HMI "HairCheck" Trichometry in Hair Loss Management & Treatment - by Alan J. Bauman, M.D. - 2012 ISHRS Bahamas Meeting | Hair Loss | Medicine


For a physician or patient, the quantitative evaluation and tracking of changes in hair growth can be a challenging task. Current methods are fraught with inaccuracies and inefficiencies. For example, global patterns of scalp coverage provide little information on the degree of miniaturization, a hallmark of early hair loss, or a patient’s subtle response to treatment over time. Even in the most controlled photo studio environments, standardized global photography can be inconsistent due to changes in hair length and styling. Video magnification of the scalp (40-200x) and hair count densitometry provides additional information and raw data, but also have limitations including having to trim hair to obtain accurate measurements as well as equipment costs. “Cross-Sectional Bundle Trichometry” is a patented, scientifically accurate, repeatable noninvasive method of measuring the cross-sectional area of hair (Hair Mass Index or HMI) in a predetermined area of scalp. A patient’s HMI measurements can be accurately obtained in minutes by a physician or another staff member without the need to trim hair. In a hair loss patient, comparing HMI between various areas of scalp can yield valuable diagnostic information. Comparing HMI measurements obtained in the same area of scalp over time allows the quantification of subtle hair growth changes such as the progression of hair loss or response to treatment. HMI can be utilized for research purposes to track the response to monotherapy. In a ‘real-world’ clinical setting, patients will typically utilize more than one treatment modality in their hair loss regimen and their compliance with treatment can vary greatly over time. The individual and overall success of a multi-therapy hair loss management program can be measured by comparing cohorts of patient HMI’s over time.

Distinguish “patterned” hair loss vs. diffuse Establish baseline data Track treatment-response Assess hair growth changes over time Improve patient compliance Improve medical management outcomes

The implementation of any new diagnostic tool requires an investment in time, effort, personnel and other resources. Each physician must make his own judgment whether these investments are “worth the return” of the benefits received in terms of patient care. In our opinion, hair bundle cross-section measurements have provided us and our patients with easily understandable clinical information within minutes that was previously not attainable. For example, during this initial trial period we were able to detect and quantify non-visible thinning in male patients with early balding and quickly differentiate diffuse from pattern balding in females with hair loss. We have able to track patients with thinning, telogen effluvium, and we were able to critically evaluate our patient’s response to minoxidil, finasteride, dutasteride, low level laser therapy and nutritional modification in a shorter timeframe than ever possible before. We also discovered that when patients related to their hair loss in quantitative terms and could see hair growth changes in shorter intervals than previously obtainable, communication and education were significantly improved and this resulted in enhanced compliance and treatment outcomes. Furthermore we expect to publish and present scientifically valid ‘real-world’ data as it pertains to the efficacy of hair regrowth in mono-therapy treatment regimens. As a practice, we are proud to be able to communicate to patients our track record and ‘success rate’ in the medical management of hair loss in not only stopping its progression, but also offering patients proof of significant improvement in their condition without surgical intervention.

US Patent #6,993,851 B.H. Cohen

Two technicians obtaining and recording HMI measurements during a routine follow-up visit.

Sample of an HMI report provided to a patient.

ISHRS Practice Census Data (2004-2010) reveals a dramatic increase in the number of non-surgical patients seeking treatment from physicians worldwide. Because hair loss is a chronic and progressive condition, both surgical and non-surgical patients will require “Medical Management” of their hair loss condition over time. A significant decrease of hair density and caliber can occur during the early subclinical phase of hereditary hair loss before coverage of the scalp diminishes.
1,000,000 800,000 600,000 400,000 200,000 0 2004 2006 2008 2010 Sx Non-Sx

RETROSPECTIVE STUDY (n=439) A retrospective chart review was undertaken to examine HMI data from 439 consecutive non-surgical patients who received a total of 1490 cross-sectional bundle measurements during a 24-month time period between 12/2009 and 12/2011. Patients had been counseled to begin and stay compliant with a multitherapy treatment regimen and return for HMI measurements at 90-day intervals. As expected, compliance with regard to treatment and follow-up appointments varied greatly in addition to response to treatment. Study interval 12/2009-12/2011 Of 439 non-surgical patients total, 18 were excluded from the data because one or more HMI measurements could not be obtained for technical reasons: e.g. hair length, hair replacement use or elected to undergo hair transplantation. 1490 HMI measurements performed (occipital, vertex and/or anterior mid-scalp) Non-Surgical Cohort = 421 patients (289 Female and 123 Male) 130 patients had two or more Frontal HMI measurements within the study interval. (ave +8.4, range of -33 to +82, 100 improved, 8 no change, 22 worse) 114 patients had two or more Vertex HMI measurements within the study interval. (ave +8.2, range of -19 to +66, 78 improved, 6 no change, 30 worse)
68% 17% 6%
Worse Same Improved

ΔFrontal HMI (n=130)

Marritt E. The death of the density debate, Dermatol Surg 1999;5:654-660. ISHRS Practice Census Survey Data 2004-2010 ( Cohen BH. The cross section trichometer: A new device for measuring hair quantity, hair loss, and hair growth. Derm Surg 2008; 34:900-910. Cohen BH. Hair breakage: an under appreciated cause of hair loss in women. Hair Transplant Forum Intl, May/June, 2008 Bauman AJ. Hair bundle cross-section trichometry in the Medical Management of 250 cases of hair loss. ISHRS 18th Annual Scientific Meeting, Anchorage, Alaska. Oct. 2011. Hendriks MAE, The usefulness of Cohen’s cross-section trichometer for measuring hair quantity.


ISHRS Practice Census Data 2004-2010

Oftentimes, patients will squander precious time and resources on ineffective treatments during the early phases of hair loss. Other patients may become non-compliant with medically prescribed treatments during early phases of treatment when their beneficial effects are too subtle to be noted by causal observation. In 2009, the author began to utilize hair bundle cross section measurements (HMI) as part of routine evaluations for hair loss diagnosis and follow-up visits for patients under treatment.

26% 5%

ΔVertex HMI (n=114)

“You can’t manage what you can’t measure.” - Dr. Bernard Cohen

Worse Same Improved

Dr. Alan J. Bauman is the Founder and Medical Director of Bauman Medical Group located in Boca Raton, FL since 1997. He is a full-time Hair Restoration Physician, Diplomate of the American Board of Hair Restoration Surgery and active member of the International Society of Hair Restoration Surgery. Dr. Bauman personally treats approximately 1,000 hair loss patients and performs over 250 hair transplants annually. In the course of the medical management of hair loss, thousands of HMI measurements using hair bundle cross-section trichometry have been performed at Bauman Medical Group since 2009.


Alan J. Bauman, M.D.


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The following conflicts of interest are germane to my presentation: NONE.

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