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Hair Restoration Research

Survey Finds Red, Low-Level, Laser Light Therapy is an Effective, Alternate Treatment for Androgenic Alopecia

Currently, only two FDA approved medical treatments exist for androgenic alopecia — minoxidil (Rogaine) and finasteride (Propecia) — but these drugs are not effective in all individuals, and to remain effective, both require consistent, daily, life-long use. Additionally, finasteride is not FDA approved for use in women.

Because of the need for additional hair loss treatment options, researchers have begun to look at low-level light laser therapy (LLLT), specifically red and near-infrared LLLT, due to its ability to promote hair growth by stimulating hair follicle cells ((Mester E, Szende B, Tota JG. Effect of laser on hair growth in mice. Kiserl Orvostud 1967;19:628–631.)) — a process called cellular photo-biostimulatiostimulation.

While many studies have investigated the effects of red and near-infrared LLLT on hair loss, specifically in the ranges of 635 to 780nm, there’s been no comprehensive survey of these studies to see if this treatment option has a consistent, positive effect on androgenic alopecia (genetic balding) for men and women.

To answer this question, researchers from the Harvard Medical School surveyed ((Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014 Feb; 46(2):144-51.)) five clinical studies designed to measure the effects of LLLT on androgenic alopecia in both men and women. In each case, they found that red and near-infrared LLLT was a safe and effective treatment option for both men and women with genetic balding.

The authors propose that LLLT may work by supporting the anagen (growth) phase of the hair follicles affected by androgenic alopecia while also protecting them from alopecia’s inflammatory effects.

While the results in the studies were positive overall, the authors did note that the most therapeutic light wavelength and dosing remain to be determined.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Study Finds Low-Level Laser Therapy (LLLT) Promotes Hair Growth in Men

Evidence that low-level laser therapy (LLLT) could be used to promote hair growth, possibly by stimulating cellular function which leads to cell proliferation, a process called photobiomodulation, was first presented by Endre Mester, a Hungarian physician, in 1967. ((Mester E, Szende B, Tota JG. Effect of laser on hair growth in mice. Kiserl Orvostud 1967;19:628–631.))

Since then, many studies investigating the effects of LLLT on patients with pattern baldness (androgenic alopecia) have found a positive therapeutic effect, but most of those studies have not been properly controlled so as to rule out other, alternative, explanations for any observed hair growth.

However, a recent study ((Lanzafame R, Blanche R, Bodian A, Chiacchierini R, Fernandez-Obregon A, Kazmirek E. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers in Surgery and Medicine 2013; Vol. 45, Issue 8: 487-95.)) published in the journal of Lasers in Surgery and Medicine tested both the safety and effectiveness of a LLLT device in a randomized, blinded, controlled study and found that low-level laser light in the 655nm range significantly promoted hair growth in male patients with androgenic alopecia.

Specifically, 20 male subjects with pattern baldness were treated with low-level laser light for 25 minutes per day every other day for 16 weeks. After 16 weeks, a 35% increase in hair growth was observed in these subjects compared to an untreated group of males with pattern balding.

The researchers suggest that LLLT may stimulate the mitochondria in the cells of the hair follicle, leading to an increase in biological activity in those cells that promote hair growth. They also suggest that low-level light in the range used in the study might affect a hair follicle’s stem cells, which may also contribute to hair growth.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Pilot Study Finds Platelet-Rich Plasma (PRP) Reverses Male and Female Pattern Baldness

Growth factors in platelet-rich plasma (PRP) have been used to help soft tissue healing since the mid-1990’s. Recently, researchers have started to look at whether or not the growth factors in PRP might also help to reverse male– and female-pattern baldness (androgenetic alopecia).

Evidence that PRP may help to reverse this type of hair loss was found in a 2014 pilot study, “Platelet-rich plasma for androgenetic alopecia” published in Dermatologic Surgery. ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9.)) In this study, researchers observed at least some noticeable improvement in 64 patients with androgenetic alopecia. Moreover, 47% of those patients experienced at least moderate to very good improvement, a level that the researchers defined as “clinically important.”

Platelet-Rich Plasma Possible Role in Hair Growth

Ongoing research has suggested various mechanisms by which PRP could reverse pattern baldness. For example, using human hair follicles in both cell cultures and in mice models, a 2011 study found that PRP was able to stimulate the proliferation of human dermopapillar cells, ((Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, Yanagibayashi S, Azuma R, Yamamoto N, Kiyosawa T. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.Dermatol Surg. 2011 Dec;37(12):1721-9.)) which in turn protected hair follicles cells from apoptosis, a process of programmed cell death. Additionally, this study suggested that PRP may be able to stimulate hair growth by prolonging the anagen (growth) phase of the hair cycle. More recently, a 2012 study found that PRP treatment significantly increased hair diameter. ((Li ZJ, Choi HI, Choi DK, Sohn KC, et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012;38:1040–6.))

Platelet-Rich Plasma for Androgenetic Alopecia: a Pilot Study

In order to better verify whether PRP could be a useful treatment for androgenetic alopecia, researchers used two treatments of PRP separated over a period of 3 months. Three months after the second treatment there was at least some improvement in almost all the patients due to an increase in hair thickness and/or more hairs, and 47% of the patients had at least moderate to very-good improvement. Patients with the most severe hair loss saw the greatest amount of improvement. Interestingly, both men and women in all age groups responded equally well to treatment.

Limitations of this Pilot Study

A limitation of the study was that each patient served as his or her own control. To more reliably test whether PRP therapy has clinical benefit for androgenetic alopecia, future studies will need to control for any spontaneous improvement by randomly assigning patients to separate treatment and control groups.

In addition, the data indicated that a retreatment with PRP at 10 to 12 months after an initial treatment may be advisable; however, a prolonged, more systematic observation on a larger number of patients would be needed to establish a reliable retreatment schedule.

In sum, this pilot study provides some preliminary evidence that PRP therapy may provide clinical advantage to patients with mild to moderate male or female pattern baldness.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Clinical Study: Platelet-Rich Plasma (PRP) Promotes Hair Growth in Men with Pattern Hair Loss

Growth factors in platelet-rich plasma (PRP) have been used to facilitate wound healing. Recently, studies have suggested that PRP may also serve as a safe and effective treatment option for male and female pattern hair loss, ((Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9.)), ((A. Trink, E. Sorbellini, P. Bezzola et al., “A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata,” British Journal of Dermatology, vol. 169, no. 3,pp. 690–694, 2013.)) but those studies lack scientific controls.

To address these limitations, researchers conducted a controlled clinical study that was recently published in the journal BioMed Research International. The researchers found that treatment with platelet-rich plasma stimulated hair growth in 10 males with pattern hair loss (androgenetic alopecia). ((V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014.))

Study: The Effect of Autologous Activated Platelet Rich Plasma Treatments on Pattern Hair Loss

In a bilateral controlled clinical study of 10 male patients with patterned hair loss, researchers treated half of a subject’s scalp with PRP and the other half with a placebo. Each patient received three PRP treatments at one-month intervals.

The researchers evaluated the benefit of PRP treatments by comparing the treated half of a scalp to its non-treated (control) half using three measures of hair growth: mean hair count, total hair density, and terminal (healthy) hair density.

Results

Compared to the non-treated portion of the scalp, the researchers found an increase in hair density of 27.7 hairs/cm2 while in the non-treated portions the mean total hair density decreased by 2.0 hairs/cm2. They also found significant increases in terminal hairs compared to the control side.

A Possible Mechanism of PRP-Driven Hair Growth

Past research has suggested that the presence of keratinocytes in the outer root sheath and in the dermal papilla causes growth in new blood vessels (angiogenesis) during anagen, ((L. Mecklenburg, D. J. Tobin, S.M¨uller-R¨over et al., “Active hair growth (anagen) is associated with angiogenesis,” Journal of Investigative Dermatology, vol. 114, no. 5, pp. 909–916, 2000.)) the growth phase of the hair follicle. Research suggests that these new blood vessels play an important role in hair growth.

This new study suggests that PRP may stimulate hair growth by causing an increase of keratinocytes in the epidermis and in the follicular bulge cells, along with an increase of small blood vessels around the hair follicles in the treated area.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

New Research Shows Laser Therapy (LLLT) is an Effective Treatment for Male and Female Pattern Hair Loss

Given the large number of people who are affected by common genetic balding and for whom traditional treatments, like surgical hair restoration or hair loss medications, may not be indicated, could low-level laser therapy (LLLT) be a viable and effective treatment option?

New research published this year (2014) in the American Journal of Clinical Dermatology says yes. ((Jimenez J.J, Wikramanayake T.C, Bergfeld W, Hordinsky M, Hickman J.G, Hamblin M.R, Schachner L.A. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014 Apr;15(2):115-27.))

Androgenetic Alopecia, The Most Common Hair Loss

Androgenetic alopecia will affect half of all men over the age of 50 and half of all women over the age of 80, and its severity increases with age. ((Olsen E.A, Messenger A.G, Shapiro J, Bergfeld W.F, Hordinsky M.K, Roberts J.L, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005;52(2):301–11.)) It is characterized by a gradual miniaturization of the terminal (adult) hair into vellus (short, fine, almost invisible) hair.

While this miniaturization has no cure, this type of hair loss can be effectively addressed by surgical hair restoration techniques (FUT or FUE) and it can be treated with the medications finasteride (Proscar®) and dutasteride (Avodart®) in men or with anti-androgens (spironolactone) and estrogens (OCAs) in women.

However, as effective as these surgical techniques and medications are, some men, and most women, are not qualified candidates for a hair transplant, and the medication treatment options available for women are sometimes not as effective as the medication treatment options available for men.

How Laser Therapy Treats Male and Female Pattern Hair Loss

Laser therapy, also referred to as photobiomodulation or photobiostimulation, works in androgenetic alopecia in both men and women by both stopping miniaturization and stimulating hair growth. Specifically, past studies have suggested that LLLT increases terminal hair density by reversing the miniaturization process and causing follicles in a telogen (resting) phase to shift into an anagen (growth) phase.

The exact mechanism by which low-level laser therapy might protect and promote hair growth isn’t clear, but various researchers ((Lubart R, Eichler M, Lavi R, Friedman H, Shainberg A. Low energy laser irradiation promotes cellular redox activity. Photomed Laser Surg. 2005;23(1):3–9.)) have proposed that LLLT may accelerate mitosis (new cell growth), reduce the inflammation associated with androgenetic alopecia, stimulate follicular stem cells, and/or alter follicular cell metabolism for greater ATP production.

Based on anecdotal experience, practitioners report that LLLT in the range of 650–900nm wavelengths at 5mW appears to both promote new hair growth and protect existing hair against the effects of androgenetic alopecia.

But Is Laser Therapy Effective For Both Male and Female Pattern Hair Loss?

So far, only a few peer-reviewed studies ((Rangwala S, Rashid R.M. Alopecia: a review of laser and light therapies. Dermatol Online J. 2012;18(2):3.)) have produced data about the efficacy of LLLT for male pattern hair loss and only one published study ((Satino J.L, Markou M. Hair regrowth and increased hair tensile strength using the HairMax LaserComb for low-level laser therapy. Int J Cosmetic Surg Aesthetic Dermatol. 2003;5(2):113–7.)) has demonstrated, with limitations, LLLT efficacy for female pattern hair loss.

In other words, past research has demonstrated the efficacy of LLLT in men, but evidence that low-level laser therapy works for women has been comparatively weaker.

In order to convincingly address the efficacy of low-level laser therapy for both men and women, researchers conducted one of the most comprehensive, randomized, sham device-controlled, double-blind clinical studies to date.1

They found that LLLT, using the FDA-cleared HairMax Lasercomb, significantly increased hair density in both men and women diagnosed with androgenetic alopecia.

Efficacy of Low-Level Laser Therapy For Androgenetic Alopecia

The researchers included 128 men and 141 women, all diagnosed with androgenetic alopecia. Half the men and women used a real HairMax lasercomb and the other half used a sham, or fake, HairMax lasercomb device that appeared to emit laser light but in fact only emitted colored white light. However, none of the study participants knew if the lasercomb they were using was real or a sham.

After 26 weeks, men using the real lasercomb gained an average of 21.6 new terminal hairs/cm2 compared to an average 5.2 hairs/cm2 for men using the sham device; women using the real lasercomb gained an average of 20.4 new terminal hairs/cm2 compared to 2.9 new hairs/cm2 for women using the sham device. As a reference, the average non-balding person has approximately 220 terminal hairs/cm2.

In other words, men and women in the real lasercomb groups gained significantly more new hair than men and women who received no treatment, and men and women benefited, on average, equally from using the HairMax lasercomb.

Not only were these gains in terminal hair density for the real lasercomb groups significant, these gains were comparable to significant gains in terminal hair density seen in short-term trials of 5% minoxidil topical solution and 1 mg/day finasteride; however, the gains in this study were less than the gains seen in long-term trials of minoxidil and finasteride.

In sum, the benefit of LLLT for men and women appears equal to the benefit of hair loss medications, at least over the short term. This comparison between LLLT and hair loss medications should be of particular interest to women for whom drug treatment options are limited compared to men.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Platelet-Rich Plasma (PRP) Treatments Containing CD34+ Cells Have “Positive Therapeutic Effect” on Hair Loss

Research published in the Journal of the European Academy of Dermatology and Venereology found that autologous platelet-rich plasma (PRP) preparations containing CD34+ cells might be an effective treatment for male and female pattern hair loss. ((Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9))

Background

Autologous PRP (concentrated blood plasma and growth factors obtained from a patient’s own blood) has been shown to improve blood vessel growth around hair follicles. ((Takikawa M, Nakamura S, Nakamura S et al. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg 2011; 37: 1721–1729)), ((Li W, Enomoto M, Ukegawa M et al. Subcutaneous injections of platelet-rich plasma into skin flaps modulate proangiogenic gene expression and improve survival rates. Plast Reconstr Surg 2012; 129: 858–866)) Researchers have suggested that this is one of the ways PRP can promote hair growth. ((Mecklenburg L, Tobin DJ, Mu¨ller-Ro¨ver S et al. Active hair growth (anagen) is associated with angiogenesis. J Invest Dermatol 2000; 114: 909–916))

CD34+ cells are also known to promote new blood vessel growth. These cells are typically found in bone marrow, but are also found in the body’s circulating blood, having migrated from the bone marrow. Since the CD34+ cells in circulating blood occur in such low amounts, and because they age after migrating from the marrow, they usually lose much of their ability to create new blood vessels. ((Mackie AR, Klyachko E, Thorne T et al. Sonic hedgehog-modified human CD34+ cells preserve cardiac function after acute myocardial infarction. Circ Res 2012; 111: 312–321)), ((Jujo K, Ii M, Losordo DW. Endothelial progenitor cells in neovascularization of infarcted myocardium. J Mol Cell Cardiol 2008; 45: 530–544))

Because PRP preparations only contain CD34+ cells from the body’s circulating blood supply, researchers tested the idea that adding bone marrow-derived CD34+ cells to PRP preparations might improve the efficacy of PRP as a treatment for genetic hair loss. ((Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9))

Results

PRP preparations containing CD34+ cells were found to grow significantly more hair with greater thickness at up to six months after treatment. There were no major side effects of the treatment.

The researchers suggest bone marrow-derived CD34+ cells have a synergistic effect on PRP’s ability to form new blood vessels, and this is what might explain the effects on hair growth. This results suggest that the PRP/CD34+ preparation had a positive therapeutic effect on pattern baldness in both men and women.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Should I Start Hair Loss Treatment With Finasteride or Dutasteride?

Q: I recently visited my dermatologist regarding my hair loss, and after checking my hair he said I am showing signs of Androgenetic Alopecia (common baldness), and said if I don’t treat it, it will progress. From my research on the net, I figured he will put me on Propecia. In fact he put me on Avodart. When I told him it is not FDA-approved for hair loss, and Propecia is, he said Avodart is better and brings DHT down more, and Propecia is nothing next to Avodart. He told me to take it every day for 2 weeks, then every other day from then on as it has a long half life. From researching on the net, many hair restoration doctors rarely prescribe Avodart for hair loss due to some dangers. What is your opinion on this? — T.G., Darien, Connecticut

A: Although dutasteride (Avodart) can be more effective for male pattern hair loss, I would start with finasteride (Propecia) as many patients do great with it and the safety profile is better. The following are things I would consider before starting dutasteride:

  1. As you point out, dutasteride is not FDA-approved for hair loss.
  2. There is no data on its safety when used for hair loss. This is important since dutasteride has been only tested on an older population of patients (with prostate disease) rather than a younger population of patients needing medical treatment for androgenetic alopecia.
  3. These is no natural model for dutasteride’s combined blockage of both type 1 and 2 5-alpha reductase (finasteride blocks only type 2 5-AR and there are families that have this deficiency and have no long-term problems. This, by the way, is how the drug was discovered).
  4. The type 1 enzyme which dutasteride blocks is present in many more tissues of the body (including the brain) compared to type 2 (which is more localized to the skin).
  5. Although so far unproven, there is a concern that finasteride may produce side effects than can be persistent after stopping the medication (post-finasteride syndrome). It this does turn out to be true, the effects from dutasteride would most likely be significantly more persistent.
  6. If you start with finasteride and do have side effects, you will most surely have side effects from dutasteride; therefore, by taking finasteride first you will have avoided the potentially more problematic side effects from dutasteride
  7. You may respond well to finasteride, and so do not need to consider dutasteride
Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Featured Hair Transplant Pioneer In Departures Magazine

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 stem 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

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

When Was the ARTAS Robotic System Approved For FUE Hair Transplants?

Q: When was the ARTAS robot for FUE approved for use in hair transplantation? — J.B., Jersey City, NJ

A: Restoration Robotics’ ARTAS System for robotic follicular unit harvesting, received 510K clearance by the Food and Drug Administration (FDA) on April 14, 2011. The indication is for “harvesting hair follicles from the scalp in men diagnosed with androgenetic alopecia (male pattern hair loss) with black or brown straight hair.”

Read about robotic FUE hair transplantation

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Latisse Drug as Hair Loss Treatment? Trials Under Way on New Formulation of Bimatoprost

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.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Dr. Christiano at Columbia University Identifies APCDD1, A Newly Discovered Gene Associated With Hair Loss

Dr. Angela Christiano of Columbia University in New York and a team of scientific researchers have identified a new gene involved in hair growth. Their discovery may affect the direction of future research for hair loss and the diagnosis and ultimate prevention of male pattern baldness.

The condition which leads to thinning hair is called hereditary hypotrichosis simplex. Through the study of families in Pakistan and Italy who suffer from this condition, the team was able to identify a mutation of the APCDD1 gene located in chromosome 18. This chromosome has been linked to other causes of hair loss.

According to Dr. Christiano, “The identification of this gene underlying hereditary hypotrichosis simplex has afforded us an opportunity to gain insight into the process of hair follicle miniaturization, which is most commonly observed in male pattern hair loss or androgenetic alopecia.”

The mutation of the APCDD1 gene inhibits the Wnt signaling pathway. Although this recently discovered gene does not explain the complex process of male pattern baldness, the importance of this discovery lies in the Wnt signaling that the gene directs, has now been shown to control hair growth in humans, as well as in mice.

Reference: Nature 464, 1043-1047 (15 April 2010) | doi:10.1038/nature08875;

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Propecia Effective In Young Patients?

Q: I know that Propecia works in only about half of patients. Are younger people more likely to be helped by this medication? — V.C. Greenpoint, Brooklyn

A: The main studies by Merck looked at men between the ages of 18 and 41. The five year data (which, in my view, is most important) showed that 48% of men had an increase in hair growth and 42% had no change over baseline. Thus a full 90% held on to their hair or had more over a 5-year period. This compares very favorably to the placebo group where 75% lost hair over the 5-year period.

I think the most interesting question relates to the 10% who continued to lose hair in the treated group. Did these men lose hair at a slower rate than the non-treated group? Based on the action of finasteride on blocking DHT and DHT’s central role in causing male pattern hair loss, it is reasonable to assume that even these “non-responders” did have some benefit from the drug, albeit small. If half of those on the medication who continued to lose hair did so at a rate slower than the placebo group, then 95% of patients actually benefited from the medication to some degree – an extraordinarily high success rate, in my opinion.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Is Hair Loss In Women Harder To Treat With A Hair Transplant Than Hair Loss In Men?

Q: Why is hair loss in women harder to treat with hair transplants than hair loss in men?

A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair loss is localized to the front and top of the scalp).

Diffuse thinning presents two problems for a potential hair transplant candidate.

The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Genetic Test for Hair Loss Worthwhile?

Q: Is it worth getting the genetic test for balding?

A: You’re referring to Hair DX (hairdx.com), which costs about $150 and came to market in January of 2008 as the first test for androgenetic alopecia, aka male pattern baldness.

The test screens for variations in the androgen receptor gene on the X chromosome, the gene that is associated with male pattern hair loss. The purpose of the test is to identify persons at increased risk of developing hair loss before it is clinically apparent – so that medical intervention can be started early, when it is most effective.

It is important to realize that, at this point, there is just an association with this gene and hair loss; the cause and effect has not been proven and the association is not anywhere near 100%. A danger is that patients may overreact to the relatively incomplete information that the test provides. It is best to have the test performed under a doctor’s supervision, so that it can be put in the context of other information that the physician gleans through a careful history, physical and a densitometry hair evaluation. As of this posting, genetic testing for hair loss is not permitted in New York State.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Research Groups Explore Genetics Of Balding

It has long been thought that the genes for common baldness come from the mother side of the family – explaining why a male whose maternal grandfather is bald is more likely to lose his hair than if his own father were bald. This observation was recently supported by the discovery of the androgen receptor (AR) gene which resides on the X-chromosome.

Remember, there are two sex chromosomes; X and Y. Females have two X chromosomes (XX), while males have one X and one Y chromosome (XY). This means that a male must get his X chromosome from the mother.

But we all have seen that some bald sons have bald fathers, even when no one on the mother’s side of the family has any hair loss. This suggests that the genetics of male pattern alopecia is more complicated, with multiple genes influencing hair growth. And it is likely that the inheritance of baldness is polygenetic, with relevant genes coming from both the x-chromosome of the mother and non-sex chromosomes of either parent. So where are the other genes?

Two independent research groups, one from England and the other Germany, both published in the journal Nature Genetics, have identified a gene locus p11 on chromosome 20 that seems to be correlated with male pattern hair loss, and since the gene is on a non-sex chromosome, it offers an explanation for why the inheritance of common baldness can be from either side of the family. It is important to emphasize that like the AR gene, the chromosome 20p11 locus has only been shown to correlate with hair loss. It is not been shown that either of these genes actually cause baldness.

Unlike many genes whose expression is one or the other (i.e. blue eyes or brown), the 20p11 variations tend to be additive; therefore, men with one affected copy will have a 3.7 fold increase in the chance of having early hair loss and those with two copies a 6.1 fold increase. Men with both the chromosome 20p11 variation and the AR gene will have a seven-fold increase of developing male pattern hair loss at an early age. This gene combination occurs in about 15% of Caucasian men.

The mainstay of predicting future hair loss is with a Densitometer – an instrument used by physicians to measure changes in hair shaft diameter (miniaturization). According to Dr. Robert Bernstein, “Looking at hair shafts under a microscope can spot shrinkage years before it is apparent – we can pick it up when kid are still teenagers.” Early diagnosis is important in androgenetic alopeica because medication is useful only if the hair loss is not too advanced. The genetic studies are significant in that they supply the physician with one more piece of information when developing a master plan for treating a person’s hair loss. See the article in the Wall Street Journal titled, Hair Apparent? New Science on the Genetics of Balding.

While researchers consider these latest discoveries to be of significant merit, caution must be made since these genes are felt to be associated with hair loss, but not yet shown to be causative. More importantly, the associations are not absolute. A clinical evaluation is still the most reliable indicator of future hair loss. Finally, the ability to identify associated genes does not suggest that a “cure” for male pattern baldness is imminent.

Reference
“On the Genetics of Balding,” Wall Street Journal, Vol. 4 – October 1, 2008.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Loss Be Induced By Acne Medication Accutane?

Q: I have hair loss due to a treatment of Accutane. I have been off this medication for about a year and a half now, yet my hair has not recovered. The texture of my hair has completely changed. Given the fact that there is no family history linking me to male pattern baldness, I attribute my hair loss exclusively to Accutane. What should I do? — H.F., Eastchester, NY

A: If the texture alone has changed there is nothing you can do except to wait. The texture should improve over time even though it has already been 18 months.

If there are signs of genetic hair loss (i.e. male pattern alopecia), then finasteride should be considered.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why is there a Different Consultation Fee for Diffuse Thinning versus Patterned Hair Loss?

Q: Why is the consult fee more for diffuse thinning than for a regular visit? — B.F., Altherton, CA

A: Diffuse hair loss, more common in women, can be the result of a number of underlying medical conditions and therefore it usually requires an extended medical evaluation.

If you are a male or female with obvious diffuse thinning from androgenetic alopecia (common baldness), or if you have patterned hair loss where the diagnosis is straightforward, the fee is less because an extensive evaluation is not required.

Please visit our Hair Transplant Costs & Consultation Fees page for more information.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

U.K. Invests in Hair Cloning Research

The British government has awarded Intercytex a grant to automate the production of their new hair regeneration therapy. Intercytex is a cell therapy company that develops products to restore and regenerate skin and hair. Intercytex has partnered with a private company, The Automation Partnership (TAP), to develop an automated manufacturing process for their novel hair multiplication treatment.

The hair multiplication product, ICX-TRC, has been submitted as a hair regeneration therapy that uses cells cloned from one’s own scalp. It is intended for the treatment of male pattern baldness (androgenetic alopecia) and female pattern hair loss. The key researcher, biochemist Dr. Paul Kemp, founder of Intercytex, is developing the hair multiplication treatment at their Manchester facility. This investment in hair cloning research is spearheaded by UK Science Minister, Lord Sainsbury.

The government grant will be used mainly to develop a robotic system specifically designed to support the commercial-scale production of their hair cloning product ICX-TRC, at a scale that can handle a large number of people. The company is currently in Phase II clinical testing.

How Intercytex’s Hair Cloning Product Works

Intercytex’s method of hair regeneration involves removing a slice of the scalp, complete with hairs and follicles, from the back of the head. Hair follicles from this area are most resistant to typical hereditary baldness. The sample is taken to a laboratory where the hair producing dermal papilla (DP) cells are extracted and multiplied in flasks. After eight weeks, the DP cells should have cloned into millions of hair cells.

To complete the hair cloning process, the new cells are injected back into the patient’s scalp under a local anesthetic. These cultured cells should then develop into brand new hair follicles.

Intercytex

Intercytex is a 6-year-old company with its main office is in Cambridge, UK and has a clinical production facility and research and development laboratories in Manchester, UK. Additional laboratories are located in Boston, Massachusetts. TAP, founded in 1988, is a private company with headquarters near Cambridge, UK. Intercytex is publicly traded on the London Stock exchange (LSE: ICX).

Additional information about this hair cloning product can be found at www.intercytex.com.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Asymmetrical Hair Loss from Telogen Effluvium or Androgenetic Alopecia?

Q: Over the past three months, my hair seems to be thinning more on one side. Is it common in male pattern hair loss for it to be more on one side? I had a lot of stress about three months ago and have heard that this could be the cause. Is this possible? Should I use Rogaine to treat it? — B.R., Landover, MD

A: Regardless of the cause, hair loss is usually not perfectly symmetric. This applies to male pattern hair loss as well.

In your case, it is important to distinguish between telogen effluvium (shedding that can be due to stress) and hereditary or common baldness. The three month interval from the stressful period to the onset of hair loss is characteristic telogen effluvium, but you may have androgenetic alopecia as an underlying problem.

The two conditions are differentiated by identifying club hairs in telogen effluvium and miniaturized hair in androgenetic alopecia. In addition, a hair pull will be positive in telogen effluvium (when a clump of hair is grasped with the fingers, more than five hairs pull out of the scalp at one time) and will be negative in common baldness. The hair loss diagnosis can be made by a dermatologist.

Hair cuts do not affect either condition.

Rogaine (Minoxidil) is only effective in androgenetic hair loss and only marginally so. Finasteride is the preferred treatment if your hair loss is genetic when it is early and a hair transplant may be indicated if the hair loss progresses.

Shedding from telogen effluvium is reversible and does not require specific treatment.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Was Propecia Originally for Treatment of Prostate Enlargement?

Q: I heard that Propecia was being used originally for shrinking the prostate, is this true? — M.D., New Hyde Park, N.Y.

A: Propecia (finasteride 1mg) is not a prostate medication that was serendipitously noted to have a side effect of re-growing hair, it is a medication that was known all along that it might be able to slow hair loss and/or to grow hair.

Although finasteride was first approved for the treatment of prostate enlargement, the researchers at Merck knew, at the outset, that there were families whose members were deficient in the 5-alpha reductase Type II enzyme and that the men in these families neither developed prostate disease nor went bald. In addition they had no long-term problems from the lack of this enzyme.

Merck used this natural model to develop a medication that could block the 5-alpha reductase Type II enzyme – the result was finasteride. Because the only approved treatment for symptoms related to prostate enlargement at the time was surgery, Merck developed finasteride as a medical treatment for this condition prior to developing finasteride as a potential treatment for men with male pattern hair loss.

This also meant that Merck would understand the safety profile of finasteride, and have it approved for a medical disease (symptomatic prostate enlargement), before developing it for a cosmetic condition.

The drug was first submitted to the FDA for the treatment of prostate enlargement as Proscar (finasteride 5mg) in 1991 and it was approved for this use in 1992. The drug was submitted for the treatment of men with male pattern hair loss as Propecia (finasteride 1mg) in 1996 and was approved for this use in 1997.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Causes Common Hair Loss or Baldness?

Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? — J.P., Paradise Valley, Arizona

A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned hair loss” or “androgenetic alopecia.”

In men, it is due to a hormone called DHT, which is a by-product of testosterone produced by the action of the enzyme 5-alpha reductase. This enzyme is inhibited by the hair loss medication Propecia. See the causes of hair loss in men page on the Bernstein Medical – Center for Hair Restoration website for more information.

In women, the mechanism is a little bit more complex as another enzyme, aromatase, is involved in the metabolic pathway. See the causes of hair loss in women page on the Bernstein Medical – Center for Hair Restoration website for more information.

We know that the inheritance comes from both the mother’s and father’s side, although the actual genes causing hair loss in men and women have not yet been identified. Statistically, the inheritance from the maternal side appears to be a bit stronger, but the reason for this is unknown.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Authors ‘Hair Transplant Blog’

Hair Transplant Blog - Bernstein Medical - Center for Hair RestorationDr. Bernstein’s Hair Transplant Blog is a new medical web log (aka “blog”) that is helping the online community handle the challenges of going bald.

Selected as one of New York Magazine’s “Best Doctors” for the ninth year in a row, Dr. Bernstein answers questions at the following website URL:

www.BernsteinMedical.com/hairtransplantblog/

His replies cover over 30 categories ranging from commonly asked questions on “male pattern hair loss” and “when to have a hair transplant” to more scientific issues on specific surgical techniques.

The Hair Transplant Blog serves as a clearinghouse for important concerns of both men and women suffering from hair loss. “I consult with many patients each week in our New York and New Jersey facilities who are so distraught about the state of their hair loss that some can barely function. There is so much information available about baldness and its treatment on the internet that it is difficult to tell exactly what is true. I spend a lot of time just clarifying false, or partially correct, ideas. This misinformation just serves to exacerbate the problem.” Dr. Bernstein says “This Blog is an outgrowth of these consultations. In the Blog, I post answers to the questions that patients bring to my office or submit via our web site.”

Question are answered by Dr. Bernstein in a concise, but easy to understand way. He covers a wide variety of subjects; including new hair replacement techniques, hair transplant repair, medical therapies and interesting diagnostic problems.

The expert medical perspective in the Blog has received the attention of editors for many popular blog directories such as GetBlogs, and Answers.com. Being a featured blog has allowed people from around the world to have a better understanding of hair loss and the process of surgical hair restoration.

Dr. Bernstein has been recognized worldwide for his pioneering work in surgical hair transplantation. His landmark publications on Follicular Unit Hair Transplants, which give results that mimic nature, and Follicular Unit Extraction, a non-invasive hair replacement technique, have earned him international recognition and make him one of the foremost authorities on hair restoration in the world. Known to audiences from his appearances on NBC’s Today Show with Matt Lauer, CBS’s The Early Show, ABC’s Good Morning America, NPR’s The People’s Pharmacy, The Discovery Channel and other nationally syndicated programs, Dr. Bernstein has been providing answers and solutions for hair loss from his Manhattan facility for over 20 years.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Discusses Hair Transplant Repair In Discovery Channel Interview

The Discovery Channel interviews Dr. Bernstein for a piece on hair transplant repair. View the segment, which includes footage of Dr. Bernstein speaking about hair transplant surgery and performing a procedure, below:

Read the full transcript of the segment:

These days, more and more men who want to compete in the marketplace are seeking cosmetic surgery because they see it as giving them a competitive advantage.

With over 35 million American men affected by hair loss, it’s not surprising that hair restoration ranks high on the list of most popular procedures, generating two billion dollars in revenue each year.

Forty two year-old New York composer Ken Gold started losing his hair 20 years ago.

Ken Gold: In your 20s, you know, everyone is more image-conscious and you don’t want to lose your hair in your 20s.

Ken is not alone. 20% of men in their 20s experience hair loss. In their 30s, the odds jump to 30%, and by the time a man is in his 50s, there is a 50% chance he will be losing some hair.

Ken Gold: Once you’ve lost your hair, you look older. And you don’t want to be 22 and look 35, you know?

Determined to stay youthful, Ken investigated his options and decided to undergo a series of hair transplant procedures beginning in 1981.

Ken Gold: One of the guys I was doing business with, he had a very thick full head of hair. And he said, “Well, I’ve got a hair transplant,” and I was just astonished.

But after five years and four painful, expensive procedures, Ken still didn’t have the full head of hair he wanted.

Ken Gold: My head was a mess. You only had to lift up the hair in the back and you could see what they call the Swiss cheese scalp, just this huge massive scar tissue with little round holes, you know.

Dr. Bernstein: When hair transplants were first started, they thought in order to get enough fullness, you had to move the hair in large clumps, and that’s traditionally known as plugs. And much of our practice is still devoted to hair transplant repair.

Ken despaired of ever finding the solution to his problem until he found the New Hair Institute in Fort Lee, New Jersey.

Dr. Bernstein: When I first saw Ken in 1995. He still had the traditional plugs, and I would say on a scale of one to ten, he was maybe a seven, with ten being the worst. We performed a procedure called follicular unit transplantation where hair is transplanted in exactly the way it grows in nature, which are little tiny groups of one to four hairs.

Ken Gold: After the first surgery I was just ecstatic because I was actually able to look at myself in the mirror.

Almost 20 years and $40,000 later, Ken has finally achieved the natural-looking hair he wanted. But there are alternatives to hair transplant surgery.

Dr. Bernstein: Probably the best thing to do if you’re noticing hair loss is to have a diagnosis of male pattern hair loss to make sure there is not some other treatable condition, and then to use a medication, such as Propecia, which actually can prevent hair loss if it is taken early enough.

But Ken Gold is convinced he’s found the right solution for him.

Ken Gold: I’m very happy now. I wasn’t happy five years ago. When I look in the mirror now, I see someone with hair and I’m able to comb it back and say, yeah, this looks okay.

Watch more videos on hair transplantation and hair transplant repair in our Hair Transplant Videos section

Posted by Robert M. Bernstein M.D.



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Address

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Phone

(212) 826-2400

Clinic Hours

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Services

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Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.

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