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CROSS SECTIONTRICHOMETRY
UPDATEA NEW TOOL FOR MANAGING
PATIENTS WITH HAIR LOSS
ISHRS – ANNUAL SCIENTIFIC MEETINGNassau, Bahamas – October 18-21, 2012
Bernard Cohen, MD
Diplomate, American Board of Dermatology Diplomate, American Board of Hair Restoration Surgery
Disclosure:Speaker owns US and foreign patentspertaining to Trichometer technology.
HAIR MASSTrichometry measures
“HOW MUCH HAIR”is actually present
Based on density and diameter.(...and not density alone)
2006 TRICHOMETER PROTOTYPE
Commercially available Trichometer
Chapter 11C
Unger & Shapiro“Hair Transplantation”
5th edition
DIAMETER – smaller and smaller FOLLICLE – smaller and smaller ANAGEN PHASE – shorter and shorter
AGA or Thinning
HAIR DENSITY COUNTAVERAGE DENSITY = 230 HAIRS /CM2
NORMAL SCALP BALDING SCALP
CROSS SECTION TRICHOMETRY
How it works...
Locating strip & 4 legged inked template
2 X 2cm area is defined by 4 dotsHair is isolated
Arms open – Hook extendsArms closed – Hook retracts
1. Hook capturesbundle
2. Arms areclosed
3. Hook retracts
4. Bundle is compressed
HMI displayed on LED screen
HMI (HAIR MASS INDEX)
mm2 of hair / cm2 of scalp
Normal range:75 fine hair
100 coarse hair
.
HMI(BUNDLE CROSS SECTION)
will change if or when
A full-sized hair falls outA miniaturized hair eventually vanishesA full-sized hair emerges from the skin
A hair diameter increasesA hair diameter decreases
CROSS SECTION TRICHOMETERY
AccuratePrecise
ReproducibleSensitive
Fast & EasyNo hair is cut
Works equally well for shedding or thinningEquivalent to dry hair weight
(INDUSTRY GOLD STANDARD LAB TEST)
THE MEDICAL MANAGEMENT OF HAIR LOSS IS
SUDDENLY SIMPLE!
INDIVIDUALLY
CROSS SECTIONTRICHOMETRY
PROVIDES
QUANTITATIVE FEEDBACK
INDIVIDUALLY
With CST you’ll be able to answer these questions:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
BASELINE
4972 65
ONE YEAR LATER
72-65/72= 10% WORSENING IN ONE YEAR
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Should I advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
BASELINE
4978 71
AFTER ONE YEAR OF MNX
TIME TO CONSIDER ADVANCING TO FINASTERIDE
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
on FINASTERIDE 1mgm daily reduce to1mgm 2x/wk
4963 62
Theoretical example – NOT clinical observation
One year later
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
MNX 2% bid x 1 yearChange to MNX 5% once
daily
4975 79
MNX 5% once dailyat end of following year
Theoretical example – NOT clinical observation
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
MNX 5% genericat end of year #1
Switch to Rogaine 5%
4961 62
Rogaine 5%at end of following year
Theoretical example – NOT clinical observation
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
On MNX 5%Switch to MNX + RetinA
4972 79
One year later
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
On MNX 5% bid x 3 yearsthen switch patient
to Laser Rx
4963 61
24 MONTHS LATER
Theoretical example – NOT clinical observation
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
FIN 1mgm daily
4957 58
FIN 1 mgm dailyplus Laser Rx
Theoretical example – NOT clinical observation
Questions that CST can easily answer:
How quickly is untreated AGA getting worse? What percent per year?
Is it time to advance my patient from MNX to FIN?
Does FIN work as well if taken 2x per week?
Is MNX 2% bid equivalent to MNX 5% daily?
Is generic MNX equivalent to Rogaine?
Is MNX more effective with added RetinA?
Do HairMax and LaserCap work better than MNX?
Is there an added benefit of adding MNX and/or laser to FIN?
If I correct a patient’s iron deficiency, does her shedding improve?
Female patientWith low Serum Ferritin
4971 85
After 12 months ofIron supplement
Questions that CST can easily answer:
When has the woman with telogen effluvium stabilized?
My patient is convinced that MNX has made her “worse.”
How does FUE affect donor site density?
What percent improvement does my patient have after HT surgery?
Is this woman’s hair loss caused by shedding or AGA?
.
Patient with activeTelogen effluvium
4971 71
2 months later...still no improvement
Questions that CST can easily answer:
When has the woman with telogen effluvium stabilized?
My patient is convinced that MNX has made her “worse.”
How does FUE affect donor site density?
What percent improvement does my patient have after HT surgery?
Is this woman’s hair loss caused by shedding or AGA?
.
Baseline HMI, then4 months of MNX.
Phone call: “I’m much worse!”
4971 71
On re-examthe next day
she is no worse.
Questions that CST can easily answer:
When has the woman with telogen effluvium stabilized?
My patient is convinced that MNX has made her “worse.”
How does FUE affect donor site density?
What percent improvement does my patient have after HT surgery?
Is this woman’s hair loss caused by shedding or AGA?
.
7896
Pre-op FUE Post-op FUE
Questions that CST can easily answer:
When has the woman with telogen effluvium stabilized?
My patient is convinced that MNX has made her “worse.”
How does FUE affect donor site density?
What percent improvement does my patient have after HT surgery?
Is this woman’s hair loss caused by shedding or AGA?
.
Pre HT surgery
4945 78
Post HT surgery
Questions that CST can easily answer:
When has the woman with telogen effluvium stabilized?
My patient is convinced that MNX has made her “worse.”
How does FUE affect donor site density?
What percent improvement does my patient have after HT surgery?
Is this woman’s hair loss caused by shedding or AGA?
.
Woman with SHEDDING
68 67
Woman with Pattern loss (AGA)
NOTE – Hair loss will NOT be visible until HMI is less than 49
81 98
END
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