I would never tell you that you need a hair transplant. It’s entirely up to you, and there are plenty of guys who make losing their hair look great. Take Charles Dance or Corey Stoll or Stanley Tucci. I mean…Dwayne Johnson! But I digress. We're talking about transplants. About which there is a huge misconception: That the results never look good—that the naked eye can always tell if hair has been transplanted. Or, that the scar it leaves in the back looks really bad. That it's just plugs that will make you look like a Chia Pet.

In fact, hair transplants actually look good these days. Alarmingly so. It’s as if continued research and technological advancements have yielded progressively better results—crazy, right? Gone are the ‘plugs’ people got in the ‘90s, as well as the horizontal scar that transplant recipients received in the early aughts and teens. For more, GQ spoke with two trusted hair transplant experts: Dr. Serkan Aygin, a hair transplant doctor in Istanbul, Turkey, and Dr. Andrew Kwak, a cosmetic surgeon who works in Bryn Mawr, PA and Wilmington, DE.

Here's how technology changed, and everything you need to know if you're considering one.

Before Getting a Transplant...

If you are thinking about a hair transplant but your most intense hair loss occurred in the last two or three years, then you might first consider other methods of hair restoration—things like finasteride, minoxidil, and plasma treatments. (These are things you’ll need to heavily consider after a hair transplant anyway, in order to preserve the hair you've got left.) If you give yourself a year or more with these other methods, you’ll have a fuller picture of the active follicles atop your head, and won’t require as much transplantation—if at all.

So, talk to your board-certified dermatologist about it, as well as the potential risks—particularly the potential sexual side effects of finasteride. You can also do this easily by enrolling with at-home subscriptions like Hims, Keeps, and Roman, all of which have on-call doctors who assess and prescribe these solutions.

The Implant Technology is More Precise Than Ever

The biggest advancement in the last few years is the precision of the tools used in the transplants. Transplants these days mostly rely on the FUE Method (the Follicular Unit Extraction) method, which uses a pen-like tool to extract and then implant each follicle. This can be done one at a time, directly from the back of the scalp, in a uniform, spread out manner (as opposed to a plug, or grafting a strip of skin from the back of the head, which previously left a scar). Each individual graft is then studied under a microscope and sorted based on the number of hairs growing from it (between 1-4). These are sorted so that, once implanted with the FUE pen, then are spread just as uniformly across the recipient area atop the head (otherwise you might end up with a bunch of follicles that have 4 hairs on one side, and a bunch with one hair on the other).

Dr. Aygin says a huge leap has come from improving the simple knowledge of angles and density: “In the hair-plug periods of the 80s and 90s, a large number of hair shafts were extracted from the donor area and implanted with gaps in between, and the angle was too straight. So transplanted hair looked fake."

Today, it’s how the hairs are transplanted is where the magic happens: Dr. Kwak likens it to using a paintbrush: "You can imagine asking an artist to paint a landscape and only giving him a large paintbrush: You can paint something, but it will look heavy handed and cartoonish. The large hair plugs of prior years were easily recognizable because of their size, and difference in pattern from natural hair. Today’s FUE micro grafts are extremely small and can be harvested and transplanted with micro accuracy.” Some practices, like his, even use machine learning to nail that not-quite-perfect precision (and at a rate no human can match). This is also why, under human hands, you’ll have as many as five surgeons and assistants working together to extract, sort, and implant hairs, to expedite the process as they carefully implant one graft at a time.

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You should also ask your potential surgeon about the DHI version of the FUE transplant. It stands for “direct hair implantation”. It simplifies the implant process by combining the steps by which the doctor creates “channels” for the implants (the tiny cuts in which the new follicle will live). The DHI method creates the cut and administers the implant all in one fell swoop, saving a ton of time compared to the traditional (equally reliable) FUE method.

It's a Major Process—but It's Relatively Painless

It's expensive. The exact amount depends on all kinds of variables, most of all the number of grafts you need, but plan on at least several thousand dollars. A big job at a high-end clinic could easily push into the tens of thousands. On the other hand, there are clinics abroad, like Dr. Aygin's, that perform this work for much less—but you'll want to do even more diligence if you take this route.

Within a week of the transplant you can be back to work, and the scabs typically fall out between days 7-12. The only pain you should feel is when they numb you to start. Afterwards, you’ll have the appropriate painkillers to navigate the next day or so until it all feels normal. There is some swelling that is mitigated with a headband for three days, so don’t plan to go back to the office immediately.

You have to limit certain behaviors for the first month (like hot showers, high water pressure, excessive sweating, intense physical activity), as well as direct sun exposure to the area for two months. Within 3-6 months you’ll start seeing results; those hairs will be thin for a few months, as is any hair that regrows after falling. But after a year you’ll see the full, thick hair.

Transplanted Hair Won’t Fall Out

When we experience male-pattern hair loss, it always happens up top the head, and not on the sides. The hairs growing up top are genetically different from the rest, and are prone to thinning and falling as we age. So, by transplanting the hairs from the back up top, you are effectively implanting follicles that are resistant to the same thinning and loss.

That being said, you need to be proactive about retaining the health of the rest of your hair up top—the hair that resided there in the first place. Because that hair can and will continue to thin and fall, if you don’t treat it with “fertilizer” as Dr. Kwak calls it. (Read more about those methods of retaining your hair.) Most hair transplant surgeons will even offer a plasma, cellular, or laser session as part of your package.

But if you stay faithful to a standard hair retention regimen (namely with minoxidil and finasteride, if deemed safe for you), then you’ll cut out the biggest concerns. Yes, you’ll have to keep doing them for life, or else a second transplant may be in your future.

Which may not be all bad, considering this technology keeps evolving. The buzz right now is around stem-cell transplants—they could be the norm in the next five or ten years, and they'd mean you wouldn't even need to sacrifice the hairs on the back of your head for the sake of a thicker crown.

BY ADAM HURLYJanuary 20, 2021

https://www.gq.com/story/hair-transplant

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