Email Response from Managing Director of HairMax LaserComb – Hair Loss Information – Balding Blog

Earlier this month, I posted an entry titled Analyzing the Results of the HairMax Laser Comb. The extensive email that I received (posted below) shows the great care that the HairMax folks went through to try to be objective. I do not doubt that objectivity was the intent, but upon reviewing the images that were presented, my counts came up differently than the counts of the researcher(s). I know how to count, and since densitometry was my invention (so to speak), I think that my expertise in counting hairs stands for itself. The conclusions of my previous writing still stand (see link above). Nothing written below changes that. The scientific study was put together properly, but it failed on the simplest level, counting hairs. All is wasted if the counts (which our readership can do) failed to be what the researchers counted. I will present the impressive piece written by David Michaels of Lexington International (makers of HairMax LaserComb), because it is fair to do so. Remember, there is no substitute for good marketing, but the success of a product should not infer that the product does as represented, nor does it make counting numbers different than what they are.

Greetings Dr. Rassman,

Firstly, I would like to thank you for taking interest in low-level laser therapy and fielding questions on your blog about our device, the “HairMax LaserComb.” Open discussions like this one can only help to further the advancement of LLLT. I spoke to our chief medical advisor, Dr. Matt Leavitt, about your remarks regarding the LaserComb on your blog and Dr. Leavitt spoke very highly of your professionalism, commenting especially about your intellectual brilliance.

We reviewed your blog page that contains comments about our clinical study’s macro photos and we encourage you to post this message as a follow up to your comments.

We would like to outline some of the background about the clinical study we concluded.

Our experience with using low-level laser therapy for hair dates back to the mid-80’s in Sydney, Australia. Our founder operated a laser clinic where he successfully treated thousands of people. I was one of these laser patients and had significant results. We then worked closely together to develop a hand held laser device for the international market that can assist individuals suffering from problem hair. The HairMax LaserComb has been on the market for five years and is in use in over 74 countries.

In 2005, we concluded a clinical study protocol entitled “A RANDOMIZED, DOUBLE-BLIND CLINICAL TRIAL TO EVALUATE THE SAFETY AND EFFICACY OF THE HAIRMAX LASERCOMB FOR THE TREATMENT OF ANDROGENETIC ALOPECIA IN MALES”. The primary efficacy endpoint was: Change in terminal hair counts, which are non-vellus hairs, in the target region between baseline and endpoint, utilizing macro images.

This is our second clinical study; unfortunately, we had bad professional direction for our first study as it was only a single site without a control. Despite this, we used the results of this initial research as a pilot study to help develop our new protocol.

Our goal was to conduct this study scientifically and in accordance to Good Clinical Practices (GCP). We utilized four clinical research facilities, three of which participated in many of the Minoxidil studies. Each facility had a primary investigator with extensive experience in Androgenetic Alopecia. All study protocols were approved by an IRB. Professional independent site monitors were employed to verify all case report forms and data managers were used to ensure that all recorded data complied with the protocol and with all applicable section of 21 CFR as required by the FDA. A biostatistician was retained to independently analyze the resulting dataset.

The equipment in use was a Fuji S2 6 megapixel digital camera with a Canfield epilume attachment. The same location was photographed every time, marked by a tattoo and the hair counts, centered around this tattoo, are well documented using Canfield Mirror DPS 6.0 software which stores a image on each individual hair counted over the original macro image for verification.

While conducting our study, we sought to show that the HairMax LaserComb had an effect on the number of non-vellus hairs present on the scalp. In an effort to eliminate any potential bias, independent medical professionals were commissioned to perform the hair counts. These professionals were blinded to the treatment assignments thus removing any bias towards the subjects’ treatment. The data from these medical professionals was then monitored and sent directly to the data management team removing and potential for us to review the data or interact with it.

All terminal hairs were marked and registered in Canfield’s Mirror DPS software using a 19 inch computer monitor. They were evaluated and counted by two independent hair professional reviewers. We are sure you can appreciate that counting many hundred macro images is a laborious task and can be very tiring on the eye. For this reason, we ensured that all hair counts were not performed consecutively. The counts were split up over a reasonable period of time in an effort to eliminate any uncertainty introduced from reviewer fatigue. Although the reviewers may have missed one or two hairs, we are confident that our macro counts represent a fair and accurate assessment of our study.

Our macro images were carefully reviewed by numerous professionals including many of your peers; all have complemented us on our fair evaluation of the data and our methods used in the study. We are unaware of what standard Dr. Rollins and you used in reviewing these images and where the difference exists in our hair counts. However, all the hairs that were counted are marked and we consider these counts to be an objective evaluation.

We will be bringing our clinical images with us to the ISHRS conference in San Diego; we invite you and Dr. Rollins to further review our images up close and hopefully once you see the standard of the images and documented counts you may have a different assessment of our macro images.

Kind regards,

David Michaels, Managing Director
Lexington Int LLC
Developers and Manufacturers of the HairMax LaserComb

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Hair Loss InformationHair Restoration Society Credentialing – Hair Loss Information – Balding Blog

I read on a doctor’s resume that he is a member of the International Society of Follicular Unit Extraction Surgery. Can you shed light on the value of this society on the doctor’s resume?

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In the past, to develop expertise that is unearned, a doctor would create a society and possibly become its only member. That could make him/her the founder of the society, president of it, director or it, or whatever he/she chooses to be. For the less than knowledgeable buyer, the name of the society implies, as is here, some international expertise, some special training and certification, some special recognition by peers in the industry (like an Academy Award Society). The International Society of Hair Restoration Surgery (with hundreds of member physicians) has looked at creative societies with disdain and so should the buyer. There is a suggestion of a ‘slight of hand’ when one invents expertise for themselves or a group of like physicians. As the inventor of the follicular unit extraction technology and the doctor who published the authoritative article in the field, I was never invited to join that society, speak before it, or review contributions by its members in the field. I would find that strange if it were a legitimate society.

Expertise should be earned. Inventiveness is something that should be published or proven. Put the doctor and his society to that test and you will see if it meets this criteria.

Hair Loops – Hair Loss Information by Dr. William Rassman

I have a few hairs that are stuck into the skin at both ends (they look like the loops of shoe laces). What should I do about this?

If there is a lock of hair with both ends in the skin, put a needle below the loop (not in the skin) and pull up on it. The loose end will come free and the secure end will stay. You do not need to have one of our staff do this for you.

Hair Loss InformationHow Propecia Works on Hair and Why Miniaturization Mapping is Important – Hair Loss Information – Balding Blog

Authors: Price VH , Menefee E, Sanchez M, Kaufman KD. Department of Dermatology, University of California, San Francisco published an article in the J Am Acad Dermatol. 2006 Jul;55(1):71-4. Epub 2006 May 3.

This is an important article which shows the impact of finasteride (Propecia) on the miniaturization process. It is clear from this study that Propecia produces much of its value by reversing the miniaturization process, making the hair shafts thicker, more so than growing new hair follicles. That is why it works well in people who still have hair that is being impacted by the genetic balding process, while being minimally effective in those men who lost most of their hair. The article concluded:

“CONCLUSION: Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

I know that many of my readers may be tired of the constant references to mapping out the scalp for miniaturization. This scientific study, by a prestigious university, shows that the degree of miniaturization in the drug treatment for hair loss is where the benefits lie. Mapping the scalp absolutely shows from ‘whence your hair came to where your hair is going’. The measurements of miniaturization is the diagnostic backbone for the diagnosis of genetic balding, particularly when it occurs in patterns (male pattern balding or MPB). Even female genetic hair loss has distinctive patterns of miniaturization and the skilled diagnostician who commands that knowledge, is more effective in giving advice and building the Master Plan that I keep talking about. The doctor should:

  1. make the diagnosis by mapping the scalp and analyzing miniaturization
  2. document the pattern of hair loss and miniaturization
  3. use his/her knowledge to predict what should happen when a person is treated with drugs on miniaturized hairs
  4. observe what happens when the drug is used on the miniaturized hairs by repeating the mapping process periodically over time
  5. build a Master Plan based upon the degree of miniaturization and its response to drugs and/or time
  6. get to know the patient and his/her goals
  7. evaluate the transplant option when appropriate
  8. learn how the treatments (transplants or drugs) impacts the patient’s goals and the balding process based upon successive scalp mappings, and
  9. re-evaluate the Master Plan based upon the knowledge of what has happened in 1-8 above.

This 9 step process is the standard of care today and anything less than this is less than what every hair loss victim should accept.

Too many times, readers of this blog tell me that they have gone to their doctors and asked to have their hair mapped out for miniaturization and the doctors they speak with essentially call mapping ‘hogwash’ or BS. As you can see from what I wrote here and the published article I referenced above, mapping out the scalp for miniaturization is possibly the most important part of the doctor’s evaluation of hair loss. Too many doctors look at the scalp hair, run their hands through it and make a diagnosis and a recommendation based upon a naked eye evaluation (as if to suggest that there is a microcope on the ends of their fingers), but this approach brings no sophistication, little added value, and no clinical science to the ‘hocus pocus’ that has been associated with hair loss and its diagnosis. The standard of care dictates that the 9 step process outlined above is the basic minimum a patient should expect when he/she visits an expert in hair loss. The metrics of miniaturization is the foundation for the clinical diagnosis of hair loss.

Very Funny Hair Loss Commercials from Merck – Balding Blog

Merck, the makers of Propecia, have created a new marketing campaign called The Stunners, which includes 2 commercials (so far) that are wildly amusing. I thought I’d show them for your enjoyment –




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Analyzing the Results of the HairMax Laser Comb – Hair Loss Information – Balding Blog

I have added a link to some of the before and after pics of people who have apparently used the lasercomb.

What do you think?

http://www.lasercomb.net/beforeafter.htm

Thanks again Dr! I’m addicted to your site now!!!

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Ah, the HairMax LaserComb by Lexington International. It’s worth noting that lasercomb.net and hairmax.com both go to the exact same site, so the link you sent is the official site of this product. The page you sent (linked above) has 2 groups of photographs, each with multiple before/after sets. The 1st group is apparently patient results, and the 2nd group is of clinical trial macro photos.

So let’s start with the first group of photos — the patient results. I looked carefully at these, and there is a real question in my mind as to what I am seeing. A few of these pictures have longer hair that is possibly responsible for the changes that I can see. I wanted to get an enlarged version of the photos to see the details that would tell me what I was looking at, but they are not available on the site. The first before/after set in the group are a good example to start with. There is a suggestion that the scalp has coloring to it (Dermatch or something similar), but as I can’t enlarge the photos, I can’t try to determine what it might be. Could the difference be lighting or combing style? I don’t know, honestly. Many of the photographs suggest styling differences. In no case was there any significant change in the hair coverage, though. Either the person had plenty of hair when they started or there was not enough hair when they finished treatment.

Moving on to the 2nd group of pictures, the clinical trial macro photos —

We analyzed two sets of the before/after high-powered magnification photos, which also includes the data that they based their research upon. The actual hair counts as they did them are well presented and can be seen by magnifying the circular areas of hair density assessments. Each hair grouping was identified, numbered, and the authors put the actual count on each follicular unit as they made the measurement. They did not separate or identify those hairs that were miniaturized. Because all of the information is present in the material presented on their website, it was easy for us to repeat their measurements and to ascertain if their numbers corresponded to an independent assessment.

Here’s a breakdown of what I found in the macro photos that Hairmax presents on their LaserComb site.

Macro Photo Set 1 – Before picture:

  • HairMax’s hair count: 107
  • My hair count: 115
  • Of these hairs, 12 were miniaturized

Macro Photo Set 1 – After picture:

  • HairMax’s hair count: 148
  • My hair count: 128
  • Of these hairs, 10 were miniaturized

See the image on the LaserComb site

Statistically, the percent difference between the before and after photos (according to my count) is insignificant. Therefore, in the first set of photos the LaserComb made no real difference.

In the second sequential set of photos, I discovered that the after photo actually had less hair than the before photo —

Macro Photo Set 2 – Before picture:

  • HairMax’s hair count: 147
  • My hair count: 161
  • Of these hairs, 12 were miniaturized

Macro Photo Set 2 – After picture:

  • HairMax’s hair count: 184
  • My hair count: 159
  • Of these hairs, 10 were miniaturized

See the image on the LaserComb site

Yes, I actually counted three fewer hairs after the LaserComb was used. My measurements of the data on their official site do not support the findings they offer.

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I am comfortable saying that I am one of the world’s experts in hair densitometry. I can prove this as I am the inventor of this technology and hold the U.S. Patent on the instruments used by HairMax (or Lexington International) to demonstrate their findings (see: USPTO.gov). With that being said, I reviewed our findings and agree with our counts. I believe that HairMax’s photos do not show any objective evidence of hair growth on the first two sets of data and that the numbers that they derived do not correspond to the assessments made by us. Lots of good hype if you’re into it.

Obsessive About Possible Hair Loss – Hair Loss Information – Balding Blog

Hello,
I am a 19 year old male. To give you a bit of a backround, after much research, no one in my family has balded before the age of 35. My father has recently developed a small receeding hairline at 50, his father at the same age. My mother’s father developed small reccession around 55, judging from photos. Now for me. My hairline in photos from when i was 13 was slightly lower than it is now. I have long hair, and I stand in front of a mirror and pull it back to see how much it changed. My hair is straight, but really thick which I inhereted from my mother it seems. I must have looked at 1000 male temples so far, and my coverage in that area seems very good comparingly. I compare my hairline pulled back to hairlines that I see on spiked hair or just unattended hair. I would not be worried except for the following: In my left temple especially, there are some small hairs that pull out easily. The hairs right after these seem brittle and can be pulled out easier than the rest of the hair on the top of my head. This is basciallly only a problem on the left side. recently, I had a slight itching problem there, but it did not last long. I have problems with looking at it every day. I have been very observant about this. I have also noticed that while alot of male hairlines seem perfectly rounded off up to the temples, while mine come down lower after the temples, then go back up if you know what I mean. This is the area where I see some of these little hairs. I have self altered my hairline alot as it is. I pull out with my hands probly 4-5 hairs a day just testing to see if it comes out. I also run my hands through my fingers and close my fingers on my hair in the temple area to see if any comes out 10 times daily. I put my forehead through about 4 or 5 different tests like this a day in front of a mirror. and it is ruining/controlling my life. I need answers soon before I go insane so I can stop worrying about this and then I can just go out and enjoy my life. Thankyou

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It does seem that you are obsessed over your hair. Assuming that you can get an answer, the question is whether it will help stop the obsession. Get your hair mapped out for miniaturization to get an answer to what is happening to you. What you do with that information will depend upon your mental state. Good luck.

Artificial Hair Implanted with Lasers? – Hair Loss Information – Balding Blog

Dear Doctor.

I lost 50% of my hair and I found in Lebanon a place called Advanced Hair Studio Center. They make fiber hair and stick it by using Laser. As I know before this is banned in Europe, did you have any advice for me to do it? If yes please advise me if 3000 pcs is enough to cover 40 square centimeter?

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If the fibers are being put into the skin, you will almost certainly run into rejection and infection issues. Artificial hair is dangerous and banned in most countries.

L’Oreal Studies 14ft 9in Length of Hair – Hair Loss Information – Balding Blog

A woman with one of the most extraordinary heads of hair in the world has agreed to donate some of her locks for intensive studies by hair researchers.

Hair typically grows to a maximum length of 5ft. But Dae Yu Quin, 41, a Chinese woman from Shanghai, has hair that trails behind her at 14ft 9in.

The article was published last November, but it just came to my attention and may be of interest to the blog readers…