The Clinical Examination


How Does A Doctor Examine You To Diagnose Your Hair Loss?

Hair Loss Stages

[Abstract 1 minute read]

  • Doctor will look for a ‘pattern’ of hair loss, which occurs in 80% of men and 40% of women
  • Less common types of hair loss may also be identified
  • Doctor will be able to stage the severity of the problem
  • A videoscope will be used to assess hair strength and scalp condition over different areas of the scalp
  • The examination also will be used to plan which mode of hair restoration suits you most
  • Careful and detailed examination and grading is a key to success in any hair restoration treatment

After the discussion about your history of hair loss and scalp conditions, a hair restoration doctor will examine you to determine to aim to achieve a diagnosis of your hair loss condition. This examination involves a ‘macroscopic’ examination i.e. looking at the scalp with the naked eye, and a more detailed view of the scalp called ‘videotrichoscopy’, using a high powered 40x – 100x magnifier specifically to examine the hair and the scalp at its base.

The macroscopic examination involves determining if it is a ‘patterned’ hair loss – male or female pattern hair loss, or whether another condition is causing the hair loss or thinning.

The doctor will also look for patches of baldness e.g. in alopecia areata and hairline recession in women.

This examination will also stage the severity of the patterned hair loss. There are a number of classifications used for this, the most common being the Norwood-Hamilton Scale for men and the Ludwig or Savin scale for women.

What Is ‘Dermoscopy Of The Scalp’ Or ‘Videotrichoscopy’?

The next step in the examination is to look at the scalp at 40x magnification to assess the appearance of the hair at its roots. This painless examination is done using a special magnifying scope. The purpose of this examination is to assess different areas of scalp, to check for the appearance of ‘miniaturization’ of hair follicles, which appear on the scope as fine, thin hair shafts.

The close up view of the scalp can also show the doctor the skin quality of your scalp and if hair follicles show characteristic signs of specific hair loss diseases, e.g. yellow and red dots in alopecia areata signifying inflammation, or redness and flakiness pointing towards a diagnosis of dandruff and seborrheic dermatitis.

The scope will also show the appearance of the thickness of your hair, while there are some people born with thick luscious coarse hair, some have thinner and finer hair. The thickness of the hair hair shaft affects how well the scalp is covered in patients with hair loss – the finer the hair, the more the scalp exposure.

Dermoscopy Of The Scalp
Videotrichoscopy Of The Scalp

This scan will also give the doctor information as to whether you have many ‘higher order’ follicular units. Hair follicles are randomly assorted and some are grouped into groups of 2s, 3s or 4s (sometimes even 5s) [these are termed ‘higher order follicular units’] – this is called a follicular unit and assessing this is used to plan the hair restoration procedure.

Your doctor will also use this tool to estimate the degree of miniaturization as this is important in determining what type of hair restoration technique is most suitable for you. For example, Regenera Activa (hyperlink) requires >30% of hair follicles to be miniaturized for good results.

The presence of ‘vellus’ hairs using this method of examination also indicates that prolonged damage has been done to that particular follicle helps the doctor provide a prognosis and manage expectations.

Lastly, In patients with severe hair loss and prolonged exposure of the scalp to UV radiation, you hair restoration doctor will be also looking out for abnormal pigmentation which may require a referral for further investigation.

What Is ‘Densitometry’?


Densitometry is a parameter used by hair restoration surgeons to determine the density of hair follicular units in a given area, for example, 70 follicular units per square centimeter. You may hear the doctor mention that you have a very dense donor area of ‘70’, which affects the way hair restoration surgery is carried out.

Densitometry is not only carried out on the donor area but also on the areas experiencing hair loss, as well as the areas surrounding the intended hair transplant recipient site. The purpose of this is to create a natural appearance to the restoration procedure. An unnatural result would be to have a very dense hairline e.g. 45 follicular units per square centimeter with the surrounding areas having a density of only ‘30-35’.

There are computer models that can perform this examination using a videotrichoscope (mentioned in section 2) but they require hair to be very short or shaved to give an accurate result.

Why Is It Important For A Hair Restoration Doctor To Perform This Examination In Detail?

Planning for hair restoration requires an in depth understanding of hair biology and disease processes. Also, it requires careful assessment of scalp / skin integrity for a successful hair transplant procedure. Your hair restoration doctor will combine the information gathered from this detailed examination, together with the clinical history that you have provided to formulate a plan to restore your hair.

This detailed assessment also determines and allows the doctor to discuss, understand and manage the expectations of hair restoration candidates.

A red flag to a patient would be a doctor that fails to carefully examine their scalp and hair and jump straight in to a ‘solution’.

If you have any questions relating to scalp health or hair loss, speak to your preferred hair restoration clinic today.

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