Hair miniaturisation is a gradual and progressive thinning of individual hair shafts that results in thinner hair and an overall increased visibility of the scalp.
A significant number of people with androgenetic alopecia continue to present with some miniaturised hair even though they have received treatment. Many incorrectly assume that ongoing miniaturisation will be completely halted, completely eradicating every trace of miniaturised hair.
Total reversal of all miniaturised hair can occur in a percentage of early stage androgenetic alopecia cases – usually patients who are young and generally healthy with no predisposing/contributory factors. The vast majority of patients with androgenetic alopecia will find things will definitely improve with treatment – but realistically we cannot restore every single hair and eradicate miniaturisation completely. For some patients – it may appear that it does – but under trichoscopy a percentage of miniaturised hair still persists. Although treatment can be very effective at improving hair thickness (both in numbers of hairs and diameter of the hair shaft) – results are rarely to the extent of how the patients’ hair presented before the first signs of hair loss.
Although hair loss is ‘reversed’ – in truth we rarely see a 100% reversal – realistically we can expect to see a 70-85% recovery – which is a great result! However – for some – a ’result’ (and improvement) is that treatment slows down and stops further hair loss. This can be seen as an improvement and a success, even though treatment hasn’t restored hair thickness (in some very rare cases – treatment can fail to even provide this benefit).
The aim of successful treatment is:
- Increase density/numbers of hairs
- Increase hair strand thickness /reduce the number of miniaturised hairs
- Restore shedding to normal.
Conclusion: Success is measured by the improved diameter and numbers of hairs on the scalp (and the patients’ positive reaction to this) and the reduction of excessive hair shedding. If hair loss is due to Androgenetic Alopecia/Pattern Hair Loss stops/slows down, it means that treatment is working. Treatments rarely restore hair 100%. A more intensive treatment plan (which could include a greater number of treatment options combined) could reduce the proportion of miniaturised hair and increase density further. In general it may be considered ‘normal’ to have up to 10% miniaturised hairs even when hair is restored to ‘normal/healthy’ growth.
Neil Harvey MIT
The Institute of Trichologists