Hair Today, Gone Tomorrow with Dr. Barry DiBernardo

We shave it, braid it, and dye it like a fashion piece. The Broadway musical by its name, shocked, shook, and shaped the world in the 1960s and seventies. Hair. The loss of it can result in emotional distress. A real head trip after the 2022 Oscars. Chris Rock could tell you that and so could Jada Pinkett Smith. But can hair lost be found again? Welcome to Skintuition. I'm Heather Furnas.

And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the nonsurgical world to bring you what's new, what's safe, and what to look for. When you're ready to hit refresh.

It's a real pleasure to introduce our guest, Dr. Barry DiBernardo. Dr. DiBernardo is a board certified plastic surgeon in New Jersey and past president of the Aesthetic Society's Education and Research Foundation. He is a world leader in creating aesthetic energy devices and has helped develop the science and technology behind Get Hair MD, a program designed to help people with hair loss. Welcome, Barry.

Thank you very much Heather and Josh. It's a pleasure to be here.

Now that's quite a hairline or byline or both. So what do real estate and hair have in common? It's location, location, location. Oh, those puns. Anyway, neither does the hair loss. Hair today gone tomorrow. So Dr. DiBernardo, why do we lose hair?

We lose hair from a multitude of reasons. It could be traumatic, it could just be genetic, it could be environmental, it could be stress, but there are a number of reasons.

So when you say a number of reasons, can you tell us a little more? Why is it that some people will lose some and it's not just men, but women too. But there's some men that are bald by the time they're 30. And is it really true that if you have your hair at 40, you're probably going to keep it? Ronald Reagan looks like he had hair even when he didn't have hair. How does that work?

So we've always heard it's genetics. It's your mother's father. That's just not true. So don't go by that. It's other factors. And again, some things you have control of, some things you don't have control of. And that's what we're going to get into on this program. But you mentioned something very important. You mentioned Ronald Reagan and just as an aside, if you look at the people that we have elected as president, they all have good hair and that's why we get into hair because it's not only how you feel about yourself, but it's how people project to you when you have a lot of hair. Look at John F. Kennedy. Look at Ronald Reagan. He was in his seventies and he still had hair. And if you go back and look at which presidents were never elected, like you look at Gerald Ford, the people who were not elected didn't have hair. There was only one exception. That's Ike. But he was a general. But if you look back at all the presidents elected, everyone has good hair. And I think that's something to speak for how people are looking at you and what they're thinking of when they view you.

So I mentioned Jada Pinkett Smith and she has alopecia absence of hair that is different from Bruce Willis's hair, which is maybe, maybe he wouldn't be president. His hair loss. What is the difference? And is one more treatable than the other?

Well, there are different disease forms also. And you've got different alopecia, like you have male pattern baldness. That's the most common and that's what we have always seen the most in hair transplant and nonsurgical hair. But what people don't really talk about in that common form is female pattern baldness. And it's very normal for women to also lose hair from alopecia, but they're just not supposed to lose hair, so they don't talk about it and it's a much bigger stress for women.

And what pattern in women?

So men are easy. It's usually in the front and it starts going back and it's right up front. Women usually retain the frontal hairline, so you'll see a hairline, but as you look further back, it starts getting thinner and thinner and there's not a lot of hair to then comb. That's typically female pattern baldness. And again, it's something, those are the cards you were dealt and that's just what you got. But for example, there's some of these alopecia that can be disease related or there's one that we see very commonly, and that's mostly women who braid their hair and put this tension on the area. That's a tension alopecia. And they're doing it to themselves by continually braiding over and over again. So again, they're the most common, which we see all the time in men and women. And then you have other types that can be a disease, it could be treated with steroids. Often those people show up to their dermatologist, they get biopsies and they figure out what's going on.

So can we prevent hair loss? Obviously the way explained it with the tension alopecia with the braiding, if you don't do it then maybe you don't get the hair loss, but male pattern bonus, any kind of hair that's falling out, there's so many products and things. So can we actually prevent hair loss?

Well, if you asked that question a few years ago, Josh, or five years ago, I'd say no. And I don't know that I can answer it fully today that we can prevent it. But I think what we have and what we're going to talk about today with all the nonsurgical methods, we can certainly either slow it down, stop it, or if done early enough, maybe prevent a lot, what would've happened in someone who's younger. We just haven't intervened in these young people because no one knew we had or they have choices. And if you look further back in the last 30 years when we started doing hair, our only tool in the toolkit was hair transplant. So you lost it, we put it back, that was it. That had nothing to do with preventative or any of the things you're asking right now.

So if I am like a 25 year old man with thinning hair, what would you recommend I do if I don't want to lose anymore?

So that's the time to react and act because the people who are not going to be susceptible to the programs we're going to talk about are those who've lost all the follicles and there's just nothing there. There's nothing left to stimulate. But in this 25 year old, I'm going to imagine there are some normal hairs. There are hairs that are thinning, hairs go through cycles. Anagen is the active growing phase. Catagen, telegen is the resting phases. But as they have these smaller hair follicles, we can intervene, which we're going to talk about in detail and stimulate and bring them back and kind of wake them up and bring them back and hopefully reverse what's going on at the very least, stabilize it. I'll hear from men, women, one of the first things they'll see when we do our program is I'm used to the hair falling out and I see it in the shower drain and my comb and my brush, and they'll say right away, Hey, I don't see it falling out anymore. So that's step one. And then as we start monitoring and we see further growth and thickening, now we're making progress.

So I think a lot of people know about hair transplants. I know they're different kinds, but let's focus a little bit on before you get to the hair transplant, when things are really things that can be done and without necessarily as aggressively as hair transplants. So there's microneedling, there's platelet rich plasma, there's laser with serum. Are these the same? Are these different? How do you choose? And even the hair transplant, you just pointed out that if there's no hair follicles, that's when you need to go to the hair transplant. But these other things, how do you decide?

Well, I think you may not have to decide because what we find as we're doing more and more work and research in this is other than hair transplant, as you said, all of these methods attack different mechanisms. So it's not like I'm going to do this or that or that. It's more like I'm going to do this and this and this and this because they're all working differently. And that's how our program works. We've been looking at all these nonsurgical methods, orals, topicals, the shampoos, the serums, the molecules, the laser stimulation. Those are all different methods. And we actually used them all together in one program. So our program started years ago with just the lasers and they did pretty well. So if one did well, how about eight altogether? So that's the theory behind this.

How does the laser work? What does it do for hair?

Good question, Heather, because that's probably one of the most studied components that we have. So I have a question for you guys. Are doctors watching this or everybody? This is for patients also?

Yeah, patients. It's geared towards patients and we hope a few doctors look too.

So I'm going to talk in both languages so everybody understands. The studies for this were done at Wellman Labs at Harvard. That's basically our best laser labs in the world. And these are a red light, usually 670 nanometers. And that light penetrates for those who took biology into the cell. In the cell is something called the mitochondria. That's what makes energy for the cell. And on the inner wall of the mitochondria, our little chemical reactions going on that produce A T P. A T P is energy. Well, we're talking about hair follicles. So what we're doing is we're basically sending those hair follicles to the gym. We're pumping them up with iron and pumping them with a t p energy. And that's the mechanism. The red light stimulates that reaction to take place. And if you either use the powerful laser we have in the office to get you started, or the one at home which you use every other night, you're basically sending your hair follicles to the gym every other night for 25 minutes to get them full of energy. And that's why ones that are losing energy will start to weaken and fall. The shaft will fall out and the hairs may just continue to disappear. But if we're stimulating them constantly and increasing blood flow, that's not going to happen. And those are very, very good studies that were done at Wellman Labs and that's the basis of at least the laser portion of what we provide.

So the laser at the office, it sounds like that's the big gun, but you mentioned laser cap at home. Can you explain the difference? And you say you put it on for what, 20 minutes,

Five minutes every other night? Now that's also important to talk about. So the one at home, if you use the right one, should get you very good results. We only do the one in the office in the beginning to really turbocharge this process, but then you're left with just doing it at home. And the reason this is important is because with everything, there's a lot of copycats out there. And if you look in the magazines and the airlines and all this, there's all these laser combs, laser caps, and they all sound alike and some may actually be even more expensive, but the one that we use actually has a high power coming out of it. They looked at a bunch of these to see are they all alike? And many, many of them, in terms of laser output only put out one watt or less. The one we use puts out four watts. So it's vastly different in energy output, which is something important when you talk about lasers. And the other thing is because this one is felt to be so good and so reliable, it actually comes with a lifetime warranty because you need to use this for many, many years. So it's very powerful. Lifetime warranty, great studies behind it. And that's the laser cap that's used with our program.

Does it hurt?

No, these are cool lasers. So that's one thing we do when patients come in for a consult for this program, we even bring them downstairs and put 'em on the big laser and you don't feel anything really.

Well, speaking of not feeling anything, let's talk about something that's a little bit mysterious exosomes. So exosomes is kind of an word and it's, we used to hear about stem cells and now hear about exosomes, these little buckets of energy of repair, but they're not yet F D A approved, but studies seem to suggest they can have a big impact. So how do they work on hair follicles and what do you think about 'em?

So exosomes just very basically are one of those categories of these molecules and groups that circulate around. And if you concentrate them and put them where they belong, and what we just said is the hair follicles, which live about four millimeters below the skin would probably be very happy being bathed in these things. So now can we use them? Well, if you type in F D A exosomes, I think the first sentence says exosomes are not allowed to be used in the United States of America. Okay, what do we do with that? So I think in our field, and if you listen, is it a drug? Is it a cosmeceutical? I think it has been split up now into, if you're putting it topically, that may be allowed. And I'm not giving any legal F d a advice here at all. I'm just talking in general. But some might believe that you can mix these up and use them topically for your skin, for your hair, and that might be okay, I think with what we're trying to do in terms of efficacy, it might be a lot more powerful if you injected it well.

(16:40)
That's what we're not allowed to do is inject these things. You can't take stem cells and process them. Same with fat grafting. If you take it from someone's body and put it back in, you're probably allowed to do that. So there are some exosomes that we're looking at that are autologous. It comes from the same person's body and then you concentrate it. So you may be able to put those back in. But this whole field has a lot of discussion all the time, and this is not the right form to say what's right to use, but exosomes can and will play a role here. And I think it's up to the practitioner or practitioners as a whole in concert with the F D A to figure out what works and what we're allowed to use and when. But that's a long-winded answer to your question.

So now I'll ask a short question. 

Thank you.

Yeah, that backs up a little bit to something that several years ago was exactly in that situation and now it's all very approved and people do it a lot, which is platelet rich plasma. So tell us what you think about plate rich plasma and specifically as it's added with microneedling. Microneedling is this thing to kind of open the pores to get through the barrier of the skin, but what do you think about platelet rich plasma? Is it good, is it useful? How should we think about it?

Okay, so it's still that category of platelets and the plasma that circulate in your body. You draw your blood, you spin it down, and now you inject it into your skin to your hair. We don't include P R P in our program and we can do it as an add-on, but it's not the main part of our program because just as I quoted very specific studies on the lasers, we don't have those kind of studies for the P R P particularly in hair. And what you'll find when you look at data is there's a bell curve and you may see some patients that will actually do very well from it. You might see more patients do okay, and then there's probably a third that don't get anything. And what do you do with that whole 30 of your patients that are paying a lot of money for this and they're not getting a result? So it's a variable. And I think right now we're on hold with recommending or putting it as the main part of our program. We have a lot of other things that do have data and do have studies. So we don't use the P R P, but it's used all over the place in the country for this purpose and for nice skin. But I think there's a lot of variability in it.

So Barry, you mentioned patients use a shampoo, something topical, there are a lot of different medications and supplements to increase hair thickness and hair density like minoxidil and fina steroid, neutrophil, replenology. Some have more side effects than others. How are they different? How does someone choose a one that's best for them and what do you incorporate in your program?

So you're right, there's variability all over the place. And I think for the patient, it's so confusing and I frankly don't know how they would figure it out. There are a lot of good products out there, neutrophil, as you mentioned, a very good oral. But let me dissect what you also were asking. Again, there's two different categories. One are the prescriptives, you need a prescription to get those medicines, and then the others you don't need a prescription or they're over the counter or something like that. So I think the general answer is in our program, you don't have to think because we work seven days a week looking at products, looking at studies, and if we have something in our program and we see right away there's something better, we will switch it out in our program so the patient doesn't have to worry, did I read all the studies and do all that work?

(21:06)
So we're doing that for you because obviously we want this to be the best nonsurgical hair program there is. We're currently looking at a different oral that we're probably going to switch out again because it has more data, more studies, and more results. So it's very hard for a patient to know that we are professionals in here and this is what we study. So we will pick for you the prescriptives, minoxidil, finasteride, and then the one you put on your eyelashes to grow the lattice. They're like three different prescription medicines that can work and which ones do you do? And that can be an issue also because some people say they use it and I use this and it's not working very well. Oh, I did and it did work well. So what we're trying to put into our program is actually a swab, a genetic swab that we do for you and send to the lab.

(22:08)
And what that will analyze is which ones of those, one of them, two of them, all of them, none of them is your particular genetic susceptible to. And then a compound will be made in the right mixture of what your body needs. So we're trying to take that to the next level of advancement by actually doing personal genetic testing to see which of the prescriptives you can use. But if you didn't get fancy like that, order finasteride, order propecia, those are things you could commonly use. And you do have to get those from a physician because Propecia, it's very small, less than 1%, but it can cause impotence. And you'd have to ask them that question for the first three months. So if it's a prescription medication, you do need to get that from your doctor or your hair doctor because there are reasons there have a prescription.

So I'm gathering that it's these hair prescriptives as you say, or products there like other things that you can't take it once. Every blue moon when you realize you're going to a party and your hair is thinner, you actually have to follow the rules and you have to for a certain length of time. So what would you say, because hair has these cycles, like you said, intelligent, the resting phase and antigen. What is the length of time that you think a client, a patient needs to devote to give it a chance to give a program, any program, a real chance to work?

Great question, right? Absolutely. I'm not taking the pill and going to the party tomorrow. It's actually the same answer, whether it's hair transplant or the nonsurgical program, it takes about a year for either of those. Even when we do hair transplant, we'll take it from the back, put it in the front for the first three to five months, not much is going to be going on. And I tell them, that's when I'll see you because that's when we're going to start to see the hair growing. And then I'll see you again 10 to 12 months in which range, I think most of your hair, anything that's going to grow should be growing and you should look more finalized. And that's the same thing with our hair program, that it's a year program. You're taking these things for a year, you will phase out of our powerful things in the office because those, as I said, are just the jumpstart.

(24:44)
But you'll continue your home laser and there's a very specialized camera from Canfield called Hair Metrics, and it takes very close up pictures of the hair at hair diameter, which is the most sensitive measurement, the density of your hair. It'll give you a printout with the ratio of telogen to anagen hairs. So we'll do that every three months or so while you're on the program so we can kind of monitor. But whatever it is, whatever we're using, whatever hair, it's all about a year to get to your endpoint. So if you're an inpatient person, this is not for you, go get something and put it on your head and go to the party.

So if you're completely bald on the top, you're a guy and you have hair transplants. So you would still do the transplants with the program with everything else, is that right?

You have two different problems. I could put you on our program and triple it, and I doubt I'll be getting hairs upfront to grow, but you have hairs in back that will not change. We can move them to the right place. And I know a lot of people more and more are doing hair transplant. It's technically easy to do, but there's another component to hair transplant, and that's the artistic nature. The angle of the hair is the density, the look, the design of the hairline. So for that big area in front, you need to do a hair transplant, but then halfway back you may just be thinning and also your hairs on the side can be thinning, losing. So the hair, the nonsurgical hair program in concert is actually the best of both. And in the past we didn't have that option. We did hair transplants and lots of people, particularly in men where we did the front and almost used up all their graphs, then they started losing in the back and we had no tool for them. So I think the two together in the right person is okay to do and probably a very good approach to this.

How about women? Would you do hair transplants or do you do hair transplants in women?

We do. And there's some women that have a very high hairline and that's not becoming of them. So we'll put hair in and lower it and they look a lot better. We have women who are what we talked about before, the typical female pattern baldness. And just behind the frontal hairline there's loss of hair. So we'll fill that in. And again, the artistic nature, we'll ask some questions like how do you comb your hair? There's a limited number of follicles to do hair transplant, so if you're combing left to right, we may favor the numbers of graft on that side to make it look fuller. So there is an art to this also, but for women who have lost a lot in the area that they really need to be combing, they could be a hair transplant candidate.

So let me take you just a little bit into a slightly different world, which is chemotherapeutic agents. They often result in hair loss and patients who are suffering through recovery from cancer, and they'll often wear a cold cap to keep their hair. How does that work? What is the success rate? And do you have any suggestions for patients having chemotherapy that are trying to hold on to whatever they can?

Yeah, that's another great question. And there's a lot of variability there Also. Certainly while they're under these intense chemotherapeutic agents, we probably wouldn't want to do much of anything because whatever happening is happening, perhaps work with the oncologist that whatever the modality is and see what its long-term effects are, but say someone's done and they're not receiving those anymore. And the drug itself does not have a long-term hair effect, but everything is so stressed. I mean, not only is the hair stressed, their bodies are stressed and stress, whether it's from cancer or from emotional or other things from a medical problem, stress can make you lose your hair. And the nonsurgical program can really work well in those situations. So yeah, there's hope for people under all those categories, which I'll put them all under the stress category.

A lot of people are in the hair loss, hair found grow business. What should people look for when choosing what treatment to have and where to go?

You mean when the patients are looking for hair treatments, how do they

Exactly. I noticed my hair is thinning and I, I'm on my Google search and I see a few things come up.

Well, they don't know. It's like finding a plastic surgeon or an aesthetic physician that you don't know for sure. You really have to look at their background and do a lot of research. So it was easy when we only had hair transplant because we all belong to a society called the International Society for Hair Restoration Surgeons, I S H R S. I think we started that in 1992. And there are certified members of that. So if you want to have a cosmetic aesthetic surgery, are you going to go to our national societies and probably if your doctor is a member of ASAPS, because we intensely screen all the new members.

That's the Aesthetic Society.

The Aesthetic Society, we screened them. And so if you look on a list, you probably are going in the right direction for hair transplant. We have that too. And these are maybe not only hair transplant doctors, but they're experts in hair and they've been for many, many years. The problem becomes there's a lot of others out there doing this, and frankly, they don't know. The program that we do is very intensive and people are selected to do it. And I told you the amount of time and effort we put into the research behind the products that are being offered, and they're the same system wide. So you can feel better about that, but you could make a mistake very easily today.

So this has really been incredibly interesting. Obviously this can go on for a long time because hair is a very dynamic process. Is there anything else you'd like to mention for people to know about that we haven't covered?

Just like anything else, as I was just saying, identify what your problem is. The more research you can do, the better. But you may just, if you're looking on Google, you can get so confused by things you were both mentioning, just find someone who might be trustworthy to do these things. But the point is go see someone because with hair, if you do nothing, it's not going to come back on its own. I think you need to do something and whether it's just one thing, like the orals or topicals or to do one thing, but my message to you is if it's nonsurgical, the more things you do in combination, the better. I think they're all different mechanisms and have patience, because it doesn't happen overnight or over the week or the month. If you're really concerned about your hair, give it a year's effort. And probably with what we know today, it's going to be time and action well spent. And does anyone want to know what the name of our program is?

Well, we certainly do want to know the name of your program. So tell us.

This is not a commercial, but if someone's listening to this and they want to find what this is we're talking about, it's called Get Hair MD. It's Physician run. The website is get hair md.com. And there are physicians participating with this all over the country. And I think if you go on the website, you'll get lots of information on everything we've been talking about from the topicals, the molecules, the lasers, and then just find one of those people and go have a chat and see if it's right for you.

Well, that's really, really helpful. So thank you for listening to this episode of Skin Tuition with Dr. Barry DiBernardo, a member and founder of Get Hair MD. Join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles, discovering new ways to be better and feel better about ourselves.

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