When it comes to hair, I can’t help but remember a line from a Lady Gaga song that goes, "I just wanna be myself, and I want you to know (that) I am my hair." Because as the cliché goes, our hair is our crowning glory. While some may disagree and trivialize it as a purely aesthetic concern, many think otherwise. People who struggle with an identity crisis, disease, anxiety, and loss of confidence often pass up on opportunities because that they aren't comfortable with how their hair looks like. When put this way, hair is no longer an aesthetic problem, but a psychological and emotional one.
This is where it becomes all too familiar with me. For us transwomen, our hair represents a new beginning. It's one of the first things we change. And as it grows out, our hair becomes a declaration of a physical and psychological transition to womanhood.
Imagine my stress as a 30-something transwoman, dealing with a naturally male-shaped receding hairline. Generally, masculine hairlines tend to have an M shape or square shape, while a feminine one tend to be rounded. Every day I would obsess about it, figuring out how I can make it work and style around it. I couldn't for the life of me wear my hair up in a high-pony (frustrating, I know) or wear it slicked back without feeling self-conscious. That's why for the longest time, I’ve relied on bangs (thanks, Alexa Chung and Jeanne Damas) to keep my confidence levels at bay. The goal was really to feminize and soften my features by rounding out the hard edges of my hairline.
This being the case, I have long thought of doing corrective surgery for my masculine hairline. Commonly, many transwomen consider a forehead feminization or scalp advancement surgery (SAS) that involves making an incision through which the bones of the forehead can be accessed. The excess bone and/or skin is then removed, lowering the gap between the hairline and forehead. This laborious procedure is super invasive and has a four to six week downtime. If you're unlucky, this process may even create secondary problems like heavy scarring or keloid.
Naturally, the major setbacks of scalp advancement surgery made me very hesitant to pursue it. I put my plans on hold, until I discovered an alternative method called direct hair transplant (DHI). As it is, hairline reshaping via transplant is not a very popular choice in the trans community. Moreover, having no trans-visibility in most mainstream hair transplant institutions added to my reluctance with this procedure—not to mention how pricey the procedure can be. The treatment cost starts from P150,000, depending on your needs and the expectations. Hence, I had to do a good amount of research to make sure it outweighed the cons of SAS.
What It Is: Direct Hair Transplant
While doing my research, I came across DHI Philippines by Clinique de Paris. Globally, DHI has almost 50 years of experience in hair transplant and restoration. Backed up by favorable reviews, DHI seemed to be a very suitable option for my problem, so it was only a matter of time until I scheduled for a consultation.
Aside from being very professional and accommodating, I couldn't help but notice how inclusive and accepting they made me feel during the initial process. They were respectful and always mindful of their questions. They welcomed my inquiries without me feeling judged or treated indifferently. Most importantly, they genuinely listened to my trans-specific anxieties, answering them without coming off as hard-sell or imposing. By the end of the session, I was already certain to give DHI a go. So, I highly recommend consulting with DHI first for a full diagnosis. This would also help you know the full cost of the treatment.
As the date of my procedure was fast approaching, the DHI team showed nothing less than personal care. Both Dr. Rafael Fortus and Nicole Sheker (Medical Director and Country Manager, respectively) checked up on me regularly to make sure I was mentally prepared and completely at ease. It goes without saying that when the day of my procedure came, I was comfortable and very much ready to conquer my hair.
How It Happened
Step 1: The Extraction Phase
Part of the brief was to expect a long day ahead. For DHI, there are four main phases in the procedure, which will take a total of seven to eight hours. It starts with the Extraction Phase. Follicular units are extracted from your donor area (FYI, they shave the back of your head!) using specialized disposable tools. DHI uses a patented extraction tool, leaving minimal trauma on the scalp.
In my case, they needed to get at least 2500 hair follicles to achieve my expected results. While this step may seemingly cause panic, ladies need not worry. They do it in such a way that it would be unnoticeable even if you tie or let your hair down. Consequently, many also seem to worry about the pain. The good thing is—since you’ll be under local anesthesia—discomfort is at minimum to none. You can even request to be sedated if it really bothers you. As for me, I was half awake—even going for bathroom breaks in between. The only discomfort I felt was the soreness from lying on my chest for an extended time.
Step 2: Follicle Sorting and Preservation
Once the extraction is finished, the next phase is Follicle Sorting and Preservation. Each follicular unit is sorted and preserved for later implantation—think carefully arranged beads and sequins for a couture dress. DHI also uses a medical grade solution to preserve extracted follicular units. They keep them under natural conditions to ensure a higher survival rate for implanted hair. The cool part in this step is you get to see all your follicles laid out according to type (triple and double strands for density and singles for softness). And during this moment, they will serve you complimentary lunch. In my case, I chose my fave, Cibo's Rigatoni All'Alfonso. Yum!
Step 3: Hairline Shape Confirmation
After lunch, the next step would be the Hairline Shape Confirmation. Dr. Raf meticulously maps out your ideal hairline contour. This is the part where you should have all your hair pegs ready. In my case, I was torn between Kim Kardashian (apparently, a staple favorite) and Poy Treechada. Since this is a major turning point in the procedure, the DHI team makes sure that you take your time before deciding. Aside from drawing on your forehead, they also take photos of you having different hairline variations. This way, you'll really get to have a close visual of your final look before you lock it in. In the end, I went for Poy's hairline (trans represent!). I think it looked more natural, especially the way the side part draped down my face.
Step 4: Implantation Phase
Once your hairline shape is decided, then comes the last step, which is the Implantation Phase. Follicular units are implanted back into the scalp using minimally invasive tools, or what they unofficially call an "implanter pen." Unlike more traditional hair transplant procedures, like FUT and FUE, DHI does not create incisions before placement, which may otherwise cause irregularities in the hair direction. Instead, they get to implant hair at a more precise angle and depth with DHI’s "pen method." The whole process reminded me of gown embroidery. As for pain, it’s really close to none since you’ll still be anesthetized. As a matter of fact, I was awake the whole time, and I was literally just binge-watching on Netflix.
At the end of it all, it's just like a normal visit to your derma for a facial. Once you’re up and about, they thoroughly explain the post-op procedures, including an expected three-day downtime (so short!) with the best results showing within four to nine months. They also provide a take-home kit for everything you’ll be needing in the next few days. And when everything’s wrapped up, they arrange a complimentary ride home for you. Now that’s what I call excellent and thoughtful customer service.
After the Procedure
Once the procedure was done, I was a little worried that my hairline was still high and that my forehead looked bigger. However, as explained, that was caused by the swelling, which is expected to go down two to three days after. Nevertheless, I was immediately happy of how the rounded shape turned out. The square corners in my forehead were already filled in and noticeably looked more ladylike.
During the first week, I was advised that shedding in the implanted area is normal as the follicles take root. The treatment also doesn’t require any long-term medication, as implanted hair will not fall. However, Minoxidil applications are suggested to prevent the further falling or thinning of existing hair. Cardio exercises and swimming are also discouraged within two weeks after the session—while intense exercises like weight lifting can be resumed after four weeks.
In most cases, patients can return to work within five to seven days after the session. But I was already back to work by the fourth day. I really can’t stress enough how amazed I am by the short downtime.
After the procedure, I can’t help but be proud of myself. Despite the unpopularity of direct hair transplant among transwomen and the hefty investment needed for it, my initial doubts have been outgrown by the happiness I gained after this experience. Only a week has passed, but the treatment has already had tremendous impact on my mental health and well-being. It’s so liberating not to constantly worry and suffer from your hair insecurities (like alopecia or hair thinning), regardless of your sexual orientation or gender identity.
However, for transwomen like me, it’s more than just looking pretty and feminine. This is a step toward becoming the person I always envisioned myself to be—to look in the mirror with pride and content. And as I reclaim my identity through my hair, Lady Gaga’s song now makes more sense. Now more than ever, I am my hair.
Direct hair transplant procedure starts at P150,000. DHI Philippines by Clinique de Paris is located at Twin Cities Condominium, 110 Legazpi Street Legaspi Village, 1229 Makati. For inquiries, you may contact +632-893-6175 and firstname.lastname@example.org.