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Is Direct Hair Transplant Worth It? A Trans Woman Finds Out

When it comes to hair, I can’t help but remember a line from a Lady Gaga song:  

"I just wanna be myself
And I want you to know (that) I am my hair" —"Hair", Lady Gaga

At this point, I think we can all agree that our hair is very important. As the cliché goes, it’s our crowning glory. This is why some haircare brands even push it further to promote hair as an essential part of one’s identity, claiming “my hair, my say.”

While some may disagree and trivialize this as an aesthetic concern, many would think otherwise. Unknowingly, these are people who struggle with an identity crisis, anxiety and loss of confidence, or passed-up opportunities all because they feel that their hair has failed them in one way or the other. When put this way, hair is no longer an aesthetic problem, but a psychological and emotional one.


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This is where it becomes all too familiar with me. For 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.


My mane concern

So imagine my stress as a 30-something transwoman, dealing with a naturally male-shaped receding hairline. Every day I would obsess about it, figuring out how I can make it “werk” and style some sense to it. I couldn’t – for my life—wear my hair up in a high-pony (frustrating, I know) or do a slicked back look 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 high.


This being the case, I have long thought of doing a 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. [1] This laborious procedure is really invasive and has a 4-6 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. Hence, I had to do a good amount of research to make sure it outweighed the cons of SAS.


Hello, DHI!

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.


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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.


The Procedure

Part of the brief was to expect a long day ahead. For DHI, there are four (4) main phases in the procedure, which will take a total of 7-8 hours. It starts with the Extraction Phase. Follicular units are extracted from your donor area (FYI, they shave your back) using specialized disposable tools. DHI uses a patented extraction tool, leaving minimal trauma on the scalp. 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 a minimum to none. You can even request to be sedated if it really bothers you.

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. And during this moment, they will serve you complimentary lunch. In my case, I chose my fave, Cibo’s Rigatoni Al Alfonso. Yum!

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 peg of your final look before you lock it in. 

Day 7 Post-Op


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 a thorough 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 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 3-day downtime (so short!!!) with the best results showing within 4-9 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.


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I’m “hair” to stay

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.

For transwomen like me, hair is more than just looking pretty and feminine. It’s a step forward to becoming the person we always envisioned ourselves 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.—Lui Castañeda

[1] Goals of Forehead Reduction in Facial Feminization Surgery.