Who Are You Calling Baldy?

When the actor James Nesbitt "came out" about his hair transplant late last year, there was definitely some sniggering. Where boob jobs, Botox and rhinoplasty have gone mainstream, hair transplants remain strangely taboo. Perhaps it's the memory of Elton John's dodgy doll-like plugs back in the '80s. Or maybe it's because a gleaming pate remains one of the few physical flaws still up for ridicule. Whatever, we remain tickled by all things toupee, and merrily speculate on Prince William's tufty temples.

As hair-transplant techniques become more sophisticated, however, the joke could soon be on us. Where old methods involved taking large round sections of skin from the back of the head and grafting them on top of the scalp - resulting in erratic and unnatural-looking regrowth - the latest technique of follicular unit extraction (FUE) is almost undetectable, leaving no scarring. British consultant trichologist Ian Sallis explains: "FUE allows surgeons to place individual follicles back into the thinner parts of the hairline. The results are sometimes dramatic, and, more to the point, very natural. You do have to be aware, though, that the hair-transplant surgeons are not all as good as each other."

Dr Barry White, founding medical director of the National Hair Institute in Melbourne, says it's hard to say how many Australian men undergo this treatment, as most patients are fiercely private, but estimates "a few thousand per year". He has been in the industry for more than 30 years, and says the big change in that time is the number of follicles that can be transplanted in a session. "We had a man last week who had 6000 grafts done in one day. The procedure's expensive, but it makes a huge difference to your appearance," he says.

Sallis concurs. "It's more acceptable for men to worry about their hair now, and spend money on correcting things they don't like about themselves," he says.

As ever, celebrities have paved the way. Nesbitt said of his transplants: "They've changed my life. It's horrible going bald. Anyone who says it isn't is lying". Comedian John Cleese, designer Marc Jacobs, cricketer Shane Warne - all have talked candidly about having the procedure. And let's not forget all the other stars rumoured to have had their roots fiddle, among them, Jude Law, Mel Gibson, Daniel Craig and Brad Pitt. Newspapers last month reported that celebrity chef Gordon Ramsay had paid $45,000 for FUE treatment to preserve his appeal to US television viewers.

Despite this, secrecy and shame continue to shroud hair transplants and pre-mature male baldness in general. Strange, given that hair loss affects 60 per cent of men before the age of 40, and that of those affected, one in four will begin the process before the age of 21.

"Thinning hair, psychologically, denotes a loss of virility, attractiveness and sexuality, any of which is depressing. It is a sign of ageing, too," explains trichologist Philip Kingsley, who operates clinics in the UK and US. " The psychological factors in male hair loss are vastly underestimated and men are constantly looking for 'cures'." No wonder an estimated $3.5 billion is spent annually in America alone on trying to halt baldness.

FUE is labour-intensive and highly skilled. It is performed under local anaesthetic, typically over two sessions, each taking several hours. Individual follicles are extracted under magnification with a small round punch and forceps, then when the required number of grafts have been taken, they are implanted into the balding areas. "It's no more painful than a filling," explains one transplantee in his thirties, who wants to remain anonymous. "Recovery takes about 10 days, though any pain usually subsides after 72 hours."

Results are gradual. "You don't wake up like David Hasselhoff - it takes 12 to 18 months for the hair to grow and for the full results to be apparent," explains patient X. "It's a good thin, because you can adjust psychologically." It also allows men to keep quiet about it if they wish - apparently, people don't notice a progressively thickening mane the way they would an overnight transformation. Such a treatment could set you back $15-20,000, although, strangely, the best surgeons (mainly found in America) charge less than many cowboy clinics.

One celebrated practitioner is New York's Dr Alan Feller, who is raved about as "an artist" by his many devotees. If Feller is the hair-transplant god, his apostle is a 36-year-old man who goes by the pseudonym "Spex". A businessman by day, Spex moonlights as Feller's ambassador and unofficial counsellor. Having been scarred by a bad hair transplant in 2000, Spex was "repaired", as he puts it, by Feller. He has since made it his mission to spread the word about hair-loss treatments and transplants, and speaks with a quasi-religious zeal and touching compassion about his subject.

Because, in truth, this isn't funny at all. Spex talks about the near-suicidal young men he meets, who feel "completely alone and out of control. You become obsessed. Every waking moment is spent analysing your hair loss. It's about identity and self-esteem and it completely strips men of their confidence". His website spexhair.com gets 200 unique hits per day. "I want to save men from making the mistakes I did," he says. "Because these guys are desperate, there are lots of ruthless people out there ready to swindle them".

He's not exaggerating. Dip into the online HT community and you will find a vast swirling world of neurosis. Sufferers speak a hyper-technical language, as if by categorising and quantifying their follicles, they will regain control of their condition. They post miserable scalp close-ups (always covering their faces) and rattle off odd labels that sould like postcodes: "I've been balding since 18. Currently I'm an anterior NW4. I inherited the balding gene from my maternal grandfather. He's a NW5A and started balding very early". Other posts reveal the devastating impact hair loss has on young men: "It was at that moment that I realise... I WAS GOING BALD. I fell into a deep, deep depression. I even thought about ending it all..."

After a glimpse of such heartache, the hair transplant suddenly doesn't seem so drastic (or so funny) after all.