treating hair loss w/ low level laser therapy emaa-2012 paris
DESCRIPTION
Low Level Laser Therapy is a non-chemical, side-effect free option for those with hair loss and hair thinning. Does Laser Therapy actually work? What are the mechanisms of low level laser therapy on the scalp and hair follicle. Are there any adverse effects? Low Level Laser Therapy (LLLT) has been used for wound healing, pain control, lipolysis, anti-inflammatory properties and more. The mitochondrial-based cytochrome-c-oxidase molecule in the electron transport chain accepts the photon which then causes a cascade of events leading to increased ATP production and more. Over time, when hair follicles that are producing weak, thin, wispy hair are exposed to significant doses of LLLT at regular intervals improvement in hair quality can be seen and measured. As the delivery of LLLT has become easier for patients (portable) and more powerful over time due to the decreasing cost of laser-diodes, results have improved. Old-style hand-held devices are relatively weak and many head-worn units contain weak non-laser, non-coherent LED's. Newer devices like the cordless, rechargeable, 100% hands-free, discreet LaserCap and the hand-held Nutreve personal laser are making it easier for patients to achieve the results they seek. LaserCap contains 224 diodes at 5mw in a paper-thin circuit board that is sized to fit underneath a standard baseball hat, bandana or scarf. It's rechargeable battery pack makes it the most powerful, portable device available for hair loss patients. 30 min every other day. Nutreve's Personal Laser, hand-held rechargeable 35 diode unit contains the most diodes of any hand-held on the market today. 20 minutes over one area every other day. Patients can see thicker, fuller and healthier hair within a few months of use but it does not reverse severe baldness where depletion of hair follicle density has already occurred. Dr. Alan J. Bauman, M.D. [email protected] ABHRS CertifiedTRANSCRIPT
The Role of Low Level Laser Therapy in the Medical Management of
Androgenetic Alopecia
Alan J. Bauman, M.D.Diplomate, American and Int’l Board of Hair Restoration Surgery
European Masters in Aesthetic & Anti-Aging Medicine2nd International Hair Surgery Masters Course
October 13th, 2012 Paris, France
DisclosuresThe following conflicts of interest are germane to my presentation: NONE
LaserSpa at Bauman Medical Group
Alan J. Bauman, M.D.
Bauman Medical Group – Boca Raton, FL (1997)
New York Medical College
Beth Israel Medical Center – NY
Mt. Sinai Medical Center – NY
Hair Transplantation – NY
American Bd of Hair Restoration Surgery
American Hair Loss Association
Low Level Laser Therapy (1999)
OverviewAndrogenetic Alopecia
Mechanisms of Laser Therapy (LLLT)
Role of LLLT in Hair Restoration
Laser Therapy Dosing Protocol
Our Experience w/ Laser Therapy
Practical Concerns
Androgenetic Alopecia
96%
4%
Hair Loss Causes
AGAOther
Hereditary : ♀♂
Androgen Receptors
Progressive
Patterned hair follicle miniaturization
Shorter/Finer/Thinner/Less Pigmented
Androgenetic Alopecia
Multi-Therapy Medical ManagementEliminate/Reduce ‘Triggers’
• Medical conditions, meds, social habits, nutrition, stress, etc.
↓DHT production and/or Androgen Effects• Finasteride, Dutasteride*, Spironolactone*
Stimulate Hair Follicles• 2%, 5%, 6%* Minoxidil, 0.03%
Bimatoprost*, • Laser Therapy, Phototherapy, PRP
Redistribute (Transplant) Permanent Follicles• NeoGraft / FUE – no linear scar
Surgically Reduce/Remove Bald Areas• Scalp Reduction/Flaps
*off-label
Low Level Laser Therapy
< 500 mW (5mW)
630-670nm (650nm)
3,000 papers
8 textbooks
6 societies
2 peer-reviewed journals
Non-chemical
Non-invasive
Non-cutting/burning
Non-thermal
No side-effects
Photobiomodulation
Phototherapy/LLLT Concepts
Mechanism:Cytochrome–C–Oxidase
↑ATP production
Non-ionizing
Non-thermal
No side-effects Tuner J/Hode L, Laser Therapy, (2004) Prima Books
near infrared lightextracellular matrix deposition growth factor production
cell proliferation & motilityanti-apoptosis and pro-survival
Gene transcriptionsignaling
- Michael Hamblin, Ph.D. – Harvard/MIT
Presented at ASLMS Annual Meeting--Orlando, April 1st 2005
Presented at ASLMS Annual Meeting--Orlando, April 1st 2005
Effects of light on HDP gene activity in culture & clinical trials
VEGF (+1.8)
HGF (+2.0)
MMP-2 (+2.7)
5-AR (0)
Photomodulation & Human Dermal Papilla Cells
April 2005
FDA 510(k) Clearances
“...indicated to promote hair growth in males with androgenetic alopecia who have NW Class IIa-V…and does not present any safety issues”
“A Multi-Center, Randomized, Placebo-Controlled Study…”
“treatment group had significantly greater increases in terminal hair density than… placebo.”
#K060305, Jan. 18th 2007 650nm male AGAHairMax LaserComb 9 x 5mW at-homeLexington Int’l, LLC
#K091496, Nov. 13th 2009 650nmfemale AGA
MEP90 82 x 5mW in-officeMidwest RF prescription
FDA 510(k) Clearances
(con’t)
“Medically prescribed for the treatment of androgenetic alopecia in females.”
“After 20 treatments, 92% of subjects had increased hair count ≥10% with 57% demonstrating an increase of ≥30%”
“After 36th treatment, 97% of the subject population demonstrated increased hair count of ≥20%, 89% increased hair count ≥30%, with 57% demonstrating increase of ≥50%”
“87% of subjects indicated it helped their condition, 60% reporting slowing of hair loss by 10 weeks, 65% reported their area of hair loss had gotten smaller.”
In-Office / 650nm / 5mW x 82 diodes
FDA 510(k): #K091496, Nov 13, 2009Device: MEP90 Hair Growth Stimulation
System Manufacturer: Midwest RF
LLLT Dosing Strategy
Wavelength635-670nm
Total Power# diodes x output (mW)
Treatment Area
Duration (min)
Interval – too short v. too long
Protocol: Device Dependent
Tuner J, Hode L, Laser Therapy Handbook (2004) Prima Books.
Biphasic Dose Response
LLLT & Hair
Cosmetic Devices650 nm
5mW X 224 Diodes
80% Duty Cycle
30 Minutes
Hands-Free
Rechargeable/Cordless
Significant coverage
High complianceLaserCap™
Results TrackingPatient History / Intake Questionnaire
Physical Exam of Scalp & Hair
Standardized Global Photography
Video Microscopy
Combined Cross-sectional Hair Bundle Trichometry
What’s your “HAIR NUMBER?”
Densitometry – Canfield Scientific
LaserCap Results:
Laser Therapy in Females
25 y/o female
In-office Laser Hood
2 / week x 6 months
LLLT x 8 months
63 y/o female
Laser Therapy regimen:3x/wk x 3 mo
1-2x/wk since
Photos after 12mo.
6 Months: At-Home LLLT
24 y/o Female: 3 mos. of LLLT
Male Patient : LLLT x 6 mos
Male Patient: LLLT x 12 mos
ReferencesNational Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Q&A Alopecia Areata
Al-Mutairi N. (2007): 308-nm Excimer laser for the treatment of alopecia areata. Dermatologic Surgery 33(12):1483-1487.
Avram M.R., Leonard R.T.Jr., Epstein E.S., Williams J.L., Bauman A.J. (2007): The current role of laser/light sources in the treatment of male and female pattern hair loss. Journal of Cosmetic and Laser Therapy 9(1):27-28.
Bernstein E.F. (2005): Hair growth induced by diode laser treatment. Dermatologic Surgery 31(5):584-586.
Chung P.S., Kim Y.C., Chung M.S., Jung S.O., Ree C.K. (2005): The effect of low-power laser on the murine hair growth. Journal of the Korean Society of Plastic & Reconstructive Surgeons.
Satino J.L., Markou M. (2003): Hair regrowth and increased hair tensile strength using the HairMax LaserComb for low-level laser therapy. International Journal of Cosmetic Surgery and Aesthetic Dermatology 5(2):113-117.
Vlachos S.P., Kontoes P.P. (2002): Development of terminal hair following skin lesion treatments with an intense pulsed light source. Aesthetic Plastic Surgery 26(4):303-307.
Waiz M., Saleh A.S., Hayani R., Jubory S.O. (2006): Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata. Journal of Cosmetic and Laser Therapy 8(1):27-30.
Pontinen, PJ; et.al. Comparative effects of exposure to different light sources (He-Ne laser, InGaAl Diode laser, non-coherent LED) on skin blood flow of the head, Int J Acupuncture & Electro-therapeutics Research 1996 21(105-118). 670nm
Weiss R., McDaniel D.H., Geronemus R.G., Weiss M., LED Photomodulation induced hair growth stimulations, presented at ASLMS Annual Meeting – Orlando FL (April 2005), www.interscience.wiley,.com DOI.1002/lsm.20164.
References (con’t)
Bauman Medical Group
Boca Raton, Florida USA
THANK [email protected]
www.twitter.com/DrAlanBaumanwww.linkedin/in/alanjbauman
