Q: How does laser therapy work?
A: The actual mechanism by which Low Level Laser Therapy (LLLT) stimulates hair growth (i.e., increases the anagen phase of the hair cycle) is still unknown. Possible mechanisms include the following:
Q: I am taking finasteride as you prescribed. You also suggested using minoxidil liberally over the entire front and top of my scalp once a day. During our meeting I think that you said that once I start using this I would not be able to stop it, and, if I did, it might lead to further hair loss. Hence, I decided to use the laser comb three times a week in addition to the finasteride. Having said that, if you still feel I should start using minoxidil daily, I will start doing so. — H.K., Brooklyn, NY
A: Stopping therapy doesn’t lead to further hair loss in that it doesn’t accelerate it; you just continue on the path that you would have been without the treatment. When you stop, there may be an initial shedding as you quickly lose any benefits that you had from the treatment.
The following applies to all three treatments: finasteride, minoxidil, and laser therapy:
However, the important issue is efficacy:
Finasteride >> minoxidil > laser therapy
This is the reason I recommended finasteride and minoxidil.
Posted byQ: I am interested in trying home laser therapy for my androgenic alopecia? Which handheld laser device do you recommend? — N.M., Northfield, NJ
A: There are several handheld lasers currently marketed as a home use treatments for androgenic alopecia. To my knowledge there has never been a clinical study comparing different laser devices. Most of the devices use diodes to emit a narrow band red light. This wavelength of light is actually similar to those that are used in hair removal lasers, except they are at a much lower intensity. The theory is that high intensity laser damage hair follicles causing hair loss, but low level laser energy can have a bio-stimulation effect and actually induce hair growth.
If you would like to try laser therapy for hair loss, I suggest using a HairMax laser comb. This is the only device that is FDA approved. They sell a few different “strengths” of lasers for different costs. They have not shown any clinical evidence supporting one laser comb versus another. The more expensive ones have more diode lights so it would be reasonable to conclude that they are “stronger” and require less frequent use. I have patients who have used the “mid tier” laser comb, the Premium Lux 9 successfully, so that is the one I recommend to other patients.
Read more about Laser Therapy.
Posted byQ: Is the LaserComb FDA approved for women? — V.F., New Rochelle, NY
A: Yes, on June 11, 2011 the FDA cleared the HairMax LaserComb Lux 9 to treat female hair loss and promote hair growth.
Read this article in the Laser Therapy section for more information on this development.
Posted byQ: If I want to use a laser to try and stimulate my hair to grow, should I use one of the hand-held units, such as the LaserComb or X5 Laser, or use a helmet?
A: Of the hand-held lasers, I feel the LaserComb is most effective. With the helmet units used in salons or doctor’s offices, we recommend the Revage. There is no evidence that the helmet lasers works any better than the LaserComb.
Some patients prefer a helmet, such as the Revage, since they can just relax and don’t have to worry about using it correctly or concentrating on reaching every spot. Others prefer the hand-held unit, since it is less expensive and can be used at home.
For more on this topic, view our Laser Therapy section.
Posted byQ: I have been trying to find some evaluation of which laser combs work best for “hair restoration”. I have seen some dermatologists speak about the Hair Max laser comb and its effectiveness (considering patient compliance, the amount of time the patient has been losing hair, the amount of total hair loss at time of treatment, etc.). I have also seen reference to the Sunetic laser comb which claims to have a superior technology to the Hair Max and offers a changeable head to allow treatment of the skin for healing, wrinkles, etc. A company in Michigan also offers a laser comb called the Hair Rejuvenator which it claims is superior to either of the other combs but I have not heard of any dermatologist who recommends this comb. A firm in Australia also offers a laser comb (Aculas) which it claims is the most effective; however, the makers of the Hair Rejuvenator comb say it is too powerful and dangerous and could cause blindness. Amidst all these claims, the consumer (patient) is left wondering which best option is and which is merely hype or fraud. What do you suggest?
A: There are no comparative studies thus far. For a hand-held device, I would stick with the Laser comb for now since it is the only one that has cleared the FDA.
Some others may work as well (and are less expensive) but we just don’t know at this time – and how useful any of them are long-term is also still not known.
Posted byQ: I am currently using the Hair Max Laser Comb. I am starting on my third week and am scheduled for a hair transplant in one week. My question is: how long do I have to wait to restart the laser comb after my hair restoration procedure? This is not my first procedure and I understand the grafts are delicate for the first couple of weeks. If I keep the teeth away from the scalp and just let the light hit the grafts will this promote faster growth?
A: You can start using the laser comb again right after the surgery, as long as it doesn’t touch the scalp.
At 10 days after the hair transplant you can use it normally, as the grafts are permanent and there is no risk of dislodging them.
Posted byQ: I heard that you could get a laser treatment for hair loss in a doctor’s office with a new laser called the Revage. What is this and how does it compare to the laser comb that I can buy myself?
A: The Revage Laser is a Low Level Laser Therapy (LLLT) treatment for thinning hair manufactured by the company Laser Hair Therapy of North America, LLC. It is FDA classified or permitted to be sold as a cosmetic device, but not as a medical device at this time.
The Revage system contains 30 laser diodes that rotate 180 degrees around the scalp. This dynamic process increases the contact of the laser energy with the hair follicles. It is available only through a physician’s office.
In contrast, the laser comb is available without a doctor’s prescription. It is a static device that depends upon the user to properly move it across his/her head in the time recommended for treatment, and at the correct angle, and thus may deliver significantly lower energy to the follicles.
Posted byQ: I heard about the laser comb and other lasers for hair loss, how do they work?
A: Low Level Laser Therapy (LLLT) is based on the scientific principle of photobiotherapy. Photobiotherapy occurs when laser light, absorbed by cells, causes stimulation of cell metabolism and improved blood flow.
Although the exact mechanism by which lasers promote hair growth is still unknown, they appear to stimulate the follicles on the scalp by increasing energy production and partially reversing the miniaturization process leading to thicker hair shafts and a fuller look.
Read more about Laser Therapy for Hair Loss
Posted byQ: I’m nervous about using the LaserComb alone and unmonitored. Can I have the HairMax treatment done at a clinic or doctors office?
A: The LaserComb is a home treatment.
Posted byQ: If I’m 20 years old and haven’t lost any hair yet, should I start using a laser comb now?
A: One should not treat hair loss until it actually occurs.
That said, once there is clear evidence that a person is thinning, non-surgical treatments are best started early to prevent further hair loss.
It is important to keep in mind that finasteride (Propecia) is still the most effective treatment for early hair loss and has a good record for at least some long-term effectiveness. It is not clear what additional benefit the laser-comb will have.
Posted byQ: If I use the laser comb will I have to have hair transplants too someday?
A: If you are destined to have enough hair loss to require surgical hair restoration, it is unlikely that using any type of laser therapy will make a significant difference.
Posted byQ: I want to use a laser comb and have already bought it. How soon after a hair transplant can I use it?
A: For the first ten days following a hair transplant you should not use the teeth on the laser comb, since it can dislodge the grafts. After this time it can be used normally.
Keep in mind, however, that as of now there are no published studies for this use.
Posted byQ: What are the long-term results with the laser comb?
A: The study for FDA approval was conducted for only six months, so the answer to this question is not known at this time. It is assumed that periodic treatments will be necessary for the laser treatments to have continued benefit.
Posted byQ: Are there any side effects to the laser comb?
A: There can be an early temporary hair shedding in some patients. This is felt to be due to an acceleration of the hair cycle and is probably a mechanism similar to the one that causes early shedding when using Rogaine (Minoxidil) or Propecia (Finasteride).
Posted byQ: Can the laser comb be used with other treatments, such as Minoxidil or Propecia?
A: Yes, it appears so, but there have been no scientific studies examining the interaction or possible synergy between these hair loss treatments.
Posted byQ: How effective is the HairMax Laser Comb?
A: It is difficult to tell since there are no long-term studies using the LaserComb.
From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.
The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.
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