Transplant For Men
What Is Surgical Hair Transplant?
Even after trying out lifestyle changes by eating foods high in nutrition and antioxidants, or by implementing hair growth techniques such as topical minoxidil applications and oral medication to modulate the hormones responsible for hair loss, hair growth can still evade us. When hair loss progresses to the stage where it becomes permanent, or covers too much of our scalp area, surgical hair transplant becomes an option.
Hair transplantation is considered the only permanent solution to hair loss, with an average 90% success rate. Not just reserved for the hair on your scalp, hair transplantation techniques can also be used for facial hair and to fill in scarred bald patches from traumatic injuries.
Scalp hairs naturally grow singly or in groups known as follicular units (a unit containing 2-4 hairs). Current modern hair transplant techniques look extremely natural as they transplant follicular units from the back of the scalp – the ‘donor site’ – to a bald or balding scalp area, called the ‘recipient site’. Read on more to understand what hair transplants in Singapore are all about!
Common Reasons for Hair Loss
Common Reasons for Hair Loss
Hereditary (Androgenetic Alopecia)
There are several common reasons for hair loss in both men and women.
1. Genetic Predisposition – A 2017 review found 63 genes that play a role in male pattern baldness, and only 6 out of those 63 genes came from the maternal side. This means that, for males, if your father, grandfather, or uncles had male pattern baldness, you have a much higher chance of it too! For females, an estimated 1 in 2 women will experience female pattern hair loss by the time they’re 80.
2. Hormonal Changes – Triggered by genetic factors, some males will have higher chances of testosterone hormones in their body being converted into di-hydrotestosterone (DHT) at the hair follicles. This causes hair follicles to become smaller, and hair to grow thinner, eventually falling out. In females, hormonal changes during certain periods of a woman’s life such as during the post-partum period or during menopause can cause hair loss as well.
3. Diet & Stress – Not ingesting enough calories to meet your daily requirements, or not getting enough essential nutrients like protein, fatty acids, and zinc that contribute to hair growth can contribute to poor hair health and hair loss. Chronic long-term stress or a sudden stressful event (childbirth, surgery, major illness) can lead to telogen effluvium, where a larger number of hairs are shifted from the ‘growth’ phase into the ‘shedding’ phase of the hair cycle, causing increased hair loss. If persisting for more than 6 months, it is considered ‘chronic telogen effluvium’, and further blood tests may be needed.
4. Scalp Infections – Scalp conditions such as seborrheic dermatitis can result in hair follicle infections. If this condition progresses in severity without adequate treatment, those hair follicles may become scarred and become unable to produce hair any longer.
Is A Hair Transplant An
Hair transplants, especially current modern techniques, are considered very minimally invasive. This means that although the procedures used will require the ‘harvesting’ or removal of scalp grafts where hair follicles are healthy, and ‘implantation’ onto the permanently balding areas, this procedure will not require you to go under general anaesthesia such as during major surgeries or procedures.
This means that you are able to go home right after the procedure since it requires no long-term stay (like in hospitalisation cases), requires no long-term bandaging, and the scabs that form on the grafted areas after the procedure will dry up within a day and shed within 7-10 days
How Long Will A Hair Transplant Procedure in Singapore Take?
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.
How Long Will A Hair Transplant Procedure in Singapore Take?
- 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.
What To Expect After A Hair Transplant?
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.
What Is FUE And How Is It Different From FUT?
The main differences in FUE vs. FUT are:
- 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.
- 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.
Are Results Immediate?
No, results are not immediate. Transplanted hairs usually take 3-4 months to start growing, as your scalp adapts to the grafts and begins the hair growth cycle. It may be a further 6-9 months, depending on the individual’s hairstyle and length of hair, before you can accurately assess the aesthetic result of the hair transplantation. Typically, once the transplanted hairs start to grow (after the 4th month), the rate of growth is usually 1cm per month. Over time and up to 12-18 months post-procedure, the transplanted hairs may continue to improve in quality and density. Be patient, and the results at the 12-18 month mark will be worth it.
How Many Hair Grafts Will I Need?
A few factors will have to be considered to identify how many hair grafts are needed. Firstly, which area is affected and to what degree of thinning has happened? On average, a full head hair transplant may need 4000-6000 hair grafts, and a front half of the head which is roughly 90cm2 may require 1000-3000 hair grafts. So, if the area involved is just the frontal hairline which is normally between 10-30cm2, you may only require 500-1500 hair grafts. At the end of the day, the number of hair grafts needed varies drastically from person to person based on their required density and donor availability. Here at Terra, we’ll use the TrichoLAB Transplanner to determine the precise number of grafts required suitable for your needs. Secondly, the quality of your own scalp’s donor hair can affect the amount of hair grafts necessary, as well as which technique will be optimal for you (FUT vs. FUE).
Those with smaller areas of hair loss can make do with only one hair transplant session, whereas those with larger areas of baldness may require 2-3 sessions to achieve good density. In those with potential progressive hair loss, it is a realistic expectation to assume that a repeat procedure may be required in the following 5-10 years, depending on donor availability.
Is It A Painful Procedure?
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, there is minimal to zero pain during the entire hair transplant procedure.
Post-procedure, there will be a slight to moderate discomfort felt as the anaesthesia wears off, depending on your own individual pain tolerance. Medication will be supplied to you to help with any pain or discomfort felt after.
Common Procedures of Hair Transplant in Singapore
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.
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.
10 Steps of A Hair Transplant
1. Hair line design and planning – the DOCTOR (not a nurse or technician) will draw the hair line with a surgical marker and demarcate the areas of transplantation in discussion with you, the patient
2. Donor Preparation – The donor area is checked for scalp health and hairs are trimmed to 1.1 – 1.3mm in length; large amounts of grey or white hair may require colouring to ensure that harvesting process is done precisely
3. Sterility – As this is a surgical procedure, strict sterility protocols are followed, all members of the team must be appropriately gowned, masked and scrubbed before handling surgical equipment. The scalp is then cleansed thoroughly with a disinfecting solution.
4. Donor Anaesthesia – The DOCTOR will administer a mild oral or intravenous sedative to help you relax during the injections of local anaesthesia to do donor area. You will feel some prickly pain during this process and within a minute, the donor scalp turns completely numb.
5. Harvesting – The DOCTOR, will inject tumescent fluid to support the grafts and use a motorised FUE punch to score skin and dissect the follicular unit grafts. Concurrently, a skilled technician will be lifting the grafts out of the skin and placing them in chilled saline solution.
6. Quality Assessment – The team of technicians will be checking the harvested grafts using Mantis 6x microscopes for graft quality and trimming away excess tissue that may hinder implantation and healing. The grafts are counted and sorted according to number of hairs per follicular unit grafts i.e. single grafts, double grafts, triple grafts etc and stored in chilled hypothermosol solution.
7. Recipient Anaesthesia – The DOCTOR combination of regional anaesthesia techniques called nerve blocks, usually 1 injection above each eyebrow, as well as a ring-block technique, a few small injections to numb the remaining recipient area, resulting in surgical or complete numbness within a minute. The recipient area is then sterilised with antiseptic solution.
8. Recipient Site Making – Customised blades are prepared based on the length and width of your follicular unit grafts and the DOCTOR will make tiny incisions ranging from 0.7mm to 1.25mm according to the pre-discussed hair line design and density. The art of recipient site making determines how natural the eventual result will look.
9. Lunch Time – You will be served lunch in a private waiting area and medications to reduce swelling and fluid retention will be served during lunch. You may make a request for specific meal preferences.
10. Graft placement – 2-3 hair transplantation technicians will then precisely and gently place the follicular unit grafts back into the scalp using surgical forceps. As your scalp will still be numb, there will be no pain during this process.
11. Application of Calecim Advanced Hair Serum – At Terra, we do not compromise on this step. After the first application of this stem cell conditioned media onto the recipient area, you will be required to continue applying this at regular intervals as instructed. This shortens healing time and provides growth factors for optimal hair cycle signalling.
12. Bandaging – The donor area is bandaged loosely after antibiotics and Calecim Advance Hair Serum is applied to the wounds, to prevent foreign material from contaminating it. Instructions will be given to you on how to care for the recipient area overnight.
FAQS on Hair Transplant
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 is meant to replace balding areas with a natural appearance using your own donor hairs. 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!