Androgenetic alopecia (AGA), while most commonly observed in males, can affect females too and it is the most common form of hair loss in women. Female pattern hair loss can be caused by hormones, aging, and genetics.
This usually starts at a later age, affecting 12% of women by the age of 29 years and 41% of women by 69 years. As seen in male pattern hair loss, excess male hormones (androgens) and a family history of hair loss influence the chances of developing female pattern hair loss (FPHL). However, if you have medical conditions such as polycystic ovarian syndrome, metabolic syndrome, hormonal imbalance, or raised aldosterone levels, these may also contribute to the development of FPHL.
Unlike male-pattern baldness, female-pattern baldness is an over-all thinning which maintains the normal hairline. While the same hair miniaturisation process experienced in male AGA also takes place in FPHL, the typical pattern of hair thinning in females differs from that seen in men. Starting at the hair parting, there is a widening of the hair partition and a gradual thinning of hair throughout the crown and mid scalp. The Ludwig classification system illustrates this and we use it to assess the extent of hair loss.
Minoxidil is an FDA approved topical treatment for both male and female pattern hair loss, and is thought to work by vasodilation (blood vessel enlargement) in the scalp and improving blood flow to the area. Minoxidil needs to be used long-term for continual support of existing follicles and maintaining hair regrowth. The concentration of Minoxidil can be increased to 5% in select cases.
Spironolactone is an oral medication for women which reduces androgen production, and also blocks the action of androgen hormones, including DHT, on the scalp. A reduced production of androgens retards the progression of female pattern hair loss and even restores partial hair growth. It is the most commonly used off-label anti-androgen treatment for female pattern hair loss that also has a long term favorable safety profile.
Follicular Unit Extraction (FUE) hair transplant is the only long-term solution for female pattern hair loss, which delivers dramatically better outcomes. Hairs from the back of the head, which do not contain androgen receptors and will not be affected by circulating DHT levels, are harvested and transplanted to bald or thinning areas that are experiencing hair loss. With this, FUE gives very effective and natural looking results that can last for years when carried out correctly.
Fotona Hair Restart Laser
Laser hair rejuvenation uses Fotona’s Smooth Er:YAG fractional non-ablative treatment to produce safe and effective hair restoration results. Specialised super- long pulsed laser beams are delivered to the scalp which warms tissue in a controlled manner, achieving fast and slow thermal effects. What results is an increase in number and size of scalp blood vessels, and the production of more fibroblasts, which are triggered to form new collagen. Scalp tissue is strengthened when natural collagen production takes place. In addition, photobiomodulation improves the scalp’s cellular response, and dormant hair follicles are stimulated to transition from a resting telogen phase to an anagen growth phase. This process promotes hair growth and reduces hair loss. Any downtime of bleeding, pain or infection is minimal because no ablation is involved here. With just one treatment of laser hair rejuvenation treatment, noticeable vellus hair has been shown to grow in individuals within a month.
Low Level Laser Therapy (LLLT)
LLLT has long been proven to deliver effective results in hair restoration. Lasers or light-emitting diodes (LEDs) are used to emit low-intensity red light (630-800nm) to the scalp. Red light prolongs the anagen growth phase in hair follicles, and also activates hair follicles that are resting to enter anagen phase. This is achieved by altering collagen synthesis, increasing cell metabolism, and improving blood flow to the scalp. The result is increased hair coverage, growth, and hair count, with hair follicles that are thicker and more pigmented. LLLT treatments are painless with no side effects, and LLLT devices commonly come in the form of a hat, comb or hood. While the specific light wavelength, energy output, and usage frequency may vary, you should choose one that best suits your lifestyle habits. A single LLLT treatment is often insufficient, and repeated treatments of LLLT are done for optimal effects. It takes between 3 to 6 months in general for hair restoration results to be seen.
Collagen Induction with PDRN Scalp Infusion
PDRN or Polydeoxyribonucleotide is a powerful scalp healing treatment that is extracted from salmon DNA. With its anti-inflammatory and wound healing properties, PDRN works at a cellular level to regenerate cells and repair scalp skin from the inside. It has been shown to improve both hair count and density in individuals with thin and weak hair due to various scalp conditions. Collagen induction treatment works by directly infusing PDRN through microchannels straight into the scalp. This releases and activates growth factors and stem cells, strengthening the foundation from which healthy thick hair can grow. The benefits of hair growth and scalp repair with a collagen induction treatment plan is more long lasting compared to a single session, where results can be seen as quickly as 3 months.
CG210 Hair Spray
CG210 is a topical botanical lotion that reduces hair shedding, fortifies hair thickness and promotes hair growth. It can be combined with minoxidil lotion, and works by prolonging the hair follicle’s anagen phase and reducing inflammation in the scalp. Patients generally notice a reduction in hair loss within 6 weeks and improvement in hair density at 12 weeks.
In ladies with more severe FPHL, they may start to lose hair follicles, or their follicular openings may be blocked with sebaceous and keratotic material. When this happens, the only way to restore hair to that area of scalp would be an FUE hair transplant. By redistributing healthy hairs that are plentiful at the back of the scalp to more deficient areas, FUE effectively restores or lowers the hairline and gives one a natural-looking head full of hair that is long-lasting. On our team, we have onboard experienced hair restoration specialists who are able to design natural looking hairlines to suit your face shape. As with other minimally invasive treatments, after a proper medical history and scalp examination is completed to assess your suitability for an FUE transplant, blood testing is done to ensure that your scalp is in an optimised condition prior to the procedure.
Our treatments are designed to be compatible with each other, therefore patients can use a combination of treatments to achieve their ideal outcome. PDRN scalp infusion and Fotona hair Restart laser that are done before an FUE transplant improves hair density and scalp health, such that fewer hair follicles are required to achieve a good cosmetic outcome. Post transplant, treatments are recommended to maintain the transplanted follicles, improve follicle survival, and prevent AGA from progressing.
Dr Chua Cheng Yu
Dr Lena Fan