quantum hairscan

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Will an effective hair regrowth treatment (finasteride, minoxidil, photomed, regenmed, etc.) increase intra-anagen hair shaft volume? In other words, in an individual growing hair, will its post-treatment long and/or short axis diameter increase? and/or will it’s growth rate increase?  (hair shaft volume = cross-section area x growth rate; change in hair shaft thickness and/or change in growth rate will change volume per unit time.)  ANSWER? – We are now bench testing a new measurement platform to detect sub-cubic-micron hair shaft volume changes in precise temporal association with a hair regrowth treatment and are targeting to detect such changes within 30-60 days of treatment initiation.

pp

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1 charger to lasercap – plug wall charger DIRECTLY TO LASERCAP (continuous red at lower brightness; wiggle/jiggle wires, twist/turn barrel connection, flex lasercap…continuous red light should stay on without any blinking)

2 charger to powerpack (switch off; u should see red light on wall charger; means battery is charging)

3 powerpack switch on (powerpack light should be flashing a rapid green and lasercap should be flashing a rapid red; light on wall charger should be green)

Data from our Optics Lab: Comparing the LaserCap to a Popular Off-Brand

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A little ventilation can go a long way folks. As discussed in a prior post, the LaserCap is specially engineered for superior management of heat. Here is some data from our optics lab to prove that.

In this experiment, we compared the output of the LaserCap 300Flex, the LaserCap MC2, and one of the most popular off-brand 272 diode laser cap copies.

We measured the intensity of each device at 30 second intervals, over 5 minutes of continuous light emission.

As can be seen in the graph below, we found that the output delivered by the off-brand cap was dramatically different than that of our LaserCaps.

First, the off brand cap (shown in purple), starts at only a fraction of the intensity of the LaserCaps. Furthermore, over 5 minutes of continuous emission, heat build-up causes intensity to drop by nearly 30%.

By comparison, the LaserCap 300Flex (shown in blue), has more diodes, can deliver almost 4x the intensity of the off-brand cap, and loses only 22% intensity over 5 minutes.

The LaserCap MC2 (shown in red), also with more diodes, and similarly delivering much higher intensity than the off-brand cap, loses less than 9% intensity over 5 minutes.   

This off-brand 272 diode cap is one of the more popular devices out there, and is sold at the same price as the LaserCap 300Flex. It has a nice look to it, but is low power, and is poor at managing heat. As a result the dose delivered to the patient is dramatically less than what would be delivered by the LaserCap.

We feel it is important to highlight these differences, because in the end patients are being mislead and mistreated.

Anyone can put light bulbs in a hat, add some cosmetic fluff, and claim that it will regrow your hair.

However making an effective therapeutic device requires a little more attention is paid to good to science and engineering.

Introducing the PRP Cell Lab and Photomed Optics Lab

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In this post we want to tell you a little more about our exciting new laboratory spaces at LaserCap Company. We have recently set up two labs, which we are using to both refine the engineering of the LaserCap, and to study the effects of other complementary treatments for hair restoration, such as platelet rich plasma (PRP). We are also excited to report that we are using our labs to plan the first ever registry trial investigating Scalp PRP + Photomedicine for Hair Regrowth.

See the links below for more info!

PRP CELL LAB

Has capacity to quantify and characterize Platelet Rich Plasma (PRP) preparations by automated hematology analysis and microscopic imaging.

click here for detail

PHOTOMED OPTICS LAB

Has capacity to measure output powers and wavelengths of photomedicine devices commonly used by physicians for hair regrowth.

click here for detail

Pulsed vs. Continuous Laser: Why should we care?

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As discussed in the prior post, there are many ways Low Level Light devices can differ – wavelength, power, area of illumination, and so on. One difference however, which we feel does not get due attention, is pulsed versus continuous light emission.

 

Most light sources (for example the light bulbs in your home, and the screen on which you are reading this blog post), emit continuous wave light, that is at a constant intensity, which appears unchanging to the naked eye.

 

Pulsed wave emission on the other hand involves turning on and off the light source many times per second. The Original LaserCap emits pulsed light, which gives it a characteristic “flicker.” There is a rhyme and reason to this, other than more attention for patients when they wear their LaserCap out to the nightclub.

 

 

A primary advantage of pulsing is improved heat management. Essentially the “off” period during pulsing (aka the “quench” period) allows the laser to cool, and compared to continuous laser, generates less heat at a given level of intensity [1].

 

Incredible amounts of energy can in fact be safely delivered with pulsed light. In one study for example, researchers illuminated the heads of rats using both continuous and pulsed light at a peak intensity of 750 mW/cm2 – over 100x the intensity of the LaserCap. The brains of rats exposed to continuous light were fried due to the heat, and they displayed severe neurological deficits. On the other hand absolutely no neurological or other tissue damage was found in the rats exposed to pulsed light [2].

 

Of course this is an extreme example – LLLT whether continuous or pulsed has been proven time and time again to be 100% safe, as it involves only a tiny fraction of the energy used in this study, which means any heat-related ill effects are limited to minor discomfort. However the principal remains – pulsed laser can be used to deliver larger amounts of energy, deeper into tissues, with greater comfort for patients.

 

Lasers furthermore do not work very well when they heat excessively. Specifically this can cause their power output to drop dramatically, resulting in an inconsistent and unpredictable dose delivered to the patient.

 

Even small barely perceptible amounts of excess heat can cause this. In fact, we tested the power output of several other laser cap brands which use continuous illumination, and compared these to the Original LaserCap, using pulsed illumination. We found that the power output of the off-brand continuous laser caps dropped by over 30% during the manufacturers’ recommended 5-6 minute treatment times. The pulsed Original Laser Cap on the other hand, when turned on for over 30 minutes, showed no drop in power [3].

 

In addition to superior comfort and more consistent output at higher treatment intensities, a number of studies have demonstrated LLLT with pulsed light to be more effective than that using continuous light [1]. This is likely at least partially due to the fact that pulsing allows for higher peak intensities and thus greater penetration into tissues. However research is revealing several other potential explanations.

 

One is that some biological processes operate with characteristic frequencies and/or other time scales, ranging from several to thousands of cycles per second. It is theorized that pulsing light in the correct way can better “sync” with, and consequently better optimize these processes. Examples of such processes implicated in the mechanism of LLLT include opening and closing of ion channels, and the photodissociation of nitric oxide [1].

 

Furthermore pulsed light may limit the filtering effect of melanin, a well-known pigment found in skin and hair. Melanin has been implicated as a cause of poor phototherapy outcomes in individuals with darker skin types, as it is highly absorptive of wavelengths in the visible and UV spectrum, and therefore can filter out substantial amounts of light, leaving less available to target cells. Studies have shown that, relative to continuous light, pulsed light can more easily penetrate through melanin-rich substances [4]. This has important implications for hair restoration, as individuals with darker hair and skin may benefit more from a pulsed LLLT treatment versus a continuous treatment [1].

 

There are advantages to continuous treatments as well however, namely shorter time of treatment needed for equivalent dose. The most effective LaserCap is of course the one that is used, so a continuous option may be more suitable for patients with busy schedules or desiring greater convenience.

 

We believe that our prescribing physicians should decide whether to recommend a continuous or pulsed treatment, based on their evaluation of the best available evidence, and the individual needs of their patient. This is why we provide both pulsed and continuous options on all of our LaserCap models.

 

The LaserCap moreover is designed for superior ventilation making it uniquely suited for continuous output. We give our competitors credit – they all provide a nice looking product. But it seems that is about all. In many cases their enclosures, although aesthetically pleasing, are heat traps, which is why their output can drop by over 30% over a short 5-6 minute period of time [3].

 

While any continuous treatment will result in some power loss, a little ventilation can go a long way. The Original LaserCap loses only 10% power with comparable starting output and time. The Original LaserCap 300Flex moreover can deliver almost 4x the intensity of the most popular off-brands – and loses only around 20% power during 5 minutes of continuous illumination [3].

 

Furthermore our newest LaserCap model, the MC2, with its unique, patent-pending vented design has even greater ability to manage heat. When we tested the MC2 in continuous mode at an intensity nearly 3x the intensity of similar off-brand caps – power dropped by less than 9% over the 5 minute treatment time [3].

 

Stay tuned for more of this original data from our optics lab!

 

 

 

  1. Hashmi JT, Huang Y-Y, Sharma SK, et al. Effect of pulsing in low-level light therapy. Lasers Surg Med. 2010;42(6):450-466. doi:10.1002/lsm.20950. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933784/
  2. Ilic S, Leichliter S, Streeter J, Oron A, DeTaboada L, Oron U. Effects of power densities, continuous and pulse frequencies, and number of sessions of low-level laser therapy on intact rat brain. Photomed Laser Surg. 2006;24(4):458-466. doi:10.1089/pho.2006.24.458
  3. Internal data on file
  4. Brondon P, Stadler I, Lanzafame RJ. Pulsing influences photoradiation outcomes in cell culture. Lasers Surg Med. 2009;41(3):222-226. doi:10.1002/lsm.20740

 

 

Thanks to Dr. Michael Hamblin and Dr. Bob Haber for their contributions to this post

How should we compare LLLT devices?

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Is there really a difference between Low-Level-Light Therapy (LLLT) devices for hair restoration? The answer is decidedly yes. While most devices look similar (often imitating the design of The Original LaserCap), the treatments they provide can differ dramatically.

 

But how exactly do LLLT devices differ? And what is the best way to measure these differences?

 

The are many ways these differences are described – irradiance, fluence, power, number of diodes, intensity,  wavelength, ect. Terminology is used inconsistently in both academic and non-academic contexts, with different terms often used to describe the same parameter. In any case, this can be difficult to understand especially if you are like me and you struggle with basic algebra. But I did find that much of my confusion was alleviated by starting with a more solid conceptual understanding of the relevant physics.  

 

The biological effect of LLLT essentially arises from a delivery of energy, from the device, to the patient. This energy is of course in the form of light, and is measured in Joules (J). 

 

The nature of this biologic effect depends very closely on the specific spatial and temporal pattern of energy delivery. That is, how much energy is delivered, over what time, and over what area. 

 

There are a few ways to describe this:

 

Power (aka radiant power, or radiant flux), indicates energy delivered per unit time. The SI unit for power is Watts (W), where 1 W = 1 J/s

 

Fluence (aka radiant exposure, or energy density), indicates the amount of energy delivered per unit area. The SI unit for fluence is J per square meter (J/m^2).

 

Intensity (aka irradiance, or power density), indicates energy delivered per unit time and area. The SI unit for irradiance is W/m^2.

 

So with these parameters in mind, we can describe any given LLLT device by (1) power output, and, (2) area of coverage, which in turn can be combined into output intensity.

 

These device parameters then interact with treatment parameters, namely amount of time the device is worn per treatment, and frequency of treatments. By combining both device and treatment parameters, we can see the full pattern of spatial and temporal energy delivery to the patient.

 

However this does not tell the whole story for a few reasons. First there are different kinds of light (or more broadly electromagnetic radiation), usually described by the property wavelength. Electromagnetic radiation can be regarded as acting like both waves and particles at the same time. Wavelength describes the distance between peaks of the waves, and is directly related to the energy of the particles, which are called photons. The range of wavelengths and their photon energies, are usually described as the electromagnetic spectrum, as can be seen in the following image:

The energetic nature inherent to each type of electromagnetic radiation causes different regions in the spectrum to have distinct properties, and physical and chemical interactions with matter. High energy, short wavelength electromagnetic radiation (some ultraviolet radiation, X rays, and Gamma rays), can ionize molecules, that is strip them of their electrons. This can damage cells, tissues, and DNA, causing acute radiation poisoning and death with high intensity exposure, or cancer if exposure is of lower intensity. On the opposite side of the spectrum, low-energy, long wavelength electromagnetic radiation (eg infrared, and microwaves), is unique in that it can can more easily penetrate and heat matter.

 

In the middle is the visible spectrum, electromagnetic radiation that is visible to the naked eye, and what we call “light”. Different wavelengths or photon energies within the, visible spectrum, are perceived by the human eye as being different colors; higher energy and shorter wavelength light is blue, while longer wavelength and lower energy light is red. LLLT of course utilizes wavelengths within the visible spectrum. As described in the prior post, the specific wavelength utilized in LLLT is one of the main determinants of its biologic effect, as a specific chromophore will only be activated by light within a specific range of wavelengths.

 

Second is the type of light source. Lasers are most commonly used in LLLT. Lasers are unique in that they emit light coherently, which allows them to be more focused over smaller areas, transmit over longer distances, and emit light within a more narrow range of wavelengths. Other LLLT devices use light emitting diodes (LEDs), which although more economical, emit non-coherent light of very different quality. There is some evidence that low-level treatment with LED can produce similar biologic effects t0 laser although this research is still ongoing.

 

A final parameter is pulsing. Most light sources are not pulsed. Instead they emit continuous wave light, that is at a constant intensity, which appears unchanging to the naked eye. Pulsed wave emission on the other hand involves turning on and off the light source many times per second. There are advantages to both which we will be discussing in next week’s post!

 

In summary here is is a good way to compare different LLLT devices:

 

  1. Total power output (W)
  2. Area of illumination (m^2)
  3. Intensity of illumination (W/m^2)
  4. Type of light source (Laser or LED)
  5. Pulsed or continuous emission

What is Low-Level-Light Therapy? Sorting through the Semantics

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What exactly is Low-Level-Light Therapy? Or should we be calling it Low-Level-Laser Therapy? Or Low-Level-Laser-(light) Therapy? Or Cold Laser Therapy? Or Photobiomodulation Therapy? What the heck is Low-Level-LED-Therapy? Who is in charge of naming these things anyways? What is the point of all these syllables?  

 

Tongue-twisters aside, these questions are important. How are we able to have an intelligent discussion about this topic if we are not sure what exactly we are discussing? The semantics can be surprisingly difficult to sort through, in no short measure due to misinformation (perhaps purposefully) perpetuated by medical device marketers, and unqualified keyboard warriors (with hopeful exception of the present blogger). Even the scientific literature can be misleading, due to non-standard and constantly changing terminology.

 

The terms listed above are often used interchangeably, referring to either identical or very similar therapies. A brief history lesson can help to explain why.

 

In 1967, shortly after the development of the first working laser (the ruby laser), Hungarian Scientist Endre Mester, was trying to replicate an experiment in which red laser light was demonstrated to eliminate malignant tumors in rats. Mester did not cure any tumors, as his laser contained only a small fraction of the power of that used in the prior experiment. However his low power red laser did produce some interesting effects – namely accelerated wound healing, and hair growth [1].  

 

Mester called this “Laser Biostimulation,” referring to the stimulatory, and regenerative effects he saw. As therapeutic applications arose for low-powered red lasers, the term Low-Level-Laser Therapy (abbreviated LLLT), was coined. “Low-level” of course described the to the power of lasers used, but more specifically the intensity of treatment, which was too low to cause excessive heating and/or damage to tissues. Although “low-level” is somewhat ambiguous, it made some sense, as it differentiated LLLT from other early applications of lasers in medicine, using much higher intensity for ablation, cutting, and thermal coagulation of tissues. Various other alternative terms reflect this dichotomy such as “cold laser therapy,” “soft laser therapy,” “low-intensity laser therapy,” “low-power laser therapy,” and so on [2].

 

Low-Level-Laser Therapy is still used very frequently today, at least recently more frequently than any alternative [2]. However many became dissatisfied with this term when it was demonstrated similar therapeutics effects could be produced using non-laser light sources, such as light-emitting diodes (LEDs)  [1]. To account for this, some replaced Low-Level-Laser with Low-Level-Laser-(light), Low-Level-LED, or the more inclusive term, Low-Level-Light Therapy. All of these terms are commonly abbreviated LLLT.

 

Today the acronym LLLT is widely utilized in both academia, and industry. It may refer to any one of the above terms, but most often Low-Level-Laser, or Low-Level-Light. Regardless of the specific name, LLLT is used to described the same therapeutic – application of non-ionizing light at low power intensity for pain relief, immuno-modulation, healing, and/or tissue regeneration. Most also consider LLLT specific to a narrow range of wavelengths within the electromagnetic spectrum, usually corresponding to red or near infrared (NIR), but others expanded it to all non-ionizing wavelengths with the infrared, and visible spectrums [3,4].

 

So which one is the correct LLLT? According to the National Library of Medicine (NLM), this would be Low-Level-Light Therapy, which is the official term in their Medical Subject Headings (MeSH) database. For those unfamiliar with MeSH, it is basically an advanced thesaurus for biomedical literature – a database of hierarchically-organized terms used for example to catalog and index pubmed.  You can also search the Mesh database (https://www.ncbi.nlm.nih.gov/mesh), for lists of “synonymous” – highly associated and/or interchangeable terms relating to a particular topic. Each list has a header term, which is the official term as recognized by the NLM. So if we search “LLLT,” or any of the various non-abbreviated versions, we find ourselves on the same page, headed by Low-Level-Light Therapy. We can also see the official NLM definition: “Treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat. A variety of light sources, especially low-power lasers are used.” [5]

 

But we are not done yet sorry guys – despite its official recognition, many argue that Low-Level-Light Therapy is too broad, as it can also describe clinical applications of low-intensity, non-ionizing light, such as photodynamic therapy (PDT), and optogenetics, which have with distinctly different methods of application, mechanisms of action, and biological effects [2].

 

This notion has become stronger in recent years, concurrent with an increase in understanding of how exactly these therapies work on the cellular and molecular level. We now know that when cells are exposed to low intensity light a biological effect can arise from absorption by intracellular molecules called chromophores. These molecules are uniquely able to absorb light due to their specialized, pigment-containing functional groups. When these functional groups are exposed to light of appropriate wavelength, they are able to absorb it to induce functional changes in the chromophore. With sufficient absorption in many chromophores, these functional changes can in turn cascade into larger-scale, long-lasting effects within the cell and the local tissue [3].

 

For example, in mammals, red and near infrared (NIR) light is absorbed by the enzyme cytochrome c oxidase (CCO), embedded in the inner mitochondrial membrane. As part of the electron transport chain, CCO plays an integral role in oxidative metabolism. Light absorption increases the activity of CCO, which in turn improves efficiency of cellular respiration, increasing production of ATP. A primary effect of this is that, all else equal, the cell is able to function more efficiently, allowing it to “work” harder, with less metabolic input. Additionally, downstream effects of CCO photoactivation result in production of various secondary mediators, such as reactive oxygen species and nitric oxide, which can result in dramatic, long-term effects on cell behavior through modulation of intracellular signaling, and transcriptional pathways [3].

 

Now we are able to have a more mechanistic basis for our definition of these low-intensity, non-ionizing light therapies. Due to low-intensity, they did not damage tissue, or result in other heat-related effects. Similarly, due to non-ionizing wavelengths, they did not damage to cells, tissues, or DNA, in short or long term. Instead the chromophore activation mechanism is allowed to propagate, and be primarily responsible for the biologic effects we observe. The chromophore mechanism also explains why we can see different biologic effects from different non-ionizing wavelengths, as different chromophores are sensitive only to very specific wavelengths of light [3].

 

Rooting our definition in the physiological mechanism, allows us to draw a clear line between LLLT, and other applications of low-intensity, non-ionizing light. Specifically both PDT and optogentics involve introduction of new chromophores, either exogenous (in the case of PDT), or through genetic engineering (in the case of optogenetics). By comparison, LLLT as it is normally defined relies wholly on activation of endogenous chromophores [2].

 

With mechanism in mind, “Photobiostimulation Therapy,” a variation of Endre Mesters original term “Laser Biostimulation” has been historically argued to be a more scientifically valid than “low-level” terminologies. However it soon became clear that photobiostimulation was inadequate as well, as research revealed a characteristic bi-phasic dose response, which indicated that, although low-intensity light can be stimulatory at low doses, higher does can actually be inhibitory [3].

 

Reflecting this, “Photobiomodulation Therapy” (PBMT) has been deemed superior to Photobiostimulation Therapy, as it most accurately describes the mechanistic basis on which these treatments operate. PBMT (or Photobiomodulation (PBM) if referring to the biological process), has gained widespread acceptance within the scientific community as the optimal term describing biomedical application of low-intensity, non-ionizing light, for pain relief, healing, and regeneration. This largely  is a result of a recent, concerted effort within the scientific community, including a nomenclature consensus meeting, organized under a joint conference of the North American Association for Light Therapy and the World Association for Laser Therapy in September, 2014 [2]. This meeting provided an updated, arguably more comprehensive definition for Photobiomodulation Therapy (aka Low-Level-Light Therapy), which is “A form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.” [2].

 

So which should we use? Photobiomodulation Therapy, or Low-Level-Light Therapy? PBMT or LLLT? If you’ve stayed with me so far hopefully you are not more confused than when we started.  

 

Arguably either is acceptable. While PBMT benefits from greater specificity and scientific validity, LLLT benefits from greater recognition.

 

In this blog we will be using LLLT, which will always stand for Low-Level-Light Therapy. This is partially because LLLT is easier for me to type, but mostly because among all alternative terms, we feel it has the best combination of inclusivity and name-recognition. We will consider LLLT and PBMT equivalent, defining both as described in bold above.

 

  1. Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics. 2016;9(11-12):1122-1124. doi:10.1002/jbio.201670113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215795/
  2. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomed Laser Surg. 2015;33(4):183-184. doi:10.1089/pho.2015.9848. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390214/
  3. Hamblin MR. Mechanisms and Mitochondrial Redox Signaling in Photobiomodulation. Photochem Photobiol. 2018;94(2):199-212. doi:10.1111/php.12864. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844808/
  4. Tsai S-R, Hamblin MR. Biological effects and medical applications of infrared radiation. J Photochem Photobiol B. 2017;170:197-207. doi:10.1016/j.jphotobiol.2017.04.014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505738/
  5. National Center for Biotechnology Information. Medical Subject Headings (MeSH) database (accessed March 2019). https://www.ncbi.nlm.nih.gov/mesh/?term=LLLT