Gender-affirming hair restoration
Objectives: 1. Develop a holistic and comprehensive approach to gender-affirming hair transplantation.
2. Identify the common gender-affirming features of hairline, eyebrow and beard transplantation.
3. Understand the key surgical, medical and structural factors that mitigate risk and improve patient satisfaction.
Introduction: Hairlines and hairstyles have long defined masculinity and femininity, hair transplantation is an effective and permanent solution to affirming a person’s gender identity. A careful history is required with open-questioned approach to gender identity and goals. There are surgical, medical and structural factors that should be managed to mitigate risk and improve aesthetic outcomes.
Materials / method: For transgender women, hairline designs should be rounder and close the temporal angles, with a soft ‘feathered’ edge. For transgender men, hair transplants can create thicker eyebrows and beards can be designed for facial masculinization.
Surgical sequencing is important; recent breast augmentation of hyoid shaving may preclude prone positioning for hair transplantation. Exogenous testosterone may cause hairline recession in transgender men, a typical male feature, though some will want this corrected while maintaining a masculine hairline.
Results: The success of gender affirming hair transplants is underpinned by proper technique- extractions that do to leave the donor zone scant, hair graft processing to ensure high percentage of graft survival, and implantation that follows direction, desired densities, and design. Post operative care between the genders is similar, though Finasteride should be reserved for biological males.
The presentation includes real-case examples and photos of hairline feminization, eyebrow implantation for both males and females and beard design variability.
Conclusion: Some patients do not fall in the binary gender classifications, so understanding the patient’s goals is more important than classifying their gender. Therefore ‘feminization of the hairline’ may not always be the appropriate term; some patients may prefer a more mathematical or purely aesthetic approach. Transitioning between genders is a non-linear process. Proper surgical planning and medical support can improve outcomes and patient satisfaction.
