In December of 2008, the FDA approved the first medication for eyelash growth, called Latisse (Allergan) containing Bimatoprost a prostaglandin F2a analog. This presentation discusses the basics of the research which led to the approval including side effects and off-label uses (like scalp hair growth). Presented by Alan J. Bauman MD at the International Society of Hair Restoration Surgery's Annual Scientific Meeting, Amsterdam, The Netherlands, July 2009.

1. FDA-Approval of Bimatoprost for Eyelash Growth Alan J. Bauman, M.D. Diplomate, American Board of Hair Restoration Surgery ISHRS Annual Meeting / Amsterdam 2009

2. Disclosures / COI The following potential conflict of interest relationships are germane to my presentation: NONE FDA-approved & non-FDA approved indications will be discussed 2

3. Overview Eyelashes & Eyelash Hypotrichosis Prostaglandin Analogs Latisse™ (bimatoprost 0.03%) Clinical Studies Photographic Results Side Effects Off-Label Use 3

4. Prostaglandin Analogs Travoprost (Travatan) Latanoprost (Xalatan) Bimatoprost (Lumigan / Latisse) Intraocular Pressure-lowering Agents No systemic side effects Increase in length, thickness, pigmentation, number of lashes Eyelid skin darkening Eye irritation bimatoprost travoprost latanoprost 4

5. (Bimatoprost 0.03%) 5 5. 1. 4. 2. 3.

6. Results: Primary Efficacy Endpoint Number (%) of subjects with ≥ 1-grade increase from baseline in Global Eyelash Assessment 6

7. Results:‘before’&‘After’16 wks 7

9. Eye redness

10. Hair growth outside of target area

11. Eyelid skin darkening

12. Eye irritation

13. Potential for iris darkening*

14. Intraocular pressure effects8

15. 16 wks x PG Analog + Tint + Perm: 9

16. Off-Label Bimatoprost Use: Scalp BEFORE AFTER: 8wks 10

17. 11 References 1.International Society of Hair Restoration Surgery. 2007 Practice Census Survey; Available at: http://www.ishrs.org/PDF/ISHRS_Practice_Census_Survey_Report_2007.pdf. 2. Website: www.ishrs.org/mediacenter/media-statistics.htm. Accessed January 2009. 3. American Society of Plastic Surgeons. 2000/2004/2005 National plastic surgery statistics. Cosmetic Hair Transplantation and reconstructive procedure trends. http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/security/getfile.cfm&;PageID=17870. Accessed January 31, 2007. 4. Breeling J, Gandelman M. ‘‘Eyelash transplantation: who, why and how.’’ January 2007. International Society of Hair Restoration Surgery. http://www.ishrs.org/articles/eyelashtransplantation.htm. Accessed April 2007. 5. Krusius FF. Ueber die EinplflanzungLebenderHaarezurWimpernbildung. Dtch Med Wochenschr. 1914; 19:958. 6. Knapp P. KlinMblAugenheilk. 1917; 59:447. 7. Sasagawa M. Hair transplantation. Jpn J Dermatol. 1930; 30:493. 8. Fujita K. Reconstruction of eyebrows. La Lepro 1953; 22:364. 9. Marritt, E. Transplantation of single hairs from the scalp as eyelashes. Review of the literature and a case report. J Dermatol Surg Oncol. 1980; 6(4):271–273. 10. Flowers RS. ‘‘Pluck and Sew’’ individual hair follicle placement. American Society of Aesthetic Plastic Surgery, Orlando FL, April 1980. Caputy GG, Flowers RS. The ‘‘pluck and sew’’ technique of individual hair follicle placement. PlastReconstr Surg. 1994; 93(3): 615–620. 11. Gandelman, M. Hair Transplantation, 2nd Ed, Walter Unger, MD (ed.). 12. Herna´ndez-Zendejas G., Guerrerosantos J. Eyelash reconstruction and aesthetic augmentation with strip composite sideburn graft. PlastReconstr Surg. 1998 Jun; 101(7):1978–1980. 13. Gandelman M. Single follicles harvested from donor area and inserted through a curved 18g needle placed into the lid. ISHRS Regional Live SurgeryWorkshop on Eyelash Transplantation, Los Angeles CA, October 23, 2006. 14. Choi YC, Kim JC. ‘‘Single hair transplantation using the Choi hair transplanter. ’’ J Dermatol Surg Oncol. 1992; 18:945–948. 15. Gandelman M. ‘‘Reverse follicular extraction’’ Hair Transplant Forum Intl. November/December 2004; 14(6):197, 203. 16. Martinick J. ISHRS Regional Live Surgery Workshop on Eyelash Transplantation, Los Angeles CA, October 23, 2006. 17. Martinick J. Direct placement of grafts into overlapping coronal slits in the eyelid; ISHRS Regional Live Surgery Workshop on Eyelash Transplantation, Los Angeles CA, October 23, 2006. 18. Lee EW, Tucker NA. Pain associated with local anesthetic injection in eyelid procedures: comparison of microprocessor controlled versus traditional techniques. OphthalPlastReconstr Surg. 2007; January– February; 23(1):37–38. 19. Johnstone M. Hypertrichosis and increased pigmentation of eyelashes and adjacent hair in the region of the ipsilateral eyelids of patients treated with unilateral topical latanoprost. Am J Ophthalmol. 1997; 124:544–547. 20. Stober B, Potash S, Grossman M. Eyelash hypertrichosis in a patient treated with topical latanoprost. Cutis 2001; 67:109–110. 21. Hollo G. The side effects of the prostaglandin analogues. Expert Opin Drug Saf. 2007; 6(1):45–52. 22. Wand M. Latanaprost and hyperpigmentation of eyelashes. Arch Ophthalmol. 1997; 115:1206–1208.

18. Thank You!doctorb@baumanmedical.comwww.eyelash-transplant.comwww.baumanmedical.comhttp://www.twitter.com/DrAlanBauman 12