the scalp. The traditional method of placement has always been using saline, normal saline, which I used to use many years ago and normal saline traditionally has done well.



I mean, they’re, Limor back in the eighties has shown about an 88% survival with just conventional normal saline. However, normal saline to me is far inadequate for state-of-the-art hair transplant surgery. You may have heard some of my podcasts on regenerative medicine and regenerative medicine refers to what I would call the fertilizers. The things that have helped hairs grow well. In a procedure such as ATP, hypothermia, Saul, ASL, and, and PRP or platelet rich plasma, well, actually these same categories of fertilizers refer to storage media because I store grafts in platelet poor plasma in platelet rich plasma, in a cell, in ATP and hypothermia cells. So this almost like a continuum of discussion, but I want to specifically tell you why I use what I use and what are the certain things that make up good storage media and why that makes a difference. 



Because even though you have a high survival rate, potentially with Limor study back in the day, two things, those were stripped grafts which have much heartier thicker, sheathing around it. Fue grafts are much more fragile. That’s the first lesson. The second lesson is the fact that 88% is pretty good, but 98% is a lot better. And I’m also noticing by using different storage media, that there is a difference, which my friend Marcello has talked about where he found that there’s variations based on a patient’s inability to grow hair. For example, if he gets to the same surgeon, transplanting a person that person may always grow 70%, another grow 90%. But to overcome that, I think that what necessary is proper storage media and regenerative techniques. So let’s talk about some basic principles of storage, meaning why does saline fail? In my opinion, even though I used to use it, the reason is that saline, first of all, is an extra cellular fluid. 



So what that means is the there’s a different sodium potassium balance of outside the cell inside the cell. So this Ivy fluid or saline has extracellular component. When you are trying to create a cold temperature change to chill the graft and to minimize the metabolism of the graft during that process and the process of taking a graft out of the body called storage injury, the graft itself starts to break down its sodium potassium ATP pump in its cell membrane, which means that the sodium starts to flood into the cell. And the calcium starts to flood out of the cell and the entire cell starts to swell and that swelling causes it to die through a pop ptosis, which means program cell death through radical damage. And what the SA the Celine does is flush more sodium into there, causing it to be even worse and exacerbated that cell death. 



The difference though is with hypothermosol, it’s an interest seller, Larry balanced formula. And why is that important? Because that is sodium potassium, ATP pump is failing. Then there’s not too much sodium because it’s a low sodium basis is it’s mimicking the intercellular environment, which has high potassium, low sodium. So, that fluid doesn’t flush the sodium is a flush into the cell causing swelling and death. So an intracellular balanced product is what is used in tissue, organ preservation. And that’s what I use hypothermia all very, very expensive. Most surgeons don’t bother to use it because they think it’s just a waste. It doesn’t do anything I’ve been using it since 2014. And seeing some tremendous improvements in terms of graft survival in terms of the speed of growth, and even how the graft look, I’m seeing growth as early as three to four months.



Whereas in the past, it would take me double that time. Sometimes three times at length, so faster growth, more consistent growth, more beautiful growth. And to me, that’s important. The other component here is the pH is like acid and base. You remember that the closer you get to a pH at physiologic levels, which is around 7.4, the better you’re off, you’re going to be. So we’re going to use saline as a comparison. Saline is around five pH of five. Why is that a problem? Because in an acidic environment, the cell has to work harder to maintain itself from collapse. And that means getting that using more ATP to try to stabilize the cell from collapsing and with a neutral, balanced solution. That’s physiologic such as with hypothermosol, you don’t get that issue. And also understand that during a time of the cells being taken out of the body, the cells also undergo was called metabolic acidosis, meaning that it starts to go anaerobic and acidotic.



And so if you’re actually putting more acid into this environment, it’s not healthy by being physiologically neutral, you’re doing much, much better. A colleague of mine actually did some studies looking at ATP with hypothermosol, to me, the two are like Reese’s peanut butter cups. They work far better together than isolated, either one alone. What is ATP? Adenosine triphosphate is the energy to the cells. So when all these cells source of breakdown, when they start to become colder, that’s when the HCP needs to help that sodium potassium ATP function help to restore against metabolic acidosis. So the study that I was about to mention is that he looked at placing grafts into ATP and hypothermosol. He had a gentleman that had a cancer on one side, and he placed grafts in there. And he, after five days of ex vivo time, in other words, he took these grafts, let him sit out.



Well, it wasn’t a refrigerator. He let these grafts either sit out and hypothermosol, or with ATP, hypothermosol, or just normal saline. He kept these graftsoutside of the body, sitting in a refrigerator for five days, and then reimplanted them. He waited a year and then measured encountered how, what percent grew. And he found that the ATP hypothermosol had a 70, some percent growth after five days, 73%. And the hypothermosol only, which is again, that interest solely balanced product had about a 44% growth. And the normal salient had 0%. So there, there can be variability in the growth in that first few hours, but that variability is exponentially increased after the first eight to 10 to 12 to 24 hours. And progressively beyond that, if you said, well, when the heck would you do a hair transplant that would last three days.



Well, nowadays with these larger fue sessions or complex fue sessions, I have sessions that go routinely into the second day. Not all the time, but I haven’t. Oftentimes for example, let’s say I’m going to do a complicated eyebrow restoration. I just had a gentleman just recently. I was eyebrow plus scalp, both of which were fue grafts placed into the eyebrows plus to beard harvest and beard, beard fue grafts place into the beard. Some of these grafts I saved overnight for the next day. Now, if I didn’t have a ATP hypothermosol, those grafts would have a very high chance of death. But given these studies, they’re showing that these graft survival rates are incredibly incredibly high, the other component of injury. So there’s three types of injury that occur. One is just cold injury.

Just the fact that you’re bringing it a temperature down of the surrounding temperature causes a cold injury. 

And some of those already talked about metabolic acidosis, et cetera, but cold reduces metabolism. So there’s a benefit to reducing the temperature. And there’s also a storage injury. Just the fact of taking the cells out of the body can cause a storage injury. We’ve talked about that. And the final component, which we didn’t really talk too much about is also known as what’s called ischemia reperfusion injury, which means that when the body’s out, when sorry, when the tissues out of the body, there’s an ischemia or lack of oxygen to the tissues. And when the, the tissues are re oxygenated plays back into the body, then those tissues start to have free radical damage. And those cells can die during the process of reoxygenation. And it takes about two to five days for those grafts are really securely be growing. And what do I do during that time?



Well, I’ve, I haven’t really talked about how I code it with PRP. And so I just don’t want to make this too long. It’s already a pretty long podcast, but as I briefly talked about in my regenerative medicine podcast, we also use ATP plasma light to spray because plasma light is actually unlike saline, pH neutral. And we spray that on the grafts during the procedure, during the entire procedure. And also you spray it for the first two to four days during the time that it takes for new blood supply to enter the grafts. It’s I call it like CPR for the grafts, and that has made such a big difference. 2010, I was doing PRP and ACL 2014. I added didn’t subtract the PRP, nasal have continued to use that, but I added ATP and hypothermosol, and seen some massively better improvements.



So summary is that even those storage media may play a smaller role in the graft survival. I think it plays a massive role given these constraints today and people that are just using saline or plasma light in general, just for graft storage and keep in mind. When I was on my plasma, I was talking about postoperative sprays and interoperative sprays. But one more time, our graft soaking and survival I’m using state-of-the-art hypothermosol, So when people are just using saline Ringer’s lactate, I really think this is outdated technology and it’s of course, saline is dirt cheap. You can get it for pennies on the dollar, whereas mine cost hundreds of dollars, but the difference is there’s so much better graft survival. In my opinion, I’ve seen it for now close to a decade.