Tue 9 Oct 2007
Having attended the annual International Society of Hair Restoration Surgery (ISHRS) meetings over the past ten years, while publishing the Hair Transplant Network, I now seem to know or be known by almost all of the prominent hair transplant physicians.
Those who have become famous online for doing outstanding work typically greet me warmly, while others who I have chosen not to recommend often stiffen up and scowl when they encounter me. One hair restoration physician last week even took me aside in the hallway and threatened to sue me for having his recommendation discontinued.
But, like it or not, most physicians have come to realize that our patient based community and our open forum are here to stay and that we will continue to say when the “emperor has no clothing” even if it may be awkward or embarrassing. As the publisher of this community, I will continue to critique various techniques, treatments and those who perform them, while keeping an eye out for top-notch hair transplant physicians and clinics. I know the active members of this community will also continue to do the same.
In this report I’d like to share highlights from the 15th annual ISHRS scientific meeting that was held in Las Vegas from September 26th to the 30th.
I will focus on what may be of most interest to hair loss sufferers and patients such as presentations on the potential dangers of Dutasteride (Avodart), new advances such as hair multiplication (follicular cell implantation), the effectiveness of low light laser therapy (LLLT) in treating hair loss, the pros and cons of FUE (follicular unit extraction) and other topics.
I’ve always been impressed by the attention to detail at these meetings, which truly give meaning to the expression “splitting hairs”.
Background on the meeting host – ISHRS
The principal mission of the ISHRS (International Society of Hair Restoration Surgery) has been the education of hair restoration physicians ranging from the novice to the masters. It is by far the prominent hair restoration professional organization in the world and the host of the annual five day scientific meeting. The group’s website at www.ISHRS.org provides contact information and profiles for its 700 worldwide physician members as well as useful information about hair restoration.
This year Coalition member Dr. Sharon Keene of Tucson, Arizona did the hard work of chairing the meeting, while Coalition members Dr. Ron Shapiro of Minneapolis and Dr. Arthur Tykocinski of Sao Paulo, Brazil chaired the advanced seminar. Coalition member, Dr. Bill Reed of La Jolla, Ca was the chair for workshop chair.
Last year’s ISHRS meeting was chaired by Coalition member Dr. Bernie Nusbaum of Miami and next years ISHRS meeting in Montreal, Quebec will be chaired Coalition member Dr. Arthur Tykocinski.
At the meeting Dr. Bessam Farjo of the UK replaced Dr. Paul Cotterill as the acting president of the ISHRS for the coming year.
Many of the physicians who have come to be recognized by patients online for their outstanding results have also become known and recognized by their colleagues as leaders and teachers.
Presentations at the ISHRS meeting of particular interest to Hair Loss Sufferers:
Dutasteride (Advodart) versus Finasteride (Propecia)
Virtually anyone who has researched hair loss treatments is familiar with Propecia (active ingredient Finasteride). This once a day pill, which inhibits the formation of the hair loss catalyst DHT in the body and thus scalp, is FDA approved as a hair loss treatment and widely known to be effective.
However, some hair loss sufferers have sought and gotten prescriptions for an even stronger DHT inhibiting drug known as Dutasteride (marketed as Avodart). This drug, like Finasteride, is FDA approved for the treatment of benign prostatic hypertrophy (enlarged prostrate). However, Dutasteride (Avodart), unlike Propecia (Finasteride), has not been FDA approved as a hair loss treatment.
Despite not being FDA approved as a hair loss treatment some physicians do prescribe it as a hair loss treatment, often only if Propecia fails to stop hair loss for a particular patient.
Both finasteride and dutasteride inhibit the development of the type 2 alpha reductase that plays a critical role in the creation of the hair loss causing hormone DHT, only dutasteride also effectively inhibits the development of the type 1 alpha reductase that also plays a role in creating DHT.
According to Dr. Bernie Nusbaum, who presented an update on Dutasteride therapy at the meeting, dutasteride is three times more potent than finateride at inhibiting the type 2 enzyme and 300 times more potent than finasteride in inhibiting the type 1 enzyme.
Based on a randomized, placebo controlled study of 416 male hair loss sufferers, dutasteride improved hair growth in these men more rapidly and to a greater degree than finasteride.
However, dutasteride was shown to remain in the body far longer than finasteride after being discontinued. Dutasteride was also found to reduce sperm counts more dramatically than finasteride along with a higher incidence of decreased libido (13%).
Of additional concern, dutasteride, unlike finasteride, reduces the type 1 enzyme which is found in the brain – unlike the type 2 enzyme which is not present in the brain. Apparently it is not clear at this time what role the type 1 enzyme may or may not play in the functioning of the brain. Thus dutasteride could potentially have yet unknown side effects due to reducing the type 2 enzyme in the brain.
Advances in Medical Therapy and Hair Multiplication
While scientific presentations on the theoretical causes and potential treatments of hair loss were made by expert hair scientists, no new break throughs or advances were presented at the meeting. However, it does appear that scientists are gaining a better theoretical understanding of the process of hair loss that may some day lead to more successful interventions and treatments.
The current front runners in developing potential hair multiplication treatments are Intercytex and Aderans the Japanese parent company/owner of the Bosely Medical Group and more recently Medical Hair Restoration). Both groups, despite continued research, investment and testing, have yet to prove that their current process of multiplying and then injecting a patient’s own dermal papilla cells can yield viable new hair growth.
I had the opportunity to visit Intercytex when I was in the UK during May of 2007 and meet with their founder Dr. Paul Kemp. I was impressed by the company’s investment in time and resources to make hair multiplication a reality. The backgrounds and research credentials of the company’s management team are also impressive.
However, despite their persistent efforts and investment it appears to me that commercially viable follicular cell implantation ( often incorrectly referred to as hair cloning ) is at least five to ten years in the future.
In addition, even if new hair follicles can be grown it still remains to be seen if the direction and angle of this hair growth can be controlled and if the hair quality will be adequate. Some feel that the replicated hair may be used, at least early on, primarily in the midscalp areas, while current hair transplant techniques using limited donor follicles will be used to recreate the hairline and other critical areas.
The costs associated with such a procedure also remain unknown and even the principals at Intercytex could not venture a guess.
In the event that follicular cell implantation becomes commercially viable it has the potential promise of enabling hair transplant patients to restore a virtually unlimited amount new hair growth. Needless to say this is a very exciting prospect, especially to who suffer from extensive hair loss and limited or compromised donor hair follicles.
FUE (follicular unit extraction): Potential Pitfalls, Problems and Remedies
Dr. James Harris, who has developed and widely shared his three step “SAFE” technique for FUE, gave an interesting and refreshingly candid presentation on the many difficulties and challenges physicians face in performing FUE successfully. Dr. Harris has recently patented a surgical methodology and instrumentation for performing FUE that in his opinion ensures graft safety and integrity. He calls it the “SAFE System” (Surgically Advanced Follicular Extraction) and the instrument is the “SAFE Scribe”.
Given that the vast majority of the information presented about FUE has been presented by those aggressively promoting it, very little of the technical challenges and problems are known among the general public.
During Dr. Harris’ talk, which was entitled “FUE: Potential Pitfalls, Problems and Remedies”, he pointed out some of the following FUE pitfalls:
Due to the traumatic cutting and pulling associated with the typical FUE extraction process, the underlying and largely unseen follicles are often transected and or damaged. The splaying (flaring outward) of the base of the follicles makes it particularly hard to cut around the underlying follicles with a punch.
In addition, the grafts produced by FUE are typically almost devoid of protective dermis and fat and are therefore particularly vulnerable to damage and ultimately poor growth.
This increased fragileness and damage of follicles is in part due to the supporting tissues and epithelium often being torn away during the pulling extraction process.
When one is aware of the many risks and disadvantages associated with the FUE procedure one will not be surprised at the notable lack impressive final result photos available online. Those who have followed FUE over the years will notice the many immediate post op FUE photos are often provided by the promoters of the high priced FUE procedure, while follow up photos and final results have been notoriously absent.
However, in recent years ethical and skilled physicians and clinics, who do not oversell the benefits of FUE, have begun to advance this procedure. It is possible that many of the pitfalls of FUE will be overcome and that these physicians and their patients will present impressive results both on and offline.
Dr. Paul Rose and DR. Jose Lorenzo also both presented impressive tools and techniques at the meeting for overcoming some of the issues and pitfalls associated with FUE.
Low Level Laser Therapy (LLLT) in Hair Restoration
Hair loss sufferers continue to debate and question the value of Low Level Laser Therapy (LLLT) for hair loss on this forum and others. Hair restoration physicians also continue to question its value, while some physicians who have been using it in their practices swear by LLLT and claim that it can improve post surgical healing, accelerate growth, stimulate increased hair diameter and even new hair growth comparable to 5% minoxidil.
Some physicians believe so strongly in the healing properties of LLLT that they provide it free of charge to patients in the weeks following their surgery. They and their staffs are confident that LLLT does at least provide a marginal if not more significant benefit in speeding post op healing and new hair growth.
Some physicians believe that LLLT combined with 5% minoxidil can provide synergistic benefits (i.e. 2 + 2 = 7) that neither treatment alone can accomplish. They believe that such a combined treatment is particularly beneficial to women with diffuse patterns of hair loss who have no other treatment options.
One study presented at the ISHRS meeting by Maria A Muricy, MD, provided some statistically significant evidence that LLLT combined with 5% minoxidil did provide noticeable cosmetic benefits for women in particular. However, this study also showed that LLLT alone produced no statistically significant new hair growth in both men and women. But while it showed no new hair growth, the researchers found that LLLT alone may increase the diameter and quality of existing hairs and thus improve the overall appearance of fullness.
I had an interesting conversation with Charles Maricle, Ph.D., who is a leading expert on medical low light lasers and the President of Sunetics International (which manufactures and markets LLLT devices to hair restoration clinics). As one would expect, he is confident in his products ability to aid in post op recovery and regrowth, as well as helping others regrow hair. The next time there is an active discussion on our forum about LLLT I intend to invite him to add his expertise to the discussion.
LLLT – FDA Approved?
Dr. Alan Bauman gave a brief presentation on the FDA clearance of LLLT devices produced by Lexington International (makers and marketers of the Laser Hair Comb) for use as hair loss treatments. While these LLLT devices were found by the FDA to be safe based on its “substantial equivalence” to previously approved LLLT devices and thus “cleared” (not “approved”), it was not clear to me to what extend the FDA reviewed or cleared the LLLT based on its effectiveness in treating hair loss.
Apparently the FDA did require Lexington to provide it with a study on the efficacy (effectiveness) of LLLT in treating hair loss. But this study and its results, which was apparently funded by Lexington International, has not been released publicly to my knowledge as Lexington International had the option of submitting it to the FDA, while keeping the study private.
To learn more about the FDA standards for “approving” food and drugs and for “clearing” medical devices visit www.fda.gov
The obvious question then is – why would Lexington not make their study public if it indeed did prove that their LLLT products were effective in treating hair loss?
It appears to me that the LLLT industry is now promoting their devices as “FDA Approved for Hair Loss” as if they are on pare with the two only other FDA hair loss treatments “Propecia” (finasteride) and “Rogaine” (Minoxidil). At this point, until LLLT provides compelling public evidence of LLLT effectiveness in treating hair loss, in my opinion the effectiveness of LLLT may potentially be oversold. I expect that “time will tell”.
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