Male pattern hair loss, also known as androgenetic alopecia (AGA) is the most common cause of hair loss. Said to affect 30% of men by the age of 30 years and 50% of men by 50 years, AGA is mainly due to the potent hormone dihydrotestosterone (DHT) that is derived from testosterone. Genetics and a family history of pattern hair loss from either parent plays an important role in determining if one develops AGA.
In early stages, you may notice your hair becoming thinner and less pigmented. This is due to the effects of DHT, where hair follicles shrink and the growth phase of your hair cycle shortens increasingly. Over time, hair strands in these follicles are unable to grow full and thick due to a shortened growth phase. This process is called miniaturisation, where hair strands gradually decrease in diameter and length, and in some cases, result in complete baldness.
Hair loss in AGA follows a pattern, with certain areas of the scalp being affected before others. In males, the frontal or crown areas, or both, are where signs of hair thinning are first noticed. Hair along the sides and back of the scalp are usually preserved and less affected. You may also notice that the hairs are uneven in length and thickness in balding areas, which is typical of male pattern hair loss.
We use the Norwood Hamilton scale to grade the extent and progression of male pattern baldness. Hair loss is classified into 7 stages in the Norwood Scale with Stage 7 being the most severe stage of hair loss. An examination will be done by the doctor to assess your degree of hair loss before recommending suitable treatment options for your condition. Typically, surgical procedures such as hair transplant would be required once significant hair loss has occured.
AGA can also be diagnosed through video dermoscopy, where we use a microscope to examine the scalp.
The following traits are seen in AGA under dermoscopy:
Yellow dots are follicular openings (ostia) filled with keratin and/or sebum.
Minoxidil is an FDA approved topical treatment for male and female pattern hair loss. It works by increasing the size of blood vessels in the scalp and improving blood flow to the area. In 3 to 6 months, most patients experience hair fall to a lesser degree and in 6 to 12 months, improvement in hair density can be noticed, especially to the vertex area. Minoxidil is best used continually in order to support existing follicles and maintain hair regrowth in the long term.
Finasteride is an FDA approved oral medication for male pattern hair loss with its anti-DHT effects. It decreases the conversion of testosterone to DHT, by blocking the enzyme 5 alpha- reductase. A lower circulating level of DHT translates to reduced hair loss.
Follicular Unit Extraction (FUE) hair transplant is the only long-term solution for male 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 Erbium Yag 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 is minimal because no ablation is involved here. With just one session 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 has been proven to be safe and effective for male pattern hair loss, 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. CG210 can be safely combined with minoxidil lotion and finasteride. When used in combination with finasteride, an increase in hair diameter was also seen in patients.
Individuals with more severe hair loss may be suitable for a FUE hair transplant. By redistributing healthy hairs that are plentiful at the back of the scalp to more deficient areas, FUE effectively restores the hairline and gives one a natural-looking head full of hair that is long-lasting. In our team, we have on board experienced and competent hair restoration specialists who are excellent at designing natural looking hairlines to suit your face shape. As with other minimally invasive treatments, after a proper medical history and scalp examination is carried out 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.
FUE transplant results are maintained and improved on by our complementary in-house treatments. 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