What Is “Hair Miniaturization”?

In DHT-susceptible miniaturization or pattern hair loss, hair follicles undergo miniaturization, shrinking from terminal to vellus-like hairs. In any single DHT-susceptible follicular unit, the terminal hairs might be in different stages of miniaturization and thus be of distinguished diameters. When there are plentiful terminal hairs in a state of miniaturization, there occurs a detectable thinning of the hair or patterned baldness in the affected areas. As enough hairs in each follicular unit become miniaturized, the process may result in full baldness in that area of the scalp. Usually, scalp hair grows in follicular units made up of 1 to 4 terminal (full-thickness) hairs.

The process would take too long for evident miniaturization to take place secondary to shorter anagen cycles alone, specifically in the aspect of the latent lag period observed in pattern hair loss that happens between the loss of a telogen hair and the appearance of an anagen hair. However, hair miniaturization reversal is clinically possible in individuals with thinning or pattern hair loss responding to finasteride treatment. It is conjectured that the miniaturization visible with pattern hair loss may be the straightforward outcome of decreasing the cell number and, therefore, the size of the dermal papilla.

Less often, few patients encounter miniaturization in the donor area. When a patient’s donor area displays miniaturization, it minimizes the chances of their chance of being a candidate for a hair transplant. Transplanting hairs that after a period of time become miniaturized and vanished invalidates the cosmetic purpose of a hair transplant procedure. Although miniaturization in the donor area is less likely to occur in men, it is the pattern in women who experience hair loss. This moderately describes why some women are candidates for surgical hair transplantation as compared to men. Only females who have a coherent donor area are recommended for hair restoration surgical procedures.

Miniaturization in the donor area is also a vital element in identifying the relevant age at which an individual is a candidate for hair restoration surgery. In most candidates with early hair loss, where severe hair loss occurs when the patient is in their late teens or early/mid-twenties, it is just next to impossible for the hair transplant expert physician to ascertain if the donor area is, in fact, going to be stable over time, or if it will ultimately miniaturize. If a consulting physician executes a hair restoration surgery on a young patient whose donor area sooner or later experiences miniaturization, then the transplant may not have the expected cosmetic effect. Not just that, but the patient will be left struggling with additional scars and seams in the donor area from donor hair transplanting without the cosmetic advantages of restored permanent hair.

That is why hair transplants are only recommended to patients 25 years old or older. If miniaturization in the donor area of 30-40% is indeed verified by scalp biopsy then surgery must not be the best suitable treatment option. This condition will relatively only generate temporary advantages and may lead to much more advanced hair thinning. The best treatment plan recommended would be a scalp biopsy. A scalp biopsy is the definitive diagnostic procedure performed prior to the best treatment plan determination.

Since DHT is the major reason for male pattern baldness, why not find a way how to stop hair miniaturization by preventing DHT from causing miniaturization? Let’s learn about what exactly happens with the medication “Propecia (finasteride)”. The finasteride obstructs the enzyme 5-alpha reductase Type II from transforming the testosterone hormone into DHT. With lower levels of DHT present in the bloodstream, lesser follicular units are revealed to the miniaturizing impacts of DHT, and thus, they continue to grow thick, healthy terminal hairs.

Rogaine, which is a topical medication for hair loss, also counteracts the adverse impacts of DHT but goes about it in a completely distinguished manner. DHT lowers down the growth phase of the hair cycle, resulting in progressively thinner and smaller hairs. Minoxidil, an active drug in Rogaine, works by elevating the growth phase of the hair cycle. It works well in early hair loss and usually eliminates the need for a surgical procedure. The outcome displays reverse miniaturization, lesser follicular units that encounter miniaturization.