Bernstein Medical Center for Hair Restoration - Latisse/Bimatoprost

Latisse/Bimatoprost

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Departures - The State of Plastic Surgery 2012The January/February issue of Departures Magazine contains a feature called “The State of Plastic Surgery 2012”. The magazine covers topics such as how to find the best plastic surgeon, the use of cells in plastic surgery and the best hair loss therapies. The section on hair loss offers a timeline of the major advances in the treatment of hair loss since its inception over 75 years ago.

Here is the list of the milestones presented in the article:

1939: Japanese doctor Shoji Okuda is the first to publish the results of clinical hair-transplant experiments.
1952: Dermatologist Norman Orentreich, M.D., uses four-millimeter punches to perform the first hair transplants, popularizing “hair plugs” to treat male-pattern baldness. Each plug of some 20 hairs is taken from a “donor site” on the scalp (usually toward the back, where there’s adequate growth). They are bulky and, more often than not, the results look like a poorly hoed garden.
1984: Mini-grafting — the use of grafts containing up to six hairs — is introduced.
Late ’80s: Mini-micrografting, the combination of mini-grafts and smaller micro-grafts containing one or two hairs, becomes popular as a more natural alternative.
1995: New York dermatologist Robert M. Bernstein, M.D., and New Hair Institute founder William Rassman, M.D., develop Follicular Unit Transplantation (FUT), which uses a special microscope to identify individual units of one to four hairs, plus nerves, blood vessels and a tiny muscle called the erector pilorum (the same muscle that makes a cat’s hairs stand on end). Transplanting these intact units ensures their maximum survival and a much more natural look.
2002: Dr. Bernstein and Dr. Rassman offer even more refinement with Follicular Unit Extraction (FUE). With FUT, the donor hair is harvested in a single strip, leaving a linear incision; with FUE, the hair is harvested with a tiny punch that leaves lots of tiny circular incisions-a noticeable advantage for patients who want to wear their hair short. The disadvantage is that FUE requires a much larger donor site, and the results may not all be permanent.
2007: The FDA clears low-level lasers, which promise that the absorbed light will stimulate cell metabolism and protein synthesis to regrow hair.
2008: Latisse, a prescription treatment to grow thicker and longer eyelashes, is cleared by the FDA. Now Allergan, the company behind Latisse, is doing a clinical study about a new formulation of bimatoprost (the active ingredient in Latisse) for male-pattern baldness and moderate female-pattern hair loss. The world waits with bated breath.

Read more about the history, milestones, and innovations in the modern hair transplant techniques that Dr. Bernstein pioneered

Reference
“Personal Best: The State of Plastic Surgery” Departures Magazine, Jan/Feb 2012

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Journal of the American Academy of DermatologyA double-blind scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology has found that latanoprost, a drug that mimics naturally-derived compound molecules called prostaglandins, significantly increases hair density on the scalp after 24 weeks of treatment in young men with mild hair loss.

Latanoprost, like the eyelash restoration drug bimatoprost (better-known by its brand name Latisse), has been used to treat glaucoma. And like bimatoprost, latanoprost has been used to treat eyelash alopecia. The scientists who conducted the study sought to determine if latanoprost could stimulate hair growth when applied topically on the scalp.

While the sample size of the study was small (only 16 subjects), the researchers found that 50% of the subjects had statistically significant differences in hair density associated with increased hair pigmentation and thickness. Overall, at 24 weeks into the study, hair density had increased 22% in the entire study population. Another interesting finding is that the proportion of hairs in the anagen phase versus the telogen phase — referred to as the anagen/telogen ratio — remained stable. The authors of the study describe the significance of this finding:

“The stabile anagen/telogen ratio might indicate that latanoprost does not modify the length of anagen and telogen phases of individual hair follicles. However, as the absolute number of both anagen and telogen hair increased, it seems latanoprost recruits new hairs into the growth phase.”

In conclusion, the authors suggest that the study shows the possibilities of using prostaglandin analogues, like latanoprost, to treat androgenetic alopecia, or common hair loss on the scalp. More research is needed on latanoprost, or other prostaglandin analogues, to determine the ideal dosage and duration of treatment for hair loss.

Latisse, the brand owned by American pharmaceutical company Allergan, is currently being studied as a topical hair loss medication. The study will conclude in September 2012.

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Journal of the American Academy of DermatologyLatisse, which is the brand name for the drug bimatoprost, has been found to effectively and safely grow eyelashes in a double-blinded scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology.

The study found that the drug starts showing improved eyelash growth at week 4 of using the medication. The growth is notable by week 8 and even more substantial by week 12. The majority of subjects using bimatoprost, 78.1% of the group, found improvements in eyelash prominence, length, fullness, and darkness by week 16. Only 18.4% of subjects using the placebo found such improvements at 16 weeks.

In the safety component of the study, adverse events were tallied and subjects were given ophthalmic examinations. Bimatoprost was found to have a “very good” safety profile. The only adverse event that occurred in a statistically significant greater proportion among those who used bimatoprost was conjunctival hyperemia, also known as “red eye”. This adverse event happened in only 3.6% of subjects — five out of 137 — and none of the subjects discontinued participation in the study. Ophthalmic examination of subjects during the study revealed that there is no statistically significant change in iris pigmentation due to bimatoprost. There was also no statistically significant change in visual acuity.

Bimatoprost, which mimics a type of “messenger molecule” called a prostaglandin, was initially designed to treat glaucoma. It was known for several years that the drug’s side effect was eyelash growth, and it was approved by the Food & Drug Administration in 2008 under the brand name of Latisse. The physiological mechanism by which bimatoprost affects eyelash growth is unknown and requires further scientific study.

Latisse — which is owned by the California-based pharmaceutical company Allergan, Inc. — is also being studied as a treatment for hair loss. That study is underway, and is on-going as of the most recent update in January 2012. The study should be complete by September 2012.

Read about Latisse/Bimatoprost

Read more about Latisse/Bimatoprost on the Hair Transplant Blog

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Journal of Drugs in DermatologyThe January 2012 issue of the Journal of Drugs in Dermatology contains an article, written by Drs. Schweiger and Bernstein, which is the first case study of eyebrow growth from the topical use of bimatoprost.

Latisse (bimatoprost) is a topical medication that is FDA-approved for eyelash growth. Some physicians have used the medication for “off-label” use, such as use with eyelashes and scalp hair. However, until recently, there had not been any published medical literature describing the off-label use.

In the case report, a 47-year-old Caucasian woman visited Bernstein Medical for an evaluation of hair loss in one of her eyebrows, also known as eyebrow hypotrichosis. The hair loss was gradual, but had become cosmetically significant, and so she became interested in treating her thinning left eyebrow.

At her evaluation, the doctor discussed treatment options with the patient, including Follicular Unit Transplantation (FUT) and medical treatment with bimatoprost. She decided on medical treatment, and so started a four month treatment regime.

At a follow-up visit four months later, the patient reported significant thickening of her left lateral eyebrow. […] Physical examination revealed increased left eyebrow density, hair length, darker color, slight skin pigmentation, and eyelash treatment.

The conclusion of the article states:

We report one of the first cases of topical bimatoprost for successful treatment of eyebrow hypotrichosis. Studies are needed to confirm the efficacy and safety of topical bimatoprost to treat eyebrow hypotrichosis.

Also noted is that if the efficacy and safety of the medication are confirmed through additional testing, it would be a viable non-surgical option for eyebrow restoration.

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Dr. Scweiger on GMA - Eyelash Enhancement

From hair extensions to eyelash enhancement, our resident expert on hair loss in women is on the case. Dr. Eric Schweiger was featured in a segment on Good Morning America where he discussed the enhancement of eyelashes, which he called, “a universal sign of beauty.”

According to Dr. Schweiger, eyelash enhancement is growing in popularity. One way to enhance your lashes is through topical hair loss medication called Latisse. Here is what Dr. Schweiger said on the topic:

“Latisse is a medicine you apply to the eyelash skin, and it actually increases the growth phase of the eyelashes,” Schweiger said, referring to the prescription treatment that is the first and only FDA-approved eyelash growth product. “You get longer, fuller eyelashes.”

In recent years, Latisse has attracted media attention for its eyelash growing properties. Testing has begun for use as an eyebrow enhancer and begun testing for hair loss on the scalp.

Read more about Latisse, which is the brand name for the product. The active ingredient in the medication is called bimatoprost.

The GMA segment goes on to discuss eyelash enhancement using eyelash extensions. Watch the segment below, or visit the article on ABC News:

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Q: I saw your post on the clinical trials of Latisse (bimatoprost) for hair loss on the scalp. What is the status of the study? — B.V., New Providence, NJ

A: Allergan, the company that makes Latisse, conducted safety and efficacy testing of three formulations of the drug for men with androgenetic alopecia (male pattern baldness). Latisse is a drug that is approved by the FDA to help eyelash growth at a concentration of 0.03 %. The drug is applied daily to the upper eyelid.

Allergan studied the results of three formulations of Latisse (Bimatoprost .03% Opthalmic Solution) comparing them to results of a control option and also an over-the-counter minoxidil 5% solution. The drugs were applied directly to the scalp, and the progression of hair loss was measured.

This study began in June 2011 and the results were published in April 2014. The results of the study did not indicate that Latisse would be a viable alternative to use on the scalp to prevent hair loss.

It should also be noted that the cost of bimatoprost, the active ingredient in Latisse is significantly more expensive than minoxidil, the active ingredient in Rogaine. This means that even if the two treatments were equally effective, it would be cost-prohibitive to treat baldness with Latisse.

Latisee (Bimatoprost .03% Opthalmic Solution) has not been FDA approved for the treatment of scalp hair loss.

For more information, view the results and details of the study on ClinicalTrials.gov .

Read more about Latisse/Bimatoprost.

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Latisse, the brand name for the drug bimatoprost, is commonly used to promote eyelash growth in women who want their eyelashes to be longer, thicker, and darker, typically for cosmetic reasons. It is also used to promote growth of eyebrow hair.

In a publication on ClinicalTrials.gov titled, “Safety and Pharmacokinetics Study of New Formulation of Bimatoprost in Patients With Alopecia,” Allergan, the pharmaceutical company that produces Latisse, has announced a new study on the safety and efficacy of a new formulation of bimatoprost for use as a topical hair loss treatment for general baldness.

The study, based out of Tempe, Arizona, will test two different formulations of bimatoprost in men who suffer from moderate male pattern baldness and women who have moderate female patterned alopecia.

According to the details of the study, the test involves, “One mL dose applied evenly onto pre-specified balding area on scalp – single dose in the am followed by multiple doses daily in the am for 14 days.” The goal of the testing is to measure the results of a single dose of bimatoprost, as well as multiple doses over time. The completion date of the study is February 2011, so we will look for the results and share them with you when they are available.

Update:

The results of the study have been published and it did not result in the FDA approving Latisse for hair loss on the scalp. Latisse was found to be not nearly as effective in treating hair loss as the control group that used minoxidil 5% solution. See the results of the study on ClinicalTrials.gov.

Visit our page on Latisse/Bimatoprost for more information on the drug and its off-label use. View the publication on ClinicalTrials.gov for more specifics on the study. Read about other medical hair loss treatments on our page on medications.

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Dr. Robert M. Bernstein was interviewed for a segment on The Today Show on the subject of eyelash enhancement and use of the eyelash medication Latisse.

Dr. Bernstein first appears about two minutes into the clip.

View the complete video:

For more on eyelash and eyebrow restoration, visit our eyebrow transplant page or our Latisse page.

You can view this video and others on hair transplantation and hair restoration in our Hair Transplant Video section.

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Bizymoms.com, the premier work-at-home community on the Internet with more than 5 million visitors per year, has interviewed Dr. Robert M. Bernstein in order to answer readers’ common questions about hair restoration and hair loss.

Below is a sample of the interview:

Q: Who would be a good candidate for hair transplant surgery?

In general, men and women age 30 and older can be candidates, but there are a host of factors that determine if a person is a good candidate…

Q: How does hair transplantation work?

Hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head…

Q: What can be done for people dissatisfied with previous mini/micrograft procedures?

If the grafts are too large they can be removed, divided into smaller units under a microscope, and re-implanted back into the scalp (the same day)…

Q: What are the possible harmful effects of Propecia and Rogaine?

The main side effect of Propecia (finasteride 1%) is sexual dysfunction, which occurs in about 2-4% of men taking the drug. Fortunately, these side effects are completely reversible when the medication is stopped. […] The main side effect of Rogaine (minoxidil) is scalp irritation. […] Both Propecia and Minoxidil can produce some hair shedding at the beginning of treatment, but this means that the medications are working…

Q: How many grafts/hairs are needed for hair transplant surgery?

An eyebrow restoration can require as few as 200 grafts, a hairline 800 and a scalp, with significant hair loss, 2,500 or more grafts. An equally important consideration is the donor supply…

Q: What are the advanced hair transplant techniques?

Follicular Unit Transplantation (FUT), where hair is transplanted exclusively in naturally occurring follicular units, is the state-of-the art. […] A more recent means of obtaining the donor hair, the follicular units are extracted individually from the back of the scalp. This procedure, called Follicular Unit Extraction (FUE) eliminates the need for a line-scar, but is a less efficient procedure for obtaining grafts…

Q: What are the new hair restoration treatments available for men and women?

Low-Level Laser Therapy (LLLT) utilizes cool lasers to stimulate hair growth and reduce shedding of hair. […] Latisse (Bimatoprost) is an FDA approved topical medication for eyelash growth.

Go to Bizymoms.com to read the full interview.

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Eyebrow transplant and restoration article - New York TimesEyebrow transplant procedures are growing in popularity. More women are realizing how much damage they can cause to their appearance by overplucking, shaping, and over-styling their eyebrows. Today, the New York Times reports on the trend of repairing eyebrows with hair transplant techniques and the use of camouflage products to cover up eyebrows that have been “tamed into oblivion.”

As the article’s headline declares, it is time to call in the professionals. The author of the article, Ms. Catherine St. Louis, turns to hair transplant pioneer Dr. Robert M. Bernstein for guidelines on performing a cosmetically-pleasing eyebrow transplant.

Here is a portion of the article:

Chronic repeated plucking is now a common reason why women have eyebrow transplants, which entail using hair from the scalp, arms or pubic area. A more timeless reason that spans the sexes is the gradual thinning, especially on the outer parts, as we age.

AND the number of such transplants is growing. In 2008, 3,484 eyebrow transplants were performed nationwide, up from 2,544 in 2004, the International Society of Hair Restoration Surgery says.

Dr. Robert M. Bernstein, a hair restoration specialist in Manhattan, said that the most natural-looking transplants for eyebrows followed a few rules. Hair has to lie flat; single-hair transplants, not units of multiple hairs, are used; hairs should follow a curve and be planted to account for changes in direction. (In general, Dr. Bernstein said, the upper hairs point down and lower ones face up slightly to create an interlocking ridge that gives brows their body.)

Visit our eyebrow transplant page for more information on eyebrow transplant and restoration procedures.

See another article by Ms. St. Louis on the topic of hair restoration and hair loss in women.

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