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Business Education for Medical Practitioners
July/August 2013 $5.00
Volume 9, Number 4
medestheticsmagazine.com
NEW
ADVANCES
in Hair Restoration
WHAT’S
LURKING
in Laser Hair
Removal Plumes?
Macrene AlexiadesArmenakas, MD
Clinician, Researcher, Entrepreneur
Plus:
Employee Selection
Laser Vein Treatment
Growing
Possibilities
Innovations abound in the field of hair restoration.
By Cindi Myers
THE ART AND SCIENCE of hair restoration has
© ISTOCKPHOTO.COM
come a long way from fake-looking plugs and obviously
unnatural hairlines. Today, physicians can offer
many patients permanent, natural-looking solutions
to thinning or lost hair, and new discoveries and
technologies offer the promise of even more options in
the future. For the professional who wants to expand a
dermatology or plastic surgery practice, hair restoration
offers variety, challenges and the potential to serve a
large population. “Hair loss affects so many people,” says
James Harris, MD, medical director of the Hair Sciences
Center of Colorado (hsccolorado.com). “If you look at
men in their 50s and 60s, probably 50% to 60% of them
have this condition, and it effects many more women
than you think.”
In addition to hair-replacement surgery, practices can
offer patients a variety of products and technologies
developed to treat thinning hair and help clients
maintain the hair they have. For many patients, multiple
therapies will offer the best results.
20 JULY/AUGUST 2013 | MedEsthetics
GROWING POSSIBILITIES
Minoxidil, sold under the brand name Rogaine (McNEILPPC, rogaine.com), was the first topical preparation
approved by the FDA for regrowing hair. Available first
as a prescription product, minoxidil is now available
in a variety of over-the-counter preparations. For his
patients, Alan J. Bauman, MD, of Bauman Medical (baumanmedical.com) prefers a compounded formulation,
Formula82M, which contains not only minoxidil, but also
anti-inflammatory Retin-A. “It’s dryer and easier to use
than the over the counter products,” he says. “It isn’t
messy or greasy, and it has a very, very powerful effect
on hair growth.”
Finasteride—an oral medication sold under the brand
names Propecia (Merck & Co., propecia.com) and Proscar— was approved by the FDA in 1992 for the treatment
of benign prostatic hyperplasia (BPH). In 1997 finasteride
received approval for male pattern baldness. It works by
blocking the production of 5a-dihydrotestosterone (DHT)
and reducing androgen activity in the scalp. Because
finasteride can cause birth defects, it is not approved for
use in women of child-bearing age. Dutasteride, brand
name Avodart (GlaxoSmithKline, avodart.com), is another
drug used to treat BPH that some doctors use off-label for
treating male pattern hair loss.
In addition to medications, practices can offer powders,
sprays and shampoos to thicken existing hair. Dr. Bauman
was involved in clinical trials for Pantene’s Age Defy line of
products and recommends these to his patients. He also
offers a proprietary hair care line, Bauman MD, which
includes therapeutic shampoos with active ingredients
including caffeine.
The doctors interviewed for this article also stress the
importance of nutrition to their patients. “In a screening
process for hair loss in men and women, you want to look
at things like poor nutrition,” says Dr. Bauman. “Diet plays
a big role. Crash dieting can cause hair loss. Young men
taking creatine supplements can unknowingly increase their
DHT and knock their hair out.” Nutrition supplements such
as Viviscal Professional (viviscal.com) and Appearex Biotin
(appearex.com) offer patients another way to boost their
intake of nutrients important for healthy hair.
Laser Options
Low-level laser therapy (LLLT) can help thicken existing
hair, and is an easy, pain-free therapy for patients. Like
topicals, it requires regular, ongoing treatment. “We use
the laser alone or in conjunction with topical therapies,”
says Craig Ziering, MD, of Ziering Worldwide (zieringmedical.com). “And for our surgical patients, we have
them come in for two weeks after surgery to have laser
therapy. This decreases shedding, speeds up hair growth
22 JULY/AUGUST 2013 | MedEsthetics
and helps speed up the results of the surgery.”
The Hair Loss Control Clinic (hlcconline.com) offers
practices a turn-key program to offer hair restoration. Their
products include in-office low-level laser devices as well as
supplements, scalp treatments and home use laser combs.
Sunetics International (Sunetics.com) also offers a variety of
in-office and home use LLLT devices.
While these treatments have traditionally been offered
in-office, there is a growing variety of LLLT devices that
allow patients to administer the treatments to themselves at
The ARTAS Robotic system allows for faster, more precise harvesting of
individual hair grafts.
home. Laser combs, including the HairMax (hairmax.com)
and the Ultimate II Laser from HLCC, have been available for several years, but the doctors interviewed for this
article were most excited about the LaserCap (lasercap.us).
“Instead of having to come into the office and sit under this
big device, the technology has enabled the same delivery
system as a big in-office laser dome that is battery operated
and fits under a baseball cap,” says Dr. Bauman. Patients
wear the cap for 30 minutes every other day while driving
to work, watching TV or relaxing.
Surgical Interventions
Though laser treatments, and topical and oral medications
can help thicken hair and produce new growth in areas
of thinning hair, the gold standard for restoring hair to a
bald pate is hair transplant surgery. New technologies and
approaches have revolutionized the results surgeons are
able to achieve. “It’s not the procedure it was 25 years
ago,” says Dr. Harris. “Some of the surgical techniques we
have now, 99% of the time when someone has had a hair
transplant, you can’t tell by looking at them.”
The primary surgical technique involves taking a strip
PHOTO COURTESY OF RESTORATION ROBOTICS
Medications To Treat Hair Loss
GROWING POSSIBILITIES
After
Hair transplant surgery results have improved dramatically with new devices that aid
in harvesting grafts. This patient underwent surgery using the Neograft system.
from the donor site—usually the back of the head—and
cutting it into individual grafts under the microscope. The
surgeon then implants these individual grafts of one, two or
three hairs into the bald areas of the scalp, in a pattern that
mimics natural hair growth. Over the next year these grafts
begin producing hair that blends in with existing hair.
Follicular Unit Extraction (FUE) harvests very small samples of hair—as small as one to four follicles at a time—with
a micropunch method. This eliminates the horizontal scar
at the back of the head that’s produced by strip surgery.
Initially, grafts harvested with this method had a high failure
rate. “One problem was that when using a sharp punch
you can damage a lot of the follicles, because the follicles
underneath the surface of the skin, their direction and
configuration, don’t always match with the hair that’s coming out of the skin,” explains Dr. Harris. In an attempt not
to damage the follicles, surgeons using the original punch
technique would penetrate only 2mm to 2.5mm, resulting
in more bruising and trauma.
Dr. Harris developed the SAFE system for FUE, which
uses a blunt-tipped dissection device powered by a small
motor. The SAFE system extracts hair follicles at a depth
of 4mm. “This allows us to separate those follicles a little
bit better and makes it easier to get the grafts out of the
skin,” he explains. The system also speeds up the extraction
process. “We’ve been using the motorized version of the
SAFE system for around 3½ years now, and it’s allowed us
to speed up the process,” Dr. Harris says. “If the conditions
are right I can dissect maybe a thousand grafts an hour by
hand.” A typical transplant might involve from 1,000 to
3,000 or more grafts.
Dr. Bauman and Richard Chaffoo, MD, FACS, use the
Neograft (neograft.com), a rotating, mechanical punch aided by suction to extract individual hair grafts. “The Neograft
system harvests up to 600 grafts per hour,” says Dr. Chaffoo. “There are no sutures and the graft sites heal within a
week of transplant surgery leaving no visible scar, allowing
patients to wear their hair quite short.” He uses the device
to restore receding hairlines, reconstruct eyebrows and
camouflage existing scars.
24 JULY/AUGUST 2013 | MedEsthetics
The latest innovation in FUE is the ARTAS Robotic
System (Restoration Robotics, restorationrobotics.com),
which takes the physical act of harvesting grafts out of the
doctor’s hands and turns it over to a robot. The robot aids
in mapping the grafts, then performs the procedure quickly
and automatically, under the supervision of the physician.
“The robot has definitely brought in a new way for doctors who want to provide this procedure to be involved,”
says Dr. Harris. “When you do it by hand, it’s a fairly taxing,
time-consuming process, removing grafts one at a time.
It requires some training to do. You need excellent vision
and eye-hand coordination. Frankly, not all physicians want
or are interested in investing the months and years that it
takes to learn this. For them, acquiring a robot would be an
excellent option. With a couple of days of training, they can
extract grafts at a very rapid rate, of very high quality.”
Once the grafts are harvested, no robot as yet will
In a screening process
for hair loss in men and
women, you want to look at
things like poor nutrition.
implant them for the physician. That takes skill, and a
significant bit of artistry. “The most important part is not
really the tool or the technique,” says Dr. Bauman. “It’s
how we recreate a natural-looking hairline and density by
mimicking the natural patterns of hair growth. It’s not just
‘close your eyes and plant the hair.’ Every single follicle
has to be angled in the right orientation and positioned
to get the right-looking result.” He estimates he spent
10,000 hours developing the necessary skill.
Treatments for Women
Traditional advertisements for hair restoration have targeted men. From famous actors to sports stars, bald men
are everywhere, so it’s a common and familiar condition.
But one of the fastest growing patient populations for hair
loss clinics is women.
Dr. Ziering estimates that about 50% of the patients he
sees are women, and about 20% of his surgical patients
are women. “We also do eyebrow replacement surgery
and about 75% of those patients are women.”
While many men face androgen-related male-pattern
hair loss, there’s no one mechanism responsible for
the majority of women’s hair loss. “Some of the treatments that men use, such as Propecia, may not work for
women,” says Dr. Harris. Hair loss in women may be due
continued on page 27
PHOTO COURTESY OF RICHARD CHAFFOO, MD
Before