Q: Dr. Bernstein, I am experiencing side effects on Propecia, are there alternative treatments? — J.D. ~ Roslyn, N.Y.
A: Yes, minoxidil (Rogaine), low level laser therapy (LLLT). Unfortunately, none of these will be as effective as finasteride.
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Dr. Bernstein was interviewed for an article in NYCityWoman.com that ran the gamut of available treatments for hair loss in women. Read below for some select quotes on a wide range of topics related to hair loss in women and treatments for female patients with androgenetic alopecia (common genetic hair loss).
On the fading stigma of hair loss in women:
“Women today are more comfortable talking about their hair loss.”
On indicators of hormone-driven female hair loss:
“It is typical to have a positive family history of hair loss and the presence of miniaturization (short, fine hairs) in the thinning areas.”
On minoxidil for regrowth of thinning hair:
“Rogaine (minoxidil) can increase the quality (length and diameter) of hair that is just starting to thin.”
On the different strengths of Rogaine (minoxidil):
“I generally recommend the 5 percent for women and men. Although it’s sold in separate packages for men and women, the basic ingredients are essentially the same.”
On Rogaine Foam:
“It is an elegant mixture, made for compliance,” says Dr. Bernstein. “It is an aerosolized foam, so it is less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.”
On LaserComb vs. cap-based Low Level Laser Therapy (LLLT) devices:
“The cap is both easier to use and more effective for very thin hair, due to the greater number of lasers. But for higher-density hair, a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the laser therapy beam to the scalp.”
On Follicular Unit Transplant (FUT) surgery:
“FUT hair transplants allow many women to have a completely natural hair restoration, producing a dramatic change in their appearance.”
On Robotic FUE hair transplants:
“Robotic FUE allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”
See before and after photos of some of our female hair transplant patients
Read about the causes, classification, diagnosis and treatment of hair loss in women
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 byQ: 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:
Hair transplantation for women is in vogue. As a pioneer in the surgical treatment for female hair loss, Dr. Bernstein was featured in an article in the ‘Beauty’ section of the October 2012 issue of British Vogue.
After describing a visit to Bernstein Medical – Center for Hair Restoration in New York City and giving readers a primer on hair transplant surgery, the article turns to Dr. Bernstein to describe the surge in popularity of the treatment of hair loss in women.
“A quarter of my consults are women. It was 10 per cent five years ago,” says Dr Bernstein. “These improved [hair transplant] techniques work especially well for female hair loss, where it is usually localised patches of thinning that need attention.” And while in the chair, you can even have your eyebrows boosted to Arizona Muse quality, too, if they’ve also taken an ageing hit.
Dr. Bernstein speaks to the difficulty of being a woman suffering from hair loss:
“This is life-changing. Bald men are commonplace, but to have less than a full head of hair for a woman can be isolating. Although there are more tricks women can use to disguise the problem.”
The article also discusses a variety of products and techniques to boost hair volume or camouflage hair loss. Among these are: Kérastase, Nicky Clarke’s ‘Tease Me’ powder, Viviscal Hair Nutrition, laser stimulation, Michaeljohn’s ‘Fine Hair Clinic’, and Touché by Flavien.
Reference
“Hold Onto Your Hair”, Vogue Magazine, October 2012; p375-6.
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: 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 byLosing one’s hair can be an uncomfortable topic of conversation for any adult, but, given the importance many women place on their appearance, hair loss in women is an especially taboo subject of conversation. Whether it is a bald patch, diffuse thinning, balding from a medical condition, or scarring from an accident, hair loss can be upsetting or even traumatic for many women.
The good news is that hair restoration pioneers like Dr. Bernstein are bringing the treatment of women’s hair loss out of the cosmetics bag and into the modern era of hair restoration. What a better way of squashing the taboo once and for all than for Dr. Bernstein to appear on national television and confront the issue head-on. Dr. Mehmet Oz invited Dr. Bernstein to appear on his show, the Dr. Oz Show, to discuss the causes and diagnosis of hair loss in women.
As seen in the image above, Dr. Bernstein used a densitometer to evaluate the hair loss of a female member of the audience. The device enables a physician to determine the amount of miniaturization, or genetic thinning, present in the patient’s scalp. Dr. Bernstein also commented on the treatment of hair loss with low level laser therapy (LaserComb).
Dr. Oz and Dr. Bernstein are colleagues at The New York Presbyterian Hospital of Columbia University. They first appeared together on the Oprah Winfrey Show where Dr. Bernstein explained his new hair transplant techniques to Oprah.
See before and after hair transplant photos of some of our female patients.
Posted byBizymoms.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.
Posted byQ: Have there been any studies showing the difference between men and women in their response to laser treatments for hair loss?
A: In the International Journal of Cosmetic Surgery and Aesthetic Dermatology (Vol. 5, Number 2; 2003), a study on low level laser therapy (LLLT) was conducted which indicated that there was a 55% increase of growth (hair count) in the temporal area as well as 64% in the vertex of the female subjects who were treated with LLLT for hair loss. The study also indicated a 74% increase in the hair counts of the male subjects in the temporal area and 120% in the vertex region. These results would initially indicate that LLLT works better in men than in women, but there were four times as many men in this study so the results might be different in a larger test group.
However, even in this notably smaller female group, the tensile strength of the hair increased dramatically over the tensile strength observed in the male subjects after treatment. This would indicate that, at least in this study, there was not only an increased hair count in women, but the tensile strength of that hair was greatly improved as well. This would be initially indicative that LLLT may be found to be more beneficial to women than to men.
It is important to note that this study was published in 2003. Further studies need to be conducted to confirm the initial results and to further elucidate the possible mechanisms of low level laser light therapy in both men and women with alopecia. As important, long term data needs to be accumulated to show the continued efficacy of this treatment. It had been our clinical experience that LLLT is not as effective as one would assume from the results of the initial studies.
Visit the page on Laser Therapy for more information, or read more answers to questions about laser therapy.
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Dr. Eric S. Schweiger, an Associate at Bernstein Medical – Center for Hair Restoration, was interviewed recently for an article in the Wall Street Journal.
The article — Can Lasers Stimulate a Hair-Growth Spurt? — discusses the efficacy of the HairMax LaserComb and low level laser therapy (LLLT) and also touches on Dr. Schweiger’s main area of expertise, the diagnosis and treatment of hair loss in women:
Eric S. Schweiger, a clinical instructor of dermatology at Mount Sinai Medical Center in New York, says the LaserComb helps grow hair, but adds that effects are often modest, typically take at least six months and aren’t seen in all patients.
The only home laser device cleared for hair growth by the Food and Drug Administration is the LaserComb, which claims to increase hair growth in men. While used by Dr. Schweiger and others for women, the device isn’t FDA cleared for them; a clinical trial is continuing, the company says.
Read more about low level laser therapy (LLLT) and the HairMax LaserComb. For further reading you can explore the Laser Therapy topic.
Posted byAug 21, 2009 – BOCA RATON, FL – A study conducted by Laboratoire Bio-EC — of Paris, France — on the on ex-vivo growth of hair from Low Level Laser Light exposure of hair follicles in culture medium were presented recently at the 17th Annual Meeting of the International Society of Hair Restoration Surgeons (ISHRS).
Michael Hamblin, PhD from Harvard Medical School/Wellman Center for Photomedicine, compared a dose of laser energy and a reference dose on the growth of hair in a lab culture to show that laser energy stimulated hair growth. Isolated follicles were placed in the Philpott hair culture medium, exposed to low level laser irradiation, and measured for hair length increases. Analysis of hairs grown ex-vivo exposed to the two laser doses, were photographed at regular intervals over ten days.
The conclusion of the study was that the wavelength dose studied induced statistically significant increase in hair growth vs. control dose at the conclusion of the study.
The significance of these results is that it documents the ability of laser light to stimulate hair growth in vitro. The results showed that laser energy stimulated proliferation of cells in the hair matrix.
For more information, see the Bernstein Medical – Center for Hair Restoration section on low level laser therapy.
Posted byQ: I have thinning hair and have heard about Low Level Laser Therapy (LLLT) for hair loss. I know that I can either buy a machine over the internet or go to a doctor’s office or medical spa for treatments. Which one should I do?
A: The advantage of the in-office LLLT systems are that the units are more powerful and that the delivery of the energy is the same each time. The treatment is also not dependent upon the patient having to remember to do the treatment and does not require the person to spend 15 minutes each time concentrating on using the hand-held machine correctly. It also had the important advantage of requiring an initial evaluation by a physician who can diagnosis the hair loss and make sure that it is the genetic type that may respond to this type of therapy. And the effectiveness of the treatment can more readily be monitored over time.
The disadvantage of the office- or medispa- based system is that the treatments are significantly more costly than the home machine and require periodic visits over an extended period of time – a nuisance for working people, or for those who do not live close to a facility offering this service.
The advantage of the hand-held system is that it is much less expensive than the office based machine and it is much more convenient to do the treatment at home than to go to a doctor’s office several times a week. There may also be a potential advantage for patients that still have a significant amount of hair. In these people, the hand-held system (that is able to part the hair) may allow the laser light to more effectively reach the scalp.
The major disadvantage of the hand-held device seems to be with patient compliance as people get tired of having to run the instrument through their hair for 15 minutes several times a week. It is also hard for the person himself to judge if the treatments are working, how to taper the treatments and if, and when, to stop.
Posted byQ: How long will Low Level Laser Therapy (LLLT) treatments for hair loss last?
A: The studies submitted to the FDA looked at the effects of low level lasers over a 6-month period. There is no published data for use beyond this time period.
Therefore, the long-term effectiveness of these lasers in treating hair loss is not currently known.
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 am a 33 year old woman and have been told my hair is too thin on the sides for me to have a hair transplant. Could I benefit from laser treatments?
A: Although the long-term benefits on hair growth are not known, Low Level Laser Therapy (LLLT) is able to stimulate hair to become fuller in appearance in the clinical trials that have been carried out for six month periods.
Since the laser light serves to thicken fine, miniaturized hair, it is particularly suitable to areas of diffuse thinning, rather than areas of complete baldness.
Since hair loss in women commonly has a diffuse pattern, because women can’t take Propecia (finasteride), and the fact that women are less often candidates for surgery (as compared to men), laser therapy in females is particularly appealing.
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: Is the use of Low Level Light Laser Therapy (LLLT) for hair loss new?
A: These lasers have been used for hair loss in Europe for almost ten years. Classified as a cosmetic laser, they are safe for human cosmetic use.
The original research in this technology was carried out at the Wellman Labs for Photomedicine at Harvard University.
Posted byQ: I have heard the term “cold lasers,” what exactly are they?
A: The lasers used in Low Level Laser Therapy (LLLT) are referred to as “cold lasers” because they are able to alter tissue function without having to raise the temperature of the target tissue above 37 degrees C (body temp).
Posted byQ: The makers of the HairMax LaserComb have claimed that it will “revolutionize the hair growth industry.” What do you think?
A: This claim is obviously overstated.
Since the Low Level Laser Therapy (LLLT) doesn’t affect the action of DHT on hair follicles, it doesn’t affect the underlying cause of genetic hair loss, and thus would be expected only to have limited effectiveness. The company’s own studies show that this is, indeed, the case.
It was also predicted that Rogaine would revolutionize the field of hair restoration and it had little impact.
In my opinion, only finasteride has made a significant impact on the long-term course of hair loss, particularly in its ability to postpone the need for surgical intervention such as hair transplants.
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