PRECISE Scale: a quantitative classification for androgenetic alopecia and its application to hair transplantation

Abstract

Background: Androgenetic alopecia (AGA) is a prevalent genetic condition that can affect both male and female, and is considered the most frequent form of hair loss. Traditional scales and methods of classifying AGA are basically qualitative.

Objective: This work aims to propose a quantitative scale to classify AGA in order to assist hair transplantation surgery.

Methods: Based on whole hairless and thinning areas that needs to receive follicular units in a hair transplantation procedure, basic equations to support the scale are proposed. Additionally, the study involves simulations that apply the classification system and compare its results with those of qualitative methods.

Results: The PRECISE scale utilizes a range of 0-10, using 30 cm² as the measured standard of a bald area. For hair transplantation, 1500 follicular units (FU) are recommended for each score in the PRECISE scale. Technological and manual methods to measure the hairless and thinning areas are presented and discussed. This new quantitative classification, combined with different and complementary methods of measurement of hairless and thinning areas endorse the understanding of the clinical condition by the patient and the planning of a surgery procedure.

Conclusion: The developed PRECISE scale brings a different way of classifying Androgenetic alopecia (AGA), through an essentially quantitative evaluation. It can be used to elaborate the best strategy for the hair transplantation surgery and to improve the outcomes.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Alopecia; Hair; Hair follicle; Plastic; Surgery.

Fig. 1

A diagram of the PRECISE Scale, for classification of AGA based on the size of the hairless and corrected thinning areas

Fig. 2

Templates showing Norwood-Hamilton class 3V with different head sizes. Temporal restoration was not necessary in those patients (TS = 0)

Fig. 3

Patient C Norwood-Hamilton class 5 with a large head; Patient D Norwood-Hamilton class 6 with smaller head

Fig. 4

Example of measurement of surface area from 3D objects using LiDAR technology. a Wireframe; b Normals; c Rendered tri-dimensional model; d Surface area measurement. The dummy head 3D model was created using LiDAR technology contained in a mobile phone

Fig. 5

Positions to take the images for area measurement, using a measurement tape (yellow) as size reference. Images were created with CGI rendered 3D models in Adobe® Photoshop 2023 version 24.1.1

Fig. 6

Measurement of hairless areas in photographs from different positions. a Measurement of frontal and mid scalp areas; b Measurement of Vertex area; c Measurement of occipital thinned area

Fig. 7

Square centimeter’s stamp. Author’s own equipment image