Am I getting new hair growth or is it breaking off?

Whenever I examine the scalp, I methodically check for a number of different things. Essentially I have a "checklist" in my mind and all components need to be evaluated before I feel I have properly examined the scalp.

One essential part of the scalp examination is evaluating if patients have new growth - and if so - how much. I like to get a sense of how much hair the patient has grown in the last one month, the last three months and the last six months. Often when I remark to patients that they are experiencing a lot of new growth, I hear a reply such as

How do you know it's new growth?

How do you know my hair is not just breaking off?

The answer is straight forward. Newly growing hairs have 'pointy' ends whereas hairs that have broken off have 'blunt' ends. The photo on the right illustrates these differences. The yellow arrow highlights a newly growing hair with a pointy end and the green arrow identifies a broken hair with a blunt end.  The presence of broken hairs can be due to many causes, including excessive hair damage (heat damage, chemical processing, use of straightners).

Examining for newly growing and broken hairs is an important part of the scalp examination and should be done each time a thorough scalp exam is done.