I cannot tell you how many of my friends are suffering from hair loss – of course most of them are athletes and I always wondered if the loss was due to wearing helmets and the bacteria associated with washing those helmets only once or twice a year…
Even though athletes seem like big tough guys, hair loss (alopecia) affects body image of the strong and sensitive alike. To add insult to injury, the results of failed treatments are financially, emotionally, and psychologically devastating. So in order to avoid disappointing results, you must know the key to successful hair loss therapy.
Understanding the cause of hair fragility is an important component to regaining hair. For example, if the problem is temporary, it may be due to stress, a hormone imbalance, or thyroid disease. These causes may all be reversible, and therefore there are effective standard medical solutions available. If the hair follicles have been weakened structurally, then laser and injection techniques might be the right treatment. However, if the problem is the total absence of hair generating follicles, then this issue rules out any of the above options.
In this case, clinical scalp evaluation and biopsy are the first line of available diagnostic tools. Unfortunately, the human eye cannot see below the skin and biopsies are too random and do not confirm hair shaft viability. Fortunately, new solutions such as stem cells, laser units, and home light based devices are available.
So if your hair loss is not due to hormones or stress, then you may need to search out and find another way to biopsy your hair. This is exactly why I feel digital ultrasound scanning is preferable to biopsy. Current methods of hair characterization have many disadvantages such as pull tests and hair extraction, but these techniques miss the small viable hairs in the early growth phase and can also leave scars: dermoscopy and new optical devices are limited to the upper superficial scalp.
Sonogram equipment used to diagnose pregnancy has been modified to study the skin and subcutaneous tissues. The hand held probe has been replaced by sophisticated systems that analyse a specific area using volumetric imaging called 3D Doppler ultrasound: 4D imaging is real time evaluation of a 3D volume, so the patient is told IMMEDIATELY the probability of follicle regeneration and the likelihood of alopecia recurrence. High suspect areas are then checked for the number and phase of active follicles, and a search is then performed for contributing inflammatory disease.
The cool thing is that active hair follicles are located in the deep dermis while inactive follicles are restricted to the upper dermis; and an ultrasound can find them! At that point and you can choose your next steps.
A complete absence of follicles means hair transplant or other devices are to be considered. Ultrasound is also used to measure the depth of the skin and subcutaneous tissues for more accurate transplantation, which is sometimes performed robotically. This is done with 4D imaging which guides placement of the injections and transplanted tissues. There is also the use of antioxidants to reduce inflammation subdermally and increase the immune system response to withering follicles.
The doppler imaging can also reduce cosmetic complications!
Blood vessel mapping using the same technology as the doppler weather radar is routinely used in cosmetic preoperative planning. Before initiating aesthetic treatments, most Asian and many European plastic surgeons routinely perform a screening overview scan of the facial and scalp tissues to check for forgotten fillers or post procedure complications such as sub-dermal scar formation, calcific deposits from healing injured ligaments, or retained silicone that may have been injected in the past.
Hair follicle shrinkage can be related to vascular dysfunction which is detectable and quantifiably measured with the 3D doppler histogram technology, which has been applied to cancer diagnosis and inflammatory disease for 25 years. The use of ultrasound has been verified by electron microscopic studies since 2013 and is available in medical textbooks from 2012.
What recent upgrades do you see in hair treatment?
Advances in laser/optical devices allow near-microscopic analysis of the cells by rapid, non-invasive testing. Inflammatory vessels found in psoriasis and dermatitis are visibly cataloged since successful treatment is quantifiably measured by the increase in the type of healing normal vessels and the number of stronger follicles documented by 3D ultrasound. Light-based and laser-generated optics, including commercially available home based units, are showing great promise since continued upgrades from 2014 when they were first introduced at the American Academy of Dermatology Congress.
Q1: DO I NEED A BIOPSY?
NONINVASIVE SCALP SONOGRAM MEANS FEWER BIOPSIES AND SCARS
SONOGRAM DIFFERENTIATES VIABLE FROM DEAD FOLLICLES
Q2: IS MY TREATMENT WORKING?
BLOOD FLOW EVALUATION SHOWS IMPROVED THERAPEUTIC PLANNING
HEALTHY SCALP RESPONSE VERIFIED BY NEW SUB-DERMAL VESSELS
Q3: WILL THE ROBOTIC TRANSPLANT HURT ME?
HEALTHY TISSUE SPARED GIVES BETTER COSMETIC APPEARANCE
3D IMAGING GUIDANCE REDUCES TREATMENT COMPLICATIONS
Q4: IS MY SKIN CONDITION CONTRIBUTING TO HAIR LOSS?
EARLY SCALP INFLAMMATION DIAGNOSIS OPTIMIZES TREATMENT
ULTRASOUND MOST ACCURATE IN DETECTING ASSOCIATED DERMATITIS
Q5: WHEN SHOULD I START TREATMENT?
DIAGNOSTIC EVALUATION MEANS EARLY ASSESSMENT OF EFFECT
DOPPLER IMAGING DOCUMENTS REGROWTH OF HAIR SHAFTS IN WEEKS
Q6: SHOULD I WEAR AN ICE SCALP DURING CHEMO?
LASER/STEM CELL IMAGE-GUIDED TREATMENTS WITH FOLLICLE MAPPING
DECREASE RISK OF HAIR DAMAGE DURING TREATMENT
Since 1990, Dr. Bard has been a leader in digital imaging technologies as alternatives to surgical biopsies for dermatologic issues. He is the author of “Image Guided Dermatologic Treatments” Springer 2019 and a Fellow of the American Society of Lasers in Medicine. Since 2014, Dr. Bard has been using laser and immune system boosting antioxidants to improve scalp health.