Hair Rejuvenation
According to the American Hair Loss Association:
- By age 21, approximately 25% of males will experience hair loss.
- By age 35, two-thirds of males will experience hair loss.
- By age 50, approximately 85% of men have significant hair loss.
- It is estimated that 20 to 25% of women experience hereditary hair loss.
- In the US, 25 to 30 million women suffer from hair loss.
Male pattern baldness is characterized by hair receding from the lateral sides of the forehead, known as “receding hairline” or “receding brow.” An additional bald patch may develop on top (vertex). The trigger for this type of baldness (called androgenic alopecia because it is caused by male hormones or androgens) is dihydrotestosterone (DHT), a powerful sex hormone. The mechanism by which DHT accomplishes this is not yet understood. In genetically prone scalps, DHT initiates a process of follicular “miniaturization”. Hairs grow in, cycle into dormancy, and then grow in again several months later. Each time they re-emerge, they do so thinner, shorter, and less pigmented. Through the process of follicular miniaturization, hair shaft width is progressively decreased until scalp hair resembles fragile vellus hair or “peach fuzz”. In time, they become so small that they are no longer noticeable, or they may become non-existent. This can take many years. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined.
Female pattern baldness, in which the midline parting of the hair appears broadened, is less common. The hair becomes thinner all over the head, and the hairline does not recede. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone, which normally occurs in women’s blood. Androgenetic alopecia in women rarely leads to total baldness.
It is easier to prevent the aging and falling out of healthy hairs than to regrow hair in follicles that are already dormant. Without treatment, most people who have begun losing hair…will continue to lose hair. In three double blind, placebo-controlled, randomized studies, 72% of the balding men with no medical treatment continued to lose hair.
Hair loss treatment alternatives available to men and women include:
· Low Level Laser Therapy (LLLT)
· Hair transplant surgery
· Medications and supplements
· Diet and lifestyle
· Hair weaves/wigs
1. Low Level Laser Therapy
Low Level Laser Therapy (LLLT) is a light energy emitted from a laser diode that penetrates skin tissue. LLLT increases cellular metabolism, blood circulation and oxygen supply to the tissues (scalp), hair follicles and papillae. As a result of the increased blood flow microcirculation, more essential nutrients can be supplied to the hair papillae and follicles, and toxins and waste products are more readily taken from the hair papillae and follicles. LLLT will also stimulate and accelerate hair growth by reducing excessive levels of DHT and an enzyme linked to hair loss called 5-alpha reductase.
The scientific term for the process is called “photobiostimulation” (PBS). The four (4) distinct effects of PBS are an increase in ATP (Adenosine Triphosphate) and protein synthesis, improved cell proliferation, and change in cell membrane permeability and increased blood circulation due to the dilation effect of the LLLT on capillaries.
Clinical studies have shown that low-level laser light is effective both cosmetically and physiologically in hair restoration. The cosmetic effects include improvements in hair sheen and strength, characteristics that enhance the perception of "fullness" in overall hair appearance. Physiologic effects on hair follicles observed in both men and women include (1) prevention of hair loss, and (2) stimulation of hair regrowth in areas of hair loss. According to Dr. Unger, a physician hair restoration specialist, in clinical trials, 97% of patients have had some benefit in improvement of hair characteristics, stabilization of hair loss, or hair regrowth. Hair regrowth is defined by Dr. Unger and colleagues as an increase of hair count of 11% or more from baseline count. In the most recently conducted FDA clinical trials, patients studied were men and women with thinning hair in the scalp area. The patients received two low-level laser light treatments per week over a six-month period. Results have shown:
- 100% of men had stabilization of hair loss in frontal and vertex (top of the head) areas
- 84.6% of men had hair regrowth in the frontal area
- 82.8% of men had hair regrowth in the vertex area
- 87.5% of women had stabilization of hair loss in the frontal area
- 100% of women had stabilization of hair loss in the vertex area
- 75% of women had hair regrowth in the frontal area
- 96.4% of women had hair regrowth in the vertex area
No side effects of low-level laser therapy have been observed, Dr. Unger said. There have been no reports of eye damage from exposure to low-level laser light.
A study in the International Journal of Cosmetic Surgery and Aesthetic Dermatology showed that:
· 90% of LLLT users achieve positive benefits
· 93% increase in hair among the respondents using LLLT
· 44% saw noticeable indications of benefits within the first 6 weeks
· Another 45% see results within 6 to 12 weeks
· The rest see subtle improvements after 12 weeks
A Leever Research Clinical Study of 375 LLLT Hair Therapy Participants showed that:
- 78% had an appearance of thicker hair
- 76% had an appearance of fuller hair
- 64% had an appearance of shinier hair
- 86% had an appearance of healthier hair
- 85% perceived that their hair looked better
- 84% were pleased with the progress
An independent 2003 LLLT study, published in the International Journal of Cosmetic Surgery and Aesthetic Dermatology (Volume 5, Number 2, 2003 [John L. Satino and Michael Markou, D.O.]), supports that hair count in men and women increased up to 93.5% on average and hair tensile (strength) increased 78.9% while being treated with LLLT. 35 patients were involved in the six-month study that included 28 men and 7 women.
In 2003, Dr. Glenn Charles, D.O. of Boca Raton, Florida, completed a 10-subject clinical study on the effects of LLLT and its effects on hair loss and post surgery healing with hair transplant patients. He concluded that the main hair count of the test subjects increased 55.4% at the six-month period of the study with some subjects experiencing as much as a 96% hair count increase. Additionally, he concluded that post surgery hair transplant patients experienced reduced shock loss (telogen effluvium) of transplanted hair as well as existing hairs and faster hair re-growth. The majority or patients also experienced a significant reduction in postoperative redness, discomfort and irritation from the surgery.
Treating hair loss takes time because of hair growth cycles. New hairs only grow in 2 or 3 a year, which is why it can take a year or more to be able to detect the success of a treatment. Within 60-90 days of beginning LLLT, significant reduction of hair loss occurs, and thickening and pigmented changes of existing hairs can be seen. Within 3-6 months, continued thickening of hairs occurs, and fullness of the scalp will become noticeable. After 16-18 months of regular treatments, maximum improvement is reached in the anagen growth phase.
Within 3 to 6 weeks of beginning LLLT, some users may experience increased hair shedding as some resting hair follicles are ejected and a new cycle of growth begins, hopefully with a thicker follicle. This is a normal stage of the process. The shedding occurs because hair rejuvenation activates the “anagen” hair follicle’s growth phase. When the hair follicle becomes active again, a new hair shaft grows, as long as the follicle itself has not been damaged or obstructed. Discontinuing treatments can also cause periods of shedding, though this hair loss is generally considered to be temporary, not affecting the baseline.
Using the LLLT for hair rejuvenation is a lifetime commitment because our bodies constantly produce excessive levels of 5-alpha reductase and DHT. Once the maximum benefit is reached, the user must continue treatments regularly to maintain their results to slow and/or stop any further hair loss.
The FDA has classified the LLLT technology as a non-significant risk device (NSR) in accordance with laser product safety standards. Treatments are entirely painless and are performed in a private setting lasting approximately 15-20 minutes. Clients sit comfortable under a device that looks like a commercial hair dryer at a beauty salon. The treatment produces no heat and runs silently while you simply relax, listen to music, watch television or read.
2. Hair Transplant
Surgery is another method of reversing hair loss and baldness. The surgical methods used include hair transplantation, where patches of skin with hair are moved from one part of the head to another. Another method is scalp reduction, where parts of the scalp are removed, the skin is stretched over the area that had been removed, and everything is stitched back together. Hair transplants generally cause scarring, sometimes severe, which may be especially visible if hair loss continues over the rest of the scalp.
3. Medications and Supplements
Increased understanding of the importance of DHT in male and female pattern baldness has led to targeted intervention to prevent this hormone from acting on receptors in the scalp.
Propecia, also called by its non-brand name Finasteride, is a pill that is FDA approved to inhibit production of DHT through the entire body. Finasteride is taken orally and has a reported 29-68% success rate (vs 17-45% in patients receiving a placebo). In three double blind, placebo-controlled, randomized studies, 83% of participants on Propecia experiencing either no more hair loss or regrowth. It is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy. In clinical studies, Propecia, like Minoxodil (below), was shown to work on both the crown area and the hairline, but is most successful in the crown area. Propecia has been shown to be ineffective for treating hair loss in women, and should never be touched by pregnant or potentially pregnant women, as it has been speculated that it could cause severe birth defects in male fetuses. Propecia can have serious side effects including gynecomastia (growth of breast tissue on men), impotence, decreased libido (“sex drive”), and low blood pressure.
In the brand name Rogaine, Minoxidil is FDA approved to stimulate regrowth and thicken hairs. Minoxidil is applied topically to the scalp, and has been shown to promote hair growth in about 25% of men and women, though it may take several months to work. New hair is usually thinner and lighter, like baby hair, and grows mostly on the top of the head, not at the hairline. Its effects may fade with time. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate have also been reported, but rarely.
Antiandrogens block DHT from binding with hair follicles. Ketoconazole (often sold as Nizoral Shampoo) and Coal Tar shampoos (such as Neutrogena T-Gel) are thought to have antiandrogen properties. These products can be prescribed by medical professionals or available over the counter.
4. Diet and Lifestyle
Daily, vigorous aerobic exercise (as opposed to short workout periods designed to increase muscle, which raise androgen levels) and a reasonable diet have been shown to reduce baseline insulin levels as well as baseline total and free testosterone, significantly lowering baseline DHT.
