Paul is a macho dude. Fabio, Saturday Night Fever—“That’s the hair I grew up around,” the 63-year-old told me on a recent call. So when Paul began to lose his hair in his 30s, he felt like he was losing everything. “Hair represented power,” he says. “Hair represented masculinity and virility—which it still does, by the way.”
Men have been fighting against their receding hairlines for thousands of years. Yet hair loss persists, affecting men roughly in proportion to their age: 25 percent of men have lost some hair by 25, half by age 50, 70 percent by their 70s. So-called androgenetic alopecia, also known as male/female pattern baldness, is progressive. It eventually leaves many men (and a significant number of women) with thinning hair on the crown of the head and a voluminous wreath of healthy hair just below the ears—you know the look. Despite its near-inevitability, such hair loss can come with feelings of immense shame, self-consciousness, anger, and even thoughts of suicide.
That’s what led Paul (his middle name, used here to maintain anonymity) to the offices of Los Angeles–based physician William Rassman several decades ago. In the 1990s, Rassman pioneered a method of hair transplant surgery called follicular unit extraction, or FUE. Most physicians at the time were still cutting whole swaths of skin and hair from the back of the head and transplanting the “plug” to the top of the head. But Rassman was harvesting each donor follicle—the shaft, the one or two hairs inside it, and ideally the fatty casing that sustains it—one by one, and then rehoming it individually along the forehead.
While Frank Sinatra, Elton John, Roger Stone, President Joe Biden, and other “victims” of the “old pluggers,” as Rassman called them, were left with strips of hair like on a doll’s head, Paul walked out of Rassman’s office with a bespoke new hairline. Years later, he’s still got it. “I’ll be honest with you, it’s worth 10,000 hours and a therapist with a couch,” Paul says of FUE. “There are just not enough hours you can spend with a therapist saying, ‘Love yourself. Adore yourself. As you are.’ And then you go out and look in a mirror, and it’s all gone to shit.”
In the U.S. today, men’s beauty is a rapidly expanding industry. While skin care, makeup, and cosmetic surgery have often been treated as an exclusively feminine domain, old standbys like hair transplant surgery show that men have always participated in beauty culture—but often with radically different goals, risks, and psychological baggage. As a journalist chronicling the rise of such procedures, and how they intersect with and even fuel our cultural ideals, I wanted to know: What could I learn from a veteran participant in the men’s beauty industry like Paul? Before finally finding Rassman, Paul searched high and low for a hardier hairline. And then, he fashioned himself into a hair transplant evangelist.
Where Hippocrates was rubbing opium, horseradish, and pigeon shit on his scalp in 460 B.C., patients today have more effective hair loss treatments at their disposal. Drugs like finasteride (Donald Trump’s Rx of choice) can stop men from losing hair while they still have it. And a topical form of minoxidil, or Rogaine, can help a fraction of users regrow hair on the top of the head. But when nothing else works, many people turn to FUE—today the most popular form of hair transplantation.
Modern hair transplantation dates back only to the 1950s, when New York celebrity dermatologist Norman Orentreich began to wonder if he could “punch out” small circles of skin and hair from the back of patients’ heads and graft it onto balding areas elsewhere on the scalp. He tried it on a few people, and the “hair plug” worked; the follicles kept growing indefinitely in their new position. “It was a eureka moment,” according to Orentreich’s 2019 New York Times obituary. But the punch-out method made it difficult to craft an aesthetically pleasing, natural-looking hairline upon transplantation. Even as the donor grafts shrunk over time, newer procedures like the so-called strip method often left visible scars at the donor site.
For men suffering from their hair loss, Rassman’s FUE seemed like a godsend. It’s considered safe and permanent (donor hair will grow forever—though the hair around it will likely continue to recede without a drug like finasteride), and the recovery time is short: While recipients will walk around with pimplelike scabs on their head for about three days, their scalps will begin to heal and sprout early hairs within a few months of the procedure. But not every balding person is a good candidate for FUE. People may be turned away for being too early in their hair loss journey, as the surgeon needs to be able to predict how an individual’s hairline will evolve so as not to leave transplanted follicles awkwardly stranded as the hair around them further recedes. Conversely, people may be turned away for being too far gone; if even your donor hair has been reduced to whiskers, it’s probably too late.
Even for good FUE candidates, the procedure is expensive and, like most cosmetic procedures in the United States, usually paid for out of pocket. Stateside, the typical cost for one FUE procedure is between $4,000 and $20,000, depending on the physician (or robot). While a skilled technician can transplant 2,000 follicles (or about 4,000 individual hairs) in a single six- to eight-hour procedure, some men will require multiple surgeries to maintain their new hairline over time.
That’s why many patients end up in medical tourism destinations like Istanbul, widely considered the hair transplant capital of the world. There, they can find world-renowned surgeons—and unlicensed, unregulated charlatans. No one knows how many hair transplant clinics operate within city limits, or how many procedures are performed behind closed doors, but the best guesses place it at more than 2,000 procedures a day, according to a 2021 Bloomberg documentary on the Turkish industry. Each procedure ranges from $500 to $10,000, depending on the clinic; the most popular packages include not just new hair, but plane tickets and hotel accommodations.
Turkey’s lack of regulation elevates hair surgery’s attendant risks, which range from infection of the scalp to a botched hairline. Whatever country they’re in, a patient’s choice of clinic can make the difference between a healthy new mane and a halo of shame (not to mention thousands more dollars to be spent on corrective surgeries). “The industry is governed by money. They prey on people’s desperation vulnerability, isolation,” says hair loss consultant Spencer Stevenson, better known as Spex Hair. “And they essentially tell people what they want to hear, not what they need to hear.”
Before Paul found Rassman, he’d considered other procedures but never found a surgeon he could entrust his scalp with. But after his FUE transplant surgery, Paul made it his personal mission to direct his balding peers to Rassman. He organized conferences and traveled the country to vouch for the surgeon’s work to other men. “These guys were suicidal—absolutely suicidal,” Paul remembers. “We had a guy who lived in his car for four years, showered in the YMCA to save enough money so he could have a hair transplant, so [that] for his band, when they had a cover shot, he had a full head of hair.” Eventually, Paul set his own father up for a transplant and “it transformed him into the man he always thought he was.” Later, when Paul’s father was dying of pancreatic cancer, the only question his father had was, “Is the hair still on top of my head?”
This level of beauty obsession is something typically associated with women. In rom-coms, it’s the girlfriends who rise before their boyfriends to do their makeup, crawling back into bed and pretending they woke up like this. In tabloids, women are the ones scrutinized for altering their faces and bodies with injectables, shapewear, and surgery. But Paul and his fellow FUE advocates are proof positive that the same desire and desperation exist within men. They just get away with it more easily.
While women are often portrayed as deeply vain, it pains me to say it’s much harder for my brain to see Paul that way. It’s partly the sheer novelty—and implied vulnerability—of hearing a man speak openly about fears that every woman I know has been parsing out since middle school. There’s some visceral pity; as a woman who will probably make it through this life with her hairline more or less intact, I can only take Paul at his word for how hard it is to go bald. And, though I know on a rational level this is textbook internalized misogyny, he just sounds kind of … rational? “You’re on a very short trip on this earth,” Paul tells me. His thinking is: Why spend it worrying about your looks, when the quick fix is right in front of you? Yeah, why!
In the hair transplant world, these stories—of men’s anguish over their appearance, and the almost-mythological emphasis placed on FUE as a cure—are everywhere. They leak out of surgeons’ WhatsApp messages and loiter on Turkish street corners. (“Recently visited Istanbul and had no idea of this industry whatsoever,” one YouTube commenter posted on Bloomberg’s documentary. “Yet my hotel was PACKED with guys having diapers on their heads and weird hairlines. This explains everything lol.”) Thanks to the small percentage of patients who are comfortable disclosing their decision publicly, these FUE fables are even hashtag-searchable on Instagram. “This is a really important journey for them,” says Dr. Özlem Biçer, an internationally renowned hair transplant surgeon in Istanbul. “We touch their lives. I know how serious the procedure is.” And, in case it’s not good enough to just have a good head of hair, more FUE applications are cropping up all the time, including for the chest, eyebrows, and beard.
Stories about women’s beauty often end with a word of warning; that must apply here, too. There’s the medical risk: Surgery is a serious undertaking, no matter what’s on the operation table. And the financial burden: “As they say, measure twice, cut once,” Paul says. “Because once you start playing with it, you are now owned by the doctors.” There’s a moral admonition as well: You don’t need to look like a Marvel superhero to live a fulfilling life—and what’s more, looking like a Marvel superhero isn’t really possible. But Paul and his peers know all that—just as the women pursuing Botox or breast implants do. Yet they soldier on, into surgical suites and CVS pharmacies, indefatigable in their pursuit of the thing we all want: a little bit of beauty.