Let’s start with a much-needed rebrand: it’s a hairmovement, not a transplant. The barnet of a tragic traffic fatality — with fortuitously-similar brown, mildly wavy hair – hasn’t been packed in ice and motorbiked at speed to the clinic. No grieving family will be taking solace knowing that their loved one’s vehicular demise has at least allowed a vain-ish middle-aged man to face with less dread the moment when the hairdresser holds the rear-view mirror aloft. No-one else’s organs – or follicles – are involved. No, it’s a movement: merely moving some of your own hair around. Much as you might fancy rejigging the furniture in your lounge (albeit permanently).
The procedure works off the simple premise: the hair at the back and sides of your head tends to stick with you for life. So it’s about plucking out some of these loyal souls and popping them back in elsewhere – in places where you’d like to thicken out some thinning, or repopulate areas where less faithful follicles have abandoned the scalp. Tactically moving your own hairs around in the battle against ageing.
What drove me to try this redeployment? More broadly, any residual stigma around a hair procedure is long gone. The sea change noticeably occurred in 2011, when Wayne Rooney Tweeted a post-op photo captioned: “Just to confirm to all my followers I have had a hair transplant. I was going bald at 25 why not. I’m delighted with the result.” Legions of footballers have followed – some more openly than others. “Yes, it’s true. I underwent a hair transplant. And I think the results are really cool, don’t you?”, shrugged Liverpool manager Jurgen Klopp. Presenters, musicians, sportsmen, business leaders, actors – “ I’d go as far as to say they’ve changed my life”, said James Nesbitt of his two procedures – have all followed hirsute. Flights from Turkey are full of men unashamedly sporting post-operative paper head coverings. Hair movements are mainstream and – to some of the near-messianic recipients – transformative.
More personally, a patch around the crown had become unavoidably thinner. No matter that I’d made a pact with my hairdresser not to hold up the mandatory-nodding-mirror after a cut, there’d always be a glimpse here and there: multi-mirrored restaurant bathrooms, hotel lifts, over-the-shoulder shots when presenting a TV documentary. An ever-lighter spot blinking away; signalling the inescapable pull of middle age. Pecking away at my self-esteem – deflating some of the once-youthful swagger when walking into a bar, even feeling more self-conscious sitting down whilst talking to someone standing above; fearful of where the recession will spread to.
Non-balding male friends, or dates over the years, who’ve gleefully pointed out increased scalp sightings perhaps have scant idea just how much of a sore spot this can be for many men. Whilst some guys can comfortably shrug off hair loss, a 2019 study of 200 balding men reported, “its impact on person’s self-esteem is so great that it cannot be ignored”. A review last year found 25 per cent of balding men “find the hair loss to be extremely upsetting and 65 per cent express modest to moderate emotional distress”. A recent study called for counselling to be offered to those experiencing hair loss – something that around half of men in their 40s will go through, and 90 per cent in their lifetime. That’s an awful lot of men (not to mention women, for whom hair loss can be way more traumatic) feeling down due to the loss up top. (An entirely unscientific poll by a hair products company — allegedly of 10,000 men across Europe – reportedly found “so many men said they would rather have a small penis than go bald”.)
For me, eventually, that blinking spot relentlessly Morse-coded: go find a hair surgeon.
In the world of hair surgery, the Platinum Follicle Award is a coveted accolade – bestowed annually for “outstanding achievement” by the International Society of Hair Restoration Surgery. The joint recipients in 2012 were Drs Bessam and Nilofer Farjo – the husband and wife surgical team behind the Farjo Hair Institute. After extensive research into clinics around the country, I decided to place my follicles into their platinum-winning hands – following in the footsteps of actors Sanjeev Bhaskar and John Thomson, ABC’s Martin Fry and businessman/Dragon Duncan Bannatyne. The institute has clinics on Harley Street and in Manchester. When a spot opened up in the latter, I jumped on a train to my old hometown.
Under the be-thatched gaze of a former football manager’s portrait, Dr Bessam Farjo – the lead surgeon - drew white lines around parts of my scalp. We’d already had a video call where he’d drilled into my family history, pattern of hair loss, expectations and established I was a viable candidate (encouragingly, he told a friend it was far too soon to consider surgery). It was around 8am. Dr Farjo was plotting out where to move the follicles to.
There’s a predictive art to this: weighing up how bountiful the donor sites are at the back and sides of the head (which will never yield enough to fully cover the scalp on top); avoiding islands of marooned hair should more loss occur; and keeping enough of the donor hairs in reserve for future treatments. “I build a mental picture of what you might look like in 10 or 20 years’ time,” says Dr Farjo. “The trick is designing something that looks realistic, looks like it’s always been there, doesn’t attract attention – but makes you feel better and look great.”
He decides the bulk of the hair he’ll be extracting should be placed in the thinning crown – and he’ll also send a limited number to the front to reinforce (not shift) the existing hairline.
The Farjos opened their clinic 30 years ago in the early era of hair restoration. The science has rapidly evolved: long gone are the days of doll-like ‘plugs’. The predominant technique now is FUE (Follicular Unit Excision) – in which individual grafts (tiny pieces of scalp containing one or more hairs) are removed from the donor area and replanted into micro cuts made in the recipient area, where they then take root in their new home. Upon healing, the scars are then too small to see. But to perform FUE, the donor area usually needs to be shaved down to grade one. (An alternative technique, Strip FUT – which accounts for around 5 percentof Farjo’s procedures - entails cutting a thin strip of skin from around the back of the head; something that doesn’t require any shaving but does leave a linear scar.)
Having been shorn down to all but a Mohican-y tuft at the front – somewhat exuding the deranged demeanour of De Niro in Taxi Driver – and given a sedative, I was ready for theatre. You’re wide awake for the surgery – which felt akin to being at the centre of a Formula One pitstop. Led by doctors Bessam and Nilofer Farjo, a team of half a dozen nurses and technicians buzzed around my locally-anaesthetised head – each carrying out their specialist part of the procedure. A fast-paced, labour-intensive choreography: extracting grafts one at a time from the donor area, making incisions for where those hairs would then be placed (and in what direction, angle and distribution), sorting the follicles by density, before slotting the grafts into the fresh incisions.
The procedure stretched out across the day. After an initial session face down – head poking through a massage-style couch – the rest of the time I was able to recline; nodding in and out of sleep, chatting to the team.
It turns out if you don’t have enough donor hair at the back and sides of the scalp, there are other alternatives. “The next option is your beard. I can take hairs from your beard to put on your head,” says Dr Farjo. “The next choice after that is chest hair – and tummy hair as well.” He has used the same principle in reverse to help burns victims – by deploying head hair to construct a beard to cover up facial scarring, or building up eyebrows for the presenter Katie Piper (who suffered an acid attack), for example.
“In terms of making a change to someone’s life, that was something major,” says Dr Farjo. “But the work we do every day is significant and sometimes life-transforming to each person. People come here because hair loss grinds at them: I’m not the person I was, it’s denting my self-confidence and social interaction, am I old?. The truth is, it’s hard to admit, but hair loss cuts deep into a person’s psyche. I say ‘person’ because it happens to women as well.”
By late afternoon, all the follicles had been extracted and replanted – sent to their new homes with some PRP (platelet-rich plasma) to help them settle in.
I look a little gruesome - my head covered in tiny red dots where the incisions had been made – but it has been a painless procedure. Dr Farjo had managed to extract 1,700 grafts which, with an average of 2.6 hairs per graft, had yielded around four and a half thousand lovely, loyal hairs to recolonise lost territory. (For scar-healing reasons, he doesn’t like to exceed more than 2,500 grafts within a one-day single operation.)
The cost? The Farjo Hair Institute charge £6 per graft for the first thousand – then £3 for each graft after that. So a 1,700-graft procedure would be around £8,000. Clinics abroad, notably Turkey, can be a fraction of the UK price. “A lot of the cheaper places abroad are kind of like hair transplant mills. It’s like a shop and you say, ‘I’ll have that transplant off the shelf please’. You may be lucky and get a great result, but you can easily be unlucky and get a total disaster.” Dr Farjo says he’s had to repair botched operations carried out abroad. “The reason why it’s a lot cheaper (overseas) is because in most cases you’re not getting the same service – here you’re getting the time, advice and somebody investing in your long-term strategy.”
That longer-term future might well include a hair-cloning technique Dr Farjo is helping develop which will thicken existing weak hairs. But for now, he hands me a Gallagher-esque bucket hat to step out onto the Manchester streets with renewed Liam swagger.
For the following couple of weeks, whilst the scars healed and the shaved hair grew back to a less unhinged-looking grade 2, I dodged face to face meetings and inexplicably became a hat guy on Zooms. Direct sunlight was avoided, I had to sleep propped up for a while, the odd spray applied – but nothing onerous.
Then the hat phase fully disappeared as quickly as it came. And the odd vague compliment began to roll in about “looking good” – but without anyone smelling a surgical rat. It took a year for all the follicles to fully flourish; if anything, the photos don’t do justice to the impact the procedure has had on overall shape and density.
These relocated hairs, with their roots in the perennial pastures of the back and side, should be there for life. Applying the topical lotion Minoxidil will help stave off future loss, but, if new barren patches start to appear there’s the option of repeating the procedure – up to several times.
Now, the hairdresser is allowed to raise the mirror aloft. Restaurant bathrooms and lifts no longer hold any trepidation. Walking into offices and bars I feel, well, less age-conscious; each of those 1,700 grafts injecting a little more self-assuredness. Hacking the mileometer is strangely thrilling.
During a recent dinner with old school friends, one recession-free mate decided to carry out an impromptu dome inspection. Ripping apart others’ thinning, he loomed above me before adjudicating, “you’re doing OK on top”. The most moving words a middle-aged man can hear.
Tim Samuels is an award-winning documentary-maker and author of “Who Stole My Spear?”. He visited the Farjo clinic.