Not Your Father s Hair Restoration: The Latest Clinical Advancements from Lasers to Robots in Treating in Men and Women

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2 Not Your Father s Hair Restoration: The Latest Clinical Advancements from Lasers to Robots in Treating in Men and Women Robert T. Leonard, Jr., DO, FAACS, FISHRS Founder and Chief Surgeon Leonard Hair Transplant Associates Massachusetts, Rhode Island, New Hampshire, The World

3 Let s Talk About Hair, Hair Loss, and Treatments

4 No Conflicts to Disclose

5 Hair Really is Important It warms us in the cold It protects us from sunburn and from cancers of the skin It is aesthetically pleasing Complements clothing and fashion It provides physical and sexual attractiveness Per scientific surveys of both men and women

6 Normal Scalp Hairs There are ~ ,000 scalp hairs It is NORMAL to shed an average of 100 hairs per day More than this may be abnormal loss Scalp hair grows in a specific cycle It cycles every 3 to 4 months This timeframe is clinically important

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10 Common Myths About Hair Loss Hair Thinning Only Comes From the Mother s Side Wearing a Hat Causes Hair Loss Hereditary Hair Loss Only Affects Men Teasing, Hair Coloring, Perming, Hair Spray, or Frequent Shampooing Cause Hair Loss Women Lose Their Hair Only After Pregnancy or During Menopause Stress & Weight Loss Cause Permanent Hair Loss

11 Just How Common is It? In Men Affects 50% of all males That s about 50 million men in U.S. Every other guy has MPHL! In Women Affects at least 1 in every 4 females That s over 30 million women in U.S. Much more common than you think

12 Etiology of Male Pattern Hair Loss Genetics: THE major cause of hair loss - 98% of hair loss is due to this - Therefore, only 2% of hair loss is from other causes Hormones: DHT is a key factor in the development of MPHL Capillary Blood Flow

13 Functions of Male Testosterone Hormones -Prenatal: internal sex organ development in the male fetus -Postnatal: spermatogenesis, libido, bone and muscle mass DHT (di-hydortestosterone) -Prenatal: external genitalia development in the male fetus -Postnatal: scalp hair loss and prostate enlargement

14 Role of DHT in MPHL Testosterone is converted into DHT by the enzyme 5- alpha-reductase -Two isozymes of 5-alpha-reductase are Type I and Type II -Type II are found in hair follicles

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17 The Hallmark of Male/Female Pattern Hair Loss Miniaturization of the Follicles

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19 Progression of MPHL REMEMBER THIS FACT!! AFTER 50% OF ONE S HAIR IS ALREADY DOWN THE DRAIN IS WHEN ONE BEGINS TO NOTICE THEIR HAIR IS THINNING! Androgenetic Alopecia is an extremely insidious process Therefore, it is very important to TREAT EARLY!

20 Never Forget It is far easier to KEEP the hair that one already has on his/her head than it is to re-grow it either medically or surgically! Therefore, EARLY detection and treatment is very important

21 Men are Concerned about Their Hair Loss In clinical studies, men with hair loss reported that they had: 1 Less attractive appearance Decreased sexual confidence Decreased self-esteem Young er men and those with more hair loss are most concerned 1. Cash TF. The psychological effects of androgenic alopecia in men. J Am

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25 Women Are Devastated About Losing Their Hair It s Normal for a Guy to Lose His Hair Most Don t Like It, But It s Normal It Absolutely Is NOT So For Women In our Society, it is considered: Abnormal, Unusual, Sickly, Unfeminine, and Unaccepted for a Woman to Become Bald I Actively Treat Women With Hair Loss with Expertise and with Compassion

26 Female Pattern Hair Loss Affects over 30,000,000 Women in the USA Can Be Psychologically Devastating Is Often Under diagnosed, Misdiagnosed, Ignored More Women Are Actively Seeking Treatment Wonderful Treatment Options Available

27 Hair Loss is Horrible I can t go out in the sun for Women People look at my head instead of in my eyes I never go to the beach anymore I can t go out to lunch without having concerns about people noticing my hair I never sit under a light in a restaurant or anywhere! I have difficulty going on dates because men think I have cancer or AIDS All I do is think about my hair all day long!!! I never underestimate how difficult life can be for women who are losing their hair

28 Treatments for the Female Patient Rogaine Foam Capillus272 Laser Therapy Hair Transplantation Non-Medical Hair Restoration Camouflage Agents Psychological Intervention

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30 Treatments for My Female Patients Rogaine Foam Efficacy and usage often misunderstood It works very, very well if it is used correctly: 70% to stabilize and 50% to re-grow It takes ~ 4 months to begin to slow hair loss rate and 12 months to notice hair to re-grow This medication needs to be used long-term

31 Rogaine Foam (cont) To achieve success with this medication: I have my patient towel-dry her hair, but keeping the hair very damp; then apply a Ping-Pong-ball-sized dollop of Rogaine Foam uniformly throughout the top of her scalp; she then can do whatever she wishes with her hair The benefit of this method of application is that the medication does not get in the hair, making it messy, but onto the scalp where it is therapeutic It should be applied twice a day every day! Very few side effects include itching and dryness of the scalp

32 Capillus272 Laser Therapy An exciting tool to effectively treat hair loss Laser Therapy has been in my practice for > 15 years This technology decreases hair loss rate and can re-grow hair How It Works: > s capillary blood flow in the dermis to the follicle > s cellular activity and oxygenation to the dermal papilla Converts approximately 70% of Telogen (resting phase) hairs back into Anagen (growing phase) of the hair growth cycle

33 Capillus272 Laser Therapy (cont) This home-use device is simple to use to achieve its clinical results FDA Cleared for Efficacy and Safety Very, very effective treatment for hair loss It stimulates capillary blood flow at the follicular level to: Stop progression of thinning: 90% Stimulate regrowth of miniaturized hairs: 50% Prolong duration of perms and hair color Increase hair growth rate and hair manageability

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37 We Need To Turn This Patient

38 Into This Patient. So, Treat Early!

39 Treatment Options FDA Approved Treatments Rogaine (minoxidil) Foam (5%) Propecia (finasteride) 1mg Tablets Surgical Hair Restoration Hair Transplantation (various techniques) Scalp Reduction/Flap Rotation Other Capillus272 Laser Therapy: FDA CLEARED, 2015 Non-medical Hair Replacement Camouflage Products

40 Hair Loss is Progressive! Treatment for all pts is to STOP the progression You can assure your patients that if they do nothing about their hair loss today, then they WILL have less hair next year YOU are their main source of ACCURATE INFORMATION; don t let them down

41 Propecia (finasteride 1mg) for Men The only FDA-approved oral tx for MPHL Slows progression in 83% of patients Re-grows hair in 66% of men Effective esp. in the crown and less so on the top of scalp First line therapy in nearly all men Contraindicated if hypersensitivity to med

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45 Propecia and PSA: The Facts In men undergoing PSA testing for prostate screening while taking Propecia, the lab value should be DOUBLED in order to accurately follow the PSA over time PSA is not routinely drawn in men < 40 years of age There is NO NEED to get a PSA level before prescribing Propecia I NEVER have ordered one

46 Propecia and Pregnancy Issues Propecia has NO impact on: Sperm Morphology, Sperm Motility, Sperm Concentration, or Sperm Development Exposure of pregnant women to semen via oral or vaginal routes poses NO risk to the fetus

47 Propecia: What To Know It WORKS: 90% maintenance and regrowth It s SAFE: 0.3% with decreased hardness of erection, decreased libido, and decreased volume of ejaculate It must be used daily for at least 18 months Follow up with your patients to monitor progress and continued use In general, NOTICE hair loss -TREAT EARLY

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49 Hair Transplantation The Gold Standard for Hair Restoration NO MORE PLUGS (since 1991) Total Follicular Unit and Follicular Micrografting Strip Harvesting Dissection Under Magnification Grafts with Only Hairs No Bandages Used Hair Re-growth in About 3-4 Months Post-op Far Fewer Sessions Than in the Past Most Natural Results Even After 1 Session Hairs Grow Forever!

50 Hair Transplantation There are two methods of harvesting the hair from the donor area The Strip Technique Follicular Unit Extraction (FUE) Manual Method Semi-automated Method Robotic Method

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52 Hair Transplantation Donor Area Permanent Growth Donor Dominance Maintains Integrity to Wherever Transplanted If Adequate, Can Provide Fertile Supply for Areas of Thinness and Baldness

53 Donor Area Traditional Harvest Technique

54 Donor Area Closure Traditional Harvest Technique

55 ARTAS Robotic Device F.U.E. or FOLLICULAR UNIT EXTRACTION METHOD Uses incredible robotic technology Individual grafts are extracted from the donor area Allows for a very short hairstyle without any linear donor scar Minimally invasive, reproducible harvesting, rapid recovery Nothing different occurs in planting the grafts in the balding (recipient) area

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58 FUE Donor Area

59 FUE Donor Area

60 One Day Post-op

61 FUE One Week Post-op

62 Recipient Area Area that is thinning or bald Hairline is marked with patient Anesthetized locally Tiny incisions are made following proper angulations, orientation, depth, et cetera Grafts are planted and patient is discharged with no bandages

63 Recipient Site Immediately Post-Op

64 Recipient Site One Week Post-Op

65 Patients Must Be Patient! Initial hairs in the transplanted grafts grow and then fall out after 2-3 weeks Hairs begin to re-grow at about 3-4 months after the procedure Noticeable aesthetic growth occurs after month 6 post op Final results at 18 months after transplant day Imperative to take before photos because patients forget how bald they were! Important to hold their hands throughout the year They get impatient & discouraged easily because it takes so long to recognize results This is nothing better than good osteopathic patient care!

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68 Before and Afters

69 Wes Welker One Session

70 Creating A Female Hairline

71 Female Hairline: 1 Week Post-Op

72 Pat Branca One Session

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75 Typical MTF Pattern

76 Looking and Feeling A Little Better

77 Almost Ready To Live Normally

78 Life Is Worth Living Again!

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82 Stan Two Sessions

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85 Once I Give Them Back Their Hair, I Have No Control What They Do With It!

86 Special Cases Traction Alopecia Transgender Hair Restoration Eyebrow Tansplantation

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104 Eyebrows 6 months post-op

105 Eyebrows Before Transplantation

106 Eyebrows During Transplantation

107 Eyebrows After Transplantation

108 Before Treatment (LLLT and Propecia)

109 After Treatment (LLLT and Propecia)

110 Before Treatment (LLLT and Propecia)

111 After Treatment (LLLT and Propecia)

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