Aria, 27, began noticing her hair loss after contracting Covid in 2021. “It initially started retreating at the temples,” she explains, noting that after experiencing two more rounds of Covid, the hair on the sides of her head has become thin and fluffy. As a part-time nanny working towards a master’s in speech therapy, she conceals this issue with a fringe. When she steps out, she puts on a cap or headband to secure it, but engaging in activities like walking in the wind or swimming feels daunting. “Even a fringe doesn’t offer enough protection because someone might flick it up at any moment,” she expresses. “It leaves me feeling so exposed.”
Two years ago, Aria started viewing videos on YouTube and TikTok about hair transplants. Now, she has made the decision to go through with the procedure herself, and she will check into a clinic in Portsmouth, Hampshire, in a few days, with a cost of £5,500.
Hair transplants have been accessible since 1952, when dermatologist Norman Orentreich conducted the first procedure in New York. In 2022, over 735,000 men globally chose this procedure, influenced by celebrities like footballer and manager Wayne Rooney and actor James Nesbitt sharing their experiences openly. Turkey has emerged as a worldwide hub for hair transplants due to its affordability. Many even label the national airline “Turkish Hairlines” because numerous men, especially from the UK, come back from Turkey with heads bandaged after hair transplants.
More women are opting for them as well, with a global rise of 16.5% projected between 2021 and 2024, according to the International Society of Hair Restoration Surgery. It remains a male-dominated realm, as men constitute 87% of the market, but the attention is gradually shifting. In 2016, transplant surgeon Dr. Edward Maitland Ball conducted procedures on one woman (and 83 men) after founding the Maitland Clinic in Portsmouth; last year, he operated on 15 women (and 148 men).
However, hair loss carries significant implications for women, making it uncommon for them to go public about undergoing a transplant. “Women are expected to embody many ideals: slender yet fertile, accomplished yet caretakers. Losing hair isn’t something women are permitted,” shares one woman who received a transplant. This narrative explores the intersection of hair loss and femininity, delving into feelings of shame tied to bald patches and illuminating why hair transplants have gained popularity among younger women. Ultimately, it’s a story about women’s behaviors and the expectations and pressures imposed upon them.
About eight million women in the UK deal with hair loss at some stage in their lives. In men, it often starts above the temples, with a receding hairline resembling an M shape. Top hair also experiences thinning. In contrast, women typically keep their hairline while thinning behind it. “It’s more of an overall, diffuse volume reduction,” remarks consultant trichologist Anabel Kingsley.
There are three traditional stages in female pattern hair loss. Stage one involves thinning at the crown and central parting, leaving full strands on either side. By stage two, hair is retreating from the center, revealing the scalp in a “Christmas tree pattern.” Stage three sees significant patches on top becoming hairless. Yet, Kingsley emphasizes, “variation is substantial. Some women experience hair loss patterns similar to men, while for others, it’s most noticeable at the temples. It’s far more complex than in men.”
Male baldness occurs due to testosterone interacting with an enzyme in the bloodstream, effectively shutting off certain follicles. This process causes hair to thin and fall. Male pattern baldness is at least 80% hereditary. “We historically referred to hair loss for both genders as androgenic alopecia,” Kingsley notes, “indicating it’s genetic and the result of androgens—male hormones. However, it’s now believed that, in some women, testosterone isn’t a factor. We designate it as ‘female pattern hair loss’ because the reasons remain unclear.”
Historically, clinical drug trials have focused on middle-aged white men, which explains why more research emphasis is placed on male pattern balding, even though hair loss impacts both genders. The reasons behind hair loss for women are diverse. Menopause (where many postmenopausal women encounter thinning or bald patches); pregnancy; iron deficiency from menstruation; pill side effects; extreme dieting and restrictive eating; and medical issues like polycystic ovary syndrome can influence hair growth. Even certain hairstyles can contribute. Gymnasts and ballet dancers who wear tight hairstyles risk traction alopecia, a hair loss type caused by tension damaging or inflaming the follicles.
Nonetheless, society reflects images of women with artificially enhanced hair. A prominent current trend on the red carpet, as well as on Instagram and TikTok, showcases “long, voluminous, abundant, shiny hair,” according to Josh Wood, owner of an upscale salon in west London and vice-chair of the British Beauty Council. The “power mane” popularized by women linked to Trump symbolizes youth and fertility. Although this style may appear effortless, achieving it requires considerable effort, particularly with aging hair. “It seems like nothing has been altered, when incredibly, you have had a significant transformation,” Wood remarks.
Harriet, 69, a retired teaching assistant from Devon, who is a mother of three, first detected thinning hair at her temples during her late 50s. “Initially, you deceive yourself. You think, ‘It seems fine.’ However, as time passes and the deterioration is gradual, you realize, ‘No, it is indeed thinning.’ I could observe my hairline steadily retreating.
My husband would remark, ‘Oh, it’s not important.’ But it’s about how I feel, and I felt very self-conscious about it. On windy days, I avoided going outside or wore hats.” If she swam, she would try to keep her hair dry. While socializing, she’d position herself away from light: “You want to prevent light from reflecting on your face as they might take notice.” She would sweep her hair forward, secure it with hairspray, and frequently check her reflection in shop windows as she passed. “It’s dreadful,” she exclaims. “It niggles at you constantly.”
Rogaine, the hair growth stimulant, provided some assistance. However, it’s not advised for those over 65, “so I halted its use. Then it started worsening significantly. I pondered whether this was just part of aging; could I accept it, similar to accepting wrinkles on my face? But this felt worse in a way.”
Harriet resolved to take action. “I searched online for the clinics where all the footballers had gotten their hair transplants done.” Yet the thought of a lengthy drive back to Devon after a procedure in London with a bandaged head was too daunting. Instead, she chose Ball’s clinic in Portsmouth. He confirmed she had adequate hair in the donor area at the back of her head. She inquired, “Will the transplanted hair fall out from my temples, too?” He assured her that, since the DNA of the transplanted hair differs, it would remain.
Hair transplant costs range between £3,000 and £10,000, influenced by the number of grafts required and the clinic’s reputation. Two primary techniques exist. Strip Follicular Unit Transplantation (FUT) involves slicing a narrow strip of skin from the back of the scalp, which is then microscopically dissected into individual follicular units or grafts, for insertion into small incisions in the scalp. A significant benefit for women is not needing to cut their hair for the procedure, facilitating a smoother return to daily life. The downside is the scar left where the strip was taken.
Alternatively, Follicular Unit Extraction employs a small device to extract individual hairs from the back or sides of the head, one by one. The primary disadvantage is that the “donor area” must be shaved bare. Conversely, this method leaves no scar.
Harriet opted for FUT and, two years later, she is delighted. It appears completely natural, she states. It’s undetectable where her original hair ends and the transplanted hair begins. “In terms of confidence and my overall happiness with myself, the change is monumental,” she reveals. However, aside from her husband, children, and hairstylist, no one is aware she underwent the procedure. “It’s personal,” she emphasizes. “It’s taboo.”
Perhaps unexpectedly, it’s not just women experiencing significant hair loss who are pursuing transplants. Dr. Roshan Vara, a hair transplant surgeon and co-founder of The Treatment Rooms in London, reports that his patients fall into two primary categories: women who are peri- or postmenopausal facing hair loss due to hormonal fluctuations, and younger women who don’t necessarily have hair loss but wish to adjust a hairline that doesn’t satisfy them.
In social media circles, high foreheads aren’t celebrated as a beauty standard, he notes. Instead, there are memes humorously addressing the singer Rihanna’s “fivehead.” Pinterest features 30 hairstyles designed to conceal large foreheads “so you can avoid hearing corny jokes or unkind comments ever again.” TikTok invites viewers to enjoy “a hilarious video” featuring actor Dakota Johnson and others showing off their “big foreheads.”
Young women are also exposed to undesirable beauty norms promoting a “masculine” hairline with pronounced temples. Ignoring the fact that hairlines are neither inherently “masculine” nor “feminine,” Kingsley asserts, “This all stems from societal pressure; yet another method of making us feel inadequate.”
Wood acknowledges this increased awareness of hairlines. “Women are in front of cameras, pulling their hair back, donning high ponytails, all while aware of how their hairline frames their face.” Furthermore, as cosmetic procedures standardize beauty expectations, a natural hairline may start to appear abnormal. “It just doesn’t seem right,” he expresses. Where there was once a fixation on straight teeth, he suggests, now it’s shifted to the “perfect hairline.”
Aria desires surgery to reshape her hairline, not solely to address hair loss. The average forehead size for women measures 4.5 to 5.5 cm from the area between the eyebrows. Aria’s forehead is around 7.5 cm. She wishes for a lower, “rounder” hairline.
Aria resides in London with her parents, twin brother, and an older sister who, she claims, has an even larger forehead. “Some family members have joked that you could land a plane on her forehead. But she doesn’t mind. She owns it! She has a buzz cut! I admire her for that.”
Nevertheless, Aria has fixated on the notion that her forehead is a flaw that needs correction. It began as a faint worry a decade ago, and it has intensified. “Anytime I step outside, my forehead is the first thing on my mind,” she shares.
While on a holiday with a friend in Croatia, Aria marveled at the myriad of “exciting activities.” Yet, each opportunity stirred anxiety. She declined to go snorkeling but agreed to kayaking instead: “I wore a cap and claimed it was due to the heat.”
Aria has begun a romantic relationship with a man in his late 20s. During a recent mini-break, he suggested a bike ride. She declined, worried that the wind would unveil her exposed forehead. “That thought was too anxiety-provoking.” Later that night, when he attempted to touch her hair, she jumped up and claimed she needed to use the bathroom. “I had to concoct a reason to escape that moment,” she admits now. This fixation is consuming her: “While in lectures, I find myself distracted, focused on my fringe. I’ve got a mirror app on my phone that showcases the extent of my insecurity.”
Aria feels “excited” about her upcoming hair transplant, but her father considers it a grave mistake that could lead to an inclination towards further surgeries. “I asked him: why is it acceptable for a man to have a hair transplant to feel better? He struggled to provide an answer. We’re currently not on speaking terms.”
She hasn’t disclosed her plans to the man she’s dating, though he has also had a hair transplant. “He knows about my surgery next week,” she explains, “but he believes it’s for a gynecological concern.”
On the day of Aria’s transplant, she checks into the Maitland Clinic shortly after 8 am. A university friend accompanies her. They arrived by train from London the day prior and are staying at an Airbnb in central Portsmouth for a week, preparing for a challenging recovery. “I’m very prone to swelling,” Aria mentions.
She met with Ball for a consultation the previous evening. One concern for Aria was the placement of her new hairline, which still seemed too elevated. “Do you think Dr. Ball will allow me to lower it?” she had asked during our initial encounter.
Upon returning to the Airbnb that night, her concerns were alleviated. The center of her hairline would descend another half inch. However, the cost surged: £8.9k for 1,500 grafts. Aria entered the bathroom, scrutinized her reflection, and burst into tears. It suddenly dawned on her that her former self was about to change. “I was mourning the loss of my childhood features,” she reflects.
The Maitland Clinic occupies the second floor of an unremarkable building located in Lakeside North Harbour, a brief drive from Portsmouth’s heart. Once IBM’s national headquarters, it now serves as a business park featuring four-story office structures arranged around a lawn, complete with a café and extensive parking facilities. Its unassuming location is deliberate, Ball explains: it offers discretion.
Ball, aged 49, is tall, tanned, and in good shape. He cycles to work, often taking a 40-minute ride from his residence in a quaint village by Chichester harbour, where he lives with his wife, a GP, and their two children. Originally a GP and plastic surgeon, he trained alongside hair transplant pioneer Dr. Craig Ziering in Beverly Hills, California. This connection is advantageous: “If celebrity patients prefer not to travel to the US, they’re referred to me.” His own transplant performed by Ziering in 2011 provides him with valuable insight into the emotional struggles surrounding hair loss. Every patient undergoes a psychological evaluation to verify their mental readiness; for him, meticulous planning and preparation are paramount.
In the surgery room, Aria is seated in what resembles a dentist’s chair. Her hair has been cleansed with a medicated shampoo, then styled into two “space buns.” Ball uses electric clippers to trim the back of her head. He injects her scalp with a combination of lidocaine and adrenaline to numb it. (He administers bupivacaine afterwards for prolonged anesthesia.) Two codeine tablets, a sedative, have already been given to her.
Ball utilizes a scalpel, smoothly slicing across the back of Aria’s head. Her scalp is held taut. He excises a strip measuring approximately 1.2 cm wide and 17 cm long, which is then placed in a petri dish soaked in Plasma-Lyte (a solution mimicking human plasma). Aria notes a “crunching sound” reverberating in her head as the incision is made. Ball stitches the wound shut, applying a bandage, and steps back to evaluate his work. “The dressing must be visually appealing and symmetrical,” he insists. “If the dressing appears unattractive with an untidy bit of tape, the patient will doubt the quality of your work.”
Meanwhile, his hair technicians busily dissect the scalp strip on a long table. The first technician, peering through a microscope, slices the strip into sections. In the petri dish, the skin appears gray and muscular, resembling an anchovy fillet. The remaining three technicians categorize and divide the sections into follicular units, sorted by the number of hairs: one, two, or three. They also subdivide based on thickness: the finest for the front of the new hairline and coarser ones behind. Each unit contains its own muscles, blood vessels, nerves, and glands. The challenge lies in preserving these elements so that the follicle can successfully take root.
As the codeine and anesthesia start to take effect, Aria sits back and watches “Bridget Jones: The Edge of Reason” on a large display a short distance away. Transplants can last up to 12 hours, during which patients remain awake, thus an extensive variety of TV stations, crisps, and chocolate bars are offered. For lunch, Aria enjoys a salmon poke bowl ordered from the café downstairs.
“Now for my favorite phase – the artistic part!” Ball exclaims. He takes a small blade with a sharp edge and meticulously punctures the bare section of Aria’s newly marked hairline, indicated with a black marker. The best transplant surgeons emulate nature through adept incisions. Nearly horizontal slits cater to delicate hairs at the brow that tend to lean forward, while more vertical cuts are made for hairs that stand straight. The precise angle and direction of each slit varies to reflect the irregularity of a natural head of hair.
After Ball has created approximately 1,550 incisions, keeping count with a digital foot counter, his transplant technicians take over. They carefully place each graft into the tiny slits using fine forceps combined with an “implanter,” a pen-style tool featuring a hollow needle for the graft at one end and a plunger at the other. The layout, direction, angle, and distribution of hair growth have already been predetermined by Ball. “It’s akin to painting by numbers,” remarks hair technician Kate Shears. “He’s the artist; we’re filling in the colors.”
Dr. Vara holds an online consultation with Beatrice, a woman in her early 30s interested in a hair transplant. “Describe your concerns to me,” he prompts, to which she replies, “I’d like to see if you can create a new hairline, perhaps lower it and make it a bit thicker.”
Beatrice, a mother to three children under 12, recounts how her hair “thrived” during her first two pregnancies. “It was incredibly thick and healthy.” Following the birth of her children, she experienced significant hair loss due to hormonal changes, though her hair regained some density. However, after her last pregnancy two years ago, her hair is now “quite thin, thinner than before. The overall density hasn’t returned.” This change is troubling her. Beatrice, who has African-Caribbean roots, has resorted to wearing a wig to mask the issue.
The idea of getting a hair transplant originated from her hairdresser, who had one in Turkey three years back. “It’s stunning!” Beatrice exclaims. Prior to that, she was unaware that women could even undergo this procedure, and it captured her full attention. The cost is around £5k, and she considers it worthwhile. “This is an issue I’ve battled with for quite a while, and I believe it would bolster my confidence,” she tells Vara. Eager to schedule it immediately, Vara, however, isn’t ready to proceed just yet. He advises Beatrice to undergo a blood test to assess her thyroid function and iron levels and suggests she consider hair growth stimulants like Rogaine. He inquires about her stress levels, as Beatrice also manages a full-time job in education. Her life is often hectic and draining. Psycho-emotional stress can trigger hair loss and also hinder recovery after surgery. “A transplant demands optimal care and nutrition for a minimum of three months. You might not have the luxury of time for self-care,” Vara cautions Beatrice. He proposes a follow-up in six to nine months.
“In fact, among my female patients, over 90% aren’t immediate candidates for surgery,” he continues. Hair loss needs to stabilize, or else, as the natural hair keeps receding, the transplanted plugs could become exposed, surrounded by areas of bare scalp. The diffuse type of female hair loss complicates transplants because of the limited number of donor hairs available. Furthermore, “many of my female patients present forms of hair loss uncommon in men,” he adds. For instance, frontal fibrosing alopecia is a scarring condition resulting in the destruction of hair follicles, leading to permanent loss, often at the hairline. “Procedures like this aren’t amenable to surgery, especially in the initial stages,” he notes, “yet many female clients seek treatment from clinics lacking experience or reputation.”
“Many women feel significant distress regarding hair loss and may mistakenly believe a transplant is a solution – as it often is for men. Unfortunately, for women, that isn’t often the case,” expresses Greg Williams, vice-president of the British Association of Hair Restoration Surgery (BAHRS). “Sadly, unscrupulous practitioners will exploit women by performing transplants when it’s unnecessary or unsuitable.”
“In the UK, no accredited training exists for hair transplant surgeons,” he goes on. “Essentially, anyone can perform it. The state of affairs is chaotic, both domestically and internationally.”
Disreputable clinics might execute incisions at the wrong angles, so if hair survives at all, it would grow in various directions, appearing tangled and uneven. Hairlines could be far too low, upsetting the natural contours of a face, and the meticulous process of relocating follicles one by one requires significant effort. “Some clinics regrettably assign surgical responsibilities—such as skin cutting—to non-doctors, which accounts for their affordability since a doctor may supervise multiple procedures,” Williams explains. BAHRS has initiated the #WhoMakesTheCut campaign to underscore which tasks should only be performed by a doctor (it’s acceptable for surgical assistants to place hair grafts into the incisions made by the doctor).
The proportion of Ball’s work involving repair procedures for botched transplants has increased to 12%, up from just 2% in 2019. “This is becoming a pressing issue,” he notes. “People are desperate for solutions and are misled into thinking they can be resolved easily.” He connects me with an actor whose identity is so recognizable that I can only communicate through email as he is working to rectify a poorly executed hair transplant.
The suggestion initially came from her aesthetic doctor. “He advised me to get it,” she recounts, “claiming it could eliminate the need for Botox and fillers by addressing the asymmetry of my face – including my high forehead.”
He recommended a colleague who was later found to be inexperienced. “Essentially, I was a test subject.”
She underwent the procedure at a clinic on Harley Street. The doctor attempted to film the process with his phone while she was under sedation. The environment was “unsanitary,” she remarked, “and the technique was poorly executed. Several strands sprouted from one follicle, creating extensive gaps.” He extracted an excessive quantity of follicles from the back of her skull – far more than necessary, which will never regenerate.
Following the procedure, her skin became infected. Three years later, it remains bumpy, red, and flaky. The repair has cost over £20,000.
Women should carefully verify the surgeon’s credentials, asserts Ball. They should take the time to conduct thorough research and read patient reviews on forums such as hairlossexperiences.com or Reddit, and consult the BAHRS website. The doctor must conduct a detailed and unrushed consultation prior to surgery to identify the hair loss causes and effectively understand the goals and expectations. “Do not rush into decisions,” Williams advises. “Consider seeing a dermatologist or specialist first.”
A successful hair transplant can be transformative. “Women suffer in silence,” Ball explains. “Resources and discussions around this topic are scarce. No celebrities are addressing it, no one is normalizing these issues, resulting in feelings of shame. It strips away their sense of femininity, and they feel guilty about being concerned or criticize themselves for being vain. This isn’t vanity!”
However, it shouldn’t be the initial response if one notices hair thinning. Kamila Hawthorne, chair of the Royal College of GPs Council, states that in certain cases, hair loss can indicate a more serious medical problem: “If a patient notices substantial hair loss, they should consult their GP practice.”
For individuals dealing with the psychological impact of hair loss, the NHS provides guidance on accepting changes and can direct them to support networks and cognitive behavioral therapy. “We understand that experiencing hair loss can be distressing,” Hawthorne conveys, “but it’s entirely natural for our hair to thin, especially as we age.”
It’s been almost a week since Aria underwent her hair transplant, and she’s back home in London. In the end, her father came down to Portsmouth to pick her up two days post-surgery. “He’s been incredibly attentive, checking in on me, bringing me drinks,” she shares. “Apparently, he told Mum, ‘I understand why she opted for it. She appears better.’ So they both support me now.”
She feels tightness around the scar on the back of her scalp and mentions that she looked like a chipmunk for a couple of days: “My face was extremely swollen.” However, she eventually revealed her surgery to her boyfriend. “He said, ‘Why didn’t you tell me earlier? Now we’re hair transplant buddies!’ He says the tiny hairs sprouting look adorable.”
Those newly transplanted strands will likely fall out temporarily, and the follicles will enter a phase of dormancy. Then, approximately three months later, they are expected to regrow. She anticipates waiting around a year to observe the results of what will ultimately develop. “Each morning, I wake up, wash my face, and feel such joy and happiness,” she proclaims. “I appreciate what I see. Everything feels so much more balanced. It truly comes together.”
Some names have been altered for privacy.
