W/Spring 2019 by The International Hair Authority

Hair Authority W/ Spring 2019 MEDICAL

INNOVATION PDOgro Bauman Medical New Thread Procedure Pg. 14

MARKETING

Forehead Reduction

2019 Visionaries

Dr. Epstein Describes Benefits

CEOs Share Vision For 2019

Pg. 32

Pg. 24

CAUTION Black Market Awareness Dr. Tykocinski explains Pg. 31

The International Hair Authority

Volume 22 No 79

The Professional Publication of Hair and Skin Rejuvenation

W/Spring 2019

A New World Record

On Sunday, March 17, shortly after 1:00 AM Pacific Time, Guinness World Records Adjudicator Brittany Dunn announced “The Great Cut” had successfully donated 339 pounds of hair to “Children With Hair Loss,” breaking the world record for the most hair donated to charity in 24 hours. The effort, teamwork and leadership was remarkable. The energy was undeniable. Everyone stepped up. Everyone gave an extra ounce. One spectator even claimed there was a single, solitary tear welling in Ms. Dunn’s eye. The Long Hair, the organizers of the event commented, “We are deeply and forever grateful in our hearts for what happened on March 16 and for every single person and organization that helped make The Great Cut an overwhelming success, even beyond our imagination.” Read the full story on page 4

China’s PCHi Welcomes 25,000 Visitors

Guangzhou, China. 02.19 - Personal Care and Homecare Ingredients (PCHi) is China’s top resource for the personal care industry. In February 2019, PCHi returned to the Guangzhou Poly World Trade Centre where it welcomed more than 634 exhibitors, 25,637 visitors and 3,986 conference delegates from 80 different countries. Hair care solutions were ranked second in “Visitors’ Interests.” With China fast on the heels of the U.S. in becoming the world’s largest market for cosmetics, the annual PCHi event is of major importance for businesses seeking international connections or looking to enter the Chinese market.

Going Natural

Dove wants media images to represent women as they really are

Unilever personal care brand, Getty Images and Girlgaze are calling on the advertising and marketing industries to represent the true diversity of women in media and advertising. The beauty giant has partnered the photo company and female-led creative agency to create the world’s largest stock photo library created by women and non-binary individuals. The library consists of more than 5,000 images, created by 116 Girlgaze photographers, that are designed to shatter beauty stereotypes on a global scale. Launching the initiative, #ShowUs, Sophie Galvani, global vice-president of Dove, has called on the industry to normalize more authentic depictions of women. She hopes the move will help spearhead a societal shift when it comes to the portrayal of women in advertising and media.

IT HAD TO HAPPEN - CBD Hair Care

Role Reversal

India Personal Care Market Booming

Mumbai. 02/19 - Hair replacement professionals are accustomed to thinking of India as a hair-exporter, but the country, the world’s largest democracy, has a booming personal care industry that is growing by 15 – 20% annually. The key drivers are consumers’ search for anti-fatigue, anti-aging and anti-pollution products. The Indian government, inspired perhaps by Trump’s America First crusade, has recently introduced a “Made in India” campaign to promote domestic products and encourage competitive product quality. Source: Statista 2019

CBD, known for its anti-inflammatory properties, is coming to the hair care and scalp treatment market. The first professional salon treatment with CBD, the Emera CBD Haircare line, was recently launched by Earthly Body, an eco-friendly, animal-friendly company founded by Kevin and Mare Wachs. “CBD promotes healthy hair growth and good scalp health and protects your hair from daily environmental stresses because it is antioxidant rich,” claims CEO Kevin Wachs. “It also strengthens your hair and reduces breakage thanks to the high levels of amino acids and offers color protection thanks to tyrosine, too.” Other companies are jumping on the healthy-scalp bandwagon and promoting the benefits of CBD direct to the consumer. CBD is a naturally occurring cannabinoid, derived from hemp and is legal in all 50 states.

Hair Authority W/Spring 2019

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Hair Authority W/ Spring 2019

Editorial There is only one Hair Authority – It is flattering that our pioneering efforts over twenty years have spawned many imitators, but it may be time to make it clear that there is still one and only one authority when it comes to hair loss information for professionals. The National Hair Journal was founded in 1995 and quickly became the go-to information tool for hair loss professionals everywhere. So much so that we were asked by pivotal hair loss providers like Merck, Pfizer, Bosley and Hair Club to share our news with the public and create a radio show. A few months later we began broadcasting live on the East and West coasts in prime time with prominent guests and special reports. Shortly after, we launched The International Hair Society to fill a gap temporarily left by The America Hair Loss Council that was restructuring. And to provide insights into the resources and skills of the overseas hair factories, we hosted a series of educational trips to Asia. The National Hair Journal tried to be a role model for a young and growing industry. Not only did we want to disseminate serious information, we also wanted to demonstrate sound ethics and values. As the industry matured, we evolved with it. We suspended The International Hair Society when the American Hair Loss Council was back up and running because there are things they can provide better than we can. We reluctantly discontinued the radio show when it became clear that we did not have the major resources needed to provide the syndication and national coverage our sponsors requested. And we stopped organizing overseas workshops at the Asian hair factories because US distributors wished to provide these services themselves. In short, we adapted to the needs of an evolving market, but always kept our focus on top level information and support. In 2016, we changed our name to The International Hair Authority in recognition of the fact that we are a key source of trustworthy and actionable information. The bottom-feeders are still out there, and they are easy to recognize as they” borrow” each other’s photos and text, but here’s the difference. The Authority is an industry resource, driven by and directed by hair loss people. The others are out to make a buck and it shows. Flight to Natural - The cosmetic market is being redrawn as consumers embrace all-natural / organic brands and high-quality (pricier) personal care brands. This move to “clean” products is driven by trend to healthier lifestyles, the public’s distrust of chemicals and some well-publicized lawsuits. Hair care company Wen settled a $26 million class-action case because one of its products was allegedly making people’s hair fall out.

As a result, consumers have started looking for products they think would be “natural” or “safer.” Movie celebrity Gwyneth Paltrow famously commented, “The idea that you’re exercising and trying to eat well and then slathering yourself with chemicals, parabens, and silicones — it’s not great.” It’s little surprise therefore, that a 2018 survey by the Fashion Institute of Technology’s graduate school of cosmetics and fragrance marketing and management found that “90% of consumers believed that natural or naturally-derived beauty ingredients were better for them.” The global organic beauty industry is forecast to grow to $22bn by 2024 and top manufacturers are responding by selling off their traditional beauty divisions and acquiring smaller companies that offer the young, independent brands that consumers want today. The Wall Street Journal reports that “Coty Inc., whose brands include CoverGirl and Clairol, has been hit hard by declining sales of its consumer beauty division. The company recently reshuffled the management team in hopes of a turnaround. Revlon Inc. replaced its CEO last year amid declining sales and is starting a restructuring program to streamline its operations. E.l.f. Beauty Inc., a smaller maker of discount cosmetics, has also struggled with slower growth in sales. The hair replacement market is no stranger to these trends. There are now only four, perhaps five, major hair system distributors in North America and like their cosmetic cousins, the two biggest companies expanded their business base largely through acquisitions. Hiking Group Shandong Jinsheng Hair Products Co., Ltd., which is based in Qingdao, China owns Hair Visions and New Image Labs. And Aderans Co., Ltd., headquartered in Shinjuku-ku, Tokyo, owns Bosley, Hair Club, Renee of Paris, Fontaine and International Hair Goods. This newspaper believes the flight to natural and more personalized products will continue to gather pace. This presents opportunities for the entrepreneurs and boutique businesses that have always been the life force of the industry, but we also expect to be reporting new mergers and acquisitions in the next 18 months as the market adjusts to changing consumer lifestyles and expectations. All or Nothing - John Travolta has decided to come clean and has publicly embraced his new bald look. Travolta is not the first celebrity to be challenged over his supposed hair replacement. Think William Shatner and Burt Reynolds. But he is one of the rare stars to go all the way and announce that he has shaved his head. he now joins Pit Bull who continues a successful career without hair. That said, certain roles still demand that traditionally virile look, can you imagine a bald James Bond? Sean Connery’ stylists couldn’t.

Hair Authority W/Spring 2019

World Record Challenge!

Most hair donated to charity in 24 hours

On March 17, 2019, a heartwarming, joyous and dramatic event took place on the waterfront in San Diego. Men, women and children from around the country gathered to beat the official Guinness World Title, “Most hair donated to charity in 24 hours.” The current record was 338.67 lbs. of hair, set on October 14, 2018 in San Juan, Puerto Rico, where over 2,300 participants donated. The record-breaking attempt was part of the San Juan Beauty Show. The 2019 challenge, “The Great Cut,” was organized by Longhairs, a “global fraternity for men with long hair that advocates for hair equality.” They had one simple mission- to donate 200 lbs. of hair from 2,000 donors and raise $200K for Children With Hair Loss—helping provide a hair replacement for 200 kids. And succeed they did! With a record turnout and an army of volunteer cosmetologist and barbers, the team handily beat the world record and officially entered the Guiness Book of World Records. Longhairs commented, “As we are so fortunate and grateful for the ability to grow our manes, we thought it only fitting to partner with Children With Hair Loss. They are an organization of kind and generous people; whose deeds heal the hearts of children and light smiles on their faces.”

It’s Easy to Take For Granted - Imagine if you couldn’t grow hair.

The Great Cut website reminds visitors it can be easy to take your own hair for granted, but there are millions of children who can’t grow their hair. From understanding why, to coping with social acceptance, the effects of medically-related hair loss go far deeper than cosmetic. Whether it’s from alopecia, cancer treatments or other causes, most kids are just trying to live a normal life. The problem is, a human hair replacement with

Hair Authority W/ Spring 2019

The team behind The Great Cut proper care and maintenance can cost up to $5,000 a year. For most families, it’s an expense they cannot afford.

Children With Hair Loss

The Great Cut is exclusively benefitting Children With Hair Loss, a nonprofit charity that provides free, customized human hair replacements & care kits to children facing cancer treatments, alopecia, trichotillomania, burns and other medically-related hair loss. They’re the only organization of their kind who serve these children completely free of charge, with no hidden fees, financial reporting or required appearances. In 2018 Children With Hair Loss provided 540 children with hair replacements at zero cost to the families. They are making a difference for hundreds of children every year but doing it all without charging requires a lot of hair donations and a lot of financial support. That’s the purpose of The Great Cut. By hitting its goals, The Great Cut will help Children With Hair Loss provide 200 children with quality hair replacements over the next year.

An international challenge

Hair donors, hair cutters, volunteers and supporters were invited to make it real and change a child’s life and be part of history. And turn out they did! While the East Coast was expecting snow and more cold weather, The Great Cut challenge kicked off beneath blue skies and a balmy 74F ocean breeze. It seemed all the stars were aligned to make this a very special day. There was music, craft beer, food trucks and in the background, sailboats sliding across San Diego harbor.

But there was a serious side to the event also, dressed in a formal black suit and standing on the sidelines was an executive from The Guinness Book of World Records monitoring proceedings and ready to bring out the official Guinness scales to officially document the results.

It’s not over yet

People who could not attend can still support this program by visiting GoFundMe.com and make a financial donation or by mailing in their hair donation.

About Longhairs - Longhairs Do Care. If you haven’t met us yet, we’re The Longhairs: a global fraternity for men with long hair. We publish tips and tactics for guys with flow, advocate for hair equality, and celebrate men’s long manes with hair whips and high fives. We’re the creators of Hair Ties for Guys™, offered with other superior products at thelonghairs.us, where they donate $1 for every sale to Children With Hair Loss. About Children with Hair Loss – Founded in 2000 by Regina

Villemure, Children With Hair Loss has helped more than 3,500 children face their daily lives with confidence and self-esteem, providing customized hair replacements, care kits, support and education, all for free. Many people don’t know that Regina, after helping children for 18 years, was diagnosed with cancer last year and lost her own hair to chemotherapy. The great news is her therapy has been effective and she is in remission. Even throughout her treatment she was going into the office making sure wigs were being sent to the children who needed them. Cont’d Pg 6

Hair Authority W/Spring 2019

Pictures From The Great Cut

IHA

Hair Authority W/ Spring 2019

How do volumizing shampoos make hair fuller? many other vegetable proteins, keratin, ceramides), which are applied to the hair and strengthen the structure, making it more full-bodied. Also included may be so-called conditioning polymers (e.g., polyquaternium or PVP to be recognized in the ingredients). These are laid around the hair shaft like a film, thus avoiding static and achieving more grip on the hair. It’s vital that volume products are silicone-free, because they complicate the hair and cause the opposite effect. Thin or fine hair has less substance compared to normal or thick hair. The hair thickness of fine hair is usually less than 0.05 mm. Normal hair has a thickness of 0.07-0.1 mm. Therefore, volume shampoos often contain structuring substances. These are, four example, proteins (wheat proteins and

Fine hair needs to be cared for carefully and will react quickly if exposed to the wrong products or excessively dosed ingredients. Courtesy: beautypress.com

IHA

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Hair Authority W/Spring 2019

How to Respond to Negative Patient Reviews A Physician’s Guide  By Jeffrey Segal, M.D., J.D.

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and online reputation. Although his advice will be of particular value to hair transplant surgeons and medical assistants, The International Hair Authority believes that this information may also provide guidance to professionals from other personal-care disciplines.

First, a brief but necessary introduction

Our hope is that physicians will finishing this article having learned how to respond to negative patient reviews in a way that is effective, concise, respectful of their limited time, and HIPAA compliant. We’ll achieve this end by providing readers with several guidelines and a real-life example. Additional examples and analyses are available for download at our website, Medical Justice.com.   Now that you know the agenda - let’s start by reviewing the essentials…

The 5 Golden Rules to Follow When Responding to Negative Patient Reviews

Responding to negative patient reviews  is a  time-consuming process. There are also regulatory landmines doctors must avoid. Some are obvious: Never reveal information about a patient’s treatment without their written authorization. Never identify the author of a review as your patient. Never post billing information online. Others are not as obvious.

When writing a response to a negative patient review, you must remember…  • A model response shows the practice is reasonable and isn’t in a debate.  • A model response educates the public.  • A model response addresses the concerns raised in the review.  • A model response takes the conversation offline.    • A model response does not address the author directly.

Write these rules on a piece of paper and share them with your staff. The employee responsible for locating and responding to negative patient reviews should commit these to memory.   The next part of this lesson involves carefully dissecting two real-life examples; an example of a negative review and an example of a model response. Consider how the example response incorporates all five of the principles outlined above. Disclaimer: All examples featured in this piece were collected and posted online by Medical Justice’s online reputation management platform, eMerit. The model responses were written by our account managers in collaboration with our clients.  We should mention most of the feedback our clients collect is positive. However, we have never filtered reviews. We believe the practice of filtering patient reviews is deceptive. Professional licensing boards regulate advertising and marketing. To such boards, filtering reviews can be perceived as false and deceptive advertising. The penalties can be harsh. You’ve been warned.  That said - let’s dive in…

So – How Do You Respond to a Negative Patient Review that Resulted from a Medical Complication?

Most medical/surgical procedures are completed without issue. The patient is satisfied with the results and renders payment in a timely fashion. The patient moves on, and so does the doctor. Other times the patient exits the practice feeling dissatisfied either because of objective or subjective

Hair Authority W/ Spring 2019

Negative patient reviews are a fact of life. You can’t avoid them, and you shouldn’t ignore them. Instead, deal with them by leveraging the techniques you’ve honed as a physician – diagnose the problem, synthesize a cure, and administer treatment.  In this article, Medical and Dental Justice Founder and CEO, Jeff Segal, MD, JD, shares the essential ingredients with the public – addressing reviews from anonymous patients slamming doctors online.

concerns. An objective concern is a complication, expected or unexpected. A subjective concern is a mismanaged expectation.  This may spark exchanges like the example depicted above...  Now that you’ve read the exchange, let’s explain why the practice’s reply is a model response. Chiefly, the response demonstrates to the public the practice is rational. When the patient suggests the physician is not board certified, the practice responds:  “While we are sympathetic toward patients who do not see their desired results, we must emphasize that Dr. [BLANK] is board certified through the American Board of Plastic Surgery for plastic and reconstructive surgery in [BLANK], [BLANK]. We hope that readers understand that unfounded allegations like in the above review serve only to start harmful rumors.”

The practice has taken a defensive stance, but it is not an emotional one. They are simply stating facts. The practice acknowledges the patient’s dissatisfaction without divulging unnecessary information. They are content to keep “their side of the story” to themselves.   At a glance, this sounds like a terrible tactic. There are, after all, two sides to every story. Sharing your side of the story may offer the public insight into the clinical aspects of your care. Your side of the story may vindicate you – if not in the eyes of patients, perhaps in the eyes of your fellow physicians.   The temptation to tell all is strong. Still - don’t do this. You’ll get burned.  Imagine a situation where a patient and a doctor are arguing. For the physician to tell his side of the story, what must Cont’d Pg 10

Hair Authority Spring 2019

he do? He must reveal details about the patient’s care. This is a potential HIPAA violation.  Therefore - a physician should never attempt to tell “his side of the story” when responding to an online review unless the patient has provided the physician with expressed written consent. Unless his audience is clairvoyant, the surgeon can’t share his thoughts without creating a public record of the patient’s care. Irritating? Absolutely. Can you still demonstrate your clinical expertise to the public? Absolutely. But there’s an optimal way to do it. We’ll explain how – let’s return to the above example.   When the patient calls into question the physician’s qualifications, the practice refutes the claim, as we saw above. But then they take an extra step… “Additionally, his well-honed skills have earned him much recognition, such as being voted one of ‘America’s Top Surgeons’ in 2014 and 2015 by the Consumers Research Council of America.”  Note, the physician also points to a third party that has criteria for determining specific accolades.  Perhaps this is more information than is necessary to refute the patient, but that’s the point. Use negative reviews as an opportunity to highlight your qualifications. The response also provides the public with some general insight into the medical complication that triggered the negative review.   “Breast implants bottoming out, though uncommon, is serious and does happen from time-to-time. It’s hard to determine one reason why bottoming out occurs, but contributing factors can include weak breast tissue, smoking, large amounts of weight loss, or even exercising without a support bra.”  This is how you demonstrate your clinical expertise to the public. Be general, and do not address the author of the negative review. The practice never refers to the review’s author as “you.” In fact, the practice barely refers to the patient at all. This is by design. When drafting your responses, you must remember: The author of the review will read your response. Your goal is to resolve his/her concerns. But the author of the negative review is not the only patient who will read your reply. It may be seen by hundreds of prospective patients. So, it pays to respond to negative reviews in a genial manner.   We’ll close our analysis by examining the practice’s final remarks: “Any patient who has experienced their implants bottoming out is encouraged to contact our office so we can discuss a revision surgery.”

The purpose of this closing statement is twofold. For one, it addresses the concerns that inspired the negative review. The patient is unhappy with her results and is seeking a remedy. The remedy the practice offers is a revision surgery. Not a free surgery, or a discounted surgery, but a surgery. Perhaps it will be free. Perhaps it will be discounted. But those are details to be worked out at the practice’s discretion. The point is the patient posted with a problem and presumably left with an answer.   Lastly: the closing statement takes the debate offline. The patient’s instructions are clear. If she wants to schedule a revision, she must contact the office directly. Taking the debate offline puts the practice in control and reduces the likelihood the patient’s personal information will be spilled online.  While the example provided has been dissected in detail, we recognize our analysis is far from exhaustive. Our original publication includes three more real-life examples and analyses. It can be read by visiting us at: https://medicaljustice.com/ how-to-respond-negative-patient-reviews/ ABOUT THE AUTHOR Jeffrey Segal, MD, JD Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation. Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a

J.D. from Concord Law School with highest honors. Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine. Disclaimer: Medical and Dental Justice are member-based organizations dedicated to protecting doctors and dentists from frivolous lawsuits, internet libel, unwarranted demands for refunds, and other medico-legal threats. Medical and Dental Justice are not affiliated with or endorsed by The International Hair Authority. The International Hair Authority is sharing this content with IHA the author’s permission.

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Hair Authority W/Spring 2019

5 Ways to Grow Longer Hair Why is it that so many of us find our hair grows to a certain length and then stops? beautypress has some top hacks for optimal hair growth… 1. Food is your hair’s best friend

It’s true that healthy hair begins from the inside out. Nutritional deficiencies are often to blame for brittle hair and your diet is in fact one of the most important elements for maintaining good hair health. Keratin, which is what your hair shaft is made of, is basically made of protein. Make sure your diet includes sources such as seeds like flax, lentils and quinoa as well as fish and lean meats to help boost growth. Omega-3 is important too because they contain essential fatty acids. This makes it especially useful for preventing breakage and giving hair a healthy shine. In addition to fish and algae sources of Omega-3, chia seeds and walnuts are fantastic natural sources of Omega-3 and easy to add to a morning smoothie or morning snack. If you are sensitive to a group of dietary proteins called lectins (which can cause gut symptoms) found in some seeds, nuts and legumes, opt for flax and sesame seeds, pressure cook lentils, and quinoa, which inactivates the lectins in them. Vitamin E is one of the most important vitamins for maintaining and growing healthy hair. Sunflower seeds, almonds, avocados and green veggies, are all excellent sources so try to pack these into your diet. If you’re suffering with hair loss, you may be suffering from a zinc deficiency – pumpkin seeds and kidney beans are great

natural sources of zinc or alternatively you could take a zinc supplement.

2. Check the labels

Forget what it says on the front of the pack – it’s time to play label detective with your hair care as many shampoos and conditioners could be causing you more harm than good. Not only are some unfit for human use, they also have a negative impact on the environment. Just because a chemical is legally available doesn’t mean it should be used. Ingredients to avoid include any derivatives of lauryl alcohol, myreth sulfate and parabens, which can all damage and dry out the hair, making hair growth more difficult to achieve. DEA (Diethanolamine), MEA (Monoethanolamine) and TEA (Triethanolamine) are hormone disrupters that are legal in the US but prohibited in the European cosmetic industry, so try to avoid these if buying in the states.

3. Look for Natural Ingredients

If possible, try to select hair care that uses organic ingredients from all-natural sources. Essential oils, such as tea tree and rosemary, are great for hair as well as aloe vera and castor oil. If you’re looking to lock in more moisture for stronger and shinier hair, then coconut oil could also be highly effective.

Hair Authority W/ Spring 2019 Apply it lightly to split or brittle ends or as a pre-shampoo treatment over the whole head. Hair lacking volume? Then rosemary essential oil is particularly good at battling thinning hair. Shea-derived products and avocado are also great natural sources of moisture for your locks. Cutting down on your number of weekly hair washes will also help and many people who switch to all-natural products, which could be sulphate and paraben free. Trying to cut down how often you wash your hair a week is also another great hack, as washing every day can strip hair of its natural oils causing further damage.

4. Out with Dry Shampoo

Although popular and convenient, dry shampoo can cause more issues than it cures for hair. If used too often in place of wet shampooing, dry shampoo can cause a build-up of residue on our scalp, which can lead to itchy scalp, inflammation and in some cases - hair loss.

5. Turn down the heat

As well as using all-natural products there are other ways you can support the health of your hair. Letting your hair dry naturally whenever you can also help as hairdryers can also cause damage. Try and ease off on the heat styling tools too, as straighteners and wands can have a detrimental effect to your hair, encouraging splitting and breakage and making the ends look dry and brittle – so you end up having to cut them off. With the effective combination of a healthy diet, natural products and care, you should be well on your way to getting So next time you’re looking for new products to tame your mane, be sure to check the label for any nasty ingredients that might damage your strands. It’s what’s inside that counts, after all. Source: beautypress IHA

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Bauman Medical Pioneers PDOgro™ New Procedure for Hair Regrowth Boca Raton, FL - Hair Restoration Physician and new treatment pioneer Alan J. Bauman, MD is the first to perform PDOgro™, a PDO Thread procedure for hair regrowth, in the United States. PDO (polydioxanone) is a well-known slowly absorbing synthetic surgical suture material that stimulates collagen production, elastin, hyaluronic acid as well as activates fibroblasts while it dissolves. FDA-cleared PDO sutures have been used safely in surgery for decades and, in recent years, have trended in aesthetic medicine for skin rejuvenation including tightening, lifting, and wrinkle reduction. Dr. Bauman is the first in the US to apply PDO for Hair Regrowth. Dr. Bauman’s proprietary PDOgro™ is a virtually painless “lunchtime” procedure that works to stimulate hair regrowth through the release of growth factors and increased blood flow in the treatment area. During initial pilot studies at Bauman Medical, initial improvements from the procedure were noted in as little as three months and continued through six months and beyond. The PDOgro™ process is performed under painless local anesthesia by aseptically inserting PDO Master-

Dr. Bauman in surgery

Threads (MasterThreadsUSA, NY) into the scalp in the thinning areas to stimulate hair regrowth by rejuvenating weakened follicles. The material slowly and safely dissolves over a period of months. The breakthrough outpatient non-surgical treatment requires no recovery, no downtime, no aftercare, and no activity restrictions. “Finding a new use for a product like PDO that already has such a long track record of safety in millions of patients worldwide is exciting,” said Dr. Bauman “We are thrilled to share the results we’ve achieved with this new technology with our colleagues in the medical community as well as those who are suffering from debilitating hair loss and those who want thicker healthier hair.” Dr. Bauman also mentioned that it can be used for stopping, slowing or reversing hair loss and can be used as a stand-alone hair growth treatment or in conjunction with FDA-approved medications, low-level laser therapy, as well as other procedures including PRP, other cell therapy treatments and hair transplantation. Dr. Bauman presented on his ongoing PDOgro™ research, including before/after results, and performed his PDOgro™ technique on a live patient at the 17th Annual South Beach Symposium (SBS) for Clinical and Aesthetic Dermatology in Miami, Florida. Alan J. Bauman, M.D. is the founder and CEO of Bauman Medical Hair Transplant and Treatment Center in downtown Boca Raton, FL. The 12,0002ft. clinic is the world’s largest stand-alone treatment center dedicated exclusively to hair loss. Dr. Bauman has been a full-time hair transplant surgeon since 1997. and has treated nearly 20,000 patients, performed over 8,000 hair transplant procedures and administered nearly 5,000 PRP Platelet Rich plasma treatments for hair regrowth. IHA

Hair Authority W/ Spring 2019

HEADS UP!

NAZI CURTIS SHARES THE PANTONE COLOR OF THE YEAR 2019 PANTONE 16-1546 Living Coral

“An animating and life-affirming coral hue with a golden undertone that energizes and enlivens with a softer edge” braces us with warmth and nourishment to provide comfort and buoyancy in our continually shifting environment.

Color affects our moods, our actions, even our health. It can soothe or stiulate our emotions, increase or decrease our appetite or arouse desire. It is part of everyday life. Have you ever “Felt Blue, “Seen Red,” “been “As Good as Gold” or told a “White Lie?” Hair-care professionals are trained in color management and top colorists are in high demand. Hair system wearers have always feared the gold and red tones that color-corrected hair displays as it oxidizes due to UV exposure, but today, more than ever, color is playing a key role in creating a personal persona or “brand” – even in the once conservative world of hair additions and replacement. But creativity requires discipline and when it comes to hair color, the controlling factor is not your clothes or accessories, but the color of your eyes. Or more precisely, your iris. I will write more fully about this in a future article, but in the interim, I thought you might like to learn about a color that will be seen on the runway, in your home and perhaps even your studio. The following poetic introduction to the 2019 Color of the Year is taken from The Pantone Color Institute official announcement and is shared with Hair Authority readers who may be fashion conscious. “Vibrant, yet mellow PANTONE 16-1546 Living Coral em-

In reaction to the onslaught of digital technology and social media increasingly embedding into daily life, we are seeking authentic and immersive experiences that enable connection and intimacy. Sociable and spirited, the engaging nature of PANTONE 161546 Living Coral welcomes and encourages lighthearted activity. Symbolizing our innate need for optimism and joyful pursuits, PANTONE 16-1546 Living Coral embodies our desire for playful expression. Representing the fusion of modern life, PANTONE Living Coral is a nurturing color that appears in our natural surroundings and at the same time, displays a lively presence within social media.” About Pantone Color of the Year - For 20 years, Pantone’s Color of the Year has influenced product development and purchasing decisions in multiple industries, including fashion, home furnishings, and industrial design, as well as product, packaging, and graphic design. The Color of the Year selection process requires thoughtful consideration and trend analysis. To arrive at the selection each year, Pantone’s color experts at the Pantone Color Institute comb the world looking for new color influences. This can include the entertainment industry and films in production, traveling art collections and new artists, fashion, all areas of design, popular travel destinations, as well as new lifestyles, playstyles, and socio-economic conditions. Influences may also stem from new technologies, materials, textures, and effects that impact color, relevant social media platforms and even upcoming sporting events that capture IHA worldwide attention.

Hair Authority W/Spring 2019

Michael’s Corner

What My Father Taught Me & Other Lessons By Michael Suba So, it’s 2019 is it? Where did THAT come from? I know that thirty years ago is almost 1990, but in my gut, thirty years ago is still 1970. But as with other years I try to use the occasion less for excessive festivities and more for self-reflection. What did I learn from 2018? Actually, it’s not what I learned, but what did I re-learn? Many of us have been around an awfully long time and have learned a lot, but I sometimes disregard what I have learned, saying to myself the most dangerous words in business: “This time it’s different.” So, what did I learn/re-learn this past year? I believe the most important subject in which I was re-educated was the fact that I should trust myself. I should have faith in the seaworthiness of my commercial ship. This is not always easy, and there is a danger of going too far and getting cocky, which is worse than being overly cautious.

“In 2018 I learned to trust again. It’s important to trust and like your suppliers, and in that order.” Earlier this year I was attending one of our “Goalie Dinners” that us ice-hockey net-minders put together once in a while. It being a 45+ year old league we are all pretty seasoned. And discussion did turn to how our various businesses/careers were moving along. There came an entertaining grocery list of people trying to push and scam their way past us. One of us, I call him David because, well, that’s his name, is a well-known plastic surgeon and he said something that I will never forget. “It’s nice that we don’t have to be whores anymore.” I think it was a perfect description of how so many of our businesses have changed. We can pick and choose who we want to do business with, both on the supply side and the sales side. We know our business and we know we are good at it. If a supplier of a client is not appreciative of that, then it’s only a problem if we make it one. Do you remember Allan Arthur? I am really going back into the Dark Ages, but as a (very) young man, my father brought me to one of their annual meetings.

I was sitting beside my dad in a seminar room where we were being told that we had to step up our game. I still remember the person at the front saying, “There are those in this room with a huge X on their backs,” as he illustrated making a large red X on the white board. I was terrified. What if we were targeted?

“One new thing that I learned this year was that I am not scared of lawyers. There was a time where a demand letter from a lawyer would have me clinging to the ceiling like a cartoon cat.” How would we know? What could we do? My father was very quiet. He would not answer my questions, saying he was thinking. Finally, after we got home and I caught him in a generous mood he told me not to worry. We did not have The Mark upon us. But he was trying to figure out if this new strategy was being implemented because the company was being cocky or desperate. Business has only two emotions; fear and greed. So, my father was trying to figure what was driving this strategy. But in the end, we all know that it does not matter which. In either case the end is the same, the dumpster. As soon as a company sees its customers as marks to be fleeced instead of clients to be serviced it will always end up the same way. In 2018 I learned to trust again. It’s important to trust and like your suppliers, and in that order. A few years ago, my main supplier in China proved herself to me. My bookkeeper made an error and paid a $20,000 invoice. The error was that she did not take into account the fact that I had sent an advance of $10.000 two months previous (my bookkeeper has never, ever, done anything like that again by the way). When I frantically got her on the phone that night (her morning) and explained the situation to her she laughed. At first, I thought it was a “you are so screwed” cackle, but it turned out that she was just humored by my panic. She asked me if I wanted the extra $10,000 to be a credit on future orders or should she return it to my bank. I had no recourse if she wanted to keep

Hair Authority W/ Spring 2019

it and cut me loose as a customer. I asked for the latter and it was in my account immediately. I have not dealt with anyone else in China since and am very happy about that. And this past year another supplier has restored my somewhat shaken and stirred faith in humanity. My supplier of virgin hair systems from Milan, Italy has proven that I can count on him if and when there is a problem (and since it’s hair, there are going to be problems). It is especially nice because besides trusting and liking him, my company makes a lot more money working with him than I have with other suppliers. I kind of like that. It’s always somewhat difficult changing suppliers. When you have been with someone for a long time it can be exciting but also awkward to be with someone new. It’s an important ‘tell’ how someone responds to a problem. Is it “Screw you, pay me” or “Let me handle that?” Choose wisely. One new thing that I learned this year was that I am not scared of lawyers. There was a time where a demand letter from a lawyer would have me clinging to the ceiling like a cartoon cat. Now, pfft! There is of course the initial jolt when you actually get one (I received one about a month ago) but it’s mostly from curiosity than anything else. What could THEY want? I forwarded it to my lawyer, telling him to handle it. By the way, I can only assume that your business has an excellent attorney and equally excellent accountant. If you do not, I cannot stress how much you need to fix that NOW. Since my lawyer fired back, I have not heard a word from my antagonists. As my old assistant Brenda used to say in those situations, “All talk and no…” how did that go? I also re-learned something from my father’s experience with New Man Hair (Allen Arthur, again - and look if you are old enough to recognize the names “Gaston” and “Hoffmann” you don’t need to read this). As a New Man dealer and distributor my father spent a lot of time and money Promoting Someone Else’s Business. Yes, he made money at it for a while, but it proved to be unsustainable. Only Promote Your Own Business: Never someone else’s. I know having someone hand you a bunch of marketing tools and promo materials can make it easy. But by promoting your supplier you weaken your own brand. You are the person people come to see for their hair loss solutions. By diluting that you make yourself vulnerable to whatever happens to someone else. What if that someone else gets greedy? Or desperate? You have thrown your lot in with that company and now must share in its ups and downs. You had better trust that company A LOT. My advice, do it yourself and be the master of your domain. I passed this on to my son, telling him “You can decide to be a partisan, or a courtesan. The former is more profitable and more fun in the long IHA run. I know because I’ve been both.”

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Revolutionary App for Skin Care L’Oréal launches My Skin Track Ph Is Hair Next?

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L’Oréal, the world’s top cosmetic company has launched the first wearable skin-sensor that can monitor the skin’s Ph level and record the results to a companion app via Bluetooth. The patch will check the skin’s acidity and allow the customer to select the best cosmetics for optimum skin health. How It Works The process is not yet seamless and takes approximately 20 minutes. First, the wearer attaches the patch to his or her inner arm and leaves it in place for 15 minutes. During that time, the patch senses the skins acidic level in minute droplets of sweat that are captured though micro channels in the patch. After five to 15 minutes, the pH content of that sweat causes two dots on top of the patch to change color. The customer then peels open the patch and utilizing their smartphone’s camera, take a photo of those dots. An accompanying app analyzes their color, and from that deduces the skin’s pH levels and advises users on what action to take.

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winner in the Wearable Technology Products category. The flexible sensor was co-developed with L’Oréal’s skincare brand La Roche-Posay. The Science The patch measures individual skin pH levels using microfluidic technology, it captures trace amounts of sweat from skin pores through a network of micro-channels, providing an accurate pH reading within 15 minutes. The pH scale ranges from acidic to basic, on a spectrum measured from 0 to 14. Healthy skin pH exists within the slightly acidic range between 4.5 and 5.5. When pH balance is compromised, whether through environmental factors and underlying conditions, it can trigger inflammatory responses. Such responses can cause or exacerbate common skin concerns including dryness, eczema, and atopic dermatitis.

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NEW YEAR’S GROOMING RESOLUTIONS ARE THE NEW TREND FOR MEN IN 2019

Love is in the air - 73% of men are planning to make grooming resolutions in 2019. 67% say it’s all about improving their chances of finding a new partner or impressing a current one! Bluebeards Revenge, a UK men’s haircare company, has completed a new survey that found that 73% of men are planning to make grooming resolutions in 2019. But what was the underlying purpose for all this grooming? According to 67% of the 2,018 men they surveyed, it’s about improving their chances of finding a new partner or impressing a current one! The survey has revealed that 48% are fixed on finding a fresh new hairstyle, with celebrity influencers such as David Beckham being the driving force. Meanwhile, 33% want to grow designer stubble or a beard. “We currently live in a very social-media savvy world,” says Bradley Wicks – Head of Content and Social Media. “As a result, men are finally starting to learn the benefits of self-grooming – whether that’s looking after their skin, the hair on the heads, their beards, or even hair in other, more private, regions! We’re always advertising ourselves in today’s society and we work hard at branding ourselves; creating an image that we want to portray to friends, family and fancies.” With the above in mind, it comes as no great surprise to hear that barbers find themselves inundated with new style requests from their regulars in the early weeks of January. “A new hairstyle is one of the quickest and easiest resolutions to tick off the list,” says Barbershop Manager Callum Marks. “Un-

like eight months of hard work in the gym, a haircut can drastically change the look and feel of a man in 45 minutes. “At Luka’s Barbers in Plymouth, Devon, we definitely see an influx of men more willing to switch up their style in January. It’s funny; because just weeks before they wouldn’t have dared to consider a restyle. But the start of a new year seems to change their mentality. It’s refreshing too as it often gives me a chance to show them what else is out there for their face shape and personality.” Current trends are seeing men adopt slightly longer hairstyles in 2019. In fact, 60% of the men that answered yes to changing their haircut in the survey suggested that their new look would be of medium to medium-long length. “Longer hairstyles are now associated with ‘rebellious cool’ and are the results of celebrity influences,” says Wicks. “Great examples include the long locks of Jason Momoa

Hair Authority W/ Spring 2019

THE INTERNATIONAL HAIR AUTHORITY

The Hair Authority’s mission is to provide hairmanagement professionals from all disciplines with accurate information that will help them provide superior service to their clients and patients. It is a full-color tabloid, published quarterly and distributed worldwide. The Authority was formerly known as The National Hair Journal, founded in 1977 as a business resource for salon and clinic owners. EDITOR IN CHIEF Christopher Webb

in Aquaman, the disconnected lengths of Chris Hemsworth’s hair and the always-trendy styles of David Beckham.” The improved standards and skills of barbers are also making them the go-to stylists for men. 47% of men say that they will regularly visit a barbershop in 2019 over a hairdressing salon, a mobile appointment, or cutting their hair themselves. The latter is probably for the best! Aside from the hair on their heads, 33% of men are planning to embrace more rugged designer stubbles or fully-fledged beards in 2019. This continues the current trends that have seen the shaving market slashed by millions in recent years. “Designer stubbles, in particular, are decorating the faces of men, helping to enhance stronger jaw lines and creating a new smart-casual vibe that’s been accepted as office etiquette,” says Marks. These kinds of style require regular maintenance, making electric beard trimmers and beard oils two of the bestselling facial hair accessories in 2019. Wicks added: “The dawn of a New Year comes with a million self-set challenges. All over the world people are desperately trying to cut down on their bad habits: booze, food, and spending being among the most popular. “But, ultimately, these aspirations are about improving a person’s physical appearance and mental wellbeing – making grooming and styling resolutions one of the fastest growing trends. This, combined with the incentives advertised to us by influencers and product brands, is creating an exciting landscape for men’s grooming in 2019.” Notes on the survey: Research was conducted among 2,018 men in the UK to collect the statistics reported on above. The men were aged between 22 and 37 and their answers were collected between December 10, 2018 and December 31, 2018. Attribution: This article was reproduced with permission from The Bluebeards Revenge. The Bluebeards Revenge is a UK based range of barbershop quality shaving, skincare and hair styling products designed for Real Men. The Bluebeards Revenge® is a registered trademark of Dash Direct Ltd. IHA

cwebb@hairauthority.com

CREATIVE DIRECTOR Dylan Case dcase@hairauthority.com

CONTRIBUTING EDITOR Larry Oskin info@hairauthority.com

LEGAL NOTICE

The views expressed in The International Hair Authority are those of the individual author or contributor and not those of The International Hair Authority, its editors or staff. The Authority’s contents reflect the opinions of the authors and are not analyzed, peer-reviewed or otherwise investigated before publication. All authors and contributors are asked to disclose any interests they have of a commercial nature. The International Hair Authority makes no attempt to validate the sufficiency of such disclosures and makes no warranty, guarantee or other representation, expressed or implied with respect to the accuracy or sufficiency of any information provided. The publication of an advertisement does not constitute on the part of the International Hair Authority a guarantee or endorsement of the quality or value of the representations or claims made by the advertiser. The International Hair Authority accepts no responsibility for unsolicited materials. All articles and letters become the property of the International Hair Authority and may be edited for clarity, presentations and space. By allowing your articles, interviews and personal commentary to be used in The International Hair Authority, you are giving the publication permission to use these materials in its pages, websites and other information materials. Advertisers are required to sign a formal advertising agreement indicating that they are not violating any trademarks or other intellectual properties. Full details are outlined in The International Hair Authority Media Kit.

The material published in The International Hair Authority is copyrighted and may not be utilized in any form without the written consent of the editor.

THE INTERNATIONAL HAIR AUTHORITY 39252 Winchester Road #107-383 Murrieta, CA 92563 Email: info@hairauthority.com Tel: 626-709-6397

Hair Authority W/Spring 2019

2019 Visions Earlier this year, The Hair Authority invited industry leaders to share their vision of the year ahead. In this edition, we share the views from three CEO’s representing different industry segments; laser therapy, women’s wigs and extensions and hair replacement systems and non-medical solutions. Innovating New Phototherapeutic Treatments - HairMax Research Continues For 2019, Lexington International will continue to research and innovate new phototherapeutic treatments for many disease states. One of our research focuses will be to characterize the optimal dosing of light energy, based in constant or pulsed delivery. The trends we see now and for the future, are for development of light-based applications that are effective and safe for many diseases that are currently treated with drugs and by developing protocols for light energy treatments alone or in combination of other modalities. David Michaels, CEO, HairMax

As innovators, we feel a special responsibility to support men and women in treating their hair loss in the way that best fits their needs, lifestyle and budget. In this effort, we will continue to expand and update our laser device line, including our first LaserCap with BioLight design, marketed under the name RegrowMD, by HairMax. With the release of our new study data, we will continue to market the most innovative hair care line to date, HairMax for den•si•ty, expanding the HairMax brand into a new category of hair care. The new 4 piece system directly targets the scalp with over ten bio-active ingredients to help energize & nourish the scalp and protect against biological aging and environmental stress. These products are formulated with our proprietary NRG8-Complex and light activated ingredient, which are uniquely delivered with targeted liposome technology to help address all six mechanisms of thinning hair and enhance laser treatment benefits.

The Imploding US Non-surgical Hair Replacement Market 2019 continues the accelerating trend of the “Chinese choke-hold”. Thousands of Chinese Trading Companies, masquerading as “manufacturers” are fighting for the spoils that is the US non-surgical hair replacement industry. And we are helping them. First it was emails, and we responded. Then phone calls, and we replied. Now “we are coming to your town” next month promising you “virgin European hair products” at impossibly cheap prices. And they are being encouraged. But that is not their end game. They want to learn how to make your designs and sell them to everyone, to hair wearers directly. They are already all over Amazon, offering make-believe products at fantasy prices with Chinglish descriptions. The inevitable result: • Declining hair quality. • Shoddy manufacturing. • Lack of innovation.

• • •

Non-existent customer service. “Truth in advertising” as a joke. No one has time to smell the coffee.

Michael Leigh, CEO, Joli Caméléon

The industry is buying into the promise of impossibly cheap products, made from swept off the floor processed “European Virgin” hair, which is to say >$3,000 per kilo European hair at $100/kilo. And we are giving it all away. Trade secrets. Margins. Civility. And, eventually, the joy of being in this business. One of the saddest things is that we won’t take the time to educate

Hair Authority W/ Spring 2019

the client on how to care for their new fine hair purchase. When it comes back doused in Moroccan oil, it is too late. BUT – there is still hope. In a world where legitimate hair manufacturers are being marginalized because an industry is embracing mediocrity, the smartest ones in the room, are a strong cadre of very experienced, talented hair replacement studio owners, who know that they can only be #1 in their available market by delivering beautiful products, quality service, large helpings of needed empathy, AND a stand out Branding Strategy. And in order to achieve the last of those, they know that they cannot create and nurture their “Personal Brand” by themselves. They reach out and choose a symbiotic partner, an empathetic, ethical vendor to help them become “larger than life” versions of themselves. They are smart enough to know that “being a successful manufacturer” is no small thing. And being a successful retailer is their bread and butter. In 2019 you are either a “generic” discounter, or you are your own personal Brand leader. Viva le difference.

The Changing Landscape - HairVisions International Looks Ahead The hair replacement landscape is changing. There is no era in our industry or any other when we weren’t faced with new challenges. But with every challenge comes new opportunities for growth. Indicators point to an upsurge in our industry powered by the demand of younger consumers. They want education, new therapies, preventive and replacement choices delivered by true experts they can trust. However; our biggest threat to growth in this interactive age is someone selling what you sell faster and cheaper. Just go to You Tube and you can view numerous applications of our products and services. While this exposure can be refreshing it also causes huge concerns. Who is protecting the expertise of true hair loss professionals when a consumer can purchase a system online and go anywhere to anyone to have it applied? With our eyes set on growth opportunities, Hair Visions International is on the move in 2019! This is a dynamic time in bringing new energy and ideas to the hair industry. As always, we will adapt and support the retailers so they can successfully face the challenges in their changing market. We continue to dedicate our efforts by investing in the best product resources available today. Quality education is still a main focus for over 25 years, we have trained thousands of stylists through our Standards and Specialty hair replacement curriculums at our Hair Academy and at regional academies throughout the country. We provided four regional classes in 2018 and have more scheduled for 2019. David Schwartz, CEO, HairVisions International

Furthermore, we will continue to create innovative marketing campaigns. New Messaging for 2019 to reach and connect with younger consumers is vital. We will be unveiling new exciting marketing videos “Give Your Hair A Future” which are part of the #MyHairMyWay awareness campaign in March. Trichology has become the difference maker in leveraging all the therapies that retailers offer. Hair Visions is proud to be the leader in this important category as we have trained over 70 certified Head First Hair Renewal Centers. To expand the brand, we are introducing five Capilia scalp and hair loss prevention home care kits that will be available to the market. Hair Visions International continues to deliver the business services that bring added value to our retailers. Our ongoing commitment to the industry is to provide the uncompromising service and support that our customers have come to expect from Hair IHA Visions. We will always set the pace for the industry with a focus on a better future for our customers.

Hair Authority W/Spring 2019

Jeff E. | Xtrands+ Client Results may vary.

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Hair Authority W/ Spring 2019

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Hair Authority W/Spring 2019

Trichology Section As hair replacement and restoration moves beyond styling and artistry and new technologies become available , it is becoming increasingly important for professionals to understand the underlying medical, genetic and lifestyle reasons for hairloss. To provide information about the latest research and developments, The Hair Authority has invited David Kingsley, PhD, founder and president of the World Trichology Society to share the latest news and links to important reports and publications. Dr Kingsley first became involved in the world of trichology over 25yrs ago. The Authority/Journal has been publishing for 21yrs, so together we bring half a century of experience to these pages.

President’s Message Following the recent World Congress of the International Society of Hair Restoration Surgery (ISHRS), I browsed through their impressive program and excellent website and noted that the membership is angry about physicians with little or no training performing hair transplants. There are dentists, gynecologists, ophthalmologists and others from non-surgical backgrounds taking up the knife and cutting into people’s scalps. Often, these physicians either have had no training, or only taken a short online course. This has led to an abundance of patients with either terrible looking hair transplants, scalp infections, or worse. This shows poorly on legitimate hair-surgeons, giving the field a bad name. The ISHRS, quite rightly, want hair-surgeons to be properly trained and certified.

David Kingsley, PhD. President World Trichology Society

This mirrors what the World Trichology Society faces. As a member of both organizations, I realize that Certified Trichologists are having the same challenges as hair-restoration surgeons. We see so-called trichologists, with little or no training selling their ‘wares’ to the detriment of our industry as a whole. Legitimate Certified Trichologists often have to help people ‘recover’ after adverse advice from a poorly trained trichologist; that is, if the client even seeks another Trichologist’s advice again. As with the ISHRS, this can irrevocably damage the confidence that people have in the WTS and other genuine trichological organizations. In this issue I explain why it is so important for our specialty to educate consumers and other hair-replacement specialists into the importance of seeking properly trained Certified Trichologists, rather than poorly trained trichologists.

New Hair Loss Research American Academy of Dermatology hair highlights.

With the winter meeting of the American Academy of Dermatology (AAD) in full session in Washington, D.C., I noticed that in their program was a section called “non-transplant alopecia treatments grow in popularity”.

The three items discussed were: 1) Platelet-rich plasma (PRP): “PRP is the autologous high concentration of platelets in a small volume of plasma. It’s performed in a 10-minute process that’s comprised of five steps: Collect the blood, centrifuge it, remove platelet-poor plasma (PPP), re-suspend and collect PRP, and inject,” said Dr. Neil Sadick. It is thought that PRP works on helping improve hair loss

by promoting “vascularization and angiogenesis”, meaning that it helps form new blood vessels around the hair papilla (bulb). This in turn will trigger new hair growth, increase the length of the growing (anagen) stage of the hair cycle, and reduce inflammation, a possible contributor to hair loss. 2) Microneedling: “Microneedling is the practice of wounding the skin to mimic embryonic follicle development and to express nascent follicles [new hair follicles]. By introducing microscopic punctures to the skin, the follicle infundibulum [the upper segment of the hair follicle] is dilated, and the patient will experience improved transepidermal [through the epidermis of the scalp] and transfollicular [into the hair follicle] delivery of hair growth agents,” said Dr. Nicole Rogers.

Microneedling does have its critics. The most common is that at-home microneedling devices are not regulated therefore they can do more harm than good. In particular, often the needles can injure the scalp and more importantly, cause scalp infections. Although the technique encourages ‘pin-point’

Hair Authority W/ Spring 2019 bleeding, if there is some follicular hemorrhaging it may result in scarring alopecia. 3) Laser-assisted drug delivery: “Transdermal drug delivery treatments can include fractionated lasers [ones that have been divided into many microscopic ‘beams]. These create small channels through the stratum corneum to the dermis and can include either ablative lasers or non-ablative lasers [the former removes the top layer–epidermis–of the skin and the latter penetrates directly to the dermal skin layers],” said Drs. Bertin and Junquira. These lasers are not the same type of lasers used for hair loss treatments in most trichological centers. Like microneedling, they act to wound the skin, increase blood flow, and enhance penetration of topical agents. {Reference: Dermatology World, March 3, 2019 meeting news edition.} Does biotin work? According to a recently accepted manuscript for publication in the Journal of the American Academy of Dermatologists (JAAD), The article states there is limited evidence that biotin supplements improve skin, hair, and nail conditions, even though it is routinely recommended by dermatologists, primary care physicians (PCPs), and other hair-loss specialists. A study of nearly 450 people concluded that 58% saw no improvement using biotin, and only 14% saw any benefit. Also, the FDA recently warned that biotin supplementation can interfere with laboratory testing, particularly thyroid disorders, such as Grave’s Disease (hyperthyroidism–over active thyroid). The researchers concluded that: “With biotin’s potential to affect common laboratory tests and the lack of significant evidence regarding its benefit, it should not be routinely recommended unless there is a confirmed biotin deficiency.” The fact is that biotin deficiency is extremely rare in a regular western diet. {Reference: John JJ, et al. Assessment of Biotin Supplementation Among Patients in an Outpatient Dermatology Clinic. Journal of the American Academy of Dermatology, in press.}

Order a big Mac and fries to treat your hair!

Another potential therapy for hair loss recently caught my eye ….. Mac fries. Yes, that’s right, McDonald’s French Fries!

One of the ingredients in McDonald fries has been found to help regrow hair. The chemical is deimethylpolysiloxane which is in the cooking oil at McDonald’s fast-food restaurants. Deimethylpolysiloxane is a silicone which contains a rich supply of oxygen. When combined with mesenchymal cells (stem cells) and hair follicle germ cells, this silicone ‘mixture’ was then placed in the back of hairless mice, and hair growth resulted. Now don’t go out and eat a load of Mac fries to regrow your hair because, 1) on its own the silicone does not regrow hair and, 2) eating too many fries can lead to a condition called metabolic syndrome which has been linked to hair loss. Metabolic syndrome includes high blood pressure, high cholesterol and triglycerides, and increased body fat. {Reference: Tatsuto Kageyama, et al. Spontaneous hair follicle germ (HFG) formation in vitro, enabling the large-scale production of HFGs for regenerative medicine. Biomaterials; Volume 154: February 2018, Pages 291-300}

Can you smell your hair grow?

Another interesting publication was in Nature Communications, which said that the outer root sheath of our hair follicles can ‘smell’ sandalwood, which may help hair growth! Before looking to see if your hair follicle has a nose, it should be noted that some of the body’s cells have olfactory receptors which are used for other metabolic processes, other than ‘smelling’. One such use is to slow down cell death and stimulate anagen-prolonging growth factors in the skin and hair follicles. The olfactory receptor OR2AT4, the study concludes, is sensitive to a synthetic sandalwood odorant which causes a signal to be sent to the hair follicle to keep the hair in its anagen phase rather than entering catagen. Some trichologists use aromatherapy as part of their treatment regimens, could this answer some of the questions about how these treatments might work? {Reference: Cheret J, et al. Olfactory receptor OR2AT4 regulates human hair growth. Nature Communications. 2018; Cont’d Pg 30

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9:3624.}

Can your headache medicine give you hair loss?

One of the oldest headache medicines, aspirin, has been found in a study to reduce the effectiveness of minoxidil, which could lead to more hair loss. The study was done on 24 people using daily low-dose aspirin treatment (75mg‐81mg), for coronary heart disease. The results indicated that the potential effectiveness of minoxidil was halved when compared with predictions of minoxidil treatment success. Minoxidil is converted into its active form, minoxidil sulfate, by enzymes in the outer root sheath of hair follicles. These sulfotransferase enzymes predict a person’s response to topical minoxidil in the treatment of genetic hair loss. In the human liver, sulfotransferase activity is significantly inhibited by salicylic acid (the active ingredient in aspirin). Therefore, by reducing the enzyme activity that helps minoxidil be more effective, aspirin can hinder a person’s hair loss treatment. As this is the first study to report the effect of low dose daily aspirin use on the efficacy of topical minoxidil, I do not suggest stopping your aspirin regimen. Many more studies need to be carried out and the reason(s) for taking the aspirin far outweigh any potential hair problems. {Reference: Goren A, et al. Low Dose Daily Aspirin Reduces Topical Minoxidil Efficacy in Androgenic Alopecia Patients. Dermatologic Therapy.18 Sept. 2018.}

“A man who thinks he knows everything, knows nothing” “A man who thinks he knows everything, knows nothing” is a paraphrase from Socrates. It means that nobody knows all things and it is a wise person who realizes this. What has this to do with learning about trichology? Everything! Nobody knows every little thing about hair loss issues. Some people know more than others but even the more knowledgeable person needs to be learning and constantly researching and reading about the topic as new theories and hypotheses are published almost daily. 1. For instance, in December 2018, new research was published about the following topics (all are accessible through the WTS monthly newsletter which has lots of new health and trichological information for its members): 2. the relationship between diet and premature hair graying. In this paper it was concluded that men were more likely to gray earlier if they had a high BMI (body mass index) amongst other factors. I have many men and women who are concerned about their ‘grays’, this is another piece of

advice we can offer our clients/patients to be aware of as part of a lifestyle change; 3. hairless skin may produce a protein that blocks hair growth. This protein was found to be important for impeding the signaling pathways that promote the anagen phase of the hair cycle; 4. gene expression in male pattern hair loss. There have been more than 300 genes found to be responsible for MPHL. Some may be more important in influencing hair loss than others. Also, different ones may be found in different areas of the scalp (such as the occipital and vertex regions); 5. skipping breakfast increases the chance of diabetes. This is important with many skin and hair loss conditions that could be affected by metabolic syndrome; a resistant structure between the cuticle and cortex of the hair. This barrier may reduce the effectiveness of hair dye which could account for differences in client results, even when using the same solution. There are many more publications on important subjects for all hair loss specialists this month alone, let alone for the whole of 2018. We all need to keep up and so give our clients/patients the best possible advice. This is why I believe education is so important in achieving more knowledge. You are never too old to learn, nor should you be too ‘comfortable’ in your trichological knowledge. One such learning pathway is taking the World Trichology Society’s Associate Trichologist Diploma course. This ONLINE course is for the professional who wants to learn more about common hair loss and scalp conditions but who does not want to practice trichology as a profession. This course is perfect for people in the hair care and health industries: • Hair Replacement Professionals • Hairdressers • Cosmetologists • Health-care professionals If you haven’t taken a course for many years, starting slowly and then building up your ability to learn will help you achieve your goal of being in the forefront of trichological knowledge. Taking the course also enables you to receive our very informative newsletters. Please visit http://worldtrichologysociety. org/associate-trichology-diploma/ for more information about our Associate Diploma Course. For more information about other courses offered by the World Trichology Society, please visit our website at: http://worldtrichologysociety.org

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The Future of the Hair Transplant Industry Arthur Tykocinski, MD, FISHRS São Paulo, Brazil After continuous evolution in the hair transplant procedure over the past three decades, we are now facing a dilemma: super high-quality clinics on the one side, offering an artistic and artisanal hair transplant that makes us really proud, and on the other side, we have the “inArthur Tykocinski, MD dustrial scale, assembly line” hair transplant clinics. The latter has been under the radar for a while, but now the bad results are surfacing…mainly in Europe and around the Mediterranean, but soon, they will be seen everywhere. What we’re seeing is just the tip of the iceberg; soon all this will be discovered by the public and can affect HT credibility worldwide. The low-quality HT has many faces: 1) the assembly lines—where 10, 20, or more HTs are done per day, and/ or 2) the untrained doctors who supervise a procedure they don’t know, which is entirely an unethical practice; yes, that’s correct: a surgeon who is legally responsible for a procedure that he/she doesn’t have expertise in and is blindly trusting the work offered by techs who are hired or offered by companies. This is a perfect example of the merchandising of medicine: unethical behavior and no care for the patient, which is ultimately our major goal as physicians. What a shame. In response, the ISHRS has created our Black-Market Awareness Campaign (BMAC), which received massive support from our members during the World Congress in Hollywood; thank you all! During the annual business meeting, we asked members about the campaign and of the 100 members who voted, 95% of them supported this campaign…remarkable! To start, we recorded several interviews with members about the BMAC, and there is much more to come. It is not an easy task to alert the public about these low-quality HT clinics that are only focused on money, are unethical and many times illegal, and that produce disastrous results such as donor area depletion, bizarre low hairlines, or poor hair growth. If nothing is done, it will be the end of HT as we know it. This is not fair to the patients who are getting harmed. Now is the time for us to unite. We need to fight the black market on many fronts and are focusing on the following:

1. Communicate to the public about what the black market is and the harm it can cause to unknowing patients. There is nothing better than getting information directly from the source: stories from patients damaged by the black-market clinics. If you have patients suffering the consequences of a black-market procedure, we encourage you to ask them to help us by sharing their story. Please email us at BlackMarketAwareness@ISHRS.org. We need to record these personal experiences. Please contribute! 2. Communicate to other medical societies. Most physicians around the world have no idea that this problem exists. We must inform them. The ISHRS is preparing a PowerPoint presentation for our members to use to share this information with any other medical society for which they will give a lecture. It is important not only to alert prospective patients but also to inform physicians “outside HT” so they don’t unknowingly get trapped by companies irresponsibly offering them easy money through unethical behavior. 3. Advance legal efforts to combat this issue. Although it takes time, we are also trying this route. This is what we can do now. At this point, anyone or any group that wants to join our BMAC is welcome—for the good of the patients, for the dignity of our profession. If you would like to support us and be involved, contact any member of the Board of Governors or Executive Committee as each and every one of us will be pleased to help you. We are also accepting donations for our BMAC. We can only succeed with your full support! Thank you so much. This article first appeared in Hair Transplant Forum International and is reproduced with permission of ISHRS.

IHA

Hair Authority W/Spring 2019

When Less Is More

Hairline Lowering Forehead Reduction Surgery

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Dr. Epstein’s website provides a perfect introduction to a doctor who is a medical and personal care innovator, “Dr. Jeffrey Epstein is one of the most highly regarded hair transplant specialists, but also is recognized for his work in plastic surgery procedures, in particular hairline lowering.” The Hair Authority met with Dr. Epstein to learn more about the benefits of integrating hairline lowering into hair restoration procedures to create more natural looking results. Hair Authority: Dr. Epstein, we are eager to learn about the hairline lowering surgery that you are helping to pioneer, but before we Dr. Jeffrey Epstein ask you to describe this procedure, we’d like to ask for your thoughts about the life-changing benefits of the work you are doing. We’re hearing a lot of discussion in academic circles these days about doctors and medical advisors trying to measure or understand happiness. At the same time, there is a powerful consumer trend towards meditation and “being in the moment.” How does the work you do fit into this changing landscape? Dr. Jeffrey Epstein: Hair is fundamental to the way people feels about themselves. Change or improve their hair density or hairline, and you can change a life- for the better if done properly. Hair Authority: The hair restoration industry has matured

and distanced itself from the period when the different disciplines were fighting among themselves for a slice of the hair-management pie. Professionals now recognize that there are multiple solutions and many of them work best when combined with other procedures. Merck and Pfizer made this clear when their drugs, far from threatening the established hair loss market actually expanded it. And several years later we saw robotic assistance in hair transplant procedures confront the same challenges before becoming accepted as an aid to greater accuracy and precision. Dr. Jeffrey Epstein: Your preface is spot on. There has been an increase in the number of studies being done to measure outcomes, based not on how much hairline lowering there is, or how much more hair density there is, but on actual patient satisfaction. It’s a big area of inquiry right now, not just for hair, but for cosmetics and medicine in general. Professionals from all backgrounds are examining how they

Hair Authority W/ Spring 2019

can positively and measurably improve the quality of one’s life. There are analytical studies being undertaken using objective measurements. In fact, we are about to start one ourselves. It’s fascinating that you bring this up, because we’re looking at procedures we’ve done, and ways we’ve treated patients and we’re actually trying to measure outcomes of patient perception. It’s not just a gimmicky like, “Oh, 80 percent of patients were satisfied,” but truly looking at standardized, well-studied, objective measurements of patient happiness, and seeing how much that satisfaction, peace of mind and confidence ultimately contributes to happiness. Hair Authority: Cosmetic surgeons have always felt they are in the business of creating confidence… perhaps even creating happiness. So, if forehead reduction surgery can improve somebody’s wellbeing and produce a better life, that’s a great place to begin our conversation. Dr. Epstein: I see those life-changing moments every day. Hair Authority: How did you first introduce the forehead reduction procedure? Dr. Epstein: I’ve actually been doing these procedures for over 20 years. I’m a facial plastic surgeon. I entered the field of hairline restoration after doing a fellowship with Dr. Sheldon Kabaker in San Francisco. He is really the innovator of this technique. He calls it ‘hairline lowering forehead reduction Before

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surgery.’ Since then, it’s always played a part in my practice, but it was never very big. I would maybe do two or three surgeries a year. But around four years ago, it really began to take off. People became more aware of the transformational effects of hairline lowering, due perhaps to the work that Dr. Kabaker-and I- were doing. I also wrote a paper on it in Hair Transplant Forum International and started publishing some results on my website. Then, at the end of 2016, I revisited Dr. Kabaker for three days, just prior to his retirement, to see how he had advanced the procedure and that turned out to be really productive. Over those three days, we did five surgeries and I saw multiple little nuances that can make the surgery more successful. I immediately started incorporating them into my procedures and began writing about them to share my experience with other doctors. I’ve come to love the procedure.

“With some patients I’ve placed the hairline as low as five centimeters above the nose. Other patients are seeking seven to eight centimeters.”

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It’s my favorite thing to do because it’s so transformative. In 90 minutes, you can take someone who’s lived their entire life wearing bangs or hats and in a single procedure lower her/ his hairline by as much as an inch or more. And the next day, literally, other than the fact they have small stiches in their hairline, they’ve got a lower, slightly rounded out hairline which is unsurpassed in density! Hair Authority: How are other doctors reacting? Dr. Epstein: More and more of my colleagues are recognizing the value of this procedure. Many of them have sent me patients, some of whom were dissatisfied with the original transplant density due to the limits of hair transplants in some patients. More commonly, these are female patients born with a genetically high hairline that are seeking a more balanced appearance to the face, with density that exceeds that which can be achieved with transplants. Whatever their circumstances, Cont’d Pg 34

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these are amongst my happiest patients. It’s pretty amazing when you can get a result like that not in a year, but in literally a day. For the right patient, it’s a game-changing procedure. Hair Authority: Is this a viable procedure for someone with traction alopecia? Dr. Epstein: There is an indication for this as well, but only

“The procedure itself takes me around 90 minutes to perform. The recovery is quite easy. Most of my patients procedure are able to resume most activities two days after the procedure.” if the traction alopecia has created a high hairline. The most common reason we’re seeing patients is genetically high hairlines. This applies to both women and men. However, with men, I need to wait until they’re at least 40, 45 years old unless they have a zero family history of hair loss. I will always carefully evaluate them to see if there is any evidence of miniaturization of the hairline hairs that would suggest future progressive hair loss. The occasional patient at risk of future hair loss must understand that once his/her hairline is surgically lowered, if their hair were to recede later, there would be an exposed fine-line scar that would need transplants to cover it up. There are some people, such as celebrities in Hollywood or models whose careers revolve around their looks, but most of my patients tend to be women with genetically high hairlines. There is also a small group with medical conditions like scarring alopecia or cicatricial fibrosing alopecia that can affect the frontal hairline and I can lower the hairline to remove the areas affected by scarring. Hair Authority: Is there any downside to this surgery? Dr. Epstein: Very little. You get a fine line scar, but the incision is designed so hair grows through it, and most patients do not Before

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require any further grafting to conceal the scar as it heals so well. There will also be some numbness behind the incision because nerves from the forehead pass through here - however, they typically regrow, and sensation returns within a year. Hair Authority: When you lower a hairline, you are recalibrating the whole face. Leonardo da Vinci argued that there exist ideal proportions and ratios for the perfect human face. How does this apply to the work you are doing? Dr. Epstein: That’s a really good point. Some patients are aware of these notions, but the rule of thirds; one third, one third, one third, doesn’t universally apply here because the ideal hairline varies with age, facial structure, sex, and individual concepts of beauty. I have a high hairline and it looks perfectly appropriate. I don’t want the hairline of a 30-year-old. There is another factor we like to measure and that is where the vertical forehead meets up with the horizontal scalp; this 15-millimeter zone is where I usually like to place the center hairline. Most patients are not looking for any degree of recession; they want a relatively flat, or even a slightly rounded hairline, particularly women. With some patients I’ve placed the hairline as low as five centimeters above the nose. Other patients are seeking seven to eight centimeters. A lot depends also on where they’re starting from. For example, an African-American woman who has a hairline that’s 10 centimeters up might be delighted if it were brought down to seven and a half. Hair Authority: It’s commonly said that at age 30, an average man has lost 30 percent of his hair density and at 40 it’s 40 percent and so on. Is there a similar scale for hairline recession? Dr. Epstein: I don’t think there’s a hard rule, but that would be an interesting thing to study. Hair Authority: A member of the public reading this might be wondering, “Could this be a procedure for me?” What is involved? Dr. Epstein: Well, it’s a surgical procedure. The anesthesia is similar to what you would have for something like a colonoscopy, which is twilight sedation. The patient is breathing on her/his own, but basically sleeping and won’t feel or remember anything. The most important part of the Before

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Hair Authority W/ Spring 2019 process is actually the consultation; making sure they’re a good candidate. They must have realistic expectations and have sufficient scalp laxity. If someone can push their frontal hairline down 15 millimeters, that usually means that I can surgically advance their hairline around 20 millimeters or almost an inch, using certain maneuvers to further loosen it. Hair Authority: Any other upfront requirements to qualify? Dr. Epstein: Yes. The second requirement is to have a stable frontal hairline. In other words, if there is already thinning, they are not a good candidate. People who are at risk of thinning and receding in the future are not good candidates. Thus, many men are not appropriately treated with this hairline lowering surgery.

“More and more of my colleagues are recognizing the value of this game-changing procedure. They’ve all sent me patients.” Hair Authority: Are you removing tissue, or are you moving and implanting hair lower down into existing tissue? Dr. Epstein: The entire frontal hairline gets advanced downwards and forward, so I’m removing the overlapped area of frontal forehead skin. Hair Authority: So, this could be a finishing touch after a regular hair transplant. Dr. Epstein: Yes, in fact patients who have had a hair transplant and now have a reasonably dense hairline are excellent candidates because that transplanted hair is permanent. They’re not going to lose that hairline. Hair Authority: Is this a complicated and expensive procedure? You make it sound quick and easy. Dr. Epstein: When you do three of them a week, you become proficient. We have specialized instruments that let me undermine the back of the head all the way back almost down to the neck. I’m literally going all the way behind the head to free up all those attachments. The procedure itself takes around 90 minutes to perform. The recovery is quite easy. Most of my patients are able to resume non-strenuous activities two days after the procedure. Many of them are already used to covering up their hairlines, so they simply continue to do this for a short time until the stitches then get removed a week later. The typical cost of the procedure, including anesthesia, is between $6,500 to $8,500. Sometimes these patients wind up getting hair grafting as soon as three months later to further shape and round out their new hairline. Hair Authority: Many people, ourselves included, were not aware of this procedure, but it appears it is now getting discovered. How is this happening? Is it just word of mouth? Dr. Epstein: Word of mouth and sites like “RealSelf ” is

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Male patient before and four months after hairline lowered 1 ½ inches in a single procedure.

how patients can learn about the potential benefits of this procedure. Meanwhile, experts in the field of hair read about the latest procedures in journals such as yours. I have written a number of articles and given lectures to plastic surgeons and the International Society of Hair Restoration Surgery. I should add that this procedure also has applications for transgender patients, so there’s interest there as well. It’s just a matter of getting the word out. More and more of my colleagues are becoming aware of the benefits for their patients and I’ll sometimes perform hairline lowering surgery for them. Most of the professionals who refer patients to me are themselves top hair transplant surgeons, people like Drs. Ron Shapiro, Dan McGrath and Scott Boden: these guys are all leaders in the field. I continue to do hair transplants myself, but I always send this doctor-referred hairline lowering patients back to their referring doctor for subsequent hair grafting. Hair Authority: What comes after hairlines? Could it be eye lifts? When you look at the human head, your hair is just a frame for the face, maybe 30 percent of your persona. Admittedly it’s where aging is first perceived, but you’ve only solved half the problem if you fix the thinning hair but still have baggy eyes and hollow cheeks. Is this a logical next step for a doctor like yourself? Dr. Epstein: Good question Chris. I sometimes perform browlifts simultaneously with the hairline surgery. I used to do a fair amount of rhinoplasty and some eyelid and neck surgery, but over the last three or four years I’ve seen such an evolution in hair restoration - FUE in particular- that I’ve chosen to focus my attention on this very exciting field. And quite frankly, when you do something every day and you get better and more and more proficient at it, it becomes even more enjoyable. So, when I go into the office and do an FUE hair transplant or an eyebrow transplant or a female hairline lowering surgery, those are great days for me. Jeffrey Epstein, MD, FACS, FISHRS, Assistant Clinical Professor, University of Miami. Board Certified, Facial Plastic Surgery, Hair Restoration Surgery, and Otolaryngology. Founder and Director of the Foundation for Hair Restoration and Plastic Surgery, with offices in Miami and NYC, Dr. Epstein has more than 25 years of experience as a hair transplant surgeon. He publishes and lectures extensively and is frequently featured in the media and press. He also provides pro bono reconstructive surgery IHA to children and other people of need.

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