Back in 2020 one of my lovely readers reached out asking for details about my hair transplant. They were considering their options to make their face softer. Should they look into a hair transplant (HT) or a scalp advancement? What’s better, having FFS before a HT or the other way around? Etc. Here is a candid email conversation with them about my hair transplant experience.
This post is based on my email exchange with my lovely reader. It’s presented in a conversational Q&A format. It has a number of edits from the original email thread. In some places I removed personal identifiable information and in others I expanded my thoughts for clarity and context. It’s written with a trans feminine person in mind, specifically for someone considering changing their hairline to make it less masculine or softer.
> Are you comfortable sharing your experience getting your hair transplant?
Yes, of course!
Male pattern baldness is a dead giveaway as a gender marker. There are ways to modify a hairline that has been affected by genetics and testosterone, in effect making it softer and more feminine. In my case I chose a hair transplant over a scalp advancement (AKA hairline lowering).
In general I can say that the experience was less of an issue than I had anticipated before going through it. I was concerned how I’d look as the hair was growing, especially the first few weeks and months after the procedure. Yet during recovery I managed to comb my hair sideways, as I’ve done to cover my temporal recession before my HT. Another major concern I had was ensuring most of the transplanted follicles survived. As a reference, my HT surgery was in early January 2017 and by early February I was out traveling to the first USPATH conference in LA. So I managed to hide the surgical site with my hairdo. And to ensure I protected the transplanted hair for the first few weeks and months I maintained a balance between the aftercare routine and a basic social life.
> This is a very sensitive topic. I have deep peaks that are a source of significant dysphoria. I’m somewhat perplexed with the different options and surgeons.
I know exactly what you’re going through. You read things online and watch patients’ videos and discussions and it gets overwhelming. Unfortunately I don’t think that’s uncommon. I certainly went through something similar. Too much noise and little useful or valuable information.
I’m a strong advocate of patients talking directly with the different surgeons. They were my main source of information when I went through my decision process. One thing is what you find on their marketing websites and Instagram posts, and another is actually having a consultation with them.
I understand your situation. In my case I didn’t know exactly what FFS procedures would benefit me the most. Though my peaks were not too deep, getting rid of them was one thing I knew for sure would make my face softer. And just like you, at the beginning I had no idea what would be the best way to go about it.
> Should I get FFS done first before getting a hair transplant?
I may be able to give you some personal perspective as it depends on recovery. When I decided to have FFS and the hair transplant as part of the process, in my head I was coming up with different logistic options. At the end I found the solution after speaking with both the FFS surgeon (in my case with Dr. Simon from Facialteam in Spain) and 2 local hair transplant surgeons.
During those consultations back in 2016 Dr. Simon told me If I wanted to have my HT and then FFS, they recommended holding FFS for about a year after a hair transplant. The HT could be done pretty much immediately after FFS if it was the other way around. Yet if I were to have FFS and then the HT, Dr. Simon also strongly recommended waiting a few months after FFS to allow for some recovery in between. Based on that my FFS was done in October 2016 and the hair transplant in January 2017.
Technically I could have done it either way, but the timing would have been much longer if I had the hair transplant done first. After having going through the recovery of FFS and then a few months later the HT, I’m extremely glad I did it that way. If I had done both surgeries back to back, the recovery would have been tougher. Though, if the HT had been done during FFS it would have been one single recovery instead of the two that I went through.
> Should a scalp advancement be considered and do I want to risk a scar on the front hairline that transplants might not take too well to?
This is a big question! I too was and still am terrified of the concept of a long scar across my forehead. I think it should be considered but only after speaking with different surgeons to discuss your specific case. Having said this, be aware that some surgeons my prefer one method over another, or worse, some may only do one method. Meaning that if you consult with a surgeon that only does scalp advancements, chances are they will only suggest that.
> Who to go to for hair transplant?
That is another incredibly difficult question. The way I went about it was, again, by meeting with the surgeons. I first spoke with Dr. Simon from Facialteam (FT), and though he himself doesn’t do the hair transplants, he works with their hair transplant surgeon and team. I also met in person with two different local hair transplant surgeons.
In my case, if I had done the hair transplant in Spain with the rest of my FFS it would have pushed my surgery date into the future about 6 months, so sometime in Q2 2017. This was due to Facialteam’s hair transplant unit’s availability. By choosing a simpler FFS that didn’t include the HT they were able to book me sooner, in October of 2016, wait 3 months, and get my HT done sooner at home.
I felt one of the hair transplant doctors I met seemed to have so much more experience. Yet I connected on a personal level instantly with the other surgeon that I thought had a little less experience. She understood exactly what I was going through and was very excited to work with me. That surgeon made a comment that most of her hair transplant surgeries were reconstructive to rebuild the areas that had hair loss, while in my case it was a creative project where she’d redesign a totally different hairline for me. She was also amazed at my process and very interested and invested in being part of it.
The first doctor had suggested a higher graft count than what I ended having with my surgeon. This meant that a higher graft count would have been more expensive. The more important factor for me was the connection I felt with the surgeon I chose.
> What was the aftercare period like immediately following the procedure and what are the best practices for ensuring the maximum density of hair is maintained post surgery?
Each surgeon has their own aftercare procedures. I know that the surgeons from FT recommend applying Minoxidil (the active ingredient in Rogaine) to the transplanted area. In my case I don’t remember the details anymore… it was a while ago but I do remember getting a special shampoo and I think I had to wash my hair with it twice a day?… It had to be done very carefully to avoid disturbing the thousands of incisions and their transplanted follicles. From what I remember I had to be very gentle with the scabs and not scratching the area. The idea is to allow the scabs to protect the incisions and let them fall on their own. Scratching them could affect the healing and the chances of follicle survival.
My eyes swelled on the second day after surgery. They warned me that could happen and there was a chance I could not open them. It didn’t get that bad, but almost. The swelling resolved itself in a couple of days. I also had a headache for the first few days, which was also normal.
I had to return for a checkup within a week. The surgeon then removed the stitches from the donor site on the back of my head. I did have to return for checkups a few more times, each with more time in between.
To protect the newly transplanted follicles they gave me a tuque. It is very soft and light so it would not put much pressure on the transplanted area. I still have it and wear it with pride. Though I don’t wear it often because I consider it the most expensive head covering I have. To get it I had to pay $$ for surgery. 🙂
> How did you make your decision?
Making the decision wasn’t that difficult. When I started researching FFS I didn’t know what procedures would benefit me the most, but I knew for sure changing my hairline would help a lot. From what I read my options were a scalp advancement, a hair transplant, or a combination. The scalp advancement creates an incision along the hairline to pull it forward. Just as you, I was not keen on having a scar running across my forehead.
I requested an evaluation and report from virtualffs.co.uk where they suggested a hair transplant over the scalp advancement. When I had my initial consultation with Dr. Simon from Facialteam, he suggested the same. Also, speaking with the HT surgeons they too recommended against a scalp advancement. By then my understandings, the report from VirtualFFS, and the recommendation from the different surgeons were all pointing to a hair transplant. That’s why I say that making the decision wasn’t too hard for me.
>Why did you choose to forego combining simultaneous hair transplant with FFS?
Dr. Simon thought I didn’t need anything done to my forehead, so their typical ‘simultaneous hair transplant with forehead’ would not apply to me. At that point it would have been a regular stand alone hair transplant. Now, because FT’s hair transplant team were not based in Marbella, like the rest of the FT surgeons, the waiting list for surgery was longer. So, if I had a ‘regular’ hair transplant at the same time as the rest of my FFS, my surgery would have been sometime around April 2017.
If I were to do the hair transplant at home a few months after returning from my FFS in October 2016, I could and was able to have it all done by early January 2017. So, mainly it was because of timing. I went through 2 surgeries and two recoveries, which I think was more expensive, but I was well into recovery from both by March 2017.
> Are you comfortable with sharing who you went with and anything relevant from the process?
After all I had my FFS with Facialteam in October of 2016 and my HT in January 2017. The HT was done at home with the local surgeon that I had a great connection with. For privacy reasons I don’t disclose on my blog who the HT surgeon was, but if someone is interested, feel free to get in touch with me by submitting a comment in the area below.
The Effects of HRT on Hair Transplant
Something that comes to mind is that HRT did have a positive impact on my hair. By eliminating testosterone either with HRT or genital surgery, that may have a beneficial effect on hair. I understood that once the hair follicles miniaturize, they’re gone. From what I gather, the good news is that in our situation with HRT and blocking testosterone the chances of loosing the transplanted hair are lower than on guys because testosterone won’t ‘attack’ the transplanted follicles.
My Surgery Experience
The surgery itself was long and tedious. It was an all day affair. That’s probably one of the reasons why it’s so expensive. Opposite to other surgeries it’s not as complex or as risky. I was awake most of the time with just local anesthesia and mild sedation. In my case I did not have to have any part of my head shaven. The surgeon pulled up my hair from the donor site on back of the head, did trim the hair where it was harvested, and proceeded to excise the donor strip. This means that I didn’t have to wait for shaven hair to grow back beyond what was grafted.
Speak With The Surgeons
My recommendation, as I said before and I think will always say, is to speak with the surgeons at least over the phone or video conference. They may require that you send photos before the consultation so be prepared to do that.
If and when you speak with different surgeons, ask them about their aftercare procedures and best practices. They may be able to send you electronic documents after the consultation. Those documents/procedures give you an idea of what to expect and also reflect how organized is their practice. Ask about their experience with trans patients. For me that was important because one thing is restoring a male hairline and the other is redesigning a more feminine one.
Have you used an instant root concealer spray? They’re supposed to help coverup hair roots that have grown after colouring. I use one from L’Oréal which I learnt about from a friend that used it to cover her bald spot. Once before my HT a friend did my makeup and used it to hide my temporal recession. She applied it directly to my scalp. That time she overdid it, but with a little moderation and practice it’s quite effective hiding areas with no or little hair. I sometimes use it on the crown because my hair there is fairly thin.
There are special hair pieces for women with hairline recession. Think of a toupee just for the hairline that clips to the rest of your hair and creates bangs or a fringe. They’re not very common but can be found at specialized wig stores. Though, just like any good quality wig, their prices tend to be on the expensive side. I would suggest going to a store and trying them out rather than hoping that an online purchase works.
Lastly, if you haven’t come across this site, you may find it useful: http://www.virtualffs.co.uk/Hair_and_Hairline.html
P.S. The header image is my hairline with long hair more than 4 years after the hair transplant.