This document discusses the role of low level laser therapy (LLLT) in the medical management of androgenetic alopecia. It provides an overview of androgenetic alopecia and the mechanisms by which LLLT may stimulate hair follicles. It then describes the author's LLLT dosing protocol and experience treating patients, showing before and after photos demonstrating hair growth with LLLT. The document concludes by referencing supporting literature on LLLT for hair loss.

1. 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 Medicine
2nd International Hair Surgery Masters Course
October 13th, 2012 Paris, France

2. Disclosures
The following conflicts of interest are germane to my presentation: NONE
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. Low Level Laser Therapy
< 500 mW (5mW)
Non-chemical
630-670nm (650nm)
Non-invasive
Non-cutting/burning
Non-thermal
3,000 papers No side-effects
8 textbooks Photobiomodulation
6 societies
2 peer-reviewed journals

8. 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

9. growth factor production
extracellular matrix deposition
near infrared light
cell proliferation & motility
anti-apoptosis and pro-survival
Gene
signaling transcription
- Michael Hamblin, Ph.D. – Harvard/MIT

10. Photomodulation & Human Dermal Papilla Cells
April 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)

11. 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

12. 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

13. 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

14. LLLT & Hair

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

16. 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?”

17. Densitometry – Canfield Scientific

18. LaserCap Results:

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

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

21. 6 Months: At-Home LLLT

22. 24 y/o Female: 3 mos. of LLLT

23. Male Patient : LLLT x 6 mos

24. Male Patient: LLLT x 12 mos

25. 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.

26. References (con’t)

27. Bauman Medical Group
Boca Raton, Florida USA
THANK YOU!
doctorb@baumanmedical.com
www.twitter.com/DrAlanBauman
www.linkedin/in/alanjbauman