Who is suitable for a hair transplant? How does it work? What are the alternatives? Dr Angeline Yong, an experienced dermatologist and hair transplant surgeon with over 15 years of medical practice, answers our questions about hair loss and the top treatments available in Singapore. Whether you’ve got alopecia (balding spots) or thinning hair, read on to find out how to fix it.
What are the causes of hair loss?
Hair loss is a common concern that can happen to anyone of any age. In fact, it affects 70 percent of men and 40 percent of women at some point in their life! Causes include iron or vitamin deficiency, hormonal imbalance and stress.
Globally, hair loss is most commonly caused by genetics, where some of us more susceptible to the hormone dihydrotestosterone (DHT). Hair follicles that are exposed to DHT become thinner and shorter with every hair growth cycle; eventually, they become dormant and stop growing. The over-production of DHT is the main culprit for androgenetic alopecia in both men and women. For females, the condition is seen through dispersed hair thinning occuring on the top of the scalp. Men tend to experience more dramatic hair thinning at the front (receding hairline) and top.
Alopecia areata is another unpredictable form of hair loss that leads to random bald patches. This autoimmune reaction occurs when white blood cells attack the cells in hair follicles, causing them to shrink and resulting in slower hair growth.
How does a hair transplant work?
There is an area on the scalp that is resistant to DHT. This so-called “safe donor zone” plays a huge role in the effectiveness of hair transplant procedures. Hair transplants work on the basis of “donor dominance”; this is the fundamental principle that transplanted hair will grow on the recipient site only as efficiently as it was in the donor site. Doctors typically retrieve hair follicles from the “safe donor zone”, which isn’t affected by the hormone.
Types of hair transplant
The two main types of hair transplant surgery available are follicular unit transplantation (FUT) and follicular unit extraction (FUE). Both are minimally invasive, outpatient treatments performed under local anaesthesia. FUT is an older technique. It involves harvesting a strip of skin from the safe donor zone at the back of the head. The harvested hair grafts are first cleaned and dissected using stereo-microscopes, then inserted into bald or thinning areas via tiny incisions.
A newer method of hair transplant, FUE obtains individual follicular units directly from the safe donor zone at the back of the head and the temples. The FUE technique can even be used to obtain grafts from body sites like the beard area or chest. The individual hair follicles are then stored in a holding solution at controlled temperatures; for the treatment to be effective, they’re then replanted into the scalp as soon as possible. The transplantation works in a similar manner as the FUT technique – inserting individual hair grafts via tiny incisions made at the recipient site. FUE involves a more tedious and time-consuming manual extraction process than FUT.
Which is better?
Scarring tends to be more visible in FUT because it involves the removal of an entire strip of hair-bearing skin from the scalp, and the donor area is then closed into a linear scar. You might feel more pain, and healing can take longer than FUE since stitches are needed to close the wound. While it may not be suitable for shorter hairstyles, many women prefer FUT as they can keep their hair long without having to shave their scalp.
Scars from an FUE hair transplant are much less visible; they look like tiny dots that can be easily hidden with shorter hairstyles. Since Asians are more prone to scarring, FUE hair transplants have become the popular option in Singapore.
Sometimes, a combination of both procedures is required!
Who is a suitable candidate?
A hair transplant work best for men and women who are currently experiencing androgenetic alopecia, or have lost hair due to an injury. If you’re significantly or completely bald, you may not be suitable for the procedure. Also, those under the age of 25 should not go for a hair transplant as their hair loss pattern wouldn’t be fully stabilised yet.
When will results be visible?
Patients may notice hair loss during the first few weeks due to “shock loss”. This happens when transplanted hairs are traumatised by their relocation. It’s completely normal and temporary; your hair will grow back within the next two to three months. Over time, the hair continues to thicken. Most people will achieve most of their hair growth nine months after the surgery.
What other options can I consider?
Other treatments for hereditary baldness include oral medication like finasteride and topical medications like minoxidil, which you need to rub into your scalp. Another FDA-approved procedure that can help with improving hair density is low-level laser therapy (LLLT).
Where should I go?
As hair loss is often a complex condition that can be caused by many factors, either simultaneously or individually, an accurate diagnosis is important for any treatment to be rendered effective. At Angeline Yong Dermatology, patients undergo a thorough consultation and examination with Dr Yong before a treatment plan is discussed. This includes a trichoscope examination, and getting in-depth medical history of the patient’s condition. A hair-pull test may be carried out to identify the proportion of the hair in the active growth stage against those in the resting phase.
Blood tests and biopsies of the scalp may be recommended, too, if there are suspected underlying disorders like thyroid dysfunction and nutritional deficiencies.
Depending on the severity of the symptoms, non-invasive therapies like minoxidil, finasteride and LLLT may be prescribed first to reduce DHT levels, stimulate follicles and induce hair growth. Patients are advised to undergo these treatments to stabilise their hair loss condition while considering a hair transplant.
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