Where Art Thou Hair Transplants?

In the mid-2010s, I carved out a little niche for myself writing about the indignities of women’s heads. As was popular at the time, much of my work aligned with a shiftless sort of feminism wherein most of the procedural and medical pain women felt was the direct result of the male gaze, something I’m not even sure I ever consciously experienced myself. But the male gaze was a popular scapegoat, and it was easy for a freelancer to draw unearned conclusions. I didn’t have to think much about the enveloping humiliation of being just a human in a body, to say nothing of gender.

It was a life spent obsessing over my oil production, looking atop my scalp instead of outward. But then I got older, went back to school, tanked my career, lived through part of a pandemic, and stopped using charcoal-based cream cleansers on my head all the time. What was the point? My life got smaller and my pores got bigger, but so did everyone else’s. Perhaps most importantly — at least for the purposes of this piece — I learned that men can have it bad too. Everything else aside, they suffer from genetic male pattern baldness, and there’s not much to be done about that, unless you catch one of those Roman ads early enough to nip it in the bud with generic Propecia.

It’s not like realizing that men too have anxiety-based appearance is my most acute takeaway from the last couple of years. I’m an egalitarian! But after spending 18 months alone looking at my face in a front-facing iPhone camera with no outside feedback, I was convinced that I needed an entirely new one. I needed a different nose, a new pair of eyeballs, and a tighter jawline.

I can fake what I desire with makeup and the help of twenty-two-year-olds on TikTok. Some things are more labor intensive. Like a new hairline. According to the New York Times, men used the pandemic as an opportunity to get a hair transplant, in a process that the paper of record described as “sheepish.” There’s also a I Think You Should Leave sketch that taps into this anxiety that I think about a lot: a hair loss system comprised of a series of 500 smaller and smaller toupees for men who have been faking their hairline for years and are “tired of living a lie” (it’s at about 4:45 here).

I am a women’s beauty expert in that I dedicated most of my 20s worrying and writing about what straight men thought of my face and body and calling it honesty. But this was mostly projection; men rarely said anything to me. Probably they were worrying about their own shit and were even less equipped than I am to solve it.

This post is about them. I wanted to understand how people with receding hairlines could find mercy in medical technology.

If you were famous or wealthy or both in the ‘70s and ‘80s, there was a surgical strategy for regaining your coif: the procedure known colloquially as “hair plugs.” For hair plugs, doctors used a punch tool to remove a small circle of skin and hair (comprised of clumps of one to four hairs known as follicular units) from the back of a patient’s head and stitched it into the scalp where hair loss occurred. These larger punches of hair resulted in tell-tale, pluggy looking hairlines, where hair grew in chunks, and all in the same direction. This is a notorious operation, according to Dr. Michael Wolfeld, a plastic surgeon and hair transplant specialist in New York who has been on Dr. Oz and the Today Show alongside his cutting edge special hair transplant robot. Learning about it has made me grateful for the knot of hair that’s lived at the base of my skull since I was five.

The hair plug treatment of yore created smooth hairlines, far flatter and more severe than the natural receding pattern near the temples of most men. It looks uncanny and it makes me uneasy — like the way fillers disrupt the Fibonacci sequence of a human face, leaving famous people looking like waxen adult babies. Wolfeld didn’t want to speak about celebrities and their alleged hair transplants, but he trained me in developing an artful eye.

Let’s see. Sylvester Stallone and John Travolta (before he went full-shaved head on us) are both classic examples of people who likely had the cruder version of a hair transplant early in their careers.

But not all is lost. The bad ‘70s hair plugs can be fixed, said Wolfeld. Hair transplant procedures have evolved dramatically in the last few decades.

“I have had patients who have had transplants 20 to 30 years ago that they want redone,” he said. “I literally remove that clump of hair, I split that clump into individual hairs and grafts, reimplant it, and then do another transplant in the natural-looking way.”

Since the early 2000s, this has been the way. Two ways, really, both starting between $6,000 and $8,000. A follicular unit transplant (FUT) is a procedure where a doctor removes a long, thin strip of tissue from a donor area, behind one ear to the other, where hair grows. The patient is awake for this procedure, numbed by Novocaine.

Under a microscope, the doctor then separates multiple follicular units (the group one to four hairs) from the skin for transplantation.This procedure typically leaves a scar. Allegedly, Jeremy Piven’s back-of-head scar can be attributed to the FUT procedure, according to a source familiar with such markings.

There’s also follicular unit extraction surgery (or FUE), in which those follicular units of one to four hairs are harvested from the scalp with the aid of a robot named ARTAS iX, which uses multiple cameras, 3D imaging, and AI to determine where follicles should go. This robot was approved by the FDA in 2011, and taken up by Wolfeld’s practice in 2013. Doctors augment the robot’s work to determine which direction individual hairs should grow in, rather than all in the same direction like hair plugs of yore grew.

Robot-aided FUE is generally Wolfeld’s preferred hair transplant method, and the famous men of today who generally, allegedly, are looking good, likely received the procedure as well. It takes a robot to do the repetitive motion of inserting hairs into the bald area in the front of the scalp 1,000 to 2,000 times over for a single transplant. This can take all day and cost between $8,000 and $12,000. Beard transplants (not to be confused with the beard weave on America’s Next Top Model), which Wolfeld also performs, can cost roughly the same.

Say what you will about Elon Musk (for real, go for it), but his head of hair looks like it’s been done by an expert who considered aging. His hairline is receding at the temples, and there’s little evidence of plugs. It’s beautiful.

Celebrity gossip websites have alleged that Bradley Cooper is a Propecia user, but experts (like me now) suspect that an expert robotic transplant is afoot.

But what about famous balding celebrities like the future King of England, Archie and Lilibet’s Uncle William? For him, it could be too late, unless he’s packing some major chest hair.

“There are people who come in very bald without a good donor area, and it is possible to remove the hair from the hair or the chest or different areas, but it doesn’t look as natural,” said Wolfeld, who has not consulted with Prince William. “The hair growth cycle is different and if someone is coming in with too much hair loss, they are likely not a candidate.”

To not even be a candidate, even if you’re inheriting the United Kingdom and its colonies due to a fluky bit of luck at birth, breaks my heart. Age ravages all of us, binary gender aside. Robots will inherit the earth and we’ll be their dowdy little helpers, assisting them as they take control of our scalps. But good for Jeremy Piven.