Mark
12-05-2008, 12:58 PM
Hey everyone!
First off, I'd like to apologize for getting this to you so late. It's been pretty hectic here at the office, plus I wanted to make sure I got all the info in this post correct so that you guys can accurately measure your level of miniaturization.
Most importantly, I wanted to put everything in my own words here because, just like you guys I'm a layman at this, a guy who works on computers for a living. So I have taken the time to sit down with Dr Rassman and Dr. Pak and really educate myself on miniaturization and I'm throwing it all in my own words to hopefully make sense to you guys. So lets start at the beginning shall we?
What we're measuring: The numbers.
When you do your miniaturization test, you're just looking at a small portion of your scalp to get a count of how many hairs you have that are normal, and how many are miniaturized. Since most all men who are balding tend to lose their hair in the same general areas (as seen on the norwood chart), we can then gauge whether you're balding at all, how much you're balding, and how much hair you've lost simply by looking at these small samples that we take.
So here's the numbers we're going to be dealing with. A normal Caucasian male without any balding pattern is going to have around 1 follicular unit per square millimeter. Now, notice I said follicular unit and not hair. Some follicular units can have one or more hairs to it. On average, a follicular unit will have two hairs, and we use the term follicular unit because it's the basic anatomical unit of how hair grows and is how hair is transplanted in surgery.
The viewing area on the microscope that you guys are using, as well as the ones we have here in the office, is about 35 square millimeters. So in an average Caucasian male, you should be seeing about 35 follicular units or 70 hairs. If you've got more, and the hairs are thick and full looking, then it could be said that you've got a higher than average hair density. If you have less, but you don't see any miniaturized hairs, that simply means that you've got a lower hair density than average, which may be completely normal for you. Everyone is different, so don't panic if you're not exactly 35 follicular units or 70 hairs in the field you're looking at. What's important is for you to get a baseline measurement of what's "normal" for you. To get the best measurement of what's normal for you, you have to check the donor area on the back of your head behind your ears. That area is never going to go bald so you can see what should be normal for you there. Now, even in the donor area you may see up to 20 percent of the hairs miniaturized, because hair is constantly growing and falling out even in non-balding men. They reflect vellus hairs, not the fully mature ‘terminal’ hairs. Vellus hairs can be up to 20% of the hairs on the head at any time in the normal person
Back to the top of your head now. Lets say that you're seeing 20 normal hairs, but 10 miniaturized hairs. This is an indication that you may have male pattern baldness, and by mapping out all 8 spots in the chart I posted you can get an idea of where you're at on the norwood chart now, and where you might be going in the future. Any area which has miniaturization above 20% will probably become a victim of the balding process and we use this as a way of predicting which area is going bald or may go bald. By doing this test repeatedly over time, you can see whether your miniaturization is getting better or worse with whatever treatment you're using to combat hair loss. You probably won't even need to count the hairs to be able to notice that you've got significant miniaturization going on since you've already looked at your donor area and should be able to tell what "normal" should look like for you.
Putting this info to use: the practical application.
Now, lets put this all into a real-world scenario. I'm going to be using photos from this thread where we originally discussed the miniaturization of a patient that came into the office a while back. (http://baldingforum.com/showthread.php?t=260)
As a side note, it is MUCH easier to count hairs when the hair is cut very short, as the hairs don't overlap. If you're interested in getting the most accurate measurement when you've got longer hair, you can cut a very small patch of hair short in the middle of all your long hair (about the size of a pea) where you can take your measurements. Remember, the viewing area on the microscope is only 7x5mm, so you may want to cut a 7x5mm patch of hair down really short in all 8 areas where you'll be taking measurements to get the best accuracy, and the rest of your long hair should cover it up nicely. This is really up to you though.
What if you have 110 hairs in the donor area in 35 follicular units? We can say with confidence that you have 50% more hair than most Caucasians. Let’s say that in area "G" (crown) you have 35 follicular units but the hair count is 70. That would mean that you have lost hair in the crown even though the hair count is normal because the hair count at this location is 1/3rd less than the donor area. That may predict that you will bald in the crown at some point in time.
What if you have in area "D" 35 follicular units with 40 hairs and no miniaturization, but the donor area has 35 follicular units and 70 hairs. That probably means that your balding process has stopped for the moment, but it has taken the toll and reduced the hair count by almost 50%. Sooner or later, that area will continue to bald and one day the hair count may be zero. That is the shinny bald scalp we see in advanced balding.
With that aside, lets look at the photos.
http://baldingforum.com/picture.php?albumid=8&pictureid=115
In this first photo, I've taken the picture of area D and counted out the follicular units the best I could. The white dots represent normal follicular units, and the green dots represent miniaturized ones. Now this isn't an exact count, but you can see I got about 27 normal follicular units and 5 miniaturized hairs.
http://baldingforum.com/picture.php?albumid=8&pictureid=114
In this second photo of area C, you can see almost the exact opposite. I've found about 20 miniaturized follicular units and only about 9 regular follicular units.
So what does this tell us? First of all, the person who we took this reading from has a lower than average density. Secondly, it tells us that he's clearly got a pretty high level of miniaturization in the C region of his scalp, about 69% of his follicular units there are miniaturized. However he doesn't have quite as much miniaturization in the A region. This means he's showing a slightly lopsided balding pattern, more on the left (his left) side of his head than the right. This is all confirmed by the actual photos of his head that we took. Now in the D section of his head where he's got a lot of thick and normal follicular units, he only shows about 15% of the hairs miniaturized.
Now, when Dr Rassman did this test on this patient, he recommended that he go on Propecia for a year to see if that would regrow any of his hair or at least stabilize his hair loss. When he comes back, he and the doctor can decide whether that treatment is working for him, and they can scientifically measure that rather than just guessing. From there, they may feel that the drug therapy is enough, or maybe he'll want to go ahead with a hair transplant procedure. That's where you'll want to talk with your doctor and make an informed decision.
I know this is a pretty big post to chew on, but I hope that I've clarified how to use this data you're getting to make an informed decision on what to do about your hair loss. Or if you're lucky, maybe you'll learn that you don't have the hair loss that you thought you did.
If you guys have any questions, feel free to post here and if I don't get back to you in a timely manner (sometimes I miss things) feel free to PM me and I'll get back to you or have one of the doctors here do so.
Good luck!
-Mark
First off, I'd like to apologize for getting this to you so late. It's been pretty hectic here at the office, plus I wanted to make sure I got all the info in this post correct so that you guys can accurately measure your level of miniaturization.
Most importantly, I wanted to put everything in my own words here because, just like you guys I'm a layman at this, a guy who works on computers for a living. So I have taken the time to sit down with Dr Rassman and Dr. Pak and really educate myself on miniaturization and I'm throwing it all in my own words to hopefully make sense to you guys. So lets start at the beginning shall we?
What we're measuring: The numbers.
When you do your miniaturization test, you're just looking at a small portion of your scalp to get a count of how many hairs you have that are normal, and how many are miniaturized. Since most all men who are balding tend to lose their hair in the same general areas (as seen on the norwood chart), we can then gauge whether you're balding at all, how much you're balding, and how much hair you've lost simply by looking at these small samples that we take.
So here's the numbers we're going to be dealing with. A normal Caucasian male without any balding pattern is going to have around 1 follicular unit per square millimeter. Now, notice I said follicular unit and not hair. Some follicular units can have one or more hairs to it. On average, a follicular unit will have two hairs, and we use the term follicular unit because it's the basic anatomical unit of how hair grows and is how hair is transplanted in surgery.
The viewing area on the microscope that you guys are using, as well as the ones we have here in the office, is about 35 square millimeters. So in an average Caucasian male, you should be seeing about 35 follicular units or 70 hairs. If you've got more, and the hairs are thick and full looking, then it could be said that you've got a higher than average hair density. If you have less, but you don't see any miniaturized hairs, that simply means that you've got a lower hair density than average, which may be completely normal for you. Everyone is different, so don't panic if you're not exactly 35 follicular units or 70 hairs in the field you're looking at. What's important is for you to get a baseline measurement of what's "normal" for you. To get the best measurement of what's normal for you, you have to check the donor area on the back of your head behind your ears. That area is never going to go bald so you can see what should be normal for you there. Now, even in the donor area you may see up to 20 percent of the hairs miniaturized, because hair is constantly growing and falling out even in non-balding men. They reflect vellus hairs, not the fully mature ‘terminal’ hairs. Vellus hairs can be up to 20% of the hairs on the head at any time in the normal person
Back to the top of your head now. Lets say that you're seeing 20 normal hairs, but 10 miniaturized hairs. This is an indication that you may have male pattern baldness, and by mapping out all 8 spots in the chart I posted you can get an idea of where you're at on the norwood chart now, and where you might be going in the future. Any area which has miniaturization above 20% will probably become a victim of the balding process and we use this as a way of predicting which area is going bald or may go bald. By doing this test repeatedly over time, you can see whether your miniaturization is getting better or worse with whatever treatment you're using to combat hair loss. You probably won't even need to count the hairs to be able to notice that you've got significant miniaturization going on since you've already looked at your donor area and should be able to tell what "normal" should look like for you.
Putting this info to use: the practical application.
Now, lets put this all into a real-world scenario. I'm going to be using photos from this thread where we originally discussed the miniaturization of a patient that came into the office a while back. (http://baldingforum.com/showthread.php?t=260)
As a side note, it is MUCH easier to count hairs when the hair is cut very short, as the hairs don't overlap. If you're interested in getting the most accurate measurement when you've got longer hair, you can cut a very small patch of hair short in the middle of all your long hair (about the size of a pea) where you can take your measurements. Remember, the viewing area on the microscope is only 7x5mm, so you may want to cut a 7x5mm patch of hair down really short in all 8 areas where you'll be taking measurements to get the best accuracy, and the rest of your long hair should cover it up nicely. This is really up to you though.
What if you have 110 hairs in the donor area in 35 follicular units? We can say with confidence that you have 50% more hair than most Caucasians. Let’s say that in area "G" (crown) you have 35 follicular units but the hair count is 70. That would mean that you have lost hair in the crown even though the hair count is normal because the hair count at this location is 1/3rd less than the donor area. That may predict that you will bald in the crown at some point in time.
What if you have in area "D" 35 follicular units with 40 hairs and no miniaturization, but the donor area has 35 follicular units and 70 hairs. That probably means that your balding process has stopped for the moment, but it has taken the toll and reduced the hair count by almost 50%. Sooner or later, that area will continue to bald and one day the hair count may be zero. That is the shinny bald scalp we see in advanced balding.
With that aside, lets look at the photos.
http://baldingforum.com/picture.php?albumid=8&pictureid=115
In this first photo, I've taken the picture of area D and counted out the follicular units the best I could. The white dots represent normal follicular units, and the green dots represent miniaturized ones. Now this isn't an exact count, but you can see I got about 27 normal follicular units and 5 miniaturized hairs.
http://baldingforum.com/picture.php?albumid=8&pictureid=114
In this second photo of area C, you can see almost the exact opposite. I've found about 20 miniaturized follicular units and only about 9 regular follicular units.
So what does this tell us? First of all, the person who we took this reading from has a lower than average density. Secondly, it tells us that he's clearly got a pretty high level of miniaturization in the C region of his scalp, about 69% of his follicular units there are miniaturized. However he doesn't have quite as much miniaturization in the A region. This means he's showing a slightly lopsided balding pattern, more on the left (his left) side of his head than the right. This is all confirmed by the actual photos of his head that we took. Now in the D section of his head where he's got a lot of thick and normal follicular units, he only shows about 15% of the hairs miniaturized.
Now, when Dr Rassman did this test on this patient, he recommended that he go on Propecia for a year to see if that would regrow any of his hair or at least stabilize his hair loss. When he comes back, he and the doctor can decide whether that treatment is working for him, and they can scientifically measure that rather than just guessing. From there, they may feel that the drug therapy is enough, or maybe he'll want to go ahead with a hair transplant procedure. That's where you'll want to talk with your doctor and make an informed decision.
I know this is a pretty big post to chew on, but I hope that I've clarified how to use this data you're getting to make an informed decision on what to do about your hair loss. Or if you're lucky, maybe you'll learn that you don't have the hair loss that you thought you did.
If you guys have any questions, feel free to post here and if I don't get back to you in a timely manner (sometimes I miss things) feel free to PM me and I'll get back to you or have one of the doctors here do so.
Good luck!
-Mark