The flexibility or "elasticity" of the scalp is an important consideration for hair transplant surgeons performing follicular unit strip surgery (FUSS also called FUT). In general terms, the more elastic an individual's scalp is, the greater the number of grafts that can be taken ... and the better the final hair density that can be created for the patient undergoing surgery.
A number of formulas and methods have been proposed to help surgeons calculate elasticity. There are even a number of commercial available instruments and tools that can also be bought to help calculate scalp elasticity.
The Mayer Paul Formula
The Mayer - Paul Formula is a well established method for calculating the elasticity of the scalp. To calculate elasticity on the scalp, two lines are initially drawn 5 cm (50 mm) apart. Then the two lines are compressed together (ideally with the two thumbs). Then, one records how far apart the two lines are after being squished together.
Scalp Elasticity is calculated as
[(50 mm - new position in mm)/50] multiplied by 100 %
VIDEO EXAMPLE: DEMONSTRATION FO THE MAYER PAUL
In this video example, the lines have been squeezed from 5 cm apart to 2.5 cm apart (X = 2.5 for the formula in this example). The elasticity is calculated as 50 %. According to the Mayer Paul formula elasticity of 30 % or more means that a strip of at least 2.2 cm can be taken (if needed) on a first FUT surgery. In contrast, 10 % elasticity means that the strip should be kept less that 1 cm in width
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Let me give some insight in the examples below. What you’ll come to see is that:
Normal loss is around 50-70 hairs per day
Anything that a person considers ‘abnormal’ is likely abnormal !
It’s completely normal to lose more on days that one shampoos the scalp.
These are the 3 principles of daily hair loss.
Hair grows longer each day by staying in the growing phase (also called anagen). Most hairs stay in the growing phase for about 4-7 years.
So for a person with no hair loss issues, the anagen phase is about 3-7 years, but let's say 4 years on average. That's 1460 days. Keep in mind that a typical person has 100,000 hairs on the scalp (provided they have no balding). So, every 4 years, a person in this example has to replace ALL his or her hair. So what this means is that it's normal to lose about (100,000 divided by 1460) = 68 hairs per day provided there is no balding. Yes, it might be higher and it might be lower. It could even be as low as 35 hairs for some people who have a growth phase that's very long (i.e. upwards of 7 years).
Now consider a female with thinning who counts her hair every day and says she loses 70 hairs per day. Is this normal? It might be or it might not be. It depends on what her previous rate was. Suppose this female had at one time 80,000 hairs on her scalp and had an anagen phase of 5 years (1825 days). Her normal rate of loss was 100,000 divided by 1825 or 44 hairs per day! Now as she develops genetic hair loss, she has 75000 hairs on the scalp, and her anagen phase is 3 years. Her scalp still looks full and she’s still very pleased with her density and nobody (even her) knows there is ANY genetic hair loss. Her rate of loss every day is now 75,000 divided by 1095 or 69 hairs per day. Is this 69 hairs per day abnormal? Yes! Are we right to reassure her that she’s fine because her number is under 100? No way! She has early genetic hair loss and the so the earlier we address it the better.
Normal shedding is under 100 hairs
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
The discussion of iron and hair growth is controversial. Some studies have shown no clear cut relationship ... and yet others have! Our cut off in the clinic for what is considered a normal ferritin level is 40 micrograms/L. Very rarely, I aim for 70.
In 1992, Drs Rushton and Ramsay conducted a study looking at women with genetic hair loss who were being treated with an antiandrogen medication (called cyproterone acetate). The researchers showed that women with iron levels above 40 had much better results with the antiandrogen pill than women who had iron levels below 40.
Conclusion:
It's clear that treating hair loss requires careful attention to many parameters, including the patient's iron status.
Reference Rushton DH, et al. The importance of adequate serum ferritin levels during oral cyproterone acetate and ethinyl oestradiol treatment of diffuse androgen-dependent alopecia in women. Clinical Trial. Clin Endocrinol (Oxf). 1992.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
Understanding the vitamin and mineral deficiencies that may occur is important since hair growth may rely on the maintenance of certain levels and loss of hair may occur from levels that are too low.
Many deficiencies have been studied. On average, women who use OCP's have slightly lower levels of B12, B6, zinc and magnesium than women who do not use OCP's. The most significant changes were for vitamin B12 and B6 with zinc, magnesium being only slightly affected. Many of these are "averages" or broad generalizations and may not apply to one specific person. For example, many women using oral contraceptives have fairly normal levels of all of these parameters. But when considered among the entire population, these trends are seen.
For example, B12 levels may be lowered by 100-150 points in women who use birth control. While low B12 levels are not clearly associated with hair loss (i.e. no good evidence), they are associated with many other health parameters. It is important to keep levels above 300 pg/ml and perhaps even 350 pg/mL.
Women using OCP's may have higher levels of other vitamins and minerals. Women who use birth control are more likely to have higher ferritin (iron) levels and less likely to be anemic. Women using oral contraceptives appear to have higher vitamin D levels than women who do not use OCP's.
The effect of every medication or supplement that a patient with hair loss uses needs to be carefully reviewed. Oral contraceptives may lower levels of some vitamins and minerals - the best evidence being for vitamin B12 and vitamin B6. Others appear to be only slightly affected.
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
We have been styling, cutting, and colouring our hair since the earliest known days. Simultaneously, we've been doing everything we can prevent and treat hair loss.
Dating back to 1550 BC, the Ebers Papyrus, a medical text, was giving insight in the treatment of an array of conditions. The ancient Egyptians were treating hair loss with a mix of the fats of a lion, hippopotamus, cat, snake and goat applied to the scalp.
If that treatment didn't work, need not worry! Other options included porcupine hair boiled in water or consider the leg of a female greyhound sautéed in oil with the hoof of a donkey. These were rubbed on to the scalp for several days.
Even now, not every patient of my own likes topical treatments that one needs to rub on the scalp ... and the same was true back then. One also had options to recite a magic spell to the sun god and then eat a mixture of red lead, iron, onions, honey and alabaster.
Grey hairs were treated with the blood of a black animal such as a cat, bull or calf boiled with oil.
In ancient Greece, 420 BC, Hippocrates was treating his own hair loss with a mixture of pigeon droppings, horseradish, spices, opium and beetroot.
We've come a long way since these early days but still have a long, long ways to go. I have no doubt that the world some 1000 years from now will look back on us in the 21st century with a similar degree of fascination, shock and laughter!
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
In short the answer is NO - not yet. However, we can state if one person has a higher chance that minoxidil will work than another person. Soon we may be able to test whether minoxidil will work by testing patient's minoxidil sulfotransferase enzyme activity . But those tests aren't available yet.
For now we gave several general predictors of who will benefit from minoxidil.
Minoxidil tends to work better if:
NO INFLAMMATION ON SCALP BIOPSY. We don't biopsy everyone to figure out if there is inflammation present or not, but Dr Whiting in 1996 showed that individuals without inflammation responded better!
ONE YEAR DURATION OF HAIR LOSS. Individuals who have had their hair loss for a shorter period of time respond better. There is no rule about one year but one study showed that patients with hair loss less than one year responded better than if hair loss had been present 10 years or more.
YOUNGER. Younger patients respond better to minoxidil than older (in general). This was true in both males and females
FIVE YEARS or LESS. One study showed individuals with balding less than 5 years had better results than those with balding more than 21.
MORE HAIR. Patients with more hair follicles per unit area had a response than those with less hair. These studies were conducted by counting the number of hairs in biopsy specimens. Those with more hair responded better to minoxidil.
FIVE CM OR LESS. One study looked at crown (vertex) balding in men and showed that balding crowns with a diameter less than 5 cm respond better than crowns with a diameter more than 15 cm.
Now if you continued reading this post right to the end you'll learn a simple phrase that I teach clinicians who are trying to learn this information. Repeat to yourself this silly phrase : "No one younger than 5 years needs more hair or five cents". This helps us remember the patients who minoxidil works best.
No=no inflammation One= one year Younger = younger patients 5 yrs = 5 yr duration (vs 21) more hair = more hair on biopsy 5 cents= 5 cm vertex diameter
This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
