Medical Management of Hair Loss for the Integrative Medicine Practice - Dr Alan Bauman
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This document summarizes Dr. Alan Bauman's presentation on medical management of hair loss. It discusses the prevalence of hair loss, treatments including pharmaceutical, nutraceutical, laser therapy, and hair transplantation. Specific treatment modalities covered include minoxidil, finasteride, low-level laser therapy, PRP therapy, and follicular unit extraction hair transplantation. Case studies are presented to demonstrate treatment outcomes. Revenue opportunities for an anti-aging practice integrating hair loss treatments are also reviewed.
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Medical Management of Hair Loss for the Integrative Medicine Practice - Dr Alan Bauman
- 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. ©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. ©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. ©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. ©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. ©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. ©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
- 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. ©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. ©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. ©2014BaumanMedicalGroupAllRightsReserved. HAIR FOLLICLE – BASIC SCIENCE
- 14. ©2014BaumanMedicalGroupAllRightsReserved. HAIR FOLLICLE CYCLING • Anagen • Catagen • Telogen
- 16. ©2014BaumanMedicalGroupAllRightsReserved. COMMON TYPES OF HAIR LOSS • Alopecia Areata • Androgenetic Alopecia • Trichotillomania • Telogen Effluvium • Anagen Efffluvium
- 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. ©2014BaumanMedicalGroupAllRightsReserved. DHT-MEDIATED HAIR FOLLICLE MINIATURIZATION HairCam Microscope 60x
- 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. ©2014BaumanMedicalGroupAllRightsReserved. TREATMENT MODALITIES FOR HAIR LOSS • Risk Reduction • Pharmaceutical • Nutraceutical • Laser Therapy • Cell Therapy • Hair Transplantation
- 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
- 26. ©2014BaumanMedicalGroupAllRightsReserved. FINASTERIDE RESULTS 30 y/o Male / Finasteride 1mg ONLY: baseline, 10 months
- 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. ©2014BaumanMedicalGroupAllRightsReserved. MINOXIDIL RESULTS (BEFORE & AFTER 6MOS) COMPOUNDED MINOXIDIL FORMULA 82M
- 30. ©2014BaumanMedicalGroupAllRightsReserved. VITAMINS & PHYTONUTRIENTS • Bioactive ingredients derived from plants • Beneficial for • Hair conditioning • Hair growth stimulation • Scalp dermatitis • Anti-microbial agent
- 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. ©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. ©2014BaumanMedicalGroupAllRightsReserved. • Saw palmetto • Azelaic acid • Zinc • Vitamin B6 • Linoleic acid • Oleanolic acid NUTRIENTS THAT MAY INHIBIT DHT Sereona Repens / Saw Palmetto
- 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. ©2014BaumanMedicalGroupAllRightsReserved. LOW LEVEL LASER THERAPY ~5 months of LLLT in-office
- 37. ©2014BaumanMedicalGroupAllRightsReserved. LLLT - RESULTS Courtesy: Alan J. Bauman, M.D.
- 38. ©2014BaumanMedicalGroupAllRightsReserved. LLLT - RESULTS Courtesy: Alan J. Bauman, M.D.
- 39. ©2014BaumanMedicalGroupAllRightsReserved. 6 MOS. OF LOW LEVEL LASER THERAPY Courtesy: Alan J. Bauman, M.D.
- 40. ©2014BaumanMedicalGroupAllRightsReserved. LASER THERAPY - LASERCAP LaserCap Regimen: 30min. every other day
- 41. ©2014BaumanMedicalGroupAllRightsReserved. LASER THERAPY - MALE PATIENT Before and After 6 Months of LLLT
- 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
- 45. ©2014BaumanMedicalGroupAllRightsReserved. FUE / NEOGRAFT [MINIMALLY-INVASIVE DONOR HEALING] NO LINEAR SCAR Courtesy: Alan J. Bauman, M.D.
- 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. ©2014BaumanMedicalGroupAllRightsReserved. 60 y/o Female 45 y/o Male
- 48. ©2014BaumanMedicalGroupAllRightsReserved. HAIRLINE + TEMPORAL POINT – 26 Y/O MALE
- 49. ©2014BaumanMedicalGroupAllRightsReserved. HAIRLINE + TEMPORAL POINT 31 Y/O MALE
- 50. ©2014BaumanMedicalGroupAllRightsReserved. CELL THERAPY & PRP IN HAIR RESTORATION
- 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. ©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. ©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
- 55. ©2014BaumanMedicalGroupAllRightsReserved. PRP FOR ANDROGENETIC ALOPECIA Dr. Alan J. Bauman uses PRP plus Extracellular Matrix for hair regrowth
- 56. ©2014BaumanMedicalGroupAllRightsReserved. HAIRCHECK FOR COMPLIANCE/TRACKING • Cross sectional trichometry • Hair Bundle Measurements • Track Regrowth • Improve Compliance
- 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.