Is it Effective in Stopping Hair Loss?

Use of low level laser therapy (LLLT) devices for treating hair loss has been heavily debated for some time by reputable hair restoration physicians and patients on our hair loss forum. While some physicians reject its use entirely, others use laser hair treatment as a regular part of their practice. Additionally, some physicians believe that laser light therapy can assist with postoperative healing after hair transplant surgery.

History of Laser Light Therapy

Shortly after the first working laser was invented in 1964, a researcher from Semmelweis University of Budapest named Andre Mester developed a theory that exposure to cold laser light (similar to UV radiation emitted by the sun) may eventually lead to cancer. To test his theory, Mester shaved a group of mice and trapped some of them in a cage with constant cold laser light exposure leaving the other half unexposed as a control group. To his surprise, the light didn’t cause cancer in any of his animal subjects. Instead, mice that were exposed to the laser light therapy grew back their shaved fur much faster than the control group. Mester named his discovery photo-biostimulation. His theory was that somehow, the laser light had stimulated the hair cells into an accelerated state of hair growth.

Laser Therapy as a Hair Loss Treatment

Today, low level laser therapy is being used as a hair loss treatment. To treat baldness with laser light therapy, laser rays are directly applied to the scalp by a mechanical device so that red blood cells are stimulated. Lasers are said to work by converting ATP (Adenosine Triphosphate) to ADP (Adenosine Diphosphate), releasing energy and causing cellular metabolic changes. During this process, additional nutrients and oxygen are provided to the scalp assisting the normal chemical processes performed by those cells, increasing overall blood circulation. Lasers, when applied to the scalp and hair, have been said to improve overall hair quality, promote hair growth, and increase hair shaft diameter.

Laser treatment devices have a similar appearance to a hood hair dryer which is placed over top of your head. The low level laser toll will rotate allowing laser rays, usually red in color, to be discharged into your scalp. Hand held devices such as the Hairmax comb have also been developed and resemble a brush in appearance.

Promoting healthy hair growth however, is not the same as the regrowth of miniaturized hairs brought on by genetic female hair loss or male pattern baldness (MPB). So what clinical evidence exists, if any, that laser therapy is an effective treatment? Below we take a closer look at the available data including exclusive interviews of leading hair restoration physicians.

Varying Opinions of Well Respected Physicians

Physicians have long shared varying views on whether or not laser treatment is viable. While some well respected physicians reject its use entirely, some believe that LLLT can provide marginal benefit for men and women suffering from androgenic alopecia (genetic baldness). Additionally, some physicians believe that laser hair treatment can assist a hair transplant patient’s postoperative wound healing process and expedite hair growth.

Dr. Charles (one of our well respected members of the Coalition of Independent Hair Restoration Physicians) believes it may provide similar hair loss prevention benefit to Rogaine in the mid vertex area and crown. Benefits in the frontal area include an increase in overall hair quality rather than hair loss prevention.

Dr. Charles believes LLLT works better when combined with Propecia (finasteride) and Rogaine (minoxidil). Like Propecia and Rogaine, he believes low level laser therapy may help some patients more than others and works better in patients with only minimal thinning hair.

Dr. Charles believes in helping balding men and women develop and maintain realistic expectations and he doesn’t oversell its benefits. Because lasers are free from side effects, he always tells his patients that the biggest risk is the money. Dr. Charles believes more research on laser hair treatment is needed.;

Dr. Williams of the Coalition has been using laser hair treatment as a regular part of his practice for over 2 years and feels quite confident in its success in some patients. In his experience, LLLT promotes healthy hair growth and can increase hair shaft diameter of miniaturized hair affected by genetic female hair loss and male pattern baldness in some patients.

Dr. Williams offers 16 free laser therapy sessions to local males following hair transplant procedures and encourages his female transplant patients to undergo laser light therapy for one full year at a highly discounted rate. Dr. Williams usually notices faster transplanted hair regrowth and a quicker resolution of postoperative telogen effluvium or “shock loss”, if it occurs.

Because androgenic alopecia is a progressive condition, Dr. Williams encourages male patients to use Propecia while encouraging out of town females to use the Hairmax laser comb to help maintain their existing hair. Dr. Williams would like to see more formal studies defining the benefits of lasers as a hair loss treatment, but he is encouraged by his experience with it to date.

Dr. Alan Feller (also a member of the Coalition) is one doctor who remains skeptical. "Medical lasers work in only one way, and that is to deliver energy to a target. When it strikes the target the energy is absorbed and converted to heat. That's it". Dr. Feller believes that more compelling evidence is needed to promote low level laser therapy (LLLT) as a hair regrowth solution or to stop hair loss.

Recent Scientific Studies

study presented at the last International Society of Hair Restoration Surgery (ISHRS) meeting in Las Vegas (2007) by Maria A Muricy, MD, confirms increase in hair shaft diameter, fullness, and overall quality with laser hair treatment alone. Additionally, some statistically significant evidence reveals that low level laser therapy when combined with 5% minoxidil (the active ingredient in FDA approved Rogaine) provided noticeable cosmetic benefits for women in particular. However, this study also showed that laser hair loss treatment alone produced no statistically significant new hair growth in both men and women.

Laser Hair Therapy and FDA Approval

Another important issue to consider is the significance and meaning of the FDA clearance (not approval) of the Hairmax laser comb. Though some have proposed the Hairmax laser comb was only approved for safety, apparently the FDA did require Lexington International (who funded the study) to provide it with a study on its efficacy (effectiveness) in treating baldness. But this study and its results have not been released to the public since Lexington International had the option of submitting the study to the FDA privately. The obvious question then is – why would Lexington hide their study from the public if it proved the efficacy of laser hair regrowth?

While the Hairmax laser comb device was found by the FDA to be safe based on its “substantial equivalence” to previously approved laser light therapy devices and thus “cleared” (not “approved”), it was unclear to what extend the FDA reviewed or cleared it based on its effectiveness in treating hair loss. To learn more about the FDA standards for “approving” food and drugs and for “clearing” medical devices visit www.fda.gov

It appears that much of the laser hair treatment industry is now promoting their devices as “FDA Approved for Hair Loss” as if they are on par with the two only FDA approved hair loss solutions Propecia (finasteride) and Rogaine (minoxidil). However, until laser hair treatment provides compelling public evidence of its effectiveness in treating hair loss, it is quite possible that the effectiveness of low level laser therapy may be oversold by some companies. We expect that time will tell.

We know that and rogenetic alopecia or male pattern baldness is by far the most common cause of hair loss, accounting for 95% of hair loss in men and women. But there are a variety of other causes for hair loss in men and women. These include disease, aging, improper hair care, poor nutrition, and stress.

Disease and Illness

It's a proven fact that medical conditions, as well as treatments and procedures, may lead to hair loss. Many people have experienced sudden and large amounts of hair loss about 3 or 4 months after an illness or a major surgery. Fortunately, this hair loss is usually temporary, and is related to the stress of the illness.

Hair loss may also signal a previously hidden disease,including lupus, thyroid disease or diabetes. Because hair loss may be an early sign, it's a good idea to identify the problem and begin treating it at this time.

Psychological disorders such as Trichotillomaniamay be responsible for self-inflicted hair loss Men and women suffering from this condition pull their own hair out by the roots.

Hair loss may stem from taking certain medicines, but this normally stops once the medication is no longer taken.

Hormonal Changes

Another cause of medical hair loss is hormonal problems. Essentially, having an overactive or under active thyroid gland may cause your hair to fall out. Treating the thyroid disease will usually help this hair loss. Hormones can also cause hair loss if male hormones (androgens), or female hormones (estrogens), are out of balance. However, if the hormone imbalance is corrected, the hair loss should stop.

Aging

Did you know that 40% of men have noticeable hair loss by age 35, and 65% by age 60?

Aging is one of the factors necessary for and rogenetic alopecia to occur, along with a genetic predisposition and the presence of hair loss-inducing hormones. Hair loss is dependent on exposing the vulnerable hair follicles to the proper hormones over time.

Improper Hair Care

Isn't it frustrating to see people with thick, full heads of hair treat it so badly? Dyes, bleaching, pigtails -- it all takes its toll on hair.

The chemicals used for dying, tinting, bleaching, straightening or any other hair-altering procedures can lead to hair becoming strained or damaged. Eventually, this hair may even break off.

But it's not any better in the hair salon, as excessive styling that pulls the hair too tightly may also lead to a type of hair loss, called "traction alopecia." As long as this pulling is stopped before the scalp scars, the hair will grow back normally. But be warned, scarring can cause permanent hair loss.

It's also not a good idea to subject your hair to hot oil treatments or the chemicals used in permanents. These may cause inflammation of the hair follicle. This too, may lead to scarring and hair loss.

Improper Nutrition

Researchers have found that some hair loss may be due to insufficient protein or iron in your diet, as well as malnutrition, in general. As effective as "miracle" or "fad" diets sound, they may cause damage. Vitamin deficiencies, as well as certain illnesses related to eating, such as bowel disease or eating disorders, can also cause poor nutrition. These may all cause hair loss.

Stress

Stress can be harmful to the entire body, and the hair on our heads is no exception. Regardless of the cause - illness, a traumatic experience, nutritional deficiency - our rate of hair loss may increase.

However, it should be noted that stress-induced hair loss is not a cause of male-pattern baldness. Rather, this type of balding is known as "telogen effluvium." Telogen effluvium is caused when the body senses a problem and diverts its energies there. This results in hair being shed, although it's usually reversible.

Stress affects the hair of men and women differently. It's been foundthat women's hair is more sensitive to stress' effects than men's hair. One possibility is that stress (along with DHT and other things) may facilitate hair loss for women who are genetically predisposed towards it While the cause of genetic female hair lossis a bit of a mystery, women experiencing hair loss are advised to consult a dermatologist or hair restoration specialist to determine its cause Many causes of thinning hair in females are non-genetic and hair loss is often reversible by treating whatever condition is promoting it.

Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

Comparing the Strip Excision procedure to the Extraction (FUE) procedure

The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

Strip Excision Procedure 

Donor strip being excised

Incision sutured together

Hair combed down after suturing

This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

Patient’s donor area 2 months after surgery

Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

To view a video of an actual strip excision surgery.

How the FUE Procedure is performed

With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

The follicular units are extracted

The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

To Extract or to Excise, that is the question.

Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.