DrBauman

It is certainly very exciting to see such a lively discussion regarding laser therapy on this forum. A healthy skepticism is certainly understandable. In fact I, too, was a skeptic back in 1999 before I acquired my first in-office phototherapy unit from Sweden. For those of you who may not know, for over a year we did not charge patients for this treatment and we tracked patients using laser therapy (ALONE, without other treatments). At that point in time, I essentially set out to DISPROVE that the therapy worked--not only to myself, but also to the local distributor. Now, I can say that certainly it was NO MIRACLE CURE, and some patients simply DID NOT achieve any measurable results. However, many of those patients did see a reversal of minaturization and an improvement in hair texture. Those were the patients that encouraged me to continue offering the therapy. In the nearly EIGHT years since, we've treated hundreds of patients with laser therapy and it has been an integral part of my hair restoration practice. I am happy to provide my patients with a non-chemical, non-invasive treatment that is effective. Certainly, improving hair quality or simply achieving minor improvements in coverage of certain areas of the scalp is not going to satisfy all patients. For those who are, as yet, not familiar with the science of phototherapy (which has been around for around 25 yrs or so), including its cellular effects, I would direct them to the medical and scientific literature, like that found at http://www.laser.nu for example. When it comes to hair loss, it's true, the studies are just starting to come to the forefront, but the anecdotal reports appeared in text books from years ago. One study in particular was presented two years ago at a medical conference is summarized below. It suggests that light-energy can have a cellular effect that mimicks that of minoxidil. This may be a clue to the mechanism of Low Level Laser Therapy and its effect on the dermal papilla cells of the human hair follicle... ABSTRACT: LED PHOTOMODULATION INDUCED HAIR GROWTH STIMULATION Robert Weiss, David H. McDaniel, Roy G. Geronemus, Margaret Weiss Maryland Laser Skin & Vein Institute, Hunt Valley, MD Laser Skin & Vein Center of Virginia, Virginia Beach, VA Laser & Skin Surgery Center of New York, New York, NY Background & Objective: The ability to stimulate human scalp hair growth is well established. Oral finasteride inhibits 5-alpha reductase (5-AR). Topical minoxidil stimulates vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), and matrix metalloproteinase (MMP-2). LED photomodulation modulates the activity of genes in human skin. This study investigates the effects of LED photomodulation on human dermal papillae cells (HDP) in culture and in clinical trials. Study Design/Materials & Methods: Male and female HDP cells were exposed to LED arrays. Variables included wavelength, energy, and pulse duration. Gene expression of 5-AR, HGF, MMP-2 and others were measured using RT-PCR and microarrays. Results: Different protocols produced significant distinctive effects on gene expression. Relative expression of 5-AR by RT-PCR ranged from -3.6 to +2.0 depending on the LED parameters. For example, one LED array produced VEGF (+1.8), HGF (+2.0), MMP-2 (+2.7) and 5-AR (0). This pattern resembled minoxidil rather than finasteride and was selected for a pilot clinical trial. Hair growth stimulation was observed. Conclusions: LED photomodulation using visible light can alter the expression of genes associated with stimulation of hair growth. This effect is dependant upon treatment parameters Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/lsm.20164 Presented at American Society for Laser Medicine and Surgery Annual Meeting"???Orlando, April 2005. I appreciate all of your questions and comments. Sincerely, Dr. B.

I don't think it is reasonable to expect the general public to really understand exactly what to expect from ANY type of therapy (minox, fin, transplants, laser, etc.) until they've spoken with a physician who can evaluate their current situation and goals. It's kind of like the average guy going to the gym and thinking he's just a couple of sit-ups away from six-pack abs. His personal trainer will let him know it's going to take more than just sit-ups and that it's going to take months, not weeks. The analogy works becasue a good personal trainer (or hair doc) will help his clients (patients) set appropriate goals, realistic expectations and time-frames. When Propecia was first approved 10 years ago, and the studies were published, most of us hair docs didn't really know exactly what to expect from the therapy. We knew it was beneficial, but by how much? Certainly, I learned what kind of reversal of miniaturization I could expect to see from prescribing it a few hundred times and following the patients' results. Some patients surprise us by how much they respond to the non-invasive therapies, some because they don't realize how much they've responded, and some because they don't respond, period. --Dr. B.

NoBuzz, I posted the abstract for the article--the physicians are listed there as well as many others who have reported unwanted (unexplained) hair stimulation with laser hair removal treatments. As I am sure you know, 10% increase in terminal hair density is about what you get with minoxidil. And, as I have said MANY times, laser phototherapy (much like minoxidil) is NOT a miracle cure. All of us know that minoxidil (or even Propecia) can't come close to what hair transplantation can do in terms of replacing lost coverage, but certainly few can argue that minoxidil is not an effective treatment, right? Minoxidil's effectiveness is well documented in the scientific literature, and by those who stop using it. My point is that laser therapy is NOT a substitute for hair transplantation--but it does have a role. It is important to keep in mind that the non-invasive treatments work in a very different way than the invasive ones. If someone needs fewer transplants because of the non-invasive treatments, that's a good thing. Whether it's worth the effort or expense is a personal decision each patient needs to make on his or her own. In terms of the skepticism--that's also a good thing. I was certainly a huge skeptic until I saw the hair changes first hand. When I went to medical school, there were no classes on how lasers or light-energy effects cellular metabolism, wound healing, etc. Today, it's being researched at institutions like Harvard and MIT: (e.g. "Lasers Stimulate Wound-Healing) In my practice back in 1999 we did not charge a single patient for the therapy for over a year. (Please note that I've treated MANY more patients with in-office laser units than with hand-helds.) Healthy consumer and physician skepticism will also help motivate the manufacturers of these devices to support more studies. Part of the problem right now is exactly what has been mentioned: in some clinics and online, men and women will be sold hand-held lasers or in-office laser regimens whether they are a "good candidate or not." If these patients or "laser-testers" are hoping for hair transplant coverage from a laser, they're going to be sorely disappointed. Just like with transplantation--appropriate expectations are critical for success. --Dr. B.

New, Peer-Reviewed Scientific Report (April 2007): Hair Growth Stimulation in Laser Hair Removal Patients. Physicians from Spain report that over 10% of 543 hair removal patients experienced hair stimulation from a laser hair removal treatment. This phenomenon occurred within the treated area and also in area adjacent to the treated area. It is postulated by the physicians in the report that 'sub-therapeutic' energy that was delivered to the area induced terminal hair growth. They identified the most important 'risk' of this unwanted, paradoxical terminal hair growth as the 'presence of fine hair growth' within the treated area. (p.300) Scientific reports such as these give us some clues as to which hereditary hair loss patients might be a good candidate for laser hair therapy. Follow this link to download the .pdf version of the published report: http://baumanmedical.typepad.com/follicleblog/2007/05/ipl_hair_remova.html Lasers in Surgery and Medicine 39:297-301 (2007) "Hair Stimulation Following Laser and Intense Pulsed Light Photo-Epilation: Review of 543 Cases and Ways to Manage It"

Bill, I wouldn't disagree that laser therapy requires more resarch. The catalog of 3000 papers is just scratching the surface of how low level laser therapy affects cell-metabolism and living organisms. (Most of the papers can be found at www.laser.nu) Of course, with hair loss, there are very few studies. It is important to remember that it took YEARS before propecia was recommended more than "rarely" in the field of hair restoration--even after the research and FDA approval. However, not many would admit to 'sneering' at Propecia back then... and how long it took them to feel comfortable recommending the treatment. Also, I would NEVER advocate the lasercomb as being the end-all be-all... especially with so many new medical-device versions that are coming to market. There are literally dozens of laser devices that are now available, in-office and home units--each with their own pros and cons. Keep in mind that only a very small handful of patients are here in the htn forums--so sometimes we can get a distorted view... For those looking for a '3rd party testimonial' of a laser patient, here's a laser-related article for you from a South Florida paper: http://www.palmbeachpost.com/accent/content/accent/epap...04/14/0414laser.html April is a patient of mine who had a good result using only pure laser therapy. The reporter first visited my office in 2002, about two and a half years after I started using laser therapy. The conclusions from initial research is quite clear. I would once again encourage anyone interested to READ what the FDA has published.http://www.fda.gov/cdrh/pdf6/K060305.pdf The increase in terminal hair density was statistically significant. I would argue that this document makes laser therapy a little less of 'a big unknown.' Does it not? Dr. B.

I think we can all agree that medications like propecia/finasteride and minoxidil only work on follicles that are still alive, right? Meaning, both minoxidil and propecia DO NOT create new density, they simply reverse the miniaturization resulting from MPB. (All of us who treat or suffer from hair loss know that a hair does you no good if you can't see it.) When you read the literature on minox or fin, the increased density over time is actually increased TERMINAL hair density. That means that the intermediate, 'indeterminate,' vellous or near-vellous hairs were not counted. Over the years, I got a few calls from David Michaels (LaserComb/Lexington, Intl) regarding 'terminal hair' and its definition, so I'm assuming that this was an important issue for the FDA. In the Lexington 510(k), under "Performance Data" it specifically says: I can tell you from personally seeing several of the photos from the study that this is true. There was a reversal of miniaturization of hair on the microscopic photos. Also, when the lasercomb data was presented in Orlando this Spring, it was all about the increases in TERMINAL HAIR density. (This would also explain why clinically laser works better on those patients who have more hair.) Hopefully, they'll publish the data in a peer-reviewed journal, so we can all dissect it!

Click the link to see the video from the eyelash transplant procedure featured on the Show. --Dr. B.

As I mentioned previously, the results take time and are typically most noticeable in the areas where the thinning is actively occurring (i.e. NOT the bald areas). Also, previously mentioned, I DON'T think its a ciruculation issue. The research points more toward cellular ATP production in the mitochondria. For more info on laser therapy mechanisms, buy the textbook: http://www.amazon.com/Science-Low-Power-Laser-Therapy/dp/9056991086 by Tiina Karu--she's responsible for a large portion of the research into how lasers affect cellular metabolism. --Dr. B.

Actually, I have plenty of photos. In my practice, I've used laser therapy since 1999--hand-helds and in-office units... Sometimes in conjunction with other therapies but many times without other treatments (just pure laser). But today, most patients in my practice are using at least two of the three fda-cleared therapies. Laser's greatest benefit is not the increase in density (which is what the fda looked at for proof), but the incredible increase in the quality of the hair growth you get. Also, I believe that the increase in blood circulation is a consequence of the hair growth, not the other way around. Here's a patient photo from my recent Laser Therapy lecture at the ISHRS conference in March: The FDA documents are pretty clear about their position on laser therapy (promoting hair growth, etc.). The 510(k) also summarizes the clinical trials that were submitted. If you haven't seen the document, here it is: http://www.fda.gov/cdrh/pdf6/K060305.pdf Laser is just another new tool. It is now up to us docs to figure out how to use it, who will benefit the most?, etc. A lot more research is needed. It is normal and natural for docs and patients to be skeptical--in the beginning, I was the biggest skeptic. The last thing we need in the industry is another 'snake oil' therapy. For those that don't remember, when the FDA approved Propecia in 1997, less than 5% of physicians in the ISHRS prescribed it initially. We already had 10% of ISHRS members recommending laser therapy "OFTEN," back in 2005--before the FDA-clearance. Check page 27 of the census survey: http://www.ishrs.org/PDF/ISHRS2005PracticeCensusReportFINAL10.23.05.pdf My gut feeling is that the more hair you have, the better results you'll see with the laser. It is not really all that different than finasteride and minoxidil in that way. -Dr. B.

The NBC TODAY SHOW clip on hair loss, hair regrowth, hair transplants, Propecia, Rogaine and Laser Therapy is up on YouTube.com. Here is the link: Enjoy! --Dr. B.

For those of us on the 'front-line' in the battle against hair loss, it was with great excitement that we learned of the recent FDA-clearance of a hand-held laser for the treatment of hair loss. Having used laser therapy in my hair restoration practice since 1999, alone as well as with other FDA-approved therapies (like Propecia and Rogaine) and hair transplantation, the clearance did not come as a surprise. However, the FDA-clearance of the first hand-held laser (and others not far behind) for hair growth should add significant confidence to those who may have been skeptical of this non-chemical, non-invasive therapy's ability to promote hair growth. In the wake of the FDA-clearance, Bauman Medical was contacted by NBC's TODAY Show's Janice Lieberman, who was reporting on the medical hair-growth treatments and procedures used by hair restoration physicians to slow, stop and reverse hereditary hair loss. I invite you to tune in to see Janice's interviews with our patients, which took place at the Bauman Medical Group's newly-expanded facility for Laser Therapy and Hair Transplantation in Boca Raton, Florida. The segment is due to air Thursday morning, March 15th, at 8am on NBC's TODAY Show. For more detailed information on the treatments and procedures used to help protect, enhance and restore hair, visit www.baumanmedical.com. I've also got some photos of the NBC visit on my flickr.com account. They interviewed more than a few paitients. I have heard from the producer that there is not time for all of the interviews. We'll all have to tune in to see which patients 'made the final cut.' Sincerely, Dr. B.

My thoughts on Shock Loss Prevention (in order of importance) 1) Technique & Instrumentation 2) Technique & Instrumentation 3) Technique & Instrumentation 4) Adjunctive hair growth treatments (propecia/minox) 5) Healing accelerator treatments (hyperbaric oxygen, low level laser therapy, copper-peptide) 6) Good nutrition (adequate protein intake) 7) Early identification & treatment of infection (if applicable) --Dr. B.

Good point. I do believe LLLT (low level laser therapy) has some benefit--I've seen some interesting responses from using phototherapy in my practice since 1999. However, the benefits should not be 'over-sold.' It would be like Pfizer promising a full head of hair using Rogaine... Minox is effective, but obviously has its limitations. The same holds true with light therapy. My opinion is that there is some kind of enhancing effect on the follicles that are still alive. Not every patient gets a result. Those with more hair do better--women especially. Bald skin, forget it. Miniaturized hair--some effect. We all know you have to stick to the fda-approved, 'tried and true' treatments first (propecia + minoxidil). But, if there's a non-chemical, non-invasive treatment that has no side effects with a chance of some moderate aesthetic benefit, why not? Some of the problem lies in the fact that it can be difficult for 'the user' to judge the results of his or her own progress. Personally, I track the progress of my patients with photos, digital and microscopic. Good photos are critical in the treatment of hair loss, as well as a physician-evaluation. (Starting a treatment without standardized photos would be like trying to judge the results of a weight loss program without stepping on the scale?) If treatments (whatever they may be), after an appropriate amount of time and compliance, are not reaching the patient's goals, we re-evaluate the situation and make changes. Sincerely, Dr. B. P.S. As an aside, it is appropriate to be somewhat wary of a hair loss evalutations performed and treatments recommended without a physician involved.

Thanks for the feedback. Women love to 'show off' the length of their new lashes. As you can imagine, sometimes I have to beg my male patients to cut their scalp transplants too... -Dr. B.

Actually, the wound-healing benefits of phototherapy and hyperbaric oxygen are well documented in the scientific literature. However, they do not replace good technique (minimal-depth incisions, low-tension donor closures, etc.) but, in my experience, they can certainly accelerate healing and have other benefits. I first became aware of hyperbaric oxygen therapy in my training at New York Medical College (where there was a large burn-unit on campus) and in my General Surgery training at Mt. Sinai and Beth Israel Medical Centers in Manhattan. Years ago, as a student, then an intern and resident, I was exposed to the use of Oxygen as treatment for non-healing wounds, burn victims, stroke victims and autistic children. It is interesting to note that the use of hyperbaric oxygen immediately after a follicular-unit hair transplantation procedure also SIGNIFICANTLY reduces discomfort--even the muscle soreness from just sitting in the chair for hours improves dramatically. Here's an example of the skin changes seen: This patient received a one hour treatment of 02 at about 2 atmospheres of pressure in a large hyperbaric chamber then returned to my office for photos. The immediate skin changes in patients who recieve hyperbaric oxygen are quite obvious on a consistent basis. In my practice, one to three HBOT (hyperbaric oxygen therapy) treatments are pretty much routine for years now, smokers and diabetics do up to ten treatments. Keep in mind that not all surgeons have access to this kind of facility. I'm lucky to have a private, high-quality facility about a mile away from my office. The treatments there cost about 1/10th of what they charge in the local hospital, about $200/hr. HBOT is quite safe and comfortable (relaxing, even)--as long as you know how to 'pop' your ears (like when you ride on an airplane). Quite a number of interesting studies appear in the medical literature regarding HBOT, wound healing, grafting, etc. Here is a small sampling: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed...&itool=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abs...s&list_uids=16604253 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abs...us&list_uids=1389055 Hyperbaric Oxygen is becoming increasingly more popular with cosmetic surgery procedures. Here's a link to some info on a plastic surgery website... http://yestheyrefake.net/HBOT_faq.htm Sincerely, Dr. B.

Here's a before and after photo of eyelash transplants w/ no mascara (less freaky?). The other photo showed the lengths quite long... check http://www.eyelash-transplant.com for more info.

There are all sorts of pillows available. I've provided these inflatable ones for our patients for years. They seem to work best and are adjustable. We also have a variety of neck pillows available for our patients DURING their procedures. Did I also mention the patient sits on a massager w/ heat during their procedure?

It's the 'Bauman Neck Pillow'... It's included in the post-op kit with all hair transplant procedures. --Dr. B.

After the grafts have been placed and checked, before the patient leaves the office, I usually place a very light and thin, but snug, bandage (almost like a jogging headband) around the temples and donor area. Between the grafts and bandage is a piece of non-adherent dressing material. (This is the same kind of material they use for burn patients in the hospital.) The patient is also given a special neck-pillow to use at night which helps prevent head movement, friction and accidental dislodging. Since these grafts are typically the first to be placed into position, the scabs are already quite 'solid' by the time the patient leaves the office. When the patient returns the next morning for the post-op scalp wash, the bandage is removed carefully by a member of the medical staff and the grafted area examined. Rarely, we might need to 'settle' some grafts that become elevated overnight. My staff and I examine the area quite carefully under magnification at that 24 hour visit. Unless the patient tries to remove the bandage, bumps or scratches his/her head, or is a very restless sleeper, there is little movement of the transplanted grafts. On the second day, the patient is already washing the transplanted and donor areas (no direct showerhead pressure, however) twice a day. I'll take a picture of the 'headband' and non-adherent dressings and post them here when I get the chance. --Dr. B.

Glad you liked the photos. As I am sure you understand, every case is different. However, the typical TP (temporal point) restorations I perform use about 100-200 grafts per point. If you already have some hair there, you'll be on the lower side. If the TP's are totally gone, you'll obviously be needing more grafts. Probably the most important thing--in terms of design--is making sure that the TP is in proportion with the location/height of the frontal hairline and that it blends nicely into both the temple-recession and sideburn. The hair-directions in both of those areas change quickly over a relatively small area of space. Temporal Points are a huge 'bang for the buck' in terms of numbers of grafts required (relatively few), as well as what they add to the aesthetic value of the hairline restoration and 'frame of the face' (a lot). Here are some more photos of an aggressive TP restoration. Patient "A.G." One session, 2500+ fu's restoring the hairline, temples and TP's. ~8 months post-op. For his age (20's), his extreme loss of the TP was somewhat unusual. Planning for his 'future-look,' with somewhat receded temples, was important. --Dr. B.

The first patient (KS) got around 2300, the second case (post-op healing) had over 2400 for sure. I have not measured the density in either case but I would estimate there to be a minimum of 40 fu/cm2 and probably more in some areas. Both hairline cases were done with 1mm incisions. I prefer to have a good variation in density across the hairline in a single pass and I like the central part of the hairline to have the highest density. --Dr. B.

Thank you for the kind words. Here's a patient whose scabs started flaking off in five days and was 'clean' in seven days. He used hyperbaric oxygen therapy, low level laser therapy as well as aggressive copper-peptide soaks all within the first few days: He was looking for a similar hairline restoration to the example I posted above. Looking at Joe's pictures, it looks like I prefer to 'round-out' the temple recessions a little more than Dr. Wong. I'll have to look back at some more photos, but I think I do it a little different for each patient. --Dr. B.

John, I couldn't agree more. On nearly every case, I'm addressing the temporal point to some degree--but it HAS to be in proportion to the hairline design. There has to be symmetry and balance to the hairline (frontal and temporal points) all the way around the frame of the face. Many surgeons ignore the temporal points and their results end up looking artificial, like a hairpiece: Too much hair in the front and deep recessions of the temporal point. Here's a frontal hairline restoration (including the temples and temporal points) I performed recently on K.S., a 34 yr old... He is about 10 months out from the single session of 2300+ grafts. Here's a closeup of the right temple and temporal point before and 10 months after the procedure. The hairs are lying very flat in the temporal point--this is critical. BTW, I have found that I don't need to use lateral slits to do this in most cases.

Re: swelling and bruising, I've noticed that with the use of smaller instruments and careful anesthesia, there is actually very little swelling and only minimal bruising (if any) with the procedure. Some women have absolutely NO bruising whatsoever. This was true of the patient from the Los Angeles workshop. Normally, we would take 'after' photos when the results are grown in; with her, the after photos (seen on CNN and ABC news) were taken immediately after the procedure. Sincerely, Dr. Bauman Medical Director Bauman Medical Group

Actually, the results of eyelash transplantation can be quite consistent. Originally used for trauma patients (burns, car-accidents) and self-inflicted injury (trichotillomania), today eyelash transplants are being sought more often for women who simply want longer, thicker and more dense lashes. When I was asked to be on the faculty at the recent ISHRS Regional Live Surgery Workshop on Eyelash Transplantation, I demonstrated a gentle technique that implants pairs of follicles in a single stroke. This allows more follicles to be implanted per session into the lid. Here's an average result from the procedure: For more before and after photos, videos and news regarding the eyelash transplant procedures I routinely perform, please visit www.eyelash-transplant.com Sincerely, Dr. Bauman Alan J. Bauman, MD Medical Director www.baumanmedical.com Boca Raton, FL 561-394-0024