For Life interviewed Consultant in Dermatology and Dermatological Surgery, Dr Angeline Yong from Angeline Yong Dermatology about alopecia treatments, and why accurate diagnosis of hair loss is crucial for effective hair restoration.
Q: Why do we lose hair?
Hair loss is a natural part of the hair growth cycle, which is divided into three phases – the anagen (active growth), catagen (transitional), and telogen (resting or shedding) phases.
While it is normal to lose about 50 to 150 strands a day, one should be concerned when there is unusual thinning of hair, receding of the hairline, or if hair starts to fall out in clumps.
Hair loss is often a complex condition that must be accurately diagnosed for it to be treated effectively. It can be caused by many factors which may present simultaneously, such as fungal infection, hormonal changes, genetics, exposure to radiation, medications and supplements, extreme changes in diet and/or level of activity, significant weight gain or weight loss, inflammation and inflammatory disorders, and autoimmune diseases.
This is why, in my practice, patients undergo a thorough consultation and examination before undergoing any kind of procedure or treatment plan. In addition to trichoscope examinations and gathering an in-depth medical history of the patient and his or her condition, I often conduct a “hair pull” test to identify the proportion of hair in the active growth stage against those in the resting or shedding phase.
Blood tests and biopsies of the scalp may also be recommended if I suspect underlying disorders such as nutritional deficiencies, autoimmune-related hair loss, thyroid dysfunction, and scarring alopecia.
Q: What is androgenetic alopecia?
Temporary or permanent hair loss is divided into two main categories: scarring and non-scarring alopecia.
Androgenetic alopecia (AGA) or male or female pattern hair loss, is the commonest form of non-scarring alopecia, affecting 73% of Asian men and women. It is caused by a type of androgen or male hormone called dihydrotesterone (DHT), which bind to the hair follicles, causing a delay in hair growth, shorter or thinner hairs, and a progressive miniaturisation of the follicles.
In males, AGA’s symptoms begin above the temples. Over time, the hairline recedes to form a characteristic “M” shape. Eventually, the crown begins to thin, progressing to complete baldness along the top, as well as sides, of the head. Female AGA, on the other hand, presents as a widened central partline and then a diffuse thinning across the scalp.
Q: How is male and female androgenetic alopecia treated?
I prescribe non-invasive therapies and surgery depending on the severity of AGA symptoms. Patients are advised to stabilise the symptoms of AHA with non-invasive therapies before undergoing transplant surgery.
To achieve this in male patients, I prescribe minoxidil, finasteride, and low-level light therapy, which decrease DHT levels, enlarge and stimulate the hair follicles, extend the hair growth phase, and induce hair growth. I prescribe similar treatments for female patients, but typically utilise spironolactone or cyprotetone acetate to reduce the body’s androgen production.
Patients are advised to undergo these therapies to reduce and stabilise their hair loss while considering hair transplant surgery. Patients are also advised that while hair transplants may improve their cosmetic appearance, their results may be short-lived if root causes of hair loss are not adequately managed.
Q: What is hair transplant surgery?
There are two types of hair transplant surgeries: follicular unit transplantation (FUT) and follicular unit extraction (FUE). Both outpatient treatments are performed under local anaesthesia and mild oral sedation if needed, and this typically takes a full day to complete.
FUT – also known as “strip” surgery – requires the removal of a strip of hair-bearing scalp, usually from the back of the head. The scalp is then stitched together to close the wound. Under high-powered microscopes, the surgical team divides the strip up into the tiny grafts of individual follicular units comprising of one to four hairs per graft. These are placed in a chilled tissue storage solution until they are transplanted into the bald or thinning areas of the head.
The FUE method requires individual harvesting of hair follicles from the donor site, usually from the back of the head. To ensure they continue to be viable, the hair follicles are stored in a holding solution at controlled temperatures. As hair follicles are cut off from oxygen and blood supply after they are harvested, they must be replanted into the scalp as soon as possible for the treatment to be effective.
Under the microscope, the surgical team inspects and tallies the number of hair follicles harvested. The surgeon then usually marks and makes micro-incisions over the area where the harvested hair follicles are to be transplanted.
Although FUE is considered the “newer” technique and is less invasive than FUT, both FUE and FUT have their uses. For instance, FUT is usually the preferred choice among women as they can keep their hair long, without having to shave the scalp. FUE, on the other hand, heals more quickly, and is also more suited to those who like to keep their hair short as there is no linear scar, but small tiny scattered scars where the FUE grafts are grafted from. A good surgeon should be capable of offering both procedures in his or her practice, and recommend them according to patients’ needs. Sometimes, a combinations of both procedures may be even be required!
Dr Yong from Angeline Yong Dermatology is an experienced and accomplished Singapore-based dermatologist accredited by the Ministry of Health. Prior to starting her own practice, Dr Angeline Yong was the founding consultant and lead of the hair transplant service of the National Skin Centre. She has in-depth experience and all-round expertise in dermatological surgery – from laser and follicular restoration, Mohs Micrographic Surgery, to other cold steel, scalpel techniques – and was the only dermatologist dual-accredited to perform both Mohs Micrographic Surgery and hair transplantation in the National Skin Centre.
