Hair-Replacement Surgery

If you have the money and the inclination, surgical hair transplants can give you your frontal hair back. Transplants deservedly got a lot of bad press after they first came out in the 1980s, when cheap operations left patients' hairlines looking like plugs of sod that didn't take. Today's transplants are much improved. By using more but smaller grafts, clumping is eliminated. The surgery is relatively simple and thousands of hair-replacement operations are performed each year with no complications.

During the surgery, grafts containing from one to eight hairs each are taken from a donor area on the back of the head and stitched into a slit or hole on the front of the scalp. Typically the procedure-done without anesthesia-takes two to four hours, during which a surgeon transplants up to 1,000 hairs (a square inch of coverage requires about 175 hairs). Two or more sessions are usually necessary and some pain and swelling is involved. The cost varies from $5,000 to $20,000 for a complete treatment. Do not plan on sporting your new look right away: Transplanted hairs fall out and can take up to six months to grow back.

In a related technique called a "flap," a larger row of hair is partially cut away from a donor area and, leaving the end attached, is pulled into a sparse area. Although this method is faster than the grafting method and the hair does not fall out, it is trickier for surgeon to do properly and requires a real specialist.

Another surgical means of minimizing a bald spot is called "scalp reduction," usually done in concert with grafts or flaps. Although it sounds like something Cherokees practiced on western settlers, scalp reduction is actually the removal of hairless skin on the top of the skull, like a face-lift for the scalp. The more extra skin on your noggin the better.

Hairpieces and toupees

If all this talk of stitching on the top of your head makes you queasy, there is always that embarrassing personal appliance-the hairpiece. For most people, when a hairpiece comes to mind, it is a really bad rug-the kind where the hair is darker than the eyebrows and seems to levitate off the wearer's forehead. Various 1970s game show hosts come to mind and, of course, Burt Reynolds. But fake hair has come a long way recently and the newest models are not that bad.

These days artificial hair comes in a lot of varieties: extensions, weaves, wefts, hairpieces, toupees, cranial prostheses, and naturally, wigs. Some are made with human hair, some artificial, and some both. Human hair is more comfortable but can fade in sunlight (Italian hair is claimed to be the best), whereas synthetic hair is more durable but less natural looking. Both types of hair can be blended or dyed to produce an exact color match to your own hair. Newer lace hairpieces are so hard to spot you can even comb your hair straight back.