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