Medical Management of Hair Loss for the Integrative Medicine Practice - Dr Alan Bauman

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Medical Management of Hair Loss
For the Integrative Medicine Practice 5/15/14
Workshop Director:
Alan J. Bauman, M.D. – Diplomate, American Board of Hair Restoration Surgery
Course Description:
Hair loss affects roughly 35 million men and 21 million women in the United States. Forty percent of men will have noticeable hair loss by age thirty‐five and sixty‐five percent of women will have noticeable hair loss by the time they are sixty years of age. Hereditary hair loss, or Androgenetic Alopecia, has cosmetic implications often associated with the aging process, can also be an indicator of other imbalances or disease within the human body. Because chronic and progressive hair loss often deeply impacts the quality of life of its sufferers, the negative psychosocial implications for the hair loss sufferer as well as the positive benefits of treatment should be strongly taken into consideration.
Learning Objectives:
In this one-day module, the participants will learn about the etiology, diagnosis, psychosocial impact and non-surgical management of androgenetic alopecia from hair loss expert, Alan J. Bauman, M.D. The anatomy and physiology of hair follicle structure and function and phases of the hair cycle will be explained in detail. Participants will learn about hair loss risk factors such as genetics, the effects of hormones, hair loss associated with the use of specific medications and supplements, in addition to medical conditions that influence hair follicle function and how to identify them. Participants will learn how to consult with the hair loss sufferer, evaluate and scientifically measure hair loss via cross-sectional trichometry, high-powered dermoscopy and global photography. They will learn to diagnose using the standard Norwood-Hamilton and Ludwig-Savin scales as well as identify and rule out non-hereditary hair loss with the purpose of developing a realistic short and long-term treatment plan. Exploration of the various modalities to combat hair loss will be discussed including the importance of hormone balancing, basic knowledge of herbal/natural remedies, mechanism and protocols of laser and light-based devices, pros and cons of traditional and pharmacy-compounded medical therapy, as well as the latest information on the application of cell therapy, growth factors and stem cells will be discussed. Instruction will be given on how to create a customized results-oriented treatment, tracking and follow-up/compliance protocol for patients suffering from common female and male pattern hair loss. Attendees will also leave this session with suggested office space plans, patient flow and staffing recommendations for incorporating the medical management of hair loss into their practice as either a stand-alone service or as an integrated part of their existing treatment offerings.
Join us for the preconference workshop on May 15, 2014 at A4M Conference held at the Orlando Gaylord Palms. Register at hai.rs/a4mhair514

Medical Management of Hair Loss for the Integrative Medicine Practice - Dr Alan Bauman

  1. 1. ©2014BaumanMedicalGroupAllRightsReserved. MEDICAL MANAGEMENT OF HAIR LOSS FOR THE INTEGRATIVE MEDICINE PRACTICE Alan J. Bauman, M.D. American Academy of Anti-Aging Medicine Pre-Conference Workshop Preview A4M WORKSHOP DATE: May 15, 2014 Orlando Gaylord Palms
  2. 2. ©2014BaumanMedicalGroupAllRightsReserved. DISCLOSURES The following conflicts of interest are pertinent to this author’s presentation: NONE Please note: This presentation discusses FDA-approved and non FDA-approved / off-label use of medications for intervention. This presentation discusses FDA-cleared and non FDA-cleared / investigational medical devices.
  3. 3. ©2014BaumanMedicalGroupAllRightsReserved. WHY HAIR LOSS MANAGEMENT TREATMENTS? • Simple to integrate into existing age-management practice • Elective treatments are performed on a cash basis and are not dependent on insurance reimbursements. • High patient satisfaction associated with treatments that help patients look and feel good. • Treatments are generally low-risk, patients are generally healthy. • Effective hair loss treatments are in high demand for the aging population.
  4. 4. ©2014BaumanMedicalGroupAllRightsReserved. REVENUE SOURCES • Low Level Laser Therapy (in-office) $4,000/yr/patient • Laser Therapy (devices) $300-$3500 • PRP Hair Restoration up to $2500/session • Dispensing of Prescription and Non-Prescription Items • Compounded Minoxidil Formula 82M • Propecia/Compounded Finasteride (FinPlus) • Latisse/Bimatoprost • Hair Transplantation procedures $5,000-$20,000+
  5. 5. ©2014BaumanMedicalGroupAllRightsReserved. ALAN J. BAUMAN, M.D. • M.D. w/ ‘Cor et Manus’ award – New York Medical College • General Surgery – Beth Israel Medical Center, NY • General Surgery – Mt. Sinai Medical Center, NY • Hair Transplant Fellowship – Eastwood, NY • Bauman Medical Group – Boca Raton (est. 1997) • Diplomate, American Board of Hair Restoration Surgery • American Academy of Anti-Aging Medicine • American Hair Loss Association • American Hair Loss Council • International Society of Hair Restoration Surgery • International Alliance of Hair Restoration Surgery Alan J. Bauman, M.D.
  6. 6. ©2014BaumanMedicalGroupAllRightsReserved. BAUMAN MEDICAL GROUP – BOCA RATON, FL • Exclusively treat men and women with hair loss. • 1000 patients/year, 250+ hair transplant procedures • 14 staff members • 5,000 sqft – expanding to 11,000+ sqft • 4 operation rooms • 50:50 male:female patients • Pro Bono hair transplants via “Operation Restore”
  7. 7. ©2014BaumanMedicalGroupAllRightsReserved. OBJECTIVES • Prevalence & psychological impact of hair loss in men & women • Etiology of common forms of hair loss • Evaluation and Diagnosis of hair loss • Effective multi-therapy regimens, Treatments & Tracking • Getting Started! MAY 15TH 2014 PRECONFERENCE WORKSHOP AT A4M ORLANDO REGISTER: WWW.A4M.COM - OR - http://hai.rs/a4mhair514
  8. 8. ©2014BaumanMedicalGroupAllRightsReserved. HAIR LOSS
  9. 9. ©2014BaumanMedicalGroupAllRightsReserved. • Affects roughly 35 million men in the US • 40% of men will have noticeable hair loss by age 35 MALE HAIR LOSS PREVALENCE
  10. 10. ©2014BaumanMedicalGroupAllRightsReserved. • Hair loss affects roughly 21 million women in the US • 65% of women will have noticeable hair loss by age 60 FEMALE HAIR LOSS PREVALENCE
  11. 11. ©2014BaumanMedicalGroupAllRightsReserved. IMPACT OF HAIR LOSS Premature Aging Embarrassment Emotional Distress ↓ Body-image satisfaction ↓ Self-esteem ↓ Self-confidence Socially & Professionally The psychosocial consequences of androgenetic alopecia Authors: Cash T.F.1; F.cash T.*Source: British Journal of Dermatology, Volume 141, Number 3, September 1999, pp. 398-405(8) Publisher: Blackwell Publishing
  12. 12. ©2014BaumanMedicalGroupAllRightsReserved. HAIR FOLLICLE – BASIC SCIENCE
  13. 13. ©2014BaumanMedicalGroupAllRightsReserved. HAIR FOLLICLE ANATOMY
  14. 14. ©2014BaumanMedicalGroupAllRightsReserved. HAIR FOLLICLE CYCLING • Anagen • Catagen • Telogen
  15. 15. ©2014BaumanMedicalGroupAllRightsReserved. ETIOLOGY: WHAT CAUSES HAIR LOSS?
  16. 16. ©2014BaumanMedicalGroupAllRightsReserved. COMMON TYPES OF HAIR LOSS • Alopecia Areata • Androgenetic Alopecia • Trichotillomania • Telogen Effluvium • Anagen Efffluvium
  17. 17. ©2014BaumanMedicalGroupAllRightsReserved. MALE ANDROGENETIC ALOPECIA
  18. 18. ©2014BaumanMedicalGroupAllRightsReserved. ♂ ANDROGENETIC ALOPECIA (HEREDITARY MALE PATTERN HAIR LOSS) Men: DHT-mediated miniaturization of hair follicles Testosterone Dihydrotestosterone (DHT) 5-αR • Shorter growth cycles • Less pigmentation • Decreased Caliber
  19. 19. ©2014BaumanMedicalGroupAllRightsReserved. DHT-MEDIATED HAIR FOLLICLE MINIATURIZATION HairCam Microscope 60x
  20. 20. ©2014BaumanMedicalGroupAllRightsReserved. DHT-MEDIATED HAIR FOLLICLE MINIATURIZATION NORMAL MINIATURIZED
  21. 21. ©2014BaumanMedicalGroupAllRightsReserved. ♀ ANDROGENETIC ALOPECIA(HEREDITARY FEMALE PATTERN HAIR LOSS) Women: ‘highly-sensitive’ hair • Hormone ‘Imbalance’ • PCO • Childbirth • Menopause /TAH • Androgen Sensitivity • Medications • Illness • Stress • Nutrition • Environmental/Social Ludwig-Savin Scale
  22. 22. ©2014BaumanMedicalGroupAllRightsReserved. TREATMENT MODALITIES FOR HAIR LOSS • Risk Reduction • Pharmaceutical • Nutraceutical • Laser Therapy • Cell Therapy • Hair Transplantation
  23. 23. ©2014BaumanMedicalGroupAllRightsReserved. PHARMACEUTICAL TREATMENT FOR HAIR LOSS
  24. 24. ©2014BaumanMedicalGroupAllRightsReserved. PHARMACEUTICAL TREATMENTS • Topical Medication – stimulate / enhance hair growth • OTC Minoxidil (2%, 5%, Rogaine, Generic, Foam) • Compounded Rx Minoxidil (Formula 82M)* • 10-14 drops / Twice a day, every day • Oral Medication (for Men) – reduce DHT • Propecia (finasteride 1mg) – daily prescription pill • 9 of 10 keep the hair they have or improve • 2% have side effects • Compounded Finasteride (FinPlus)* *off label
  25. 25. ©2014BaumanMedicalGroupAllRightsReserved. MEDICAL THERAPY: RESULTS
  26. 26. ©2014BaumanMedicalGroupAllRightsReserved. FINASTERIDE RESULTS 30 y/o Male / Finasteride 1mg ONLY: baseline, 10 months
  27. 27. ©2014BaumanMedicalGroupAllRightsReserved. FINASTERIDE RESULTS 30 y/o NW5, Finasteride x 5 months, no Surgery 49 y/o start finasteride at time of frontal surgery, 10 months; note: crown improvement Courtesy: Alan J. Bauman, M.D.
  28. 28. ©2014BaumanMedicalGroupAllRightsReserved. MINOXIDIL RESULTS (BEFORE & AFTER 6MOS) COMPOUNDED MINOXIDIL FORMULA 82M
  29. 29. ©2014BaumanMedicalGroupAllRightsReserved. NUTRACEUTICAL OPTIONS
  30. 30. ©2014BaumanMedicalGroupAllRightsReserved. VITAMINS & PHYTONUTRIENTS • Bioactive ingredients derived from plants • Beneficial for • Hair conditioning • Hair growth stimulation • Scalp dermatitis • Anti-microbial agent
  31. 31. ©2014BaumanMedicalGroupAllRightsReserved. PHYTONUTRIENTS FOR IMPROVED HAIR GROWTH • Promote hair growth secondary to: • Increased blood flow • Activation of dermal papilla • DHT inhibition • Anti-inflammatory effects • Increased nutrition
  32. 32. ©2014BaumanMedicalGroupAllRightsReserved. • Asiasari • Proanthocyanidins • Saw Palmetto / Serenoa Repens • Ginkgo biloba • Aloe • Bergamot • Ginseng • Henna • Hibiscus • Ilicium • Biotin • Atragalus Root • Poria Cocos • Rehmannnia • Nettle Leaf • Horsetail PHYTONUTRIENTS PROMOTING HAIR GROWTH
  33. 33. ©2014BaumanMedicalGroupAllRightsReserved. • Saw palmetto • Azelaic acid • Zinc • Vitamin B6 • Linoleic acid • Oleanolic acid NUTRIENTS THAT MAY INHIBIT DHT Sereona Repens / Saw Palmetto
  34. 34. ©2014BaumanMedicalGroupAllRightsReserved. LOW LEVEL LASER THERAPY
  35. 35. ©2014BaumanMedicalGroupAllRightsReserved. LOW LEVEL LASER THERAPY • Cytochrome-C-Oxidase • ATP production • non-ionizing • non-thermal • non-mutagenic • no side-effects growth factor production extracellular matrix deposition cell proliferation & motility anti-apoptosis and pro-survival Gene Transcription
  36. 36. ©2014BaumanMedicalGroupAllRightsReserved. LOW LEVEL LASER THERAPY ~5 months of LLLT in-office
  37. 37. ©2014BaumanMedicalGroupAllRightsReserved. LLLT - RESULTS Courtesy: Alan J. Bauman, M.D.
  38. 38. ©2014BaumanMedicalGroupAllRightsReserved. LLLT - RESULTS Courtesy: Alan J. Bauman, M.D.
  39. 39. ©2014BaumanMedicalGroupAllRightsReserved. 6 MOS. OF LOW LEVEL LASER THERAPY Courtesy: Alan J. Bauman, M.D.
  40. 40. ©2014BaumanMedicalGroupAllRightsReserved. LASER THERAPY - LASERCAP LaserCap Regimen: 30min. every other day
  41. 41. ©2014BaumanMedicalGroupAllRightsReserved. LASER THERAPY - MALE PATIENT Before and After 6 Months of LLLT
  42. 42. ©2014BaumanMedicalGroupAllRightsReserved. SURGICAL OPTIONS
  43. 43. ©2014BaumanMedicalGroupAllRightsReserved. SURGICAL THERAPY: HAIR TRANSPLANTATION • Redistribution of ‘permanent’ follicles into thinning/balding areas • Donor Dominance • Follicular Unit Extraction “FUE” • Large sessions / tiny grafts • Artistic • Hairline location / shape • Hair Follicle angle, orientation, position • Pain-free computerized local anesthesia • Natural results Donor Area Naturally-occurring follicular units at 60x magnification
  44. 44. ©2014BaumanMedicalGroupAllRightsReserved. FOLLICULAR UNIT EXTRACTION
  45. 45. ©2014BaumanMedicalGroupAllRightsReserved. FUE / NEOGRAFT [MINIMALLY-INVASIVE DONOR HEALING] NO LINEAR SCAR Courtesy: Alan J. Bauman, M.D.
  46. 46. ©2014BaumanMedicalGroupAllRightsReserved. NEOGRAFT FUE BENEFITS • No Stitches, No Staples, No Linear Scar • Less Trauma, More Rapid, More Comfortable Healing • Less Activity Restriction Postoperatively • Useful for BHT (Body Hair Transplantation), Scar Coverage
  47. 47. ©2014BaumanMedicalGroupAllRightsReserved. 60 y/o Female 45 y/o Male
  48. 48. ©2014BaumanMedicalGroupAllRightsReserved. HAIRLINE + TEMPORAL POINT – 26 Y/O MALE
  49. 49. ©2014BaumanMedicalGroupAllRightsReserved. HAIRLINE + TEMPORAL POINT 31 Y/O MALE
  50. 50. ©2014BaumanMedicalGroupAllRightsReserved. CELL THERAPY & PRP IN HAIR RESTORATION
  51. 51. ©2014BaumanMedicalGroupAllRightsReserved. PRP FOR TISSUE REGENERATION • Platelets are storehouses for regulatory, signaling, and growth factor molecules that contribute to the recovery and healing of tissue. Dr. Joseph Purita uses PRP/Stem Cell Therapy to revive pitching career of Yankee Bartolo Colon.
  52. 52. ©2014BaumanMedicalGroupAllRightsReserved. PRP IN HAIR RESTORATION • Platelets are storehouses for regulatory, signaling, and growth factor molecules that enhance hair growth (stand-alone therapy) as well as healing after hair transplantation
  53. 53. ©2014BaumanMedicalGroupAllRightsReserved. GROWTH FACTORS • platelet-derived growth factor - PDGF • transforming growth factor beta - TGF-B • fibroblast growth factor • insulin-like growth factor 1 - IGF1 • insulin-like growth factor 2 - IGF2 • vascular endothelial growth factor - VEGF • epidermal growth factor - EGF • nerve growth factor - NGF • interleukin-1 – IL1-B • Interleukin-8 – IL8 • keratinocyte growth factor • connective tissue growth factor
  54. 54. ©2014BaumanMedicalGroupAllRightsReserved. PRP FOR ALOPECIA AREATA
  55. 55. ©2014BaumanMedicalGroupAllRightsReserved. PRP FOR ANDROGENETIC ALOPECIA Dr. Alan J. Bauman uses PRP plus Extracellular Matrix for hair regrowth
  56. 56. ©2014BaumanMedicalGroupAllRightsReserved. HAIRCHECK FOR COMPLIANCE/TRACKING • Cross sectional trichometry • Hair Bundle Measurements • Track Regrowth • Improve Compliance
  57. 57. ©2014BaumanMedicalGroupAllRightsReserved. THANK YOU! Join us for a full day of lectures! Thursday May 15th 2014 Register at www.a4m.com or http://hai.rs/a4mhair514 www.baumanmedical.com www.linkedin.com/in/alanjbauman www.twitter.com/dralanjbauman www.facebook.com/baumanmedical Alan J. Bauman, M.D.
  58. 58. ©2014BaumanMedicalGroupAllRightsReserved.

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