Beard Transplant

The length of the entire procedure will depend on the area for transplantation, and the number of graftings needed. Patients should clear their schedules on the day of the procedure, as it may take an allocated 6-9 hours on average for the whole procedure, which includes a lunch break in between. Read on below to the “10 Steps of A Hair Transplant” for more details on the entire procedure

• 1-3 days post-procedure: The grafted areas start to dry up. Small scabs begin to form, which should not be scratched or picked at until they fall off naturally on their own.
• 3-5 days post-procedure: An individual may choose to clear their schedules and stay indoors for this period of time to avoid exposing the grafted areas to potentially dirty environments, sun exposure, sweat, and excessive oil production.
• 5-10 days post-procedure: Light physical activities can be resumed after the first 3-5 days.
• 10-14 days post-procedure: Return to normal activities are possible, such as going to work or running errands.
• 3-4 weeks post-procedure: It is advised that contact sports or extreme exercises are avoided. This gives the skin on the scalp adequate time to heal without getting potentially re-injured. 

Read on below to “What To Expect After A Hair Transplant?” for a more in-depth explanation of what not to do in the 2 weeks post-procedure!

Terra Medical Clinic is a medical hair and aesthetic clinic that offers the latest techniques in hair transplantation. We understand not only the value of skills and techniques, but also of applying the right surgical procedures to produce an aesthetic result that fits the goals and expectations of each individual client.

As much as it is a profession, it is also a skill that combines both technique and creativity. Factors like age, gender, ethnicity, and personal expectations are taken into  account in combination with the availability of donor sites, facial contours, and existing hair characteristics. That is why we believe in taking the time for a thorough consultation before finalising any treatment plans for our clients.

The initial consultation equips all clients with the right understanding of the surgery, the do’s and don’ts involved before and after the procedure, as well as what to expect in the following weeks. At Terra, our doctors will see you through the journey of hair restoration.

Two minimally-invasive surgical techniques are used today for hair transplantation: Follicular Unit Extraction (FUE, or FUEE), and Follicular Unit Transplant Technique (FUT), or FUT strip harvesting method. These procedures can only be performed by a licensed medical professional.

FUT Strip Harvesting Method

In Follicular Unit Transplant (FUT) strip harvesting, the doctor applies local anaesthetic to the donor area before removing strips of scalp tissue that bear healthy hair follicles. This strip of donor follicles are dissected under a microscope to obtain individual follicular units, which are then implanted on the balding areas. The surgical wound is closed, allowing the hairs just next to the surgical wound to be as close as possible to each other, minimising any large visible scars.

FUE Method

In Follicular Unit Extraction (FUE) or Follicular Unit Excision and Extraction (FUEE), the technique is slightly different from FUT strip harvesting. The difference in name highlights the difference in surgical procedure – instead of removing a strip of scalp tissue for dissection (separating the follicles from scalp tissue), FUE excises follicular units by using a harvesting punch machine that does not damage the hair follicles. The result of not damaging the follicles in the tissue fully depends on the medical personnel’s skill, hence this technique requires training and experience. 

Those individual follicular units in surrounding healthy tissue that support the follicle survival are called ‘grafts’. As they are retrieved from the scalp, they will be assessed by a team of trained technicians under high powered microscopy. Suitable grafts are arranged and put in a specialised storage medium called ‘hypothermosol’ to improve survival for implantation into areas of balding.

Some common questions we get about FUE: 

• Why is FUE so popular? 

You may have heard of the FUE (or FUEE) method in your search for hair restoration techniques. This is no surprise as FUE has gained popularity over the last decade despite being around for more than 15 years. The main reason for the increased popularity is that scarring is often minimal (not scar-free!) after the procedure. This is due to advancements in FUE punch technology. Punch technology refers to a system that removes a portion of skin bearing hair from a donor area. Since some of the larger punch grafts can cause scarring, new technology allows for smaller hybrid punch technologies to graft hair follicles which ensure grafts have minimal or no damage. This allows for healthier grafts and greater success with transplantation.

• What type of FUE system does Terra Medical use? 

At Terra, we deploy the use of Trivellini FUE System as well as the Devroye WAW FUE System.

• Is this a manual or automated system?

FUEE procedures can be carried out by robotic applications like the ARTAS robot. Despite our doctors being ARTAS-qualified and having utilised it for 3 years and counting, not every individual is suitable for an ARTAS procedure. The hybrid punch technology has equalled or bettered ARTAS graft quality in recent years. A thorough consultation is needed with all patients before deciding which method is more suitable.

The main differences in FUE vs. FUT are:

1. Procedure steps – FUE utilises small, round punch incisions around the tissue holding a hair follicle > extraction of the hair follicle > graft harvesting under microscope > implantation on balding areas. FUT utilises the removal of a larger strip of scalp tissue containing multiple follicles > cutting the strips into smaller pieces > separation of hair follicles from the main strip > implantation of grafts into scalp.

2. Scarring – FUT tends to leave a linear scar on the back of the patient’s scalp. FUE has smaller scarring which is not as obvious due to its smaller punch incisions. The tip of the punch micro-motor penetrates into the skin by spinning during the extraction of follicular units and allows easy extraction of bulbous healthy grafts.

Tip: Before your transplantation procedure, you might want to get used to a shorter hairstyle! This helps better recovery after the procedure. Once healing is well on its way 5-7 days after the surgery, the surrounding hairs in the donor zone will grow out, giving you the freedom to leave your house and meet up with people without any social worries.

10 Steps of A Hair Transplant

• Trimming of donor hairs – The donor area is trimmed according to the number of grafts to be harvested.

• Anaesthesia – The area is numbed with administration/injection of local anaesthesia.

• Harvesting/Extraction – Follicular units containing 1–4 hairs are loosened from the scalp and picked up for inspection.

• Quality check – Every one of these grafts are looked at under high-magnification microscopes to ensure the follicles are intact and there is a sufficient amount of supporting tissue surrounding them. They are then placed into a dish containing Hypothermosol solution, a bio-preservation media which protects the viability of the grafts.

• Lunch break for you!

• Marking/hairline design – The doctor draws out the hairline and marks out recipient areas in accordance to the plan.

• Recipient site preparation – Area is cleaned and numbed with administration/injection of local anaesthesia. Trimming/removal of surrounding hairs in the recipient areas may or may not be required.

• Site-making – The doctor uses small customised blades to make size-specific incisions, placing them in a predetermined density and pattern, and angling the wounds in a consistent pattern to promote a realistic hair design.

• Hair Implant – The earlier harvested grafts will be carefully placed into the pre-made sites by a team of trained nurses and hair technicians.
• Dressing – Antibiotic ointment and Calecim Stem Cell serum will be applied to the donor area and the area will be bandaged for 1 day. The recipient area is left exposed to be sprayed with a special solution provided to you to keep the area moist and healthy.

The first 2 weeks after your hair transplantation is usually the best time for you to take care that the hair grafts do not dislodge! Although life has to go on as usual, here are some specific things to avoid while you recover:

• Excessive Physical Exercise – Although light exercises can be done after the first few days (walking, light jogging) we do discourage physical exercise from happening for at least 2 weeks. Yes, this includes golf too! Too much oil and sweat reduces healing and increases chances of a graft dislodging.
• Excessive Aggravation – While it may be tempting to rub on your scalp to feel whether the stubs of hair are growing out, do avoid touching or rubbing your head. Not only does it disturb the healing graft, it also increases the chances of transmitting bacteria to the wounds.
• Excessive Compression – Keep the head elevated by sleeping in a recliner or with up to 2–3 pillows for the first 2–3 days helps to prevent the healing wounds from bleeding, and reduces chances of you accidentally aggravating the grafts while you sleep. You may also need to avoid wearing a hat, however loose-fitting, for the first 2 days as it might dislodge the grafts.
• Contact with Chemicals – Submerging in a pool, using styling or chemical sprays, or using hair dye is a big no-no during this time.
• Contact with Heat – Excessive sun exposure needs to be avoided as the scalp will be sensitive to UV rays post-procedure and may damage the scalp and hair follicles. Heat also includes avoiding hot showers or baths.
• Impeding Circulation – Avoid alcohol and tobacco. They affect circulation to the scalp, which is vital for recovery.
• 1-2 Months Post-procedure – Avoid steam rooms, saunas, and chlorinated pools to ensure the hair grafts takes strongly to your scalp’s skin.

The most painful part of the procedure is typically the beginning, where local anaesthesia is injected to the scalp in the initial 5-10 minutes. After the anaesthesia kicks in quickly, the first part of harvesting the donor sites will have minimal to zero pain. While the extraction of hair follicles is going on, the anaesthesia may wear off slightly. Hence, there is a second round of smaller local anaesthetic injections to prepare the balding area for graft implantation. Post-procedure, there will be a slight to moderate discomfort felt as the anaesthesia wears off within 12-18 hours, depending on your own individual pain tolerance. Medication will be supplied to you to help with any pain or discomfort felt for 1-2 days after. Prolonged pain is rare, so it is important that you inform your hair restoration doctor if you experience prolonged pain after a hair transplant procedure. There may be other conditions like an infection that has happened to cause the prolonged pain.

FUE (or FUEE) is not a scar-less procedure. There will be scars seen, which will be covered up well by hair of minimum length 3-5mm once hair grows back. If a person shaves their head, tiny spots of 0.8mm hypopigmented (lighter colour than your original skin colour) marks can still be noticed.

This is only advised for patients who have work that is completely sedentary and does not require walking around in the open, such as a desk-bound office job. This is because even though it is a minimally invasive surgery, you may still feel uncomfortable while waiting for the effects of the anaesthesia to wear off. 

A bandage will cover the donor area to ensure that hygiene is maintained and bacteria-free. One day after the procedure, you will need to return to the clinic for bandage removal. Your scalp will also be washed by our team to ensure further hygiene and so that the grafts are not damaged. Further instructions will be given to you on how to care for your scalp, including hair washing techniques, usage of skin healing serums, and a regime of antibiotics to prevent infections.

In optimum situations, the donor area hair should have grown out sufficiently to cover the punch marks by 1 week. The scabs that have formed after the procedure will also have started to drop off on their own. Follow the advised do’s and don’ts listed here and given by your hair transplant team, and you will recover within 7-14 days! 

Transplanted hairs usually take 3-4 months to start growing. In fact, it is normal to actually see more ‘hair loss’ over the donor sites in the first few months as the transplanted hair shafts may detach from the implanted roots. If this happens, do not worry. It just means that new and strong hairs will start to grow out from those areas within 4-6 months. The rate of growth is usually 1cm per month. From 6-9 months, implanted hairs will look denser and gain 80% of results. Up to 12-18 months post-procedure, the transplanted hairs may continue to improve in quality and density for the full results!

Firstly, your comfort matters! As this is a process that will last up to a year, you need to be comfortable with the clinic and the team that will journey with you. You should feel comfortable enough to bring your concerns and worries to them over the course of the months leading up to full hair growth, and all your questions should be answered well before you make any decisions.

Secondly, make sure that you have gotten a thorough consultation done. Hair transplantation is a permanent solution, and usually used as a last resort when all other avenues have failed. A proper consultation makes sure that your investment into this procedure is long-lived and that you are a suitable candidate for this surgery. There may be other regenerative medicine procedures such as Regenera Activa to stop further hair loss and optimise the condition of the existing hairs first.

And thirdly, ensure that the clinic you have chosen for your hair transplantation journey is Led and certified by licensed doctors e.g. a Diplomate from the American Board of Hair Restoration Surgeons. After all, your health is in their hands! The right doctor should not only ensure that the hairline that you decide on will be able to ‘age’ with you and still look natural 30 years down the road, they will also make sure that the procedure is done with strict hygiene and safety. The ISHRS position statement should be adhered to by all the physicians that are in charge of the surgical decisions and incisions.

Hair transplant in Singapore costs around SGD$6000 for small cases and up to SGD$15-20k for complicated, larger cases. Hair transplantation surgery should always be performed by a professional team led by a doctor for the safest results. For questions that have not been answered by this article, contact Terra Medical Clinic to get in touch with someone from our team!