Often, media discusses gender-affirming surgeries like gay sex roles, in which there are supposedly only two: bottom and top. But recently, facial hair grafts — colloquially known as a beard transplant — have become an increasingly popular masculinization surgery.
It makes sense. For many of us, facial hair is a crucial part of not getting clocked. I found this out for myself after getting a beard transplant. Post-surgery, I went from passing 75% of the time to almost always passing. Casual interactions with strangers used to put me on edge because I was so concerned I’d get clocked as trans, but facial hair grafts changed that. Now, I watch strangers glance at my healing goatee, with its angular soul patch, and their expressions click into place: Beard = man.
I’m happy with my facial hair surgery results, and I’m not alone. Facial hair modifications like facial hair grafts and hair removal through procedures like electrolysis can be a crucial part of alleviating dysphoria for many trans people. In fact, the World Professional Association for Transgender Health (WPATH) classified electrolysis as medically necessary gender-affirming treatment in 2016. Still, despite the often life-saving benefits of facial hair surgeries, U.S. insurance providers rarely cover them.
In the guide below, we’ll look at how facial hair grafts went from a clunky niche practice to a growing form of trans healthcare. We’ll also touch on crucial factors such as cost, recovery, and how to avoid breaking out after the procedure.
How did beard transplants become a form of trans healthcare?
Dr. Alexes Hazen, a plastic surgeon and professor at NYU, first heard about neografts — a medical term for hair restoration procedures — 20 years ago. She had just started hosting a Sirius XM radio program called the Plastic Surgery Show, speaking to different doctors about cutting-edge practices in the field. When a Plastic Surgery Show guest first told her about the grafts, she was suspicious; at the time, she thought most grafts “sucked and looked terrible.” Then she saw the results — and changed her mind.
Because hair grafts “that didn’t look like shit” were such a new procedure, however, getting the tools and staff required to perform the surgery was still very difficult. It took Hazen six months to get the right machine and staff to form her operation, but two years later, her team was doing eyebrows, mustaches, and beards.
Unsurprisingly, most early facial hair patients she saw were cis; but roughly seven years ago, Hazen began seeing more trans clientele. As always, the girls were ahead: the first trans patients she treated were overwhelmingly trans women who wanted their hairlines modified. According to Hazen, many of her transfemme patients had bald spots or receding hairlines that they wanted adjusted through neografts.
Soon after, she began seeing transmasc people who were seeking beard and mustache transplants. It made sense: a lack of facial hair can mean many trans men are read as younger than their age, Hazen tells Them. “Which to me is always a good thing because I'm a plastic surgeon and I want people to look young. But it's not so awesome for trans men to feel they look like a child. Facial hair is definitely associated with masculinity.”
What is a beard transplant?
During any hair transplant, hair is removed from one part of the body, called the “donor site,” and placed onto another. During a beard transplant in particular, hairs are removed one by one — typically from the back of the head — and inserted into the face.
Today, there are two main types of facial hair grafts, FUT and FUE:
- FUT: A process in which hair follicles are extracted by cutting pieces of the donor site out and transferring it to the place a patient wants facial hair.
- FUE: A process in which hairs are transplanted from the donor site to the desired facial hair area by a robot, leaving smaller, pinprick scars.
In the early aughts, only FUT was available, says Hazen: “Back in the day, the only way they could get the follicles was to cut a piece of the scalp out and then sew that up.” While the graft worked well enough, patients were often dissatisfied with the horizontal scar on the back of their heads, she adds.
In contrast, FUE only leaves “little tiny dot scars,” Michael Wolfeld, a plastic surgeon and hair restoration specialist, tells Them. FUE thus allows patients to keep their hair “quite short without those scars being visible.” Wolfeld performs FUE procedures using a robot called the ARTAS, which is equipped with multiple cameras and artificial intelligence. While the patient lies on their stomach, “the robot scans the back of the scalp where the donor hair is,” selecting and sucking up individual follicles. Tiny holes are then poked into the patient’s face, and the hairs are inserted.
Both FUE and FUT are typically performed under local anesthesia. As Wolfeld explains, what this means is that “the areas themselves are numb, but the patient isn’t knocked out.” It also means that FUE can be painful. Luckily, because the procedure is so long (6-10 hours), medical teams often take a break halfway through, allowing patients to reset. (During my break, with my face still numb, I was even able to eat a chicken caesar wrap.)
How long does recovery take?
“The recovery for facial hair grafts is comparatively painless and short,” Wolfeld tells Them. “For 10 days, it's going to look noticeable. There's going to be redness, swelling, scabbing.” Around three months post-op, the hairs that were inserted into your face will fall out, and new hairs will begin to organically grow in.
The worst part of the recovery is less the pain and more the acne. Wolfeld says some patients experience pimples caused by “ingrown hairs,” as well as outbreaks caused by bacteria. Hazen’s solution? Sterilize a needle, heat it, and pop. If jabbing a needle in your face is unappealing, just keep the recovering area as clean as possible. (In my anecdotal experience, African Black Soap on both the hands and face significantly cuts down on bacteria-induced breakouts, as do any moisturizers with LHA, a salicylic acid derivative.)
While patients are technically allowed to shave one month post-op, many prefer to wait until the swelling has fully gone down, which can take six months. In the meantime, you can cut your facial hair with contactless buzzers or nail scissors.
How much do beard transplants cost? Are facial hair grafts covered by insurance?
Because insurance coverage has yet to catch up to patient demand, gender-affirming facial hair procedures are less likely to be covered by insurance than top and bottom surgery, though access also depends on where you work and live. According to Wolfeld, the cost of graphs at his office ranges anywhere from about $9,000 to $15,000.
The beard hair transplant cost coupled with the lack of insurance providers that cover this procedure is, unsurprisingly, a significantly inhibiting factor for many patients. Hopefully, the rising demand for these procedures from trans people across the gender spectrum will help persuade insurance companies to offer more coverage.
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