Trichoscopy

Trichoscopy is dermoscopy applied to the scalp: examination of hair shafts, follicular openings and the skin between them under magnification and polarised light, using a handheld dermatoscope or a video system. It is the fastest way to see what the unaided consultation cannot — calibre variation, empty follicular openings, and the surface signs that separate one alopecia from another. It needs no preparation and no anaesthesia, which makes it repeatable at every visit.

In androgenetic alopecia its signature finding is hair-diameter diversity: shafts of visibly mixed calibres in one field, a growing proportion of fine and vellus hairs, and more follicular units carrying a single hair. Other conditions read differently — the patchy, abrupt findings of alopecia areata, the lost follicular openings of scarring alopecias, the uniform-calibre shedding picture of telogen effluvium — which is why trichoscopy sits at the centre of differential diagnosis, and why a scarring process it reveals can contraindicate the transplant a consultation was drifting towards.

Surgically, it earns its place twice. In the donor area it grades true density, calibre and any miniaturisation at the margins — data that set graft budgets and safe-zone boundaries far better than a glance through parted hair. In follow-up it provides the before-and-after the mirror cannot: same site, same magnification, same lighting, photographed and filed, showing whether a medical protocol, a PRP course or a transplant actually changed the numbers.

Operationally it is cheap leverage. A dermatoscope costs little against the equipment of a surgical clinic, adds minutes to a consultation, and upgrades both the medicine and the record-keeping — provided it is used with discipline: fixed reference points, consistent settings, images stored with dates and stated locations. Its findings also anchor honest conversation; showing a patient their own miniaturisation map explains progression and treatment logic better than any brochure. It is a teaching instrument too: trainees who learn to read calibre diversity stop diagnosing pattern loss from arm’s length.