Can Fractional Non-Ablative Laser Therapy Treat Alopecia?

Sciton, the producer of a fractional ablative and non-ablative hybrid laser known as HALO®, has just launched a pilot study. They’ll be testing the use of the non-ablative function of their HALO® laser (1470 nm) as a treatment for male and female androgenetic alopecia (pattern hair loss) and scarring alopecias. (1,2)

The exploratory study will be very small, enrolling up to 10 participants (five with androgenetic alopecia and five with some form of scarring alopecia). Although subjects will only receive a maximum of three 10 to 15-minute treatments, follow-up visits are planned for 6, 9, 12, and 15 months. (2)

Fractional non-ablative lasers have been used to treat hair loss before. However, other studies have assessed hair regrowth after 10 to 12 treatments performed over a span of a few months. (3-5) Previous studies also report the use of a different wavelength of fractionated non-ablative laser. Importantly, fractional lasers should not be confused with the lasers or light sources used in low-level laser therapy (LLLT) devices, like Hairmax Laser Combs or Capillus Laser Caps. 

What Are Non-Ablative Fractional Lasers?

Fractionated non-ablative laser lasers are approved by the US Food and Drug Administration (FDA) for a number of dermatological indications. They’re meant to be used when a procedure requires skin resurfacing or the coagulation of soft tissue. They can be used to treat issues such as melasma (dark spots), stretch marks, and scarring from acne or surgical procedures. (6) 

Fractionated non-ablative lasers may also be used in combination with fractionated ablative lasers at different wavelengths. This combination increases the number of indications and provides treatment for conditions that neither non-ablative nor ablative versions of the fractionated laser are well-suited to on their own. (7)

Although fractionated lasers of different wavelengths can be used to treat a number of skin problems, they’ve never been approved for the treatment of any form of alopecia. The main concern is that the damage that both ablative and non-ablative fractionated lasers can cause will penetrate too deeply, damaging hair follicles that reside in the dermis. (8)

The 1470 nm fractionated non-ablative laser has the capacity to penetrate past the epidermal surface layer of skin into the dermis. However, this particular laser is tunable between 100 and 700 microns in depth, which means that it doesn’t necessarily have to affect hair follicles negatively. In fact, if the non-ablative laser is tuned to a depth above the hair bulge, where transitional stem cells reside, it may actually have the potential to affect skin and hair positively. (7). Some investigators hypothesize that the heat delivered by the laser to this microscopic region stimulates hair growth. (20)

LLLT vs. Fractionated Lasers

While both low-level laser therapy and fractionated laser therapy could technically be considered to be types of “laser hair therapy”, they are completely different. LLLT is considered to be completely non-invasive and may use multiple types of light sources, not just lasers. It’s synonymous with the term “photobiomodulation”, the use of light to regulate or influence cellular behavior. (9,10)

Fractionated lasers are also considered to be non-invasive. However, they are grouped into two categories: ablative and non-ablative. In both cases, these fractionated lasers intentionally cause thermal damage to the skin. (7)

What Is Photobiomodulation?

LLLT, also known as photobiomodulation, has been used as a hair loss treatment for nearly three decades. Laser hair therapy was first cleared by the US FDA as a treatment for male androgenetic alopecia in 2007. Shortly after, in 2011, it was cleared by the FDA as a treatment for female androgenetic alopecia. (9,10)

Lasers are reasonably new technologies and have been around since the 1960s. Shortly after their discovery, photobiomodulation began being explored. Besides for LLLT, photobiomodulation is known by a number of alternative names, including (9,10):

• Cold laser therapy
• Laser biostimulation
• Low-intensity laser therapy
• Low-power laser therapy
• Low-level laser therapy 
• Low-level light therapy
• Photobiostimulation
• Red laser therapy
• Red light therapy
• Soft laser therapy

As you may notice from the variety of alternative names it goes by, photobiomodulation can refer to both laser therapy and light (LED) therapy. More specifically, according to Drs. Anders, Lanzafame, and Arany, photobiomodulation is “a form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum…This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.” (10)

LLLT is particularly distinct from fractional lasers in this sense since even non-ablative fractionated lasers cause intentional injury. Their application is also likely to induce inflammation, albeit temporarily, rather than reduce it. (10) 

Do Fractional Non-Ablative Lasers Help with Hair Loss?

Dozens of studies have been published proving the efficacy of fractional laser treatments for multiple types of alopecia. Another half a dozen recent clinical trials using fractional, non-ablative lasers have also been publicly listed online. 

However, the Sciton-sponsored clinical trial is the first time a fractional non-ablative laser with a 1470 nm wavelength has been tested. This laser is usually used for facial rejuvenation treatments. (11) It’s unclear how effective this laser will be compared to those at longer wavelengths (like thulium lasers) or shorter wavelengths (like those used for LLLT). 

Fractional Non-Ablative Lasers as Alopecia Treatments

Hair density and thickness are consistently reported improvements after treatment with fractional lasers. However, treatment regimens vary, as do the selected lasers.

1540 Laser Treatment

The most popular approach to treating hair loss seems to be the use of 1540 to 1565 nm fractional non-ablative lasers. These have been used for the treatment of both male and female pattern hair loss and other types of alopecia. (3,12-14)

The 1550 laser (sold as Fraxel® by Solta) was actually the first commercial fractional non-ablative laser to come into the market. These days, however, there are a number of other competitors, including StarLux Lux®, Matisse®, Dermablate®, Mosaic®, and Sellas®. (15)

There are currently two active clinical trials testing the use of this type of laser as a hair loss treatment. One is exclusively treating alopecia areata, while the other is exploring androgenic alopecia, telogen effluvium, and alopecia areata. (12,13)

1927 Laser Treatment

The 1927 nm fractional non-ablative laser is the second most common type used to treat hair loss. However, the two clinical trials using fractionated thulium lasers with a wavelength of 1927 nm were withdrawn in the last few years. (16,17) The reasons for this are unclear, but it doesn’t seem to be because 1927 nm lasers are ineffective. Studies in Korea have shown that this laser can improve hair density, hair thickness, and even hair graying in some patients. (4,18)

Do Fractionated Laser Treatments Work for Hair Loss?

The use of fractional non-ablative lasers for alopecia is still fairly new – particularly as a treatment for pattern hair loss (androgenetic alopecia). Currently, only a handful of fractionated non-ablative laser hair therapy studies have published results. Of those published, the wavelengths used, treatment regimens, and populations participating in the trial have all been notably different. And on top of that, there haven’t been any long-term studies on the use of these lasers for progressive forms of hair loss like androgenetic alopecia. (5,14,15)

All that being said – the few articles that have been published have all reported improvements in hair regrowth. In particular, fractionated non-ablative laser treatments seem to produce improvements in hair density and hair thickness (the average diameter of hair strands). Despite concerns that these laser treatments can damage skin and hair follicles, alopecia-directed treatments have only produced minimal side effects, like irritation, itching, burning, tingling, and at worst, dermatitis. (5,14,15) These side effects are similar to those produced by the FDA-approved topical hair loss treatment minoxidil. (19)

There’s nothing to show that fractionated non-ablative laser treatments are a poor choice of treatment, a risk to your health and well-being, or detrimental to hair growth. However, given how novel the use of fractional non-ablative lasers for alopecia is, this experimental therapy probably shouldn’t be your first choice of hair loss treatment. It might be better to start out by buying an LLLT device or using another FDA-approved pattern hair loss treatment. 

But if the typical options aren’t working well for you, keep an eye out for a clinical trial that’s a good fit for your needs. So far, most fractional non-ablative laser studies have taken place in the United States, Ukraine, China, and Korea. There’s also a male androgenetic alopecia clinical trial in Turkey that’s currently recruiting. This study is using laser hair therapy but has modified the delivery method to make the treatment more effective.