The key to understanding the subject of hair and its restoration is knowing how awful things used to be. Back in the day, transplants were better known as “plugs” (derogatory). “Plug” is a phonetically ugly word that connotes the idea of a cavity — a hole or gap that needs to be filled. Plugs don’t necessarily solve a problem, as much as they fill one.
“We don’t use that term anymore,” Dr. Jason Champagne, a Los Angeles-based celebrity facial plastic surgeon who specializes in hair restoration, tells Vox. Champagne explains that 40 or 50 years ago, in the early days of hair restoration, surgeons would try to move large groupings of hair from one part of a person’s head to another. “It was almost like a punch of scalp that would be moved,” Champagne said. “They would sort of just line it up in rows, too. And the effect, that’s what we would call ‘doll hair.’ ”
“Doll hair” looks obvious, and grows in a pattern that’s unnatural compared to the way hair grows on our heads, Champagne says. There’s a sense of disgust when I prod Champagne about this type of restoration; I can hear his displeasure when he goes on about the “little tufts of hair” growing in aesthetically unpleasant formations where they shouldn’t be.
Since those early days of plugs and doll hair, hair restoration has become more advanced. The two main procedures today are known as follicular unit transplantation (FUT) and follicular unit extraction (FUE). The former is a process in which an incision is made — usually on the back of one’s head, near the neck — and a strip of hair is sliced away. The follicles on that sliver of skin are harvested one by one and then placed where a patient needs growth. In an FUE procedure, the individual follicles are more or less “punched out,” Champagne says. Instead of a linear incision and stitches, FUE results in more scars that are smaller and less distinct.
The beauty of both these procedures is that they allow surgeons to harvest and individually place the transplanted hair follicles with more precision than in the past, avoiding the appearance of “plugs” or “doll hair.” They’ve even learned to account for the problem that not all follicles are the same. As Champagne tells me, follicles along our hairlines usually grow single hairs while those on the top of our heads around the crown can grow two to four hairs. Because of how good science has gotten at extraction and magnification, surgeons can transplant specific follicles to specific places on the scalp, allowing hair to look and lie naturally: follicles sprouting single hairs along the hairline, and follicles with more growths toward the back of the head.
The aesthetic advancements in hair restoration are a huge reason why these procedures have gotten so popular. The results look better and more natural, and the procedures themselves have become less invasive as the years go by. Since the results are so good and procedures now have easier recoveries, more and more people are inclined to take the leap.
“The projected market in the next 10 years is supposed to double or triple,” Champagne, the plastic surgeon, tells me, explaining that though hair transplants are predominantly marketed toward men, women can benefit from the process too. Champagne himself is specializing in using the advancements in hair transplant tech to give patients fuller eyebrows. He also works on mustaches and facial hair.
“I see a lot of celebrity clients — a lot of people that are on camera and want to look like nothing was ever done,” Champagne says. “You have to be somewhat of an artist if you’re going to get the best, most natural-looking results.”
