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THE CROSS SECTION THE CROSS SECTION TRICHOMETERTRICHOMETER
A NEW DEVICE FOR MEASURINGA NEW DEVICE FOR MEASURINGHAIR LOSS - HAIR GROWTH - HAIR DAMAGEHAIR LOSS - HAIR GROWTH - HAIR DAMAGE
Bernard Cohen, MDBernard Cohen, MD VOLUNTARY PROFESSORVOLUNTARY PROFESSOR
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
SEPTEMBER 27, 2008SEPTEMBER 27, 2008Breakers Hotel, Palm Beach, FLBreakers Hotel, Palm Beach, FL
HAIR LOSSHAIR LOSS&&
HAIR GROWTHHAIR GROWTH
Cannot be measured inCannot be measured inan office settingan office setting
NORWOOD SYSTEMNORWOOD SYSTEM
GLOBAL PHOTOGRAPHY
““HOW MUCH HAIRHOW MUCH HAIR””cannot be quantifiedcannot be quantified
8686 9898
4949
IF IT CANIF IT CAN’’T BET BE
MEASUREDMEASUREDIT CANIT CAN’’T BE T BE
MANAGEDMANAGED
What determinesWhat determines
HOW MUCH HAIRHOW MUCH HAIRMASS - QUANTITY - VOLUMEMASS - QUANTITY - VOLUME
DENSITYDENSITY - number of hairs per cm- number of hairs per cm22
DIAMETERDIAMETER - coarse - average - fine - coarse - average - fine
LENGTH LENGTH - short - average - long- short - average - long
Length is not a consideration. Length is not a consideration.
Length is determined by personal styling. Length is determined by personal styling.
Length changes with every haircut.Length changes with every haircut.
AN INCREASE INAN INCREASE IN
DENSITYDENSITY AND/ORAND/OR DIAMETER DIAMETERIS PERCEIVED ASIS PERCEIVED AS
GROWTHGROWTH••••••••••••••••••••••••••••••••••••••••••••
A DECREASE INA DECREASE IN
DENSITYDENSITY AND/ORAND/OR DIAMETER DIAMETERIS PERCEIVED ASIS PERCEIVED AS
LOSSLOSS
DIAMETERDIAMETERMEASUREMENTMEASUREMENT
USING HAND-HELD MICROMETER USING HAND-HELD MICROMETER
ASIANASIAN AFRICANCAUCASIAN
DENSITY COUNTDENSITY COUNT
COUNT THE HAIRS IN ONE CMCOUNT THE HAIRS IN ONE CM22 OF SKIN OF SKIN
ANDROGENETIC ALOPECIA - diameter reduces in size
MIXTURE OFMIXTURE OF
FULL SIZEFULL SIZE&&
INTERMEDIATEINTERMEDIATEHAIRSHAIRS
ANY HAIR LARGER THANANY HAIR LARGER THAN30 MICRONS IS 30 MICRONS IS COUNTED ASCOUNTED AS
ONE HAIRONE HAIR
BALDING WITH MINIATURIZATIONBALDING WITH MINIATURIZATION
HAIR DENSITY COUNTHAIR DENSITY COUNT
rr22 = = CROSS SECTIONAL AREACROSS SECTIONAL AREA••••••••••••••••••••••••••••••••••••••
CHANGING THECHANGING THE HAIR DENSITY HAIR DENSITY 10%10%
CHANGES THE HAIR QUANTITYCHANGES THE HAIR QUANTITY 10%10%
CHANGING THECHANGING THE HAIR DIAMETERHAIR DIAMETER 10%10%CHANGES THE HAIR QUANTITYCHANGES THE HAIR QUANTITY 20%20%
DIAMETERDIAMETER IS MORE INFLUENTIAL THAN IS MORE INFLUENTIAL THAN DENSITYDENSITY
Meaningful Meaningful measurementmeasurementmust includemust include
bothboth
DENSITYDENSITY &&
DIAMETERDIAMETER
• • Demarcate a standard-sized Demarcate a standard-sized AREA of SKINAREA of SKIN• • Isolate and gather the hairs into a bundleIsolate and gather the hairs into a bundle• • Measure the cross sectional Measure the cross sectional AREA of BUNDLEAREA of BUNDLE
2 x 2 cm
1 x 2 mm
CROSS SECTIONAL AREACROSS SECTIONAL AREAwill fluctuate ifwill fluctuate if
Diameter increasesDiameter increasesDiameter decreasesDiameter decreases
Diameter decreases… hair vanishesDiameter decreases… hair vanishesExisting hair falls outExisting hair falls outNew hair emergesNew hair emerges
DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED AREA OF SCALP AREA OF SCALP
2 x 2 cm
This can be a 4cm2
SquareRectangleTriangleHexagon
DESIGN A DEVICE TO DESIGN A DEVICE TO CAPTURE - COMPRESS - COMPACTCAPTURE - COMPRESS - COMPACT
ANDANDMEASUREMEASURE
THE CROSS SECTIONAL AREA THE CROSS SECTIONAL AREA
THE IDEAL DEVICETHE IDEAL DEVICE
1.1. Always compress the bundle with the same exact load…Always compress the bundle with the same exact load… regardless of the hair sample size regardless of the hair sample size
2.2. Compact the bundle completely …donCompact the bundle completely …don’’t damage the hairt damage the hair
3.3. Apply the load with mechanical precision… not by handApply the load with mechanical precision… not by hand
4.4. Include a precise scientific measuring elementInclude a precise scientific measuring element
5.5. Be easy-to-use and widely availableBe easy-to-use and widely available
6.6. Not require that hair be cutNot require that hair be cut
7.7. Not require a physician operatorNot require a physician operator
8.8. Generate results in less than 5 minutesGenerate results in less than 5 minutes
EARLY PROTOTYPEEARLY PROTOTYPE
HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT(HOOK AND AVIL)(HOOK AND AVIL)
HAIR IS CAPTURED IN HAIR IS CAPTURED IN RECTANGULAR CHAMBERRECTANGULAR CHAMBER
TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD
BUNDLE ISBUNDLE ISCOMPRESSED & COMPACTEDCOMPRESSED & COMPACTED
CROSS-SECTIONAL AREACROSS-SECTIONAL AREA IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN
4 cm4 cm22 of SKIN of SKIN containscontains 2.80 mm 2.80 mm22 of HAIR of HAIR
DivideDivide 2.8O 2.8O byby 4.00 4.00 = .70 = .70 mm mm2 2 HAIR HAIR / cm/ cm2 2 SKIN SKIN
.70 X 100 =.70 X 100 = TRICHOMETRIC INDEXTRICHOMETRIC INDEX = 70= 70
1 x 2.80 mm
2 x 2 cm
mmmm22 HAIR CROSS SECTIONHAIR CROSS SECTIONPERPER
cmcm22 SKIN SURFACESKIN SURFACE
X X 100100
7575 = Fine hair (60 microns) = Fine hair (60 microns)
100100++ = Coarse hair (80 microns)= Coarse hair (80 microns)
For an average density of 230 hairs / cmFor an average density of 230 hairs / cm22 of scalp of scalp
TRICHOMETRIC INDEXTRICHOMETRIC INDEX
HOW WELL DOES HOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN
DIAMETER?DIAMETER?
3-0 80 60 40 20
4-0 20 40 60 80 60 40 20
5-0 20 40 60 80 60 40 20
6-0 20 40 60 80
3.813.81 3.633.63 3.073.07 2.702.70 2.362.36 2.142.14 2.032.03 1.651.65 1.371.37 1.261.26 1.091.09 .82.82 .66.66
STRANDS OF SILK SUTURE MATERIAL
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION PRECISELY CORRELATES WITH PRECISELY CORRELATES WITH
FILAMENT DIAMETERFILAMENT DIAMETER
BUNDLE CROSS SECTION
HOW WELL DOES HOW WELL DOES BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN
DENSITY?DENSITY?
STRANDS of SILK 20 40 60 80 100 120 140 160
BUNDLE CROSS SECTION .36 .75 1.17 1.58 1.93 2.36 2.75 3.14
RATIO BUNDLE CROSS SECTION :: STRANDS
.018 .019 .020 .020 .019 .020 .020 .020
BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES TO THEPRECISELY CORRELATES TO THE
NUMBER OF STRANDSNUMBER OF STRANDS
HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTION BUNDLE CROSS SECTION
MEASUREMENTMEASUREMENT
CORRELATE WITH CORRELATE WITH
DRY WEIGHT MEASUREMENT?DRY WEIGHT MEASUREMENT?
(THE INDUSTRY GOLD STANDARD)(THE INDUSTRY GOLD STANDARD)
STRANDS ofSILK
150150 148148 146146 144144 142142 140140 138138
GRAMS .2754.2754 .2728.2728 .2705.2705 .2672.2672 .2546.2546 .2590.2590 .2565.2565
BUNDLE CROSSSECTION
2.742.74 2.722.72 2.712.71 2.652.65 2.622.62 2.522.52 2.482.48
RATIO GRAMS :: BUNDLE CROSS
SECTION
.101.101 .100.100 .100.100 .101.101 .101.101 .103.103 .103.103
BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE
WEIGHT OF BUNDLEWEIGHT OF BUNDLE
RATIO STRANDS :: BUNDLE CROSS
SECTION
5555 5454 5454 5454 5454 5656 5656
SAME STUDY USING SAME STUDY USING
HAIRHAIRINSTEAD OF INSTEAD OF
SILK FILAMENTSSILK FILAMENTS
NUMBER OF HAIRS
xx X X MINUSMINUS
22
X X MINUSMINUS
44
X X MINUSMINUS
88
X X MINUSMINUS
1010
X X MINUSMINUS
1212
X X MINUSMINUS
1414
X X MINUSMINUS
1616
X X MINUSMINUS
2020
GRAMS .5536.5536 .5528.5528 .5519.5519 .5511.5511 .5506.5506 .5494.5494 .5480.5480 .5467.5467 .5434.5434
BUNDLE CROSSSECTION mm2
2.082.08 2.042.04 1.981.98 1.951.95 1.941.94 1.921.92 1.891.89 1.871.87 1.821.82
RATIO GRAMS ::
BUNDLE CROSS SECTION
.265.265 .271.271 .278.278 .284.284 .283.283 .286.286 .289.289 .292.292 .298.298
BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE
WEIGHT OF BUNDLEWEIGHT OF BUNDLE
WHEN HAIR IS USED INSTEAD OF SILK, AMBIENT MOISTURE IS ABSORBEDWHEN HAIR IS USED INSTEAD OF SILK, AMBIENT MOISTURE IS ABSORBED
THE SEVERITY SCALETHE SEVERITY SCALE MINIMALMINIMAL MILDMILD Much more hair than skin More hair than skinMuch more hair than skin More hair than skin
MODERATE SEVERE MODERATE SEVERE More skin than hair Much more skin than hairMore skin than hair Much more skin than hair
1999 - E. Marritt conclusively demonstrated:1999 - E. Marritt conclusively demonstrated:
50% of the hair mass must be lost before50% of the hair mass must be lost beforethe underlying skin becomes visible.the underlying skin becomes visible.
When a man discovers for the first time When a man discovers for the first time that hethat he’’s balding… he has already s balding… he has already
lost 50% of his hair! lost 50% of his hair!
THE SEVERITY SCALETHE SEVERITY SCALE MINIMALMINIMAL MILDMILD Much more hair than skin More hair than skinMuch more hair than skin More hair than skin
MODERATE SEVERE MODERATE SEVERE More skin than hair Much more skin than hairMore skin than hair Much more skin than hair
SEVERITY SCORESEVERITY SCORE TRICHOMETRIC INDEXTRICHOMETRIC INDEX
Patient #1Patient #1 minimalminimal 4747
Patient #2Patient #2 minimalminimal 4444
Patient #3Patient #3 minimalminimal 4444
Patient #4Patient #4 mildmild 3636
Patient #5Patient #5 mildmild 3333
Patient #6Patient #6 mildmild 3333
Patient #7Patient #7 moderatemoderate 2525
Patient #8Patient #8 moderatemoderate 2828
Patient #9Patient #9 moderatemoderate 2626
Patient #10Patient #10 severesevere 2222
Patient #11Patient #11 severesevere 2020
Patient #12Patient #12 severesevere 2121
Severity Score and Trichometric Index
HOW CAN THE TECHNOLOGY HOW CAN THE TECHNOLOGY
BE APPLIED TOBE APPLIED TO
MEDICINEMEDICINE AND AND
HAIR PHYSIOLOGYHAIR PHYSIOLOGY
TODAYTODAYNo treatmentNo treatment
49497575 6161
18 MONTHS LATER
TODAYTODAYSTART PROPECIA
49497575 8686
18 MONTHS LATER
PRE OPPRE OPHAIR TRANSPLANTATION
49493333 6363
POST OP
4 MONTHS AFTER4 MONTHS AFTERCHILDBIRTHCHILDBIRTH
49497575 9595
10 MONTHS AFTERCHILDBIRTH
FEMALE with HAIR LOSSFEMALE with HAIR LOSS(occiput & mid scalp are about equal)(occiput & mid scalp are about equal)
CONCLUSION = Hair Loss is DIFFUSE not PATTERNCONCLUSION = Hair Loss is DIFFUSE not PATTERN
7474
7777
MALE with EARLY BALDINGMALE with EARLY BALDINGVertex = 50% LOSS = VISIBLEVertex = 50% LOSS = VISIBLE
Mid scalp = 12% LOSS = NOT VISIBLEMid scalp = 12% LOSS = NOT VISIBLE(86/98 X 100 = 88%)(86/98 X 100 = 88%)
8686 9898
4949
CAN THE DEVICECAN THE DEVICEBE USED TOBE USED TO
MEASUREMEASURE
HAIR DAMAGE?HAIR DAMAGE?
If hair is chemically treated each month. If hair is chemically treated each month.
DISTAL DISTAL shaft willshaft willreceive more treatments receive more treatments thanthan PROXIMAL PROXIMAL shaft.shaft.
Breakage will occur in Breakage will occur in DISTALDISTAL shaft. shaft.
THEREFORETHEREFORE
Measure a hair bundleMeasure a hair bundle’’s X-section s X-section along its length along its length
to detect the absence of to detect the absence of DISTALDISTAL hair shafts. hair shafts.
BUNDLE OF DAMAGED HAIRBUNDLE OF DAMAGED HAIR
X-sect = 1.73 sq mmX-sect = 1.73 sq mm
X-sect = 2.06 sq mmX-sect = 2.06 sq mm
X-sect = 3.89 sq mmX-sect = 3.89 sq mm
X-sect = 4.54 sq mmX-sect = 4.54 sq mm
Skin surface
2 cm
5 cm
7 cm
10 cm
If the X-section is 1.73 mmIf the X-section is 1.73 mm2 2 at 10 cm at 10 cm
and 4.54 mmand 4.54 mm2 2 at the skin surface…at the skin surface…
1.73 divided by 4.54 = .381.73 divided by 4.54 = .38
WE CAN CONCLUDEWE CAN CONCLUDE
THERE IS 38% HAIR BREAKAGETHERE IS 38% HAIR BREAKAGE
@ 10 CM FROM THE SCALP@ 10 CM FROM THE SCALP
HAIR DAMAGEHAIR DAMAGE measurements can be performed on the measurements can be performed on the 2 x2 cm bundle that was captured for the standard2 x2 cm bundle that was captured for the standard TRICHOMETRIC INDEX TRICHOMETRIC INDEX measurement.measurement.
HAIR DAMAGEHAIR DAMAGE measurements can be performed on measurements can be performed on anyany random bundle of hair, provided it fits into the random bundle of hair, provided it fits into the capture chamber of the device.capture chamber of the device.
The size of the bundle has no relevance. No scalp The size of the bundle has no relevance. No scalp measurement is required.measurement is required.
Performance of aPerformance of a HAIR DAMAGE HAIR DAMAGE measurement measurement takes about 2 minutes. takes about 2 minutes.
Hair may be wet or dry.Hair may be wet or dry.
No training or experience is required.No training or experience is required.
SUMMARYSUMMARY
• Measure hair damage and breakageMeasure hair damage and breakage• Track & measure shedding (effluvium) Track & measure shedding (effluvium) • Track & measure thinning (balding) Track & measure thinning (balding) • Manage hair loss treatmentManage hair loss treatment• Measure the efficacy of a device or drugMeasure the efficacy of a device or drug• Measure HT resultsMeasure HT results• Determine if a drug causes hair lossDetermine if a drug causes hair loss• Detect balding many years in advanceDetect balding many years in advance
ENDEND