At the Hair Transplant Institute of Miami, we have developed the most comprehensive approach for evaluating and treating patients with hair loss, while providing the very latest in scientific techniques at our state-of-the art facility. Unlike other clinics that perform hair restoration, both Dr. Nusbaum and Dr. Rose have extensive experience in medical hair loss therapy as well as research, and are also Board Certified in Dermatology, the only medical specialty with certified residency training in hair loss and scalp diseases. We not only perform hair transplant surgery for men and women, but also evaluate and treat patients with different causes of hair loss and scalp conditions.
We approach each hair loss patient with a comprehensive methodology, obtaining a detailed medical history, performing an in-depth scalp examination using state-of-the art diagnostic tools and, if indicated, blood tests to detect any underlying imbalances or deficiencies that may be contributing to the hair loss problem. Utilizing these techniques we determine not only the cause of hair loss and the most effective treatment, but we can also detect the earliest signs of hair thinning before it becomes apparent to the human eye. Early detection is crucial, as all medical therapies are most effective if started in the earlier stages of hair loss. Conditions which we evaluate and treat are: hereditary male and female pattern hair loss, hair breakage, alopecia areata, traction alopecia and dermatologic conditions which cause both permanent and non-permanent hair loss as well as hair shedding. One of our treatment protocols involves mesotherapy, which utilizes superficial scalp injections of very small amounts of organic substances and proven medications. This method enhances the penetration to the follicle in contrast to topical applications at the same time avoids the systemic side effects associated with some oral medications. The injections are very superficial and are administered with the use of vibration devices developed by our physicians to create a virtually painless experience.
We pride ourselves in providing ethical, research-based patient education as well as prescription treatments such as topical applications, oral medications and supplements as well as low level laser therapy. We also utilize platelet rich plasma (PRP) which involves injecting part of your own blood products which contains numerous hair growth factors.
Following are some tests that will be performed in order to establish your hair loss diagnosis.
MICROCOPIC EXAM – HAIR SHAFT AND BULBS
In addition to chemical damage resulting from color, perms, and straighteners, we screen for inborn abnormalities of the hair shafts. These include bubbles in the central cortex, twisting of the shaft, constrictions along the shaft, and other unusual features. The bulb, or attachment of the hair shaft to the scalp, is also examined.
Your hair will be categorized in terms of its caliber or diameter. A coarse hair is 80 microns, a normal hair 70 microns, and fine hair is 60 microns or less. The hair’s diameter determines its cross sectional area or mass. A person with 100,000 coarse hairs has about twice the amount of hair as someone with 100,000 fine hairs.
HAIR MASS MEASUREMENT
Trichometry, which measures hair mass, takes 10 minutes, and no hair cutting is required for its performance. The precision and accuracy of this method are superior to other methods available today. It detects the smallest changes in hair number or caliber and can be used to predict baldness years before it can be seen with the naked eye. It can also be used to diagnose hair loss in women and to track your response to the treatments we will prescribe.
This test determines how many hairs are present per sq cm of scalp. It is performed by trimming a small area of scalp to the length of 1mm. The closely trimmed area is then photographed, enlarged, and hairs are counted. The average scalp, in the absence of balding, has approximately 200 full-sized hairs per sq cm. arranged in 80-90 groupings of one, two and three hairs, with an occasional grouping of four hairs.
When a man begins to bald, the process slowly advances in a recognizable pattern, hence the name pattern balding. For the past 50 years, each stage has been defined by comparing its appearance to a series of pictures called the Norwood classification.
When a woman develops pattern hair loss, it occurs predominately on the top of the head, but with some important differences to men. Rarely does the hair loss progress to a complete loss of hair. When it begins, it usually starts on the top or temples. Women with pattern loss typically do not develop hairline recession. Three progressive stages are described utilizing the Ludwig classification.
The ratio of full-sized to miniaturized hairs can be estimated by scalp dermoscopy visualization. The miniaturization process affects hairs in male and female pattern hair loss. Hair become progressively thinner and shorter and eventually these hairs are lost. In the picture the percentage of miniaturized hairs is greater on the top of the scalp (left) as compared to the back of the head(right), indicating pattern hair loss.
HAIR CYCLE SYNCHRONIZATION
Most fur-bearing animals molt or lose all their hair in a regular seasonal manner. Humans lose their scalp hair in a more irregular manner. At any given time, 90% of the hairs are in their growing phase (anagen) and 10% are in their resting phase. The hairs grow for about 3 to 4 years, the shedding phase lasts 3-4 months, they then fall out and restart the cycle again. Hair loss of about 50 to 100 hairs per day is normal. In some medical situations, the synchronization becomes disrupted and more that 10% of hairs enter the shedding phase, resulting in a significant loss of full-sized hairs. The phenomenon is called shedding or effluvium. Shedding usually occurs 3-4 months after a high fever, childbirth, or discontinuation of a birth control pill as well as other factors. Eventually the synchronization is restored, and the hair stops shedding.
THE HAIR PULL TEST
There are two ways to evaluate whether abnormal hair loss is actively occurring. First and simplest is the hair pull, which is a very subjective test. In the hair pull, the physician grasps the base of a clump of 50 to 100 hairs between the thumb and forefinger. The hairs are then gently but firmly pulled with a stable degree of traction.
In a normal adult, two to five hairs will be obtained in this manner, depending on how many hairs were gathered in each clump, when the hair was last shampooed and styled. Shampooing will, of course, have removed many of the readily shed hairs so that the longer the time period since shampooing, the more hairs obtained in a hair pull. Abnormal shedding is generally easy to recognize since, in this situation, the number of hairs in a hair pull will be at least three to four times normal.
DAILY HAIR COLLECTION ANALYSIS
Determining the actual number of hairs shed per day can be helpful to corroborate hair loss or to reassure the patient that the shedding is either stable or resolving. Because shampooing and grooming practices vary from day to day and each affects hair shedding, averaging the daily hair shedding over at least a week’s span is important. Patients are asked to collect all hairs shed in the shower, sink, and brush and on the counter and pillow daily for 7 days in individual plastic bags and then bring them in to our office. Normally, the daily loss averages 50 to 100 hairs per day. The hair shedding can be several hundred per day in an abnormal shedding condition. Performing a hair count is tedious and time-consuming but is often reassuring. In addition, it is a simple tool that we can use to follow the progress of abnormal hair shedding.
When the hair loss appears to be a follicle scarring process, a scalp biopsy is necessary to confirm the diagnosis. A biopsy also yields important information in cases of unexplained hair loss, and when the potential for regrowth is in question. Scalp biopsy involves taking one or two small specimens of scalp tissue (about the size of a pencil eraser) with local anesthesia (like a dentist uses). A stitch is used in each site to minimize any small scar. The specimens are submitted to a skin pathologist with special expertise in diagnosing hair loss processes.