WOMEN'S HAIR LOSS & SONOGRAPHY OF SCALP AND HAIR

DIANE PINSON, recognized expert in the hair transplant industry speaks out about her devastating surprise hair loss in her late teens and her arduous journey to find answers. Diane has been a passionate researcher for clinical answers and resources to address women's hair loss and made a career out of this mission. Today, Diane is an outspoken supporter of women's hair loss and has recently joined the IHRC research group in pursuit of technological advancements and imaging validation of subdermal disorders identifying the root causes of hair loss in women. She also maintains her professional goal as a technical trainer, sharing her expertise and helping others achieve their goals in the hair transplant industry.

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WHY ADD DIAGNOSTIC IMAGING TO HAIR RESTORATION MODALITIES?

Diagnostic protocols in the hair loss & regeneration industry includes the use of microscopy and subdermal scanning. This includes the blood flow functions in 3D ultrasound, offering real-time quantitative reporting of hair follicle health and conditions. Health issues of the scalp indicate a wide range of possible disorders including Dandruff, Seborrheic Dermatitis, Fungal Infections or inflammatory conditions like Psoriasis. They may likely result in cosmetic interference and quality of life issues that may call for the need for medical surveillance or clinical intervention.

Upon review of the latest advancements in ultrasound technology, scalp pathology and cross-sectional imaging presented physicians with a new areas of pathological reporting, yielding to a more targeted way of prescribing solutions to mitigate scalp-related issues including HAIR LOSS.

(L-Image) Inflamed Hair Follicle note feeding arteries -red-/ high flow turbulence from tortuous vessels- yellow

(L-Image) Scarred hair follicle- orange outlined area shows scar formation from inflammatory fibrosis

PART 2:

Disorders of the scalp often result in severe cosmetic interference with quality of life, creating the need for optimal medical surveillance. We tested the latest generation of ultrasound machines in patients with scalp pathology and prepared a cross-sectional library encompassing a wide assortment of conditions. Normative data on the sonographic anatomy of scalp and human hair, and important methodological considerations, are also included. 

Figure 1. (a) Ultrasound of normal scalp (transverse view) shows the typical echogenicity of the different skin layers; note the oblique orientation of the hair follicles. (b) Hair follicles on three-dimensional ultrasound (asterisk; 5 sweep). bms, bony margin of the skull; d, dermis; epidermis; em, epicraneous muscle; st, subcutaneous tissue.

Figure 2. Hair growth cycle. (a) Schematic representation. (b) Ultrasound; note the progressive dermal penetration of the hair follicle, from the telogen phase

(inactive and resting phase with the hair bulb in a subepidermal location) to the anagen phase (active growth phase with the hair follicle reaching the bottom of the dermis)

Figure 3 (R). Estimation of scalp follicular population. Density gradient ultrasound depicting variation in hair follicle number (arrows).

TRAUMA & TOXINS (and Non-Invasive Treatments) - Written By: Robert Bard MD

The human body is continually assaulted by harmful forces which may be obvious-trauma and burns-or dismissed as the “flu or nerves”-chronic poisoning and delayed hidden scarring. However, in the unregulated world of fillers, patients and physicians often encounter unexpected findings and potential complication medicolegal traps. One picture is worth a thousand words and one image may launch a thousand lawsuits while possibly giving birth to a new medical image guided treatment paradigm. (Fig 1)

TRAUMA: Soft tissue trauma causes a black and blue area but subcutaneous pathology is best imaged by ultrasound FIG 2 The normal dermal layer is light gray on scans while inflammation is dark gray and fluid (blood) is black. Dermal ultrasound has been used for 30+ years to find skin cancer and guide scar treatment so the use in subacute trauma victims is a logical progression of this portable and non invasive technology.

Foreign bodies such as glass and splinters are easily visible as bright white areas so the surgeon is directed to the exact removal site under ultrasound guidance with minimal tissue “exploration” Fillers have characteristic echo pattern where HA products appear as black globules when they coalesce.  Often the HA injected aliquot disperses immediately leaving a diffuse hazy picture. Complications of fillers are well described in recent textbooks. A special case is free silicone having specific “snowstorm” pattern that is commonly seen in breast imaging of ruptured implants. The theoretical possibility of immune system compromise by free silicone is still being studied.

FIBROTIC SCARRING: Elastography shows scar tissue quantitatively in the liver parenchyma but also in traumatized skin, muscles and tendons. The “elastic” properties of tissue are used worldwide for cancer diagnostics because malignant tumors are rock hard and “gritty” has we feel with the needle biopsy while benign lumps are soft. Ultrasound maps tissue signatures to that free silicone has a MG value 35-40.