Answers

Q: 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:

1. Stimulating the production of various growth factors (insulin-GF, vascular endothelial-GF, fibroblast-GF)
2. Dilating the blood vessels of the hair follicles
3. Increasing the production of ATP (molecular energy) in the cells through its effects on mitochondria.

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Q: 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.

Q: Is the LaserComb FDA approved for women? — V.F., New Rochelle, NY

A: Yes, on June 11, 2011 the FDA cleared the HairMax LaserComb Lux 9 to treat female hair loss and promote hair growth.

Read this article in the Laser Therapy section for more information on this development.

Q: 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.

Q: 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.

Q: I have been trying to find some evaluation of which laser combs work best for “hair restoration”. I have seen some dermatologists speak about the Hair Max laser comb and its effectiveness (considering patient compliance, the amount of time the patient has been losing hair, the amount of total hair loss at time of treatment, etc.). I have also seen reference to the Sunetic laser comb which claims to have a superior technology to the Hair Max and offers a changeable head to allow treatment of the skin for healing, wrinkles, etc. A company in Michigan also offers a laser comb called the Hair Rejuvenator which it claims is superior to either of the other combs but I have not heard of any dermatologist who recommends this comb. A firm in Australia also offers a laser comb (Aculas) which it claims is the most effective; however, the makers of the Hair Rejuvenator comb say it is too powerful and dangerous and could cause blindness. Amidst all these claims, the consumer (patient) is left wondering which best option is and which is merely hype or fraud. What do you suggest?

A: There are no comparative studies thus far. For a hand-held device, I would stick with the Laser comb for now since it is the only one that has cleared the FDA.

Some others may work as well (and are less expensive) but we just don’t know at this time – and how useful any of them are long-term is also still not known.

Q: I am currently using the Hair Max Laser Comb. I am starting on my third week and am scheduled for a hair transplant in one week. My question is: how long do I have to wait to restart the laser comb after my hair restoration procedure? This is not my first procedure and I understand the grafts are delicate for the first couple of weeks. If I keep the teeth away from the scalp and just let the light hit the grafts will this promote faster growth?

A: You can start using the laser comb again right after the surgery, as long as it doesn’t touch the scalp.

At 10 days after the hair transplant you can use it normally, as the grafts are permanent and there is no risk of dislodging them.

Q: 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.

Read more about Laser Therapy

Q: If I stop the treatment will any benefit that I had be lost?

A: As with other medical therapies for hair loss, once the treatment is completely stopped, any benefit should subside.

It is anticipated, therefore, that periodic treatments will be needed after than the initial treatment course.

Q: 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.

Q: 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.

Q: I heard that you can buy a laser for hair loss and use it at home. What are the advantages or disadvantages of doing this?

A: The advantages of home use are convenience and that it is generally less expensive than going to a doctor’s office for treatment.

The main disadvantage of using laser treatments without a doctor’s supervision is that a more effective treatment for hair loss may be available and you may not know about it. By spending time using the laser, the window for a more effective treatment may be missed. A good example is the 20 year old male who has extensive hair loss in his family and is just starting to thin. It is very important for this person to start Propecia (finasteride) as soon as possible, since the long-term benefits of using this medication are well established.

Laser treatment at home, without a prior evaluation by a physician, also risks missing the diagnosis of an underlying medical condition. This can be a particular problem in women where hair loss tends to be diffuse and the cause may not be readily apparent. If the cause of the thinning was due to anemia, thyroid, or ovarian disease, the diagnoses of these treatable conditions might be missed.

Finally, the laser therapy available in a doctor’s office may be significantly more effective than a home unit.

Read more about Laser Therapy for Hair Loss

Q: 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.

Q: 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

Q: 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.

Q: 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).

Q: I’m nervous about using the LaserComb alone and unmonitored. Can I have the HairMax treatment done at a clinic or doctors office?

A: The LaserComb is a home treatment.

Q: I have been told I am a Norwood Class 6; will the HairMax LaserComb or other types of laser therapy work for me?

A: Laser treatments, as with other medical treatments for hair loss, only work when there is some existing hair in the area.

Q: If I’m 20 years old and haven’t lost any hair yet, should I start using a laser comb now?

A: One should not treat hair loss until it actually occurs.

That said, once there is clear evidence that a person is thinning, non-surgical treatments are best started early to prevent further hair loss.

It is important to keep in mind that finasteride (Propecia) is still the most effective treatment for early hair loss and has a good record for at least some long-term effectiveness. It is not clear what additional benefit the laser-comb will have.

Q: If I use the laser comb will I have to have hair transplants too someday?

A: If you are destined to have enough hair loss to require surgical hair restoration, it is unlikely that using any type of laser therapy will make a significant difference.

Q: I want to use a laser comb and have already bought it. How soon after a hair transplant can I use it?

A: For the first ten days following a hair transplant you should not use the teeth on the laser comb, since it can dislodge the grafts. After this time it can be used normally.

Keep in mind, however, that as of now there are no published studies for this use.

Q: What are the long-term results with the laser comb?

A: The study for FDA approval was conducted for only six months, so the answer to this question is not known at this time. It is assumed that periodic treatments will be necessary for the laser treatments to have continued benefit.

Q: Are there any side effects to the laser comb?

A: There can be an early temporary hair shedding in some patients. This is felt to be due to an acceleration of the hair cycle and is probably a mechanism similar to the one that causes early shedding when using Rogaine (Minoxidil) or Propecia (Finasteride).

Q: 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.

Q: Can the laser comb grow hair back in bald areas of scalp?

A: The HairMax LaserComb only works in areas where there is still some hair.

It will not bring back hair that has been lost. You need hair transplantation to do this. The laser comb works by thickening fine, miniaturized hair.

Q: Can the laser comb be used with other treatments, such as Minoxidil or Propecia?

A: Yes, it appears so, but there have been no scientific studies examining the interaction or possible synergy between these hair loss treatments.

Q: Do I need a doctor’s prescription to get the Laser Comb?

A: The HairMax Laser Comb is an over-the-counter hair loss treatment so it does not require a doctor’s prescription. You can order a Laser comb without consulting a physician and you do not need to be monitored by a doctor when using it.

Q: Where can I buy the HairMax Laser Comb?

A: The Laser Comb is currently available for purchase on-line at a variety of hair loss and hair related websites including Drugstore.com, Amazon.com and Hairmax.com.

Q: How much does the LaserComb cost?

A: There are two types of HairMax Laser Combs currently available:

• The Premium Comb has 9 laser beams and the cost is approximately $545.00 plus shipping.
• The SE Compact version of the Laser Comb has 5 laser beams and costs $395.00.

Q: How effective is the HairMax Laser Comb?

A: It is difficult to tell since there are no long-term studies using the LaserComb.

From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.

The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.