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Hair Care and Facial Feminization Surgery


Not all patients undergoing facial feminization surgery are good candidates for hair restoration – including hairline lowering and hair grafting. We at Saxon MD thought it was important to share our patient’s first-hand experience along with tips to guide you through your journey.

A Trans Woman’s Solution to Hair Problems

I originally wrote this to a friend as a response to her questions about my solution to my hair issues. This is what I’ve learned and what works for me, but it’s not necessarily something everyone should do. If you can grow your own hair or if you’re happy wearing a wig, that’s great! If not, then perhaps this may be useful for those who are looking for another solution to thin hair problems.

Like many of us I’d experienced a fair amount of male pattern balding before transition, and unlike some of us my hormone therapy did nothing to reverse my hair loss. I knew I would have to come up with some sort of long-term solution, and I set out to find a functional, affordable, easy and nice-looking hair replacement solution.

I began my transition while I was in the Army. As a soldier I had a short men’s style military haircut and I was not able to transition at work or gradually grow my hair out over time as most of us will do. If you’re in the same situation and have to go from a man’s hairstyle to a woman’s hairstyle overnight, or if you’re transitioning in stages and have to go back and forth between gender presentations then you’ll probably need a wig, so take as much time as you need to learn about them. is a great website, and you can learn about wigs and see what’s available and what they cost (their prices are comparable to most local wig shops). However, I recommend that you buy it from a local shop so you can get expert advice and personal service and actually try on wigs to see what suits you. I have found that the smaller shops are far better than those wig superstores, as the small shops tend to cater to women who are in various stages of life challenges (such as surviving cancer). I have never had a bad experience as a trans woman in one of these shops, and I have always received caring, expert attention and excellent service.

If you’re thinking about making some radical changes to your appearance, a new wig and a new hair color will definitely do that, so have fun! But if you’re trying to make a natural transition to longer hair then I recommend that you consider looking for a wig that looks as much like you hope or expect that your own hair will eventually look when you grow it out. If you’re planning on keeping your current hair color then try to match the wig to your own color and natural curl. Consider getting the wig just a little on the long side compared to the length you expect to eventually wear your hair, and then you can style your own hair and ditch the wig when you’ve grown your hair out long enough. If, as you transition, you usually have a short hairstyle with the wig and then you suddenly come to work some morning with longer hair people will notice, but if your hairstyle after your first visit to the salon is a bit shorter than your wig was then you’ve simply gotten a shorter haircut and people will usually just compliment you on your new style.

Of course, this is more important of you’re trying to live stealth or are just sensitive about what people will think about you wearing a wig, but you needn’t be sensitive about that. Plenty of women wear wigs to enjoy a variety of hairstyles and the convenience of looking good without too much work, and if anyone does discover that you’re wearing a wig and questions you about it that’s all you’ll have to say.

When buying a wig remember that this is not the time to be frugal; buy the best you can afford. When it comes to wigs, hairpieces or any sort of hair replacement item that you are going to wear in front of other people always, Always, ALWAYS buy the best you can afford! This is all about looking your best and nothing ruins your appearance (or gets you clocked) as quickly as a shabby-looking wig or hairpiece, so don’t ever skimp on quality!

When I began my transition, I started with the best wig I could find for around $150. Not bad for the first time, but if this is going to be your daily thing you need something more realistic and natural-looking. If you buy a synthetic hair wig you have to be careful around heat; I ruined a perfectly good and very pretty wig when I took some biscuits out of the oven while wearing it.

My next wig was better. It cost $300 and had a lace front with a skin cap, which looks very realistic. And this is really very important, because a wig like this will allow you to have a part in your hair with the appearance of skin showing, and that looks very natural. That one little detail is often the difference between blending in and getting read. That wig was also a synthetic hair wig, which was very easy to care for and always looked great without any styling.

The big lesson I learned about wigs is this: if I were to do it again I’d get a human hair wig with a full lace cap. Although that can be expensive, you can style a human hair wig just as if it were your own hair, it’s not any more sensitive to heat than your own hair (and you can bake those biscuits), and if it’s a quality wig you can take it to a good wig shop for maintenance to replace missing hairs no matter if the hairs are natural or synthetic (and yes, you will lose hair through styling and normal wear).  You can even replace the lace front when it wears out, and the front will eventually wear out. A wig like that might cost $800 to well over $1,000 and up but with care and maintenance it will last for years, so over the long haul it’s actually the cheapest solution.

Many people will graduate to something a bit more durable, like a weave. I can’t offer much advice about them since I’ve never used one, but as with everything hair related make sure you’re buying the best quality and most natural-looking product you can afford.

If you have full head coverage of hair but it’s merely thin then another solution is an integration hair system. This is also a sort of wig but the cap is an open weave that allows you to grow your own hair, which is pulled through the open weave and blended in to the hair of the system. These are either partial piece or full cap systems and come in every type of hair and all the colors you can imagine. This might be a good choice if your hair is shorter, but if you plan on having long hair then pulling all that hair through the mesh can be time consuming. Either way, this is the sort of solution that works best if you have someone available to help you put it on your head and get the hair arranged properly; usually this requires the services of a stylist at your wig shop.

When I began living full time in my congruent gender I went to a plastic surgeon to discuss hair replacement surgery. The two most common hair replacement surgery methods are follicular unit hair transplantation (FUT) and follicular unit hair extraction (FUE). FUT uses a strip of scalp with hair and, after being cut into tiny sections, it’s transplanted in small sections throughout the hair loss area.  This will require stitches along a line of scalp where the donor hair was removed (the scar is covered up by the surrounding hair).  Naturally, this is less expensive than FUE, which takes hair out in many tiny little dots of scalp tissue and transplants them. The FUE method leaves only tiny holes and which heal quickly and require no stitches (and leaves no scars), but it is more expensive. The success rate either way is about the same, and that will depend on factors such as scalp blood flow in the area of loss to ensure that the transplanted hair takes root and flourishes. Your surgeon can explain this in detail.

Given my level of hair loss (about a 4-inch swath from hairline to crown) I was quoted a price of $10,000. That really was reasonable but I didn’t do it, mainly because it’s a surgical procedure. Surgery doesn’t bother me, but with a surgical procedure there was the possibility that my results might not have been satisfactory. In other words, like every cosmetic procedure the surgeon can only guarantee the process but he or she cannot guarantee the results, which depend on your body’s ability to respond favorably to the surgical modifications. I also knew that the procedure would do nothing to prevent any future hair loss so I couldn’t see spending that kind of money for any hair solution that had less than a 100% chance of success.

I had heard about hair replacement systems so I decided to check them out. The advantage of a hair system was that the results would be immediate and 100% successful and with no down time, and when properly fitted and worn I could do whatever I wanted just as if it were my own hair. I’d be able to swim, ride my motorcycle, shower – whatever I’d do if I had my own natural hair. Hair systems are lighter, they fit close to your head without excess bulk, they’re cooler and more comfortable, so this seemed like a solution worth investigating.

I found out about Farrell Hair systems and I went to a consultation with Richard Farrell when he came to Houston (a few hours’ drive from my house). I knew from reading their website and discussing my consultation with the staff that I should arrive with some ideas of what I wanted my hair to look like (I brought some photos of hairstyles I liked), and when I met Richard I found him to be professional and pleasant. He’s very trans-friendly and he made me feel very much at ease while we discussed the various features of his systems and what he could do for me.

I liked what I heard and the price seemed right, so I had Richard fit me for a system. He examined my existing hair for color, natural curl, texture, and direction of growth, and he took a small hair sample. He fit me using a piece of plastic sheet (it was the same type of plastic used in something like a bread bag) and as I stretched it over my scalp he covered it with clear packing tape to form a shell in the exact shape as my noggin. I know, this sounds very primitive, but it’s a very effective low-tech procedure that gives a perfectly-shaped mold that was used to make the system conform to the exact shape of my head.

It works like this:

I cannot over stress how important an exact fit is because this is what will make the system sit comfortably and work properly. He then drew on the mold with markers to annotate hair density (also very important, because hair that is too dense looks just as unnatural as hair that’s too thin) as well as the direction of growth. I paid my 50% deposit to get the ball rolling and over the next couple of months I paid the remainder and before I knew it I had a system of two handmade hairpieces.

They were wonderful! They came configured with hair that was quite long (well beyond shoulder length), they looked great, the color and curl perfectly matched my own hair and they were soft and attractive. When I wore it you really could not tell which hair begins and ends where, and it can be styled, cut, shampooed, curled, whatever you’d want to do with your own natural hair. I’d go to a salon to get my own hair properly styled to blend in with the system. Yes, you’ll have to tell the stylist it’s a system so she won’t cut it (except for the first time, if needed), but if you’re worried about outing yourself you can use some other reason for hair loss (such as androgenetic alopecia). Plenty of genetic women suffer from hair loss, so you probably won’t be the first client your stylist has seen with hair issues.

To attach a system to your head you can use various methods. Check out this YouTube video to see one method:

Some hair system companies ask you to return to their salon to have your system removed and replaced, adjusted and maintained. That’s fine if that works for you, but this is inconvenient for most of us and works in favor of the provider, who has the opportunity to see you regularly and hopefully sell you expensive hair care products. The sales representative from Farrell actually brought this up when we spoke on the phone, and he explained that hair systems are supposed to provide freedom from fussy hair issues. Attaching and removing a hair system is relatively easy and is definitely something you can and should do yourself.

Some people use liquid adhesive, which works very well. In my case the area of my hair loss is shaved so it’s smooth (I keep it long on the sides and back) and the system is held on to my scalp with a special double-sided tape that is very strong. It’s lightweight and comfortable. I leave it on continually and about every 6 or 7 days I remove it, clean off the adhesive residue (you will have a bit of care and maintenance to do with these) and shave what little hair I have in the area before I reattach the system.

There are some drawbacks. First, these things wear out. Farrell says that they last 5-7 years with annual maintenance (about $100 per hairpiece per year), but that was not my experience. Truth be told, I put more wear and tear on mine than I should have because I was unfamiliar with how to care for long hair, how to style my hair, and the effects of heat damage. I attribute that to a lifetime of not being socialized as a girl and learning about hair care, and you’d better believe that now I pay close attention to every hair care tip and advertisement for hair care products I see! I also didn’t know how to properly care for the system, and I had my hairpieces just a little over a year when I decided they’d had enough wear to replace them.

The second drawback is that they are expensive. I paid $5,000 for one system (two hairpieces). I really loved them but for financial reasons I needed to find another option.

I went to a local wig shop to see what my options were and I discovered that they sell something called a “topper”, which is basically the same thing as my hair system but instead of being custom made they are made in a wig factory like regular wigs. This may be all you need, and they can send in a sample of your own hair to the factory where they’ll match the sample and make one for you. A good synthetic topper starts at around $200 and goes up in price for natural hair. If you’re considering a hair system and you want to explore the idea without making a huge investment then you might talk to your local wig shop about this option.

A word of warning – if they try to talk you out of a topper that might be because they don’t know anything about them and just want to sell you what they have. That’s not client-focused service, so just thank them and move on. Even if you do end up sticking with a wig wouldn’t you rather buy one from someone who’s more concerned with your needs than they are with their own? In my experience, the best wig shops are those that cater to cancer survivors, as they seem to be far more understanding of the unique needs of their customers than the huge wig megastores are.

Keeping the idea of a topper in mind as an option I ultimately decided I liked the hair system approach and decided to do more homework and conduct a more thorough search than I did last time. I originally ended up with Farrell Hair because I thought they were the only game in town, but I found out there are others.  Here’s a little bit of information on some of the various suppliers (and there are many) I found on the web:

  • Apollo Worldwide – I’m not sure exactly what their solutions are, but I think they have some sort of hair system. There’s practically no useful information on their site, and I suspect they wanted me to contact them so they can discuss my needs directly and pressure me into a sale, so I kept looking.
  • Farrell Hair – This is what I was using. Their product is very good and their website is very informative, but they’re expensive. Located in Hollywood, but Richard Farrell makes a big trip around the country a couple of times a year for consults and fittings so you needn’t go very far if you want a Farrell system. There’s tons of information on their website, so take a look and learn all you can. You can watch the videos and see how a hair system works and listen to testimonials. I can tell you that I have actually met one of the people giving a testimonial, she really does use the product and she’s totally legitimate. You can view this site with confidence that you’re getting honest information.
  • Hair Club – They’re big on surgical procedures, but they do have non-surgical solutions. Again, the website is very weak on info (but they do broadcast infomercials on TV and will send out information kits).
  • JA Alternatives – Located in New Jersey and New York, they look very similar to Farrell Hair. No pricing info on their site.

Ultimately, you’ll have to come up with a solution you like best and for many this means a wig, which is always the easiest and lowest-cost solution.  But the hair system is, for me, more comfortable, more natural-looking and easier to keep up with and less susceptible to damage from getting too close to the barbecue grill at a family picnic.

I hope this provides enough information to help you make some informed choices on dealing with your hair decisions.

Transform your self-doubt into self-confidence.

click here to schedule a Facial Feminization Surgery consultation today.


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