Are adipose derived stem cell injections for androgenetic hair loss more effective than PRP with Acell?

Thank you for your question. This question is answered in full detailed video in the link below, including a study for adipose derived stem cells in pattern hair loss treatmentL 
You’re asking if adipose derived stem cell treatment for hair loss is better than PRP and Acell. You state you have female pattern hair loss or androgenetic alopecia. You’re aware that the adipose derived stem cell treatment is more expensive than PRP and Acell, and you want to know if it is better.
I can share with you my perspective on this which is something that comes up in our practice fairly frequently. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, based on a system used by us, developed by us for the past 7 years of using PRP with Acellular matrix, and having developed systems and algorithms of dosing and intervals unique to this system for both men and women with pattern hair loss or androgenetic alopecia.
The concept of treating female pattern hair loss begins with  the cause of female pattern hair loss. Besides the genetics, there is no known associated factor for female pattern loss, as opposed to male pattern hair loss where there is awareness of dihydrotestosterone or DHT that’s a variable that Is potentially treatable in male pattern hair loss.
For female pattern hair loss, the only pharmaceutical intervention is minoxidil 5% foam, which was relatively recently approved, but otherwise, there has been nothing else. When we started doing Acell and PRP combination over 7 years ago, we were doing it for hair transplant surgery to improve the healing and yield of the hair grafts, and healing the donor area. A side effect in some patients was thinning hair became thicker, so it became an opportunity for me to look into using this as a way to treat hair loss.
We have to understand there is no cure for hair loss, so what we are doing is managing hair loss. What we learned from our clinical experience is a specific concentration of Acellular matrix and platelet-rich plasma injected in a specific way can reactivate hair that isn't growing. That means when hair is thinning, the growth cycles get shorter, and the resting phases get longer. By definition, there are more hairs in the resting phase, greater than the normal percentage of 8-10% of hairs not actively growing because of the prolonged resting phase. Stimulation of hair growth is observed by the reactivation and growth, and we also see thinning hairs becoming thicker, so the hair quality improves. You add numbers with quality, then you get better coverage.
What we learned over time is patients come with different lengths of hair growth cycles, depending on a lot of variables. We ultimately created an algorithm a based on gender, age of onset, duration of hair loss, rate of progression of hair loss, and degree of hair loss, in addition to other hormonal factors for women.
That said, with TrichoStem™ Hair Regeneration, we have been able to get consistent improvement with the overwhelming majority of women with female pattern hair loss. Sometimes, there is a mixed picture where a female pattern hair loss patient will also have hormonal irregularities not detected by blood tests. There are some patients who also happen to have some degree of chronic telogen effluvium or shedding due to stressors. However, the mechanism of action is still unclear.
One variable probably contributing to this is based on the work done using fat, which is where we also look at the adipose derived stem cells. The premise is with liposuction, then processing of what’s known as stromal vascular fraction or SVF, you can inject fat cells into the scalp, and get a fat grafting effect.
What is a common thread between the two procedures? As is observed when we use PRP and Acell into the skin, the fat cells improve, shown in study after study in histology. Basically, stimulating fat cells has benefit to skin, so we can transfer that idea into better and more stem cell activity in the scalp, probably resulting in some positive benefit in the fat cells, which thereby affects the hair growth cycles.
So which is better? As a cosmetic surgeon, liposuction has been a very big part of my practice, so harvesting fat is no problem. My objection to fat transfer or fat grafting compared to Acellular matrix and PRP is that first, is it worthwhile to put a patient through fat harvesting, then fat placement? Placement of fat in the scalp is more traumatic than injecting Acellular matrix and PRP. That trauma has a risk of inflammation and bleeding.
A recent study I believe done in behalf of a particular medical fat processing device was done in a small group. I believe it was 10 people where fat was harvested and processed, and were able to show some benefit in a handful of those patients. Only 6 of them remained in the study, and several were lost to follow-up. The numbers are too small to make a significant comparison, but we can conclude fat transfer had some benefit in hair growth in some patients in the study.
When we look at our own history treating patients with Acellular matrix and PRP and developing Hair Regeneration with the algorithm, there is no advantage I can see of using fat grafting over the injection of Acell and PRP. It may change if we find something better.
In management of hair loss, we have to think of growth cycles, longevity, and maximizing sustainability. That means timing of injections when  more than one injection necessary. It’s very difficult for patients to undergo multiple fat grafting sessions, and go through the risk, trauma, and amount of swelling associated. One patient in that small study had a hematoma, meaning there was a lot of bleeding under the scalp, and that complication in my opinion is avoidable when using Acellular matrix and PRP.
You should look into the options because with Acell and PRP, not all practitioners are equal. It’s important you find a practitioner who has extensive experience with female pattern hair loss, the use of Acellular matrix and PRP, and not part of the overwhelming group of people joining the parade and doing it for only a relatively short period of time, and still learning how to use it. It’s important to understand there is a necessity for customization to get the best outcome in managing hair loss, whether it’s for women or for men.
In conclusion, thus far, I would not recommend adipose derived stem cells over Acellular matrix and PRP. I hope that was helpful, I wish you the best of luck, and thank you for your question.

There are many studies showing the efficacy of PRP with ACell benefits for hair loss. One study showed all patients studied had benefits ranging from about 60% to 100% improvement over their baseline density. I've been informed that there are studies currently being done comparing PRP/ACell vs PRP/ADSC (nanofat). Preliminary results have shown a better benefit in the arm of the study using ADSC's. I believe that this make sense because the ACell is not human derived and ADSC's are your own stem cells. Please also remember that most PRP is not highly concentrate or High Density (HD). The ideal concentration of platelets is 6x or about 1.5 million/ml. There are many systems which get about 2x and those aren't very effective.