As more breakthroughs in the understanding of photomedicine and low level laser therapy occur, it is increasingly important for physicians to understand the role of low level laser therapy in the management of androgenetic alopecia (male and female pattern hair loss). This brief overview from the 19th Annual World Congress of Anti-Aging and Aesthetic medicine (A4M) in Orlando April 2011 followed Harvard/MIT professor, Dr. Michael Hamblin's detailed talk on the mechanisms of low level laser therapy.

1.
The Role of Low Level Laser Therapy !
in the Medical Management of !
Androgenetic Alopecia!
Alan J. Bauman, M.D.
Diplomate, American Board of Hair Restoration Surgery
19th Annual World Congress
American Academy of Anti-Aging and Aesthetic Medicine
Orlando, FL - April 8th, 2011

2. Disclosures
! The
following
conflicts
of
interest
are
germane
to
my
presentation:
NONE
! FDA:
510(k)-­‐cleared
and
cosmetic
devices,
off-­‐label*
medication
! Anecdotal
Case
Presentations
‘LaserSpa’
at
Bauman
Medical
Group

3. 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)

4. Overview
! Androgenetic
Alopecia
! Mechanisms
of
Laser
Therapy
(LLLT)
! Role
of
LLLT
in
Hair
Restoration
! Laser
Therapy
Dosing
Protocol
! Our
Experience
w/
Laser
Therapy
! Practical
Concerns

5. Androgenetic
Alopecia
! Hereditary
:
HAIR
LOSS
CAUSES
! Androgen
Receptors
4%
! Progressive
AGA
! Patterned
hair
follicle
miniaturization
Other
! Shorter/Finer/Thinner/Less
Pigmented
96%

6. Androgenetic
Alopecia
Multi-­‐Therapy
Medical
Management
! Eliminate/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

7. 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

8. growth
factor
produc4on
extracellular
matrix
deposi4on
near
infrared
light
cell
prolifera4on
&
mo4lity
an4-­‐apoptosis
and
pro-­‐survival
Gene
signaling
transcrip4on
-­‐
M.
Hamblin

9. FDA
510(k)
Clearances
#K060305,
Jan.
18th
2007
650nm
male
AGA
HairMax
LaserComb
9
x
5mW
at-­‐home
Lexington
Int l,
LLC
! ...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.
#K091496,
Nov.
13th
2009
650nm
female
AGA
MEP90
82
x
5mW
in-­‐office
Midwest
RF
prescription

10. FDA
510(k)
Clearances
(con’t)
FDA
510(k):
#K091496,
Nov
13,
2009
Device:
MEP90
Hair
Growth
Stimulation
System
Manufacturer:
Midwest
RF
! 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

11. LLLT
Dosing
Strategy
! Wavelength
Biphasic
Dose
Response
! 635-­‐670nm
! Total
Power
! #
diodes
x
output
(mW)
! Treatment
Area
! Duration
(min)
Tuner
J,
Hode
L,
Laser
Therapy
Handbook
(2004)
Prima
Books.
! Interval
–
too
short
v.
too
long
! Protocol:
Device
Dependent

12. LLLT
&
Hair

13. Cosmetic
Devices
! 650
nm
! 5mW
X
224
Diodes
! 80%
Duty
Cycle
! 30
Minutes
! Hands-­‐Free
! Rechargeable/Cordless
! Significant
coverage
! High
compliance
LaserCap™

14. Results
Tracking
! Patient
History
/
Intake
Questionnaire
! Physical
Exam
of
Scalp
&
Hair
! Standardized
Global
Photography
! Video
Microscopy
! Combined
Cross-­‐sectional
Hair
Bundle
Trichometry
! What’s
your
“HAIR
NUMBER?”

15. Densitometry
–
Canfield
Scientific

16. LaserCap
Results:

17. Laser
Therapy
in
Females
25
y/o
female
In-­‐office
Laser
Hood
2
/
week
x
6
months

18. LLLT
x
8
months
63
y/o
female
Laser
Therapy
regimen:
3x/wk
x
3
mo
1-­‐2x/wk
since
Photos
after
12mo.

19. 6
Months:
At-­‐Home
LLLT

20. 24
y/o
Female:
3
mos.
of
LLLT

21. Male
Patient
:
LLLT
x
6
mos

22. Male
Patient:
LLLT
x
12
mos

23. References
! National
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.

24. References
(con’t)

25. Bauman
Medical
Group
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