HAIR RESTORATION SURGERY
Hair Restoration Utilising Follicular Unit Transplant (FUT) And Follicular Unit Extraction (FUE)
Androgenetic Alopecia is a common hair problems in Singapore that affect both men and women alike. Male-pattern hair loss affects nearly all men at some point in their lives and is perceived as a cosmetic issue by many. This can have a significant negative psychosocial impact on one’s life. Medical treatments available in clinics include topical Minoxidil and oral medications such as oral Finasteride, and in female-pattern hair loss, Spironolactone and Cyproterone Acetate.
With more extensive patterns of hair loss, however, surgical options such as hair restoration are an integral part of a multifaceted approach. Hair replacement surgery is the surgical movement of 'permanent' Dihydrotestosterone-resistant hair from the safe donor zone in the back and/or sides of the scalp to the thinning or balding areas.
Once transplanted, hair continues to grow during a person’s lifetime. Aside from Androgenetic Alopecia, hair restoration surgery is also useful for treatment of various forms of Cicatricial (scarring) Alopecias such as those induced by previous surgeries or even conditions such as Triangular Alopecia and Aplasia Cutis.
Hair treatment clinics in Singapore utilise two main methods of hair transplantation:
- Follicular Unit Transplant (FUT)
- Follicular Unit Extraction (FUE)
FOLLICULAR UNIT TRANSPLANT (FUT)
FUT is known as ‘strip surgery’, where the procedure involves removing a strip of hair-bearing skin on the donor area of the scalp. This is usually done on either on the back or on the sides of the head. The strip is then stitched back together to form a thin linear scar, which is then covered by surrounding hair. After 10 to 14 days, stitches are removed and the donor area heals to form a thin linear scar.
The strip is placed under high-powered microscopes where a surgical team will divide it meticulously into tiny grafts of individual follicular units. These units comprise of one to four hairs. Thereafter, the grafts are stored in a chilled tissue storage solution until they are transplanted.
Benefits of strip harvesting include the ability to harvest a large number of grafts in one session, higher graft survival rates due to more robust grafts compared to those obtained through FUE, lower follicle transection rates, and a higher maximum follicular unit graft yield over the patient’s lifetime when compared with FUE.
FOLLICULAR UNIT EXTRACTION (FUE)
In FUE, the procedure involves shaving of the donor area of the scalp, followed by individual excisions of follicular unit grafts. This is carried out meticulously using a sharp and small cylindrical punch (between 0.8mm to 1.1mm in diameter), before incising the surface of the skin around each hair follicle and carefully teasing out the fine forceps. This procedure is carried out either manually or with a motorised surgical tool.
FUE involves many tiny dot scars on the scalp which are scarcely noticeable. However, with more FUE procedures in place, more dot scars will be accumulated and hair in the donor area will be slowly thinned out. There is only a limited amount of donor hair present, and thus surgeons and patients have to ensure that there is sufficient donor supply for the transplant in the long-run.
FUE leaves no linear scar, decreasing the healing time with few limits on post-operative activity. The procedure is a viable alternative for decreased scalp laxity. It is also recommended if limited number of grafts is required (especially for cases such as transplantation into scar tissue or eyebrows) and is also useful for utilising body hair (for body hair transplantation) in patients with insufficient scalp donor hair.
RECIPIENT SITE DESIGN AND IMPLANTATION
Following harvesting of the donor grafts, the surgeon will proceed to create recipient sites. This is done with precise aesthetic ideas in mind, as proper recipient site creation is crucial to the outcome. Once recipient sites are created, individual follicular unit grafts are placed into these sites. This step is performed with care as mechanical injury to the graft impacts growth. The surgical team uses special implanters and special forceps to insert grafts into the recipient sites.
FUT VS FUE
THE DIFFERENCE BETWEEN FUT & FUE
- Perfect for patients that require a large amount of grafts, typically providing higher yield of hair than FUE.
- No requirement for shaving hair. Existing hair can be kept in longer lengths and used to cover up the linear scar.
- Shorter surgery time compared to FUE. This ultimately depends on the size of the donor area and the amount of grafts that is required for transplantation.
- The price of treatment is less expensive compared to an FUE procedure.
- In FUE, individual follicular units are taken leaving only tiny dot scars that are barely noticeable.
- Ideal for relatively small transplants, suitable for younger patients requiring a small number of grafts in the hairline.
- Rapid recovery period compared to FUT.
- Longer surgery time.
It should be noted that both the FUT and FUE procedures have different benefits and varying costs. It is important that a well-trained surgeon thoroughly examines and offers the option of either, or a combination of both depending on patient characteristics and price preference for a cost effective treatment. Every patient is different and there is no one-size-fits-all solution. A proper assessment is imperative before considering hair transplantation surgery, hence seeing a dermatologist and dermatological surgeon that specialises in hair transplantation surgery is important, as some types of hair loss may not be amenable to surgery, and may in fact aggravate some of these conditions if incorrectly diagnosed and treated.
Dermatologists who are MOH-accredited specialists in managing disorders of the skin, hair and nails primarily manage hair disorders. Dr Angeline Yong is a dermatologist and dermatological surgeon in Singapore who sub-specialises in hair disorders and hair transplantation. She was previously the founding consultant and lead of the hair transplant service in the National Skin Centre.