Hair Transplant In Singapore: What To Expect, And More
Date: 25 October 2018
Common reasons for hair loss
The most common reason for hair loss is androgenetic alopecia, or pattern hair loss. Up to 80% of men and 40% of women will experience significant hair loss from this condition. It is a condition that is understood to be hereditary (passed down from parent to child in the genes) and related to the male hormone, di-hydro-testosterone or DHT.
This pattern of hair loss is progressive and the main feature of it is thinning of the shafts of the hair (i.e. each strand of hair appears thinner and limper) due to damage to the hair follicle (some refer to this as the hair root) – this phenomenon is called ‘miniaturisation’.
The condition is called ‘pattern’ hair loss because, in the large majority of those afflicted, it follows a ‘pattern’ of hair thinning. In men, it usually starts from the hairline or crown and spreads to involve the rest of the scalp. In women, it starts from the centre parting and spreads outwards to involve a larger area of the scalp. In women, especially, a prominent amount of shedding can occur as part of this type of hair loss.
Other reasons for hair loss include telogen effluvium, where shedding of hair is the main feature and does not follow any particular pattern, this type of hair loss is often seen around 3-6 months after a sudden stressful event such as childbirth, major surgery or severe emotional stress. If the shedding is severe, it can reveal more areas of the scalp, causing the appearance of balding.
If telogen effluvium persists for more than 6 months, hair restoration practitioners deem this as ‘chronic telogen effluvium’ and further investigations such as blood tests are warranted.
What is ‘hair transplant’ and what are the common procedures or methods of hair transplant?
Hair transplant, also known as hair restoration surgery and hair transplantation surgery, refers to the use of ‘donor’ hair follicles found at the back of the scalp. These donor follicles are located in Unger’s ‘Safe Donor Area’ but may vary from person to person. These follicles are used for hair transplants because they are resistant to the harmful effects of DHT and are much less likely to undergo thinning, or ‘miniaturization’. As such, these hairs are considered permanent hairs.
The most common techniques for hair transplants today are using the FUE (now termed FUEE) and the FUT strip harvesting method. It is worth noting that both methods are surgical in nature. By law, any surgical procedure has to be carried out by a licensed medical professional.
FUT strip harvesting method
FUT strip harvesting is a method of removing living hair follicles from the donor area by surgically removing a strip of scalp-containing skin. After harvesting the strip of donor follicles, they are dissected into individual follicular units for reimplantation into the areas of balding. The surgical wound is then closed, allowing the hairs just next to the surgical wound to be as close as possible to each other, minimizing the large visible scars that were common in the past.
FUE stands for Follicular Unit Extraction whereas FUEE stands for Follicular Unit Excision and Extraction. The revised terminology highlights the surgicalnature of the procedure, having to excise and dissect scalp tissue from a patient’s scalp.
The FUE (or FUEE) procedure involves individually harvesting follicular units using a harvesting punch (excision), taking great care not to damage any part of the follicles. To perform this well requires training and experience. The same microscopic follicular units are retrieved from the scalp (extraction) and assessed by a team of trained technicians under high powered microscopy – these are now called ‘grafts’ that contain hair follicles and surrounding tissue that supports the follicle’s survival. Suitable grafts are arranged and put in a specialized storage medium called hypothermosol to improve survival for implantation into areas of balding.
The FUE (or FUEE) method has gained in popularity over the last decade. A major reason for this is that the patient can be close to being scar-free (but not scar-less) after the procedure. FUE has also gotten popular due to advancements in FUE punch technology, . Hybrid punches ensure that grafts come out with minimal or no damage, meaning that we end up with healthier grafts when compared to older systems. At Terra Medical, we use Devroye Instrument’s WAW FUE Hybrid punch system.
FUEE procedures are also carried out by robotic applications like the ARTAS robot. In my opinion, despite being ARTAS-qualified and having utilized it for 3 years, I believe that not everyone is suitable for an ARTAS procedure and that hybrid punch technology has equalled or bettered ARTAS graft quality in recent years. With my patients, I normally do a thorough consultation before recommending which method is more suitable.
1. Will I feel pain during and after the transplant?
The first 5-10 minutes will involve the injection of local anaesthesia which will then numb the area of harvesting. You may experience some discomfort during this period of the procedure but after that, the excision and extraction are painless.
There will be another round of smaller local anaesthetic injections to prepare the recipient area (bald area) for implantation of the follicular grafts, which can be slightly uncomfortable as well, during the 2nd part of the procedure.
After this, you will not feel any pain and your scalp will feel numb for up to 18 hours.
Most patients may require 1-2 days of mild painkillers post-operatively but prolonged pain is uncommon. It is important that you inform you hair restoration doctor if you experience prolonged pain after a hair transplant procedure.
2. Does the transplant procedure leave scars?
Using the hybrid punch FUE technique, the donor area skin heals very well. Note that FUE (or FUEE) is not a scar-less procedure – upon close inspection tiny spots of 0.8mm hypopigmented (lighter colour than your original skin colour) marks can still be noticed if you shave your head.
If you leave your hair out to 3-5mm in length at the donor area, these ‘scars’ will not be visible.
3. Can the patient go back to work right after the surgical procedure?
While we have had patients go back to work after the procedure, this is not advised unless your work is completely sedentary. There will be a bandage that covers the donor area to keep the area free from bacteria and to ensure quick healing. The bandage will be removed one day after the procedure and your hair and scalp will be washed in the clinic by our team, to ensure that the grafts are not damaged.
Further instructions will be given to you on how to care for the areas operated on over the following few days including hair washing techniques, skin healing serums and a regime of antibiotics to prevent infections.
4. How many days to fully recover?
At the 1-week mark, the donor area hair would have grown out sufficiently to cover up the punch marks caused by the FUE (or FUEE) procedure. At this point, scabs would have formed, which signify that the healing process has started and some scabs may have already started to drop off at the 1-week mark.
We advise that you avoid heavy physical activity for the first 2-3 days after a hair transplant procedure. We also advise against steam rooms, saunas and chlorinated pools for 1-2 months after the procedure.
5. How long will it be before the patient notices a difference after a hair transplant?
The first 1-4 months after surgery involves hair shafts detaching from the implanted roots and you may feel that all the implant hair has ‘been lost’. From 4-6 months, new strong transplanted hairs will start to sprout. From 6-9 months, the implanted hairs will appear denser and you will see 80% of the results at 9 months.
It is usually one year after your hair transplant procedure that you see full results, as hair follicles go through a cycle of shedding and then growing. Some hair restoration physicians state that there will be further improvement up to 18 months.
6. What are the most important considerations when patients are thinking about going for a hair transplant?
You should feel comfortable with the clinic and team that is treating you. You should be consulting the doctor who is performing the surgery for you and he or she should be able to answer all your questions pertaining to your condition.
While hair transplant may be touted as a permanent solution to your hair loss woes, you may not be the most suitable candidate for the procedure. At Terra, we may suggest that you go on medications or perform a regenerative medicine procedure to stop further hair loss and optimize the condition of the existing hairs first.
For general hair restoration procedures involving the hairline, your doctor will discuss your expectations with you. Because the procedure is a permanent surgical treatment, the hairline that you decide on with your doctor should be able to ‘age’ with you. In other words, the hairline should still look natural 30 years down the road.
Most importantly, hair transplantation surgery or hair restoration surgery is a medical procedure and must be performed by a team that involves a medical doctor trained in the procedure. The ISHRS position statement that physicians are in charge of all the surgical decisions and incisions should be adhered to.
7. What are the general costs of treatment?
Hair transplant procedures in Singapore cost around SGD$6000 for small cases and up to SGD$15-20k for complicated, larger cases if performed by a professional team led by a doctor. If you would like to know more, contact Terra Medical Clinic for further information.