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

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  

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)  

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  

Androgenetic  Alopecia  

96%  

4%  

HAIR  LOSS  CAUSES  

AGA  Other  

!   Hereditary  :    ♀♂  

!   Androgen  Receptors  

!   Progressive  

!   Patterned  hair  follicle  miniaturization  

!   Shorter/Finer/Thinner/Less  Pigmented    

 

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  

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  light extracellular  matrix  deposi4on   growth  factor  produc4on

cell  prolifera4on  &  mo4lity  an4-­‐apoptosis  and  pro-­‐survival

Gene    transcrip4on signaling

-­‐  M.  Hamblin  

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  AGA  HairMax  LaserComb  9  x  5mW      at-­‐home  Lexington  Int’l,  LLC      

#K091496,  Nov.  13th  2009  650nm    female    AGA  MEP90      82  x  5mW  in-­‐office  Midwest  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,  2009  Device:    MEP90  Hair  Growth  Stimulation  System    Manufacturer:    Midwest  RF    

 

LLLT  Dosing  Strategy  !   Wavelength  

!   635-­‐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  Devices  !   650  nm  

!   5mW  X  224  Diodes  

!   80%  Duty  Cycle  

!   30  Minutes  

!   Hands-­‐Free  

!   Rechargeable/Cordless  

!   Significant  coverage  

!   High  compliance  LaserCap™  

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?”  

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  

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.      

References  (con’t)  

Bauman  Medical  Group  

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