Understanding Male-Pattern Baldness

Male pattern baldness is a common type of male hair loss that occurs in most men at some stage in their lives. While it typically takes 15 to 25 years to for a man to go bald, some men can suffer complete hair loss in fewer than five years. Men who begin to lose their hair in their early 30’s tend to go bald faster and, although male baldness is difficult to predict, it still follows a pattern.

The cause in over 90% of hair loss cases is defined as hair loss at the front, top or crown of the scalp – known as the non-permanent area. The back and sides of the scalp, where hair usually grows for life, is known as the ‘permanent’ area.

Male pattern hair loss is brought on by the presence of hormone receptors in the hair roots in the non-permanent area – no such receptors exist in the permanent area. These receptors are stimulated by the male hormone dihydrotestosterone (DHT) and, when this happens, the hair loss process is triggered. The number and location of these susceptible hairs is determined by inherited genetics from parents.

Hair is lost because of a change in the lifecycle of the hair root caused by DHT. This cycle consists of a growing phase and a resting phase. Before hair loss sets in, the growing phase lasts up to seven years and the resting phase lasts three to four months. Genetic hair loss is a result of the life cycle phases going into reverse, which means the growing phase becomes shorter and the resting phase gets longer. Eventually, the hair growth becomes minimal or not at all.

What Causes Hair Loss in Women?

For a woman, losing your hair can be particularly difficult, especially with the social stigma surrounding females going bald. However, female hair loss is actually quite common, with around 50% of women over the age of 64 experiencing female-pattern baldness.

Female pattern hair loss can be identified with hair thinning on the top and crown of the scalp, which usually begins with a widening of the centre parting. This is caused by the hair follicles gradually getting smaller and finer until the hair stops growing altogether.

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Other Causes of Hair Loss

Hair loss can be caused by a multitude of factors - From poor nutrition to hormonal imbalances and stress.
  • Alopecia Areata: This type of hair loss occurs when the immune system mistakenly attacks hair follicles where the hair growth begins. The condition usually appears as one or more isolated patches of complete baldness. In more severe forms, there is total baldness of the scalp (alopecia totalis) and, in extreme cases, total loss of all body hair (alopecia universalis). Sometimes medical treatment is successful in treating the less severe forms of the hair loss. In most cases of Alopecia Areata, hair will grow back within a few months, but may then recur at a later stage.
  • Traction Alopecia: This hair loss condition is gradual, caused primarily by force being applied to the hair through strain or tension. It commonly results from the sufferer wearing tight hairstyles such as braids and ponytails. The constant tension in the affected area either pulls out the hairs’ roots completely, or causes the follicles to become inflamed. Damage to the follicles causes them to fall out.
  • Physical & Emotional Stress: Hair loss can be brought on and accelerated by rapidly losing weight, becoming ill, undergoing surgery, medical conditions such as a low blood count or thyroid abnormalities and emotional stress. Once diagnosed and the source of the problem is eliminated, hair will normally grow back in a few months.
  • Chemical Burns & Scarring: Chemical hair treatments such as harsh dyes, perm solution, highlights, relaxers and straighteners may cause damage to our scalps due to the chemical involved. However, it is usually a breakage, not true hair loss, and it can be curbed by reducing or stopping the application of the chemical. In the case of burns, in which the hair roots may be destroyed, follicular unit transplantation could be the solution, but is dependent on how much scar tissue is involved.
  • Pregnancy & Childbirth: The reason for hair loss during pregnancy and the post-partum stage is a surge in oestrogen and progesterone hormones, which can cause hair to become brittle and begin to thin. Some women may also experience hair loss in the months following birth due to a thyroid hormone imbalance. The good news is that hair loss during and after pregnancy is normally temporary. Normal growth function should resume within 2-3 months of childbirth as hormone levels begin to stabilise.
  • Trichotillomania: This is a compulsion disorder where a person uncontrollably pulls their hair out. They may do so from their scalp, eyebrows or even eyelashes. Usually there is an intense urge to pull your hair out and an immense relief after pulling out the hairs. Pulling out hair on the scalp or other areas can leave bald patches. The first line treatment should be counselling and psychological therapy. Only when assured that the urge to pull is no more, can treatments such as hair transplant surgery be considered if necessary.

What is FUE Hair Transplant?

FUE hair transplant is a harvesting technique where healthy hair follicles are removed directly from a donor area on the scalp (usually at the back of the head where the hair is plentiful) and grafted onto bald or thinning areas. The FUE transplant uses a specialised punch device to extract follicular units from the donor area, complete with their necessary glands and and implanted using a stereo microscope in groups of one to four hairs, just as they grow in nature. Hair is handled with extreme care ensuring minimal trauma to the hair follicles. Although scars are still produced, they are usually very subtle and undetectable dots (0.8mm to 1.0mm) scattered over a large area, making it possible to conceal even with a cropped haircut.

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Advantages of FUE Hair Transplant

While FUE hair transplant procedure can be more expensive than other hair transplant methods such as grafting, it is a lot less invasive, precise and can be performed without sutures or leaving long linear scars on your scalp. This means there is no need for long rest periods between sessions and the transplant procedure can be completed in a single day. Patients experience less post-op discomfort and, although the scars are more numerous, they are smaller and require less time to heal. FUE hair transplant will be a great option for patients who are more prone to scarring.

FUE hair transplant also allows for wider harvesting options . With FUE, extended donor sites can be used. This includes beard, upper chest and back, in addition to scalp hair.

What is the FUE Hair Transplant Process?

Step 1: Consultation & Examination

Dr Gerard will make sure that he understands your expectations in hairline or crown design by meticulously checking aesthetic measurements and thoroughly examining your condition. On the day of surgery, your hair will need to be shaved short and thoroughly disinfected prior to procedure. Local anaesthetic will be administered in both the donor and recipient areas.

Step 2: Extraction of Hair Follicles

Dr Gerard will extract hair follicles from where the hair on the head is the thickest (donor area), taking out individual hair grafts one by one. To extract one hair graft, he will make a miniscule ‘punch’, leaving tiny pinholes in the donor area. These pinholes are barely detectable.

Step 3: Transplant to Bald Areas

Tiny holes are created in the balding area where hair is needed (recipient areas), which Dr Gerard will then carefully implant the grafted hair follicles into these tiny holes at a very natural-looking angle. The entire procedure is very clean and, when complete, no bandages or dressings are required in most cases.

A standard FUE hair transplant procedure would involve anywhere from 800 to 2,000 grafts that would take approximately 10 hours to complete. To maintain the quality of results, FUE procedures are generally recommended for small balding areas. Alternatively, the procedure may be spreaded out over two or more sessions for larger balding areas.

Am I A Suitable Candidate for FUE Hair Transplant?

There are a lot of factors that play a part in making a hair transplant successful. Your suitability for a hair transplant will be made during a consultation with the doctor. Below are a few key factors that the doctor will be assessing to determine your suitability for FUE hair transplant procedure:

  • Severity of hair loss: You must have a good supply of healthy hair follicles available to be transplanted.
  • Type of Hair Loss: The best candidates are those suffering with male or female pattern baldness as the condition typically only affects certain areas of the scalp. Hair loss conditions that affect the entire scalp such as un-patterned alopecia would not have a successful hair transplant.
  • Age: While FUE procedure can be done for hair loss patients at any age, patients over the age of 30 will make better candidates as their hair loss pattern has been established. Many younger patients who rush into hair transplant procedures is often likely to find themselves seeking additional treatment later on in life as their hair loss will still continue naturally.

Is FUE Hair Transplant Process Painful?

FUE hair transplants are performed under local anaesthetic and donor and recipient sites are completely de-sensitised. Dr Gerard and his team will make sure the patient is as comfortable as possible throughout the entire procedure.

Cost of FUE Hair Transplant in Singapore?

The cost of FUE hair transplant procedure depends on the number of grafts and the complexity of the area to be transplanted required by the patient. The cost can range from S$4 to S$7 per graft.

Comparing FUE vs FUT Hair Transplant

The  Follicle Unit Transplantation (FUT) procedure is where a strip of hair is surgically removed from healthy parts of the scalp, such as the back of the head or even the side, and follicle unit grafts – a collection of hairs ranging from one to four follicles – are then extracted and replanted into the balding area. One main drawback with the FUT hair transplant process is that when the grafts are fitted, there tends to be a scar left in the donor area, which is visible if the patient wants short hair. In comparison, FUE grafts are usually less bulky compared to FUT or strip grafts and therefore they require smaller size incisions for plantation resulting in less trauma. Thus no linear scarring, no scalpel and no stitches. However, because of the intricate nature of the procedure, FUE hair transplant procedure is more expensive compared to FUT.

Graft quality as well as the maximum graft yield of FUE is lower compared to FUT hair transplant procedure. FUE can result in a greater rate of follicular transection (damage to grafts) compared to FUT and this difference may be exaggerated in patients with very fine hair. FUE grafts are often more fragile and subject to trauma during placement, because extracted grafts often lack the protective dermis and fat of microscopically dissected FUT grafts. Without the protective dermis and fat of the microscopically dissected grafts, the FUE grafts run a greater risk of being traumatised or impaired at the implantation stage. Furthermore, the time they are outside the body tends to be longer than FUT grafts and this can be detrimental to their health. Lower quality grafts may not grow as well. Furthermore, the scarring and distortion of the donor scalp from FUE makes subsequent FUE sessions more difficult.

Also for large FUE hair transplant sessions, the entire donor area needs to be shaved and that could pose as a limitation and cosmetic inconvenience for some patients. It can take 10 days to two weeks for one’s donor hair to grow to camouflage the small holes created in the FUE procedure.

What Results Can I Expect from FUE Hair Transplant?

You will be able to see the outline of your new hair line immediately after the procedure. Typically, you will see some redness on the scalp post-procedure and there will be some small scabs for the initial 3-7 days. After which, your hair will go through a shedding period for around 3-6 weeks after your hair loss treatment, which is completely normal. Transplanted hairs will have re-grown fully within 6-12 months post-treatment and the bald patch or receding hairline will have disappeared. The results will be permanent and completely natural in appearance.