ISHRS

1. THE CROSS SECTIONTHE CROSS SECTION
TRICHOMETERTRICHOMETER
A NEW DEVICE FOR MEASURINGA NEW DEVICE FOR MEASURING
HAIR LOSS - HAIR GROWTH - HAIR DAMAGEHAIR LOSS - HAIR GROWTH - HAIR DAMAGE
Bernard Cohen, MDBernard Cohen, MD
VOLUNTARY PROFESSORVOLUNTARY PROFESSOR
UNIVERSITY OF MIAMI SCHOOL OF MEDICINEUNIVERSITY OF MIAMI SCHOOL OF MEDICINE
SEPTEMBER 27, 2008SEPTEMBER 27, 2008
Breakers Hotel, Palm Beach, FLBreakers Hotel, Palm Beach, FL

2. HAIR LOSSHAIR LOSS
&&
HAIR GROWTHHAIR GROWTH
Cannot be measured inCannot be measured in
an office settingan office setting

3. NORWOOD SYSTEMNORWOOD SYSTEM

4. GLOBAL PHOTOGRAPHY

5. ““HOW MUCH HAIR”HOW MUCH HAIR”
cannot be quantifiedcannot be quantified
8686 9898
4949

6. IF IT CANIF IT CAN’T BE’T BE
MEASUREDMEASURED
IT CANIT CAN’T BE’T BE
MANAGEDMANAGED

7. What determinesWhat determines
HOW MUCH HAIRHOW MUCH HAIR
MASS - QUANTITY - VOLUMEMASS - QUANTITY - VOLUME
DENSITYDENSITY - number of hairs per cm- number of hairs per cm22
DIAMETERDIAMETER - coarse - average - fine- coarse - average - fine
LENGTHLENGTH - short - average - long- short - average - long

8. 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.

9. AN INCREASE INAN INCREASE IN
DENSITYDENSITY AND/ORAND/OR DIAMETERDIAMETER
IS PERCEIVED ASIS PERCEIVED AS
GROWTHGROWTH
••••••••••••••••••••••••••••••••••••••••••••
A DECREASE INA DECREASE IN
DENSITYDENSITY AND/ORAND/OR DIAMETERDIAMETER
IS PERCEIVED ASIS PERCEIVED AS
LOSSLOSS

10. DIAMETERDIAMETER
MEASUREMENTMEASUREMENT
USING HAND-HELD MICROMETERUSING HAND-HELD MICROMETER
ASIANASIAN AFRICAN
CAUCASIAN

11. DENSITY COUNTDENSITY COUNT
COUNT THE HAIRS IN ONE CMCOUNT THE HAIRS IN ONE CM22
OF SKINOF SKIN

12. ANDROGENETIC ALOPECIA - diameter reduces in size

13. MIXTURE OFMIXTURE OF
FULL SIZEFULL SIZE
&&
INTERMEDIATEINTERMEDIATE
HAIRSHAIRS
ANY HAIR LARGER THANANY HAIR LARGER THAN
30 MICRONS IS30 MICRONS IS
COUNTED ASCOUNTED AS
ONE HAIRONE HAIR
BALDING WITH MINIATURIZATIONBALDING WITH MINIATURIZATION
HAIR DENSITY COUNTHAIR DENSITY COUNT

14. Πrr22
== CROSS SECTIONAL AREACROSS SECTIONAL AREA
••••••••••••••••••••••••••••••••••••••
CHANGING THECHANGING THE HAIR DENSITYHAIR 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 THANIS MORE INFLUENTIAL THAN DENSITYDENSITY

15. MeaningfulMeaningful
measurementmeasurement
must includemust include
bothboth
DENSITYDENSITY
&&
DIAMETERDIAMETER

16. •• Demarcate a standard-sizedDemarcate 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 sectionalMeasure the cross sectional AREA of BUNDLEAREA of BUNDLE
2 x 2 cm
1 x 2 mm

17. CROSS SECTIONAL AREACROSS SECTIONAL AREA
will fluctuate ifwill fluctuate if
Diameter increasesDiameter increases
Diameter decreasesDiameter decreases
Diameter decreases… hair vanishesDiameter decreases… hair vanishes
Existing hair falls outExisting hair falls out
New hair emergesNew hair emerges

18. DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED
AREA OF SCALPAREA OF SCALP
2 x 2 cm

19. This can be a 4cm2
Square
Rectangle
Triangle
Hexagon

20. DESIGN A DEVICE TODESIGN A DEVICE TO
CAPTURE - COMPRESS - COMPACTCAPTURE - COMPRESS - COMPACT
ANDAND
MEASUREMEASURE
THE CROSS SECTIONAL AREATHE CROSS SECTIONAL AREA

21. 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 sizeregardless of the hair sample size
2.2. Compact the bundle completely …donCompact the bundle completely …don’t damage the hair’t 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

22. EARLY PROTOTYPEEARLY PROTOTYPE

23. HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT
(HOOK AND AVIL)(HOOK AND AVIL)

24. HAIR IS CAPTURED INHAIR IS CAPTURED IN
RECTANGULAR CHAMBERRECTANGULAR CHAMBER

25. TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD

26. BUNDLE ISBUNDLE IS
COMPRESSED & COMPACTEDCOMPRESSED & COMPACTED

27. CROSS-SECTIONAL AREACROSS-SECTIONAL AREA
IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN

28. 4 cm4 cm22
of SKINof SKIN containscontains 2.80 mm2.80 mm22
of HAIRof HAIR
DivideDivide 2.8O2.8O byby 4.004.00 = .70= .70 mmmm22
HAIRHAIR / cm/ cm22
SKINSKIN
.70 X 100 =.70 X 100 = TRICHOMETRIC INDEXTRICHOMETRIC INDEX = 70= 70
1 x 2.80 mm
2 x 2 cm

29. mmmm22
HAIR CROSS SECTIONHAIR CROSS SECTION
PERPER
cmcm22
SKIN SURFACESKIN SURFACE
XX
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 scalpof scalp
TRICHOMETRIC INDEXTRICHOMETRIC INDEX

30. HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES INCORRELATE WITH CHANGES IN
DIAMETER?DIAMETER?

31. 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 WITHPRECISELY CORRELATES WITH
FILAMENT DIAMETERFILAMENT DIAMETER
BUNDLE CROSS SECTION

32. HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
CORRELATE WITH CHANGES INCORRELATE WITH CHANGES IN
DENSITY?DENSITY?

33. 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 SECTION
PRECISELY CORRELATES TO THEPRECISELY CORRELATES TO THE
NUMBER OF STRANDSNUMBER OF STRANDS

34. HOW WELL DOESHOW WELL DOES
BUNDLE CROSS SECTIONBUNDLE CROSS SECTION
MEASUREMENTMEASUREMENT
CORRELATE WITHCORRELATE WITH
DRY WEIGHT MEASUREMENT?DRY WEIGHT MEASUREMENT?
(THE INDUSTRY GOLD STANDARD)(THE INDUSTRY GOLD STANDARD)

35. STRANDS of
SILK
150150 148148 146146 144144 142142 140140 138138
GRAMS .2754.2754 .2728.2728 .2705.2705 .2672.2672 .2546.2546 .2590.2590 .2565.2565
BUNDLE CROSS
SECTION
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 SECTION
PRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE
WEIGHT OF BUNDLEWEIGHT OF BUNDLE
RATIO STRANDS ::
BUNDLE CROSS
SECTION
5555 5454 5454 5454 5454 5656 5656

36. SAME STUDY USINGSAME STUDY USING
HAIRHAIR
INSTEAD OFINSTEAD OF
SILK FILAMENTSSILK FILAMENTS

37. NUMBER OF
HAIRS
xx XX
MINUSMINUS
22
XX
MINUSMINUS
44
XX
MINUSMINUS
88
XX
MINUSMINUS
1010
XX
MINUSMINUS
1212
XX
MINUSMINUS
1414
XX
MINUSMINUS
1616
XX
MINUSMINUS
2020
GRAMS .5536.5536 .5528.5528 .5519.5519 .5511.5511 .5506.5506 .5494.5494 .5480.5480 .5467.5467 .5434.5434
BUNDLE CROSS
SECTION 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 SECTION
PRECISELY 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

38. 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 SEVEREMODERATE SEVERE
More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

39. 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 before
the underlying skin becomes visible.the underlying skin becomes visible.
When a man discovers for the first timeWhen 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!

40. 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 SEVEREMODERATE SEVERE
More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

41. 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

42. HOW CAN THE TECHNOLOGYHOW CAN THE TECHNOLOGY
BE APPLIED TOBE APPLIED TO
MEDICINEMEDICINE
ANDAND
HAIR PHYSIOLOGYHAIR PHYSIOLOGY

43. TODAYTODAY
No treatmentNo treatment
49497575 6161
18 MONTHS LATER

44. TODAYTODAY
START PROPECIA
49497575 8686
18 MONTHS LATER

45. PRE OPPRE OP
HAIR TRANSPLANTATION
49493333 6363
POST OP

46. 4 MONTHS AFTER4 MONTHS AFTER
CHILDBIRTHCHILDBIRTH
49497575 9595
10 MONTHS AFTER
CHILDBIRTH

47. 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

48. MALE with EARLY BALDINGMALE with EARLY BALDING
Vertex = 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

49. CAN THE DEVICECAN THE DEVICE
BE USED TOBE USED TO
MEASUREMEASURE
HAIR DAMAGE?HAIR DAMAGE?

50. If hair is chemically treated each month.If hair is chemically treated each month.
DISTALDISTAL shaft willshaft will
receive more treatmentsreceive more treatments
thanthan PROXIMALPROXIMAL shaft.shaft.
Breakage will occur inBreakage will occur in DISTALDISTAL shaft.shaft.

51. THEREFORETHEREFORE
Measure a hair bundleMeasure a hair bundle’s X-section’s X-section
along its lengthalong its length
to detect the absence ofto detect the absence of
DISTALDISTAL hair shafts.hair shafts.

52. 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

53. If the X-section is 1.73 mmIf the X-section is 1.73 mm22
at 10 cmat 10 cm
and 4.54 mmand 4.54 mm22
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

54.  HAIR DAMAGEHAIR DAMAGE measurements can be performed on themeasurements 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 INDEXTRICHOMETRIC INDEX measurement.measurement.
 HAIR DAMAGEHAIR DAMAGE measurements can be performed onmeasurements can be performed on
anyany random bundle of hair, provided it fits into therandom bundle of hair, provided it fits into the
capture chamber of the device.capture chamber of the device.

55.  The size of the bundle has no relevance. No scalpThe size of the bundle has no relevance. No scalp
measurement is required.measurement is required.
 Performance of aPerformance of a HAIR DAMAGEHAIR DAMAGE measurementmeasurement
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.

56. 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

57. ENDEND