These Are Not Your Grandfather’s Hair Plugs

These Are Not Your Grandfather’s Hair Plugs

The long history of hair transplants, and why they?re suddenly so popular

Image for postIllustration: Sammy Stein

Kirk Peffer, 39, started noticeably losing his hair in his late twenties.

?It was just like a slow, gradual decline to a point where you?re like, ?Man, I really wish I could do something about this,?? says the on-air jockey for 94.5 Bay FM in San Jose, CA. ?For the longest time I kind of defined myself by my hair, and so losing it was a blow to me as a person, or at least, my confidence.?

Male-pattern baldness impacts an estimated 50 million men in the United States, and more and more men like Peffer are turning to surgical procedures to fix it. Surgical hair restoration procedures have increased 60% worldwide from 2014 to 2017, according to the International Society of Hair Restoration Surgery. Many public figures have undergone hair transplant procedures, and spoken publicly about them too, from singer Joey Fatone to footballer Wayne Rooney to actor Jon Cryer. And for those who haven?t been paying attention, hair transplant technology has greatly improved since the days of hair plugs.

?Everyone can remember those very early transplants featuring Elton John 30 years ago where the transplanted hair looked completely artificial ? like the hair on a doll.?

?Everyone can remember those very early transplants featuring Elton John 30 years ago where the transplanted hair looked completely artificial ? like the hair on a doll,? says U.K.-based hair transplant specialist Dr. Asim Shahmalak. ?That ended many years ago, and good hair transplantation these days looks completely natural and blends perfectly with the existing natural hair.?

After some internet sleuthing, Peffer became interested in one method called a Follicular Unit Extraction (FUE). ?I did a lot of YouTube [viewing] to understand what the process was,? he says. ?It looks natural. I became excited about it.?

FUE and Follicular Unit Transplantation (FUT) are the two most prominent modern hair transplant procedures. FUE involves cutting the person?s hair to a buzz cut, then ?harvesting? thousands of individual hair follicles from denser-haired areas on the back of the scalp and implanting them into the balding areas. In the FUT procedure, one large graft is taken, rather than individual follicles, and then the surgeon uses this graft as a source of ?follicular units? (small groups of 1?4 hairs) which they place into balding areas. The best procedure varies per person, as does the cost: Hair transplants can range from $4,000 to $15,000, according to some estimates.

Since the FUE procedure focuses on moving individual hair follicles, it leaves fine, dot-like scars. The FUT procedure, which can appear ?fuller,? can result in a distinct horizontal scar on the back of the head, which is not a problem if the recipient plans to have longer hair. For men who like to wear their hair shorter, experts recommend FUE.

Peffer had a FUE transplant done over a year ago and the entire procedure took about eight hours. He was given Percocet, so there was no pain, and the time seemed to go by quickly. He started noticing a difference around eight or nine months post-transplant and says it was ?100% worth it.?

HHair procedures to combat all manner of baldness have come a long way over the past several decades. The classic ?hair plug? hair transplant, in which circular grafts of hair are punched from the scalp, and placed onto balding areas where matching sized ?punches? have been made, dates back to the 1930s, in Japan. Dr. Shoji Okuda, an ophthalmologist, developed the ?punch graft? procedure for hair transplants as a way to restore hair in burn victims. According to the International Society of Hair Restoration Surgery, Okuda?s work never made it outside of Japan because of World War II. His research would only be located and translated into English many decades later, in 2004, in a series of documents called ?The Okuda Papers.?

His hallmark procedure, which involved the removal and replanting of circular ?plugs? of hair, would often leave a ?result in a scalp that looks like a toothbrush.?

One of the western pioneers of hair procedures is the late Dr. Norman Orentreich, who the New York Times called a ?force behind hair transplants.? Orentreich served in the U.S. Navy Medical Corps before continuing his education at the New York University School of Medicine, eventually becoming head of the hair clinic in NYU?s skin and cancer unit in 1953. Orentreich performed the first hair transplant procedure ?specifically for treating male pattern baldness? in 1952, according to an article published in JAMA Dermatology. In his work, Orentreich pioneered the now-canon concept of ?donor dominance,? in which balding-resistant hair in the back and sides of the head will retain its balding-resistant characteristics when transplanted to the top of the head. His hallmark procedure, which involved the removal and replanting of circular plugs of hair, would often leave a ?result in a scalp that looks like a toothbrush? according to the Wall Street Journal.

Today, some countries are really capitalizing on the more natural-looking results of modern FUE and FUT procedures. Turkey, specifically, has a $1 billion hair transplant industry, with over 350 clinics in Istanbul alone, according to Wired. The procedures cost much less than in the United States ($2,000 to $4,000, according to one source), but there are concerns around clinic regulations, cleanliness, and who is actually performing the procedure. A 2017 investigation in Quartz revealed that some Turkish clinics do not rely on doctors to complete the transplant procedures, as a way to keep costs low.

Transplants like Peffer?s are only anticipated to increase. An April 2019 report published by the market research firm Global Market Insights suggests that the hair transplant industry is expected to grow to $24.8 billion by 2024, noting that an increase in unhealthy lifestyle factors will ?lead to increase in adoption rate of hair-loss treatment,? as poor health can cause or exacerbate hair loss.

Dr. Kristen Lo Sicco, an associate director in the NYU Skin and Cancer Unit, says the underlying cause of hair loss is androgenetic alopecia, or male or female pattern baldness. However, factors like having a sedentary lifestyle, smoking, and high-stress occupations can bring on ?telogen effluvium,? which is shedding, or temporary hair loss, due to a specific stressor or event. ?So when it comes to [environmental factors], a lot of people are going through the shedding phenomenon, making their underlying androgenetic alopecia more noticeable,? she says.

Another reason for the increase in hair transplant demand, according to Lo Sicco, is beauty standards, and that ?it?s perhaps not as socially acceptable as it once was, because of social media and media in general, for men to just shave their head.? This is not the case for all men, she notes, including her boyfriend, who refuses to let her treat him.

Across the country, Dr. Sachin Parikh, of Lieberman & Parikh (where Peffer had his procedure), reports a similar stigma. He says many of his patients work in technology, and that noticeable hair loss can make them feel out of place amongst their colleagues. ?The average age of the workforce seems to be going down,? Parikh says. ?And people feel like when they are older, they have ?aged out? of their job.?

?These people have suffered from ageism,? he says. ?And they feel the need to look younger, in order to blend in with their colleagues, so they don?t seem like they?re out of date.?

Shahmalak, on the other hand, argues that the stigma goes the other way. He says getting a hair transplant is no longer viewed as silly, and men feel more comfortable being open about getting work done. ?I would go as far as to say that there is no stigma attached to a man having a transplant these days,? he says. ?A big factor in the change of attitudes has been a number of high profile celebrities going public with the fantastic results from their procedures. A man having a hair transplant is viewed in much the same way as a woman having breast implants ? it is a simple way to improve body confidence.?

Kirk Peffer notes that his decision to undergo a hair transplant was entirely personal, and other people may feel differently, or at least more comfortable with hair loss. ?Some people probably look better bald,? he says. ?Could you imagine Jason Statham with hair? He owns it. He?s fine with it. He doesn?t define himself by his hair, but a lot of people do. So if you?re wanting to do it, why not??

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