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My hair transplant journal (1997)

Note: This is my first-hand report of hair transplants with Douglas Ousterhout written September 29, 1996, revised June 23, 1997. I’ve left it as I wrote it and made notations where necessary.

DO NOT GET TRANSPLANTS until you have spoken with a plastic surgeon about the option of scalp advancement.

Disclaimer

I’m not a doctor, and I don’t even play one on TV. I am a consumer who spent a lot of time researching her specific hair loss issues, and I thought there might be general information of use to others here. This anecdotal evidence is NOT TO BE CONSIDERED MEDICAL ADVICE. Consult with several physicians before undergoing any procedure described herein. Heck, talk with anyone else who is qualified to answer your questions. Knowledge is power, forewarned is forearmed, look before you leap, etc., etc.

Description of my hair loss problem

I’m about halfway through what I plan to be a gradual transition. When I began looking into surgical hair replacement options, I very rarely went out en femme. Even though I occasionally got _ma’amed_ while wearing a hat before my surgery, it never happened without a hat because of my receding hairline. Luckily for me, my hair is very thick overall, and it’s not thinning on the crown. Once the spironolactone had halted any further recession, I felt it was time to feminize my hairline. Some transsexual acquaintances of mine with similar recession have opted not to do this, and I think it really hurts their ability to pass. It’s my opinion that it can help immensely in presenting a less ambiguous first impression. Because I’m about 6’1″, I also feel that the more passable my face is, the less self-conscious I am about my height and broad shoulders. Furthermore, everyone’s going to see my face, and only a very lucky few will ever see my genitals, so it’s my priority to present as feminine a face as I can.

I have a job where the dress code is extremely casual. I can wear a baseball cap all day, every day, without anyone thinking much about it. I started wearing one every day starting in the summer of 1996 so people would get used to seeing me that way. Plenty of guys at work have long hair as well, so I’ve been growing mine out for about 18 months with no suspicions and only a few comments.

Like everyone, I have a limited amount of money to spend on transitioning, so I prioritized what was most important. I prioritized things I wanted to get done by money issues as well as time issues. Since it takes a long time for hair to grow, and a long time to break down facial hair, it seemed that electrolysis and hair transplants both needed to be done first. I didn’t want to look like a balding, bearded guy trying to pass as a woman. Visually, those were THE two dead giveaways in my case. Nose job, minor cosmetic fixes, trachea and jaw shave, implants, and SRS can all wait, as far as I’m concerned. Electrolysis and forehead were the two biggest financial hurdles as well (I estimate $12,000 for each), so once I got those under control, I knew I’d be in good shape. Plus, they’re both things that aren’t gender-specific: guys get hair transplants, and plenty of guys don’t have facial hair, so no one at work was going to catch on about my transitioning until I told them. I’d probably raise a lot more suspicion from, say, a nose job or something more obvious.

I spent a year reading up on various options available. I’ve included this as Appendix B in this document. If you are considering cosmetic surgery or surgical hair replacement at any point in your transition, I suggest you start with a consultation with Dr. Douglas Ousterhout. I wish I had seen him before I got my first transplants with someone else, as described below.

My first transplant procedure, now known as my big mistake

Despite all the reading I did, I still made a mistake I hope I can keep you from making. I thought I would get my hair transplants in Chicago and THEN get my brow shaved, so I didn’t talk to any surgeons about brow shaves before my first round of transplants in September, 1996. This turned out to be a big mistake. Once I spoke with Dr. Ousterhout, I learned that he does scalp advancements combined with brow shaves that offer fantastic results for bringing the hairline into normal female ranges. The nearly $2,000 I spent on transplants in Chicago was a total waste, as Dr. Ousterhout cut almost all of the transplants out when I had my forehead and brow recontoured and my hairline moved forward. Please do yourself a favor and talk with Dr. Ousterhout or another qualified plastic surgeon about scalp advancements and brow recontouring and lifts before spending a dime on transplants.

My second transplant procedure

In December 1996, Dr. Ousterhout performed a forehead recountouring, brow lift, scalp advancement and trachea shave for me. The results were truly outstanding, and I have written about them separately. Unlike plugs, the results were immediate. In 6 hours my hairline went from not feminine to feminine. This had many wonderful effects as far as my appearance and confidence, but it also allowed me to get rid of almost all of the unsatisfactory hair transplants I had gotten from the Chicago doctor.

Although I have been passing with absolutely no problems since Dr. Ousterhout’s surgery (in fact, no one has guessed I had anything done), I felt my hairline could be improved a bit more with a few hair transplants along the hairline. I decided to do this now so they’d have time to grow before I plan to go full-time sometime in early 1998. Even though it’s not necessary for me to pass, I feel that if I’m going to do this, I want to look as great as I can. My hair transplant procedure took place exactly six months after my forehead work with Dr. Ousterhout. I had a four-day weekend at work while our offices were relocated, so I decided that was the best time to go.

My surgery journal

6/11/97

I took a morning flight to San Francisco, rented a car, and drove to the Metro Hotel. Previously, I had stayed in a guest room at Davies Medical Center, where Dr. Ousterhout’s office is located and the surgery is performed, but the hospital had nearly doubled the rate of their guest rooms since my forehead surgery. I found the Metro’s price, location, and room quite nice. The Metro is about 4 blocks north of Davies Medical Center, a five- to ten-minute walk (depending on how ambitious you are about walking uphill). See Appendix A at the end of this document for specific hotel information.

I walked to Davies and visited with Mira, Dr. Ousterhout’s office manager, and Dr. Ousterhout’s assistant Hirumi. As I mentioned in my last piece, they are very accommodating. I took care of financial matters with Mira, signed some consent forms for Hirumi, and set up an appointment to talk with Dr. Ousterhout later in the afternoon. After a trip down the hill to have a snack in the Castro, I met Dr. Ousterhout. I mostly discussed my earlier surgery, my plans for jaw and nose work I’ll be doing later, and questions I had about ways to surgically improve my complexion. Since I’d already had hair transplants with the Chicago doctor, I pretty much knew the drill. Dr. Ousterhout had no special instruction, but he suggested I not eat in the morning, then amended that to say I could have something light. I had plans to meet a friend which fell through, so I got some Chinese food and went to bed.

6/12/97

I didn’t set the alarm right, but luckily I awoke at the time I wanted to get up. I showered and got ready. I normally don’t dry my hair, but I thought they might need it dry for the procedure. I put on makeup, although that was pretty much a waste of time, since it all got smeared or rubbed off during the procedure. I decided not to eat anything. I arrived a little before 8:00.

I stepped out of my bodysuit (don’t wear any pullover clothes) and put on a hospital gown. I’d also recommend wearing loose pants and taking your shoes off before starting. The key is to be as comfortable as possible, since you’re not going anywhere for many hours. I’d recommend you go to the bathroom immediately before starting. I bought a couple of sodas to have during the procedure. If you get thirsty, ask for some water, but keep in mind you can’t get up before the procedure is over, so plan (and drink) accordingly.

When I arrived, I spoke with Hirumi for a while, then Mira introduced me to Barbara, who was going to assist with preparation of the hair plugs. The work is done in Dr. Ousterhout’s offices in a dentist-like examination chair. They set up a tray in front of me, and they had me lean forward while they pinned back my hair to expose the donor area at the back of my head.

The Chicago doctor who did my work, besides giving me inadequate results, took a big pair of shears and pretty violently cleared the donor site with what seemed like a bit too much enthusiasm. Of my first experience, this was probably the most disturbing part for me.

Dr. Ousterhout was much better about this, using an electric clipper, which shortened only the hair that needed to be cut. I think in general, Dr. Ousterhout is much more cognizant of patients’ needs than other doctors I’ve met, and he probably realizes that having a huge patch of hair cut from your head is a bit traumatic, even if it’s not noticeable to others.

Once they had cleared the donor area and sterilized it, they had me lean forward onto the towels and rest my head on the tray again. They put some towels on my lap and around my neck. I made sure the towels didn’t obstruct my breathing. Now they were ready to start. Dr. Ousterhout came in and began injecting anesthesia (ephedrine, I believe) into the donor site. Once it was numb, I believe they also injected saline solution under the skin to make the areas easier to work on. Getting shots in the back of your head doesn’t exactly tickle, but I didn’t find it any worse than electrolysis under my nose. Mira was nice enough to come in and hold my hand as they gave me the shots. She said she can usually tell how someone feels before they say anything from their body responses. I kept instinctively tensing up and she kept telling me to relax and take deep breaths, which helped. Soon the area was numb, and Dr. Ousterhout began cutting strips. It didn’t hurt at all, but it made an odd sound resonate inside my head that sounded like cutting cloth with scissors. For obvious reasons, he was insistent that I keep my hands still and away from the area he was working in. I’m kind of fidgety, so for me, this was harder than it sounds.

So, while Hirumi and Barbara were working on separating the hairs into individual pieces, Dr. Ousterhout stapled the donor site closed. Another interesting sound, just like someone putting staples in the back of your head. They put some antibiotic ointment on the donor site and covered it up. Next I was asked to lean back against the head rest, but because my head was numb I had the sensation that my head wasn’t resting against anything, and I couldn’t get my neck to relax until they put a couple of towels behind my neck. Once I was comfortable, Mira put a sheet and blanket on my legs so I wouldn’t get too cold. At first I thought it might be too much, but it soon felt pretty good to have my legs warm. I took this opportunity to stretch my legs as much as possible while I sat there. Be sure to do that often.

Soon it was time to create my hairline. The scalp advancement Dr. Ousterhout did six months earlier put my hairline into normal female range. As I mentioned, I have since had no problems passing, but I was interested in rounding out the corners a bit more for an even more feminine appearance. He gave me a mirror, and as I watched he drew a perfectly symmetrical freehand line on my forehead for my new hairline (I had him measure it, and it was exactly the same on both sides). We looked at it a while, and I said it wasn’t quite as rounded at the corners as I was thinking. He went into the other room where they were preparing the hair plugs and looked at the other women’s hairlines. When he returned, he removed the line and drew one with more rounded corners. The very front of the hairline was in perfect position, so the curved line he drew arched downward from there to my temples, where it was about 2 centimeters at the widest point from my hairline to the drawn line. I looked at this new line for a very long time and talked about it with him for quite a while. After all, you need to be very comfortable with this hairline, so don’t hesitate to make sure it’s exactly how you’d like it. I was especially concerned about how natural it would look at the temples, where it would be blended in with finer hairs. He assured me this new Japanese technique allowed him to put in plugs at the proper angle to make that look fine.

Then I had quite a bit of time to sit and relax. They brought in a radio and I had them tune it to a very mellow station. I could have read, I suppose, but I don’t like to read without my glasses on, so I just sat there and sipped my soda. I didn’t have a watch on, but I would guess it was about 90 minutes. Once they were pretty far along in the plug preparation, Dr. Ousterhout returned and began prepping the recipient site on my forehead. They pinned my hair back and swabbed my forehead with betadyne. They leaned me way back, and then started giving me injections again. In my case, it took a lot more for the front to feel numb, so don’t hesitate to mention you still have sensation in an area.

Next Dr. Ousterhout opened a large bag full of 3-centimeter-long pins about the width of pencil leads. Dr. Ousterhout explained that these were a recent development from Japan. In the past, hair transplants were either done as punch grafts (the kind I’d gotten before), which involve removing a round piece from the back and putting it into a smaller round hole made in the front. Micrografts in the past have been done by making an incision in front and putting individual hairs into each incision. The two difficulties with these incisions involve control. It’s basically like threading a needle to get each hair plug into these incisions, and once in, it’s a bit harder to keep the plug settled in the direction you want it to grow. The pins address both of these problems. First, he puts in as many pins as plugs he plans to do, then when it’s time to put in the plugs, he pulls out the pin and puts the hair plug in the hole. The hole soon closes up around the hair, leaving less scarring and allowing easier, more accurate hair plug placement. I suspect it also causes less bleeding and potential for cutting nerves. The earlier procedure I had done by the Chicago doctor bled profusely and left me with a couple of scalp nerves that tingled for several months after.

The pins did not hurt at all going in, but they made a sound like a shovel going through sod. Odd, but not bothersome. I had to stay very still and very quiet during this stage. Dr. Ousterhout was counting as he put in the pins, so I didn’t want to throw him off. He ended up doing about 350 instead of the 400 in my estimate, so Mira refunded the difference to my credit card account. There was a moment of concern at one point that they wouldn’t have enough plugs, but it turned out fine. Putting in the pins took about 90 minutes. Once Dr. Ousterhout was finished, I asked if I could see. I looked like a porcupine with metal quills– we all decided I looked pretty silly.

Every now and then I’d start sliding down in the chair and I’d need to readjust. If this happens, don’t make any movement until you’ve told Dr. Ousterhout and he gets to a good point to stop so you can move. Also, saline solution from the prepared plugs would occasionally drip on my face and drive me crazy. Since I wasn’t allowed to wipe it myself, I’d have to wait till they were at a good point to do it for me.

Once he was done, they were almost finished with the plug preparation. Hirumi came in to assist with placing the plugs. She would pull out a pin, and Dr. Ousterhout would put in a hair. The smaller, best-quality ones were put at the very front. Larger ones were placed further back. The only difficulties seemed to be if they got a plug that wasn’t trimmed properly, then it was difficult to fit them in. During the procedure, two of the pins fell out, but they were able to put in hairs before the holes closed up. Every now and then, they’d pull out a pin, and the hole would bleed a bit. This was easily fixed with a little pressure with a cotton swab. At one point I began getting sensation back in the area they were working on, so they stopped and added anesthesia in that area. The whole process was very labor-intensive and took a couple of hours. Everyone, myself included, sighed with relief when they put in the last one. They cleaned me up and put on a dressing in front. Hirumi then put a turban-style gauze bandage around my head and under my chin. If you wear glasses, make sure you can put them on with the bandage in place. Also, make sure your ears are not pressed too tightly against your head. Bring your scarf with you if you don’t want to be walking around with a bandage on your head. Once I was all wrapped up, they sat me up and had me wait a while to make sure I was OK. As I sat there, I sipped my other soda and read a magazine.

I had made plans with friends, thinking I’d be done sooner than it actually took. Plan on being there all day. They let me go a bit earlier than scheduled (around 4:00) so I could meet my friend. In all I’d spent just over 6 hours sitting without moving (perhaps a record for me!) and an hour before and after. The only instructions were to take it easy, and not to bear down. They gave me Vicodin, but I didn’t need any. The only unpleasant parts of the whole thing were the shots and having to sit still and quiet for so long.

Dr. Ousterhout said typical hair density is about 80-100 hairs/square centimeter. He estimated the density he achieved in my recipient area was about 23-25, and that they typically aim for about 50 for adequate thickness. Therefore, I will need at least one more procedure done, and I’m guessing a third to make it look perfect.

From there, I went to my room, got a bite to eat with a friend, bought a scarf (which I hadn’t done before the procedure), and went back to make some calls, write a bit, then rest. I’d brought an inflatable neck pillow and slept propped up. I had no problems sleeping.

6/13/97

I returned to the office at 10:30 to get my bandage removed. Hirumi took it off, cleaned things up a bit, then Dr. Ousterhout examined me. Everything looked fine, and he gave me the names of two Chicago doctors who could remove the staples from my donor site in 10 days. This additional work was done at no cost to me. Hirumi took a couple of pictures for me, I hugged everyone, and then I headed out.

I had tied my scarf under my chin before, but with the bandage off, I could tie it behind my head, which actually looked almost stylish. I spent from then until about 3:00 am meeting various friends, and I had no difficulties at all. I did take it easy going up hills, plus chewing and eyebrow movement were a bit hampered, but not much. I had a bit of swelling at my temples, but it was certainly not noticeable to others.

I slept in the next day, took a welcome shower, applied my Minoxidil, checked out around noon, and caught a 3:30 flight back to Chicago. I didn’t wear my scarf, since I can style my hair to cover most of the tiny scabs near my hairline. Once home, I soaked in the tub to get most of the remaining stuff out of my hair. Sleeping was no problem that evening.

6/14

I spent most of Sunday sleeping and taking it easy. I also wrote up this information while it was fresh. Monday I went shopping without getting a single stare. The tiny scabs on each hair started coming off in the shower and from rubbing on my pillow over the next couple of days. They itched a bit, as did the staples at the donor site, but I resisted the sometimes strong temptation to touch them. I continued to take it easy per instructions, and the whole recovery has been quite uneventful. When I press on a couple of the hairs, it seems they are touching a nerve, but it doesn’t hurt. The back seems fine, with very minor tenderness at either end of the incision.

6/23

I had my staples removed at Northwestern Hospital, a few blocks from where I work. Dr. Ousterhout had called and made arrangements with Dr. Lewis, so there was no charge for this appointment. I was in and out in 10 minutes. The staples were shaped like this –> (\/) <– Kind of like an office staple but bent into a V in the middle and with curved brackets. There was one that was a bit troublesome (he had to get another device to remove it), but it didn’t hurt. The raised ridge where the incision was went down that week, and now it’s hard to feel anything there except a few bristly short hairs around the site. It felt good to get them out and give the area a good shampooing.

I will need to wait another few months before getting my next series of transplants. My plan is to either do that in November or possibly to combine it with some cosmetic surgery in December.

7/6

The majority (at least 70%) of hairs fell out since the surgery. Oh well. The site still has some redness and flakiness, but overall it looks fine. As I mentioned, It’s totally unnoticeable with my hairstyle. I’ve been very diligent about keeping the area out of the sun. About six of the hairs are surrounded by slightly raised bumps of skin, but I suspect some of this will subside eventually. By this time next year, those hairs will be past bang length, and I’ll have done the rest of the transplants I need.

Some advice and instructions

** IF YOU ARE CONCERNED ABOUT YOUR HAIR LOSS, START USING ROGAINE OR GENERIC MINOXIDIL NOW.**

This is in all caps because it’s a simple, inexpensive thing you can start today to arrest your hair loss. Generic minoxidil is about $15 for a month’s treatment, but it’s been on special here for $10 sometimes. Rogaine is about twice that. You may have a period of fallout when you first start (I did), but eventually I found that thinner hairs at the corners of my hairline were growing back thicker. Also, I experienced an itchy scalp after I started Minoxidil, although the itchiness could be related to my surgery. I found that an over-the-counter antihistamine alleviated this

**I WOULD ALSO STRONGLY RECOMMEND GETTING ON AN ANTI-ANDROGEN OR TESTOSTERONE BLOCKER.**

Spironolactone is commonly prescribed as part of hormone therapy for MTF transsexuals. Among its effects, it can also help prevent hair loss. Talk to your endocrinologist about this.

I’ve also compiled a list of tips that anyone concerned about thinning hair should practice:

  • Wash hair with a mild shampoo frequently enough to keep the scalp clean, and use a conditioner or cream rinse. The sebum or oils that the scalp produces has high levels of the enzymes and hormones linked to hair loss.
  • Have a couple of brands made for your hair type, and switch every few days.
  • Shampoo gently, working it into your scalp’s oily parts with your fingertips, not your nails.
  • Shampoo often enough to keep scalp clean, but take care not to dry it out. Your scalp will compensate by producing more sebum.
  • Be very careful with wet hair. It’s much easier to pull out. Avoid styling it until it’s dried a bit.
  • Pat hair dry with a towel- don’t rub vigorously.
  • Avoid dryers and curling irons whenever possible.
  • Let hair dry naturally. The less you do to it when wet, the better.
  • Use a natural bristle brush or a wide-toothed comb.
  • If you hit a tangle, use your fingers to separate it, not your comb or brush.
  • If you feel you need to perm or dye your hair, have a professional stylist do it- they can choose the mildest treatment. Consider vegetable-based dyes. Use low pH shampoo. Better yet, don’t treat your hair.

A number of factors can add to hair loss. I’ve tried to eliminate as many as possible:

  • Limited blood supply to scalp: Rogaine helps with this (it’s a vasodilator), and it can’t hurt to massage your scalp occasionally.
  • Hats or headbands that are too tight can rub against hair and cause it to get more oily that it would without a hat.
  • Ponytails and other hairstyles like tight braiding or hairweaves can pull a lot of hair out. Avoid them.
  • Diet can affect hair- be sure you’re eating well. Consider a multivitamin. While you need a certain amount of fat and protein in your diet, some studies have made links between meat consumption and hair loss.
  • Stress can cause hair loss among other worse things, try to eliminate it.

Post-surgical care

The Chicago doctor I saw may have given me unsatisfactory results, but he did have a pretty detailed list of written instructions that seemed helpful to include here:

  • Don’t chew hard or chewy foods or gum.
  • First night after surgery, sleep in a chair or propped up with your head resting on an inflatable neck pillow.
  • No physical activity for 48 hours, including sex [not a problem for me lately!]
  • No bending from the waist. Bend from the knees and keep your head up.
  • No heavy lifting or other strenuous activity for at least a week.
  • Don’t shampoo until 48 hours after surgery.
  • While shampooing is necessary 48 hours after surgery, don’t let the force of the showerhead hit the grafts directly. They suggested using a cup to pour water on your head.
  • The crusts begin to fall off the week after surgery. Some of the hairs may fall out, too. In 3 to 5 months, the new hairs will appear.
  • If you color your hair or scalp, get it done before the procedure and don’t do it again for two weeks following.
  • Don’t disturb the donor or recipient areas when combing your hair.
  • Be very careful not to bump your head on car doors, cabinet doors, etc.
  • Don’t expose the recipient area to sun for three months after the procedure.

They gave me painkillers, but if you don’t need it, don’t take it, since it could cause vomiting which could pop out plugs.

Scalp numbness and tingling can occur due to small nerves cut during the procedure. This can last 6-12 months as the nerve endings regrow. I experienced both numbness and tingling in isolated parts of my scalp after my first procedure in Chicago, but Dr. Ousterhout’s procedure left me with very little of this.

Dr. Ousterhout recommended I begin using 2% Minoxidil (Rogaine or its generic equivalent) on the new plugs after the second day. Since I was already using it, this was not a problem. As I said earlier, I would suggest if you have hair loss concerns, you should start using Rogaine or Minoxidil NOW.

Things to bring

  • mild shampoo (baby shampoo, Neutrogena, etc.)
  • no pullover tops– bring buttoned shirts or things you can step into
  • loose clothes for the procedure
  • a hair clip if your hair is long
  • Rogaine or generic minoxidil
  • scarf or bandana or cloth headband or big floppy hat (optional)
  • an inflatable neck pillow (optional)
  • a hair dryer (optional)
  • a camera (optional)

Reminder:

It’s a good idea to go to the bathroom right before you start, as you won’t be going anywhere for 6 hours. Before we got going, I went to the cafeteria and bought a couple of sodas to ward off nausea and to keep my energy up.

Put a towel over your pillow at night in case you have a bit of spot bleeding, which I did.

About costs

I have deliberately omitted price information in this piece because your estimate might vary significantly from mine. Costs are determined on an individual basis at the time of your consultation, and they will depend on the complexity of procedures you seek and the efficiencies of doing more than one procedure at once. Dr. Ousterhout’s prices are competitive with other surgeons– maybe 15% higher for some procedures. To me, this is a nominal difference for the feeling of confidence I get from Dr. Ousterhout and for work I have to look at and live with the rest of my life. I feel that surgery is like any major investment– you want to get the highest quality available, and you have to pay a bit more for the highest quality.

Dr. Ousterhout uses state-of-the-art surgical techniques and the very latest equipment, and in my opinion, gets the best result. The process is very labor-intensive, but I found it went fairly quickly, as has my recovery.

That’s it for now. I’ll update this as things progress. I might even post some pictures.

Some heartfelt gushing

[I originally wrote this a few weeks after my forehead surgery, but it still applies.]

Those of you who know me know that unalloyed praise of the following type does not pour forth readily from me. But I have been deeply impressed by my experience with Dr. Ousterhout.

I believe that in every person’s lifetime, you come into contact with just a handful of really extraordinary people. I count Douglas Ousterhout among my extraordinary acquaintances. He is a brilliant, humble, compassionate man who has mastered an immensely difficult craft: combining the exacting artistry of sculpting with the technical skill required of surgery. As a dentist as well as a plastic surgeon (talk about a lot of school!), he has unique insights into surgical methods to reshape your face. Add to this rare combination the fact that he has dedicated much of his career to serving our transgender community, and you start to get a sense of how wonderful he is. How fortunate we are to have his expertise available to us!

Not only has he mastered facial feminization, but he also treats you with a kindness and a genuine respect for what it’s like to be transgender. He works on everyone from crossdressers to transsexuals. He sees the feminine, the beautiful in your face and brings it forward. He’s surrounded himself with the most competent, accommodating associates. His staff is, and I am not exaggerating, the nicest and most efficient group of people I have ever had the pleasure of working with. They all make you feel like you’re part of a partnership working toward the same goal, and they take great pains to make sure your every need is met.

I strongly recommend consulting with him about your options. If you can’t make it to San Francisco, he frequently lectures at transgender conventions and conferences, and often gives consultations at those. His work is the best available, and his advice could really help you prioritize what you need to have done in order to pass, if that’s your goal.

Dr. Ousterhout’s skills have made the greatest difference in my appearance and have boosted my self-confidence exponentially. If you feel you’d like to feminize anything about your face or hairline, I honestly cannot recommend Dr. Ousterhout highly enough.

You may reach him at:

  • Dr. Douglas K. Ousterhout
  • San Francisco Institute of Plastic Surgery
  • Davies Medical Center, Ste. #150
  • San Francisco, CA 94414
  • Phone: (415) 565-6525
  • Affiliations: HBIGDA (Harry Benjamin Institute), plus fellowships in 18 (!) medical societies
  • Credentials: M.D., D.D.S., F.A.C.S.
  • Education: U. of Michigan D.D.S. ¬61, M.D. ¬65; Captain, U.S. Army Medical Corps ¬66-’68; Chief Resident in Plastic Surgery, Stanford U. Med. Ctr. ¬71-’72; first American to assist plastic surgery pioneer Paul Tessier in Paris; Board certified and in private practice since ¬74.

Oh, and since a lot of people ask me, it’s pronounced OH-ster-howt.

APPENDIX: RESEARCHING AND CHOOSING A HAIR OPTION THAT’S RIGHT FOR YOU

Look in magazines. Women’s fashion magazines have tons on dermatologists and cosmetic surgery, but since hair transplants are usually undergone by men, check out magazines like GQ, Esquire, and Details, too. If you can stomach all the cool-guy junk, you might find something of use in them. Major cities usually have a local lifestyle magazine which often features ads and articles on local cosmetic surgeons. (For instance, in Chicago, these magazines include North Shore, Chicago, and Lake Shore Drive. Within the last year, each had stories profiling prominent cosmetic surgeons in town.) I’ve also noticed ads in newspapers (often in the sports section) or in sports-themed magazines and other magazines with large male readerships.

Look in the yellow pages. If a business has a display ad instead of just a listing, it’s probably a clinic that does a large volume of hair transplants. This can be good and bad. While the price is usually much better at a clinic, my impression (and you should form your own by visiting) was that they were more interested in the hard sell than they were in the quality of care. However, I can’t say what the results are — for some, the savings may be more important than the incremental gain in quality.

Use your computer. Subscribe to the _alt. baldspot_ newsgroup and read their hair loss FAQ.

It’s a pretty up-to-date bulletin board describing various treatments and research. There’s a physician who posts frequently and is considered the unofficial newsgroup answer man about about hair loss. Start reading it if you’re considering doing any hair restoration. Most of it won’t apply, but every now and then something interesting gets posted. Several transplant doctors and clinics also have websites which give good overviews of various procedures.

Ask around. While most personal acquaintances probably aren’t willing to talk about hair loss with you, the anonymity of the Internet makes it the perfect forum to talk about this. So while I haven’t told anyone but my closest friends, I am happy to share my experiences over the net with tons of strangers. Others are too, so email people who post something pertaining to your questions.

Don’t limit yourself just to surgery when researching, either. I spoke with several Hair System places to get a comparison of price and to compare pros and cons. One top-quality hairpiece for my amount of recession was about $1200, along with some preparation costs. They said most people had two made so that one could be repaired and maintained while the other was worn. This cost additional unspecified money, and eventually (after a few years) you need to buy new ones. They had some convincing hairpieces, but for me, the hassle of maintenance was a big issue. Plus, while some hairpieces looked nice, they didn’t offer the flexibility and naturalness of having your own real hair. For $2500-$3000 every five years, I figured I would eventually break even on the cost of transplants, and it’s kinda like renting vs. owning: when I’m done paying for transplants, the hair’s mine forever.

So after a few months of research, I decided what was best for my hair loss: surgery.

RESEARCHING SURGERY

The main thing is to decide what’s best in YOUR SPECIFIC SITUATION. Everyone has different hair loss and hair type, different priorities and different economic issues.

There are several surgical procedures done to alleviate hair loss. The hair loss FAQ posted on alt.baldspot describes them in detail, but I’ve summarized the main ones here. Here’s how I decided:

FLAPS: This surgery involves partially detaching a flap of hair-bearing skin from the side of the head and suturing it to the front. This is a MAJOR procedure usually reserved for people with much more hair loss than I had, so I ruled it out early. Despite the fact that they move the flap without shortening the hair, thus giving very dramatic results, three things seemed very problematic: a noticeable scar along the hairline and the unnatural direction the hair sometimes falls when moved to the front from the side. The real kicker was a horror story I read in _Chrysalis Quarterly_ about someone whose flap didn’t take, leaving her with a necrotic strip of dead skin which had to be removed and left a 2 x 8 inch scar right in the center of her forehead. Yuck! Some people have been very pleased with the results, though, so don’t rule it out without checking into it.

PLUGS: Standard plug transplants are the most common method of surgical hair replacement, but they’re certainly not without risks. I read some stories that made (what’s left of) my hair stand on end. Scarring, rejection of plugs, plugs set too deep or too shallow, and the doll’s-hair look that can happen when transplants are done improperly or incompletely. In my case, I decided not to go with a chain of clinics, but rather with a plastic surgeon with extensive experience. Check accreditation. In my research, I found an article on doctors who spent one weekend seminar learning techniques by slicing honeydew melons with scalpels, after which they were considered qualified to do transplants. I’ve listed some numbers at the end of this where you can call to get names of accredited surgeons in your area.

SCALP REDUCTION/ADVANCEMENT: Here, they cut out the bald part and sew it together so the hair now covers it. Once again, this is done for more advanced hair loss, and you often have to get transplants to hide the scars. Some doctors perform a surgery where they insert an inflatable bag under the skin at the crown, and then you spend several weeks filling it with more and more liquid to stretch the skin. As you might imagine, this could be a pretty odd look, so it’s not for everyone. Once it’s fully stretched, they simply pull the stretched skin toward the bald area to cover it. You don’t get the potential doll’s hair of plugs that way, but you get to walk around looking like a _baby conehead_ for a couple of months, as one patient (who was pleased with the results) described it.

Dr. Ousterhout performed a scalp advancement on me that was able to move my hairline forward over 4 centimeters (about 1.5 inches). The scalp advancement combined with forehead recontouring and a trachea shave took me from not passable to 100% passable. The scalp advancement I got is described in detail in my piece about my forehead surgery. It’s available at most websites that have this piece posted. If you can’t find it and would like a copy, please email me at the address at the end of this piece.

CONSULTATIONS

While the clinics usually offer free consultations, these are often with Sales Associates. Don’t let these Salespeople talk you into anything. Ask to see the person who will be performing the procedure. Bring a list of questions:

  • How long have you been doing this procedure?
  • How many patients have you performed it on?
  • May I see pictures of YOUR patients (not just ones in brochures)
  • Are there any of YOUR patients I can talk to?
  • How much does the procedure cost?
  • Are there any preparation fees or other costs besides the per-plug charge?
  • Describe the procedure.
  • How many grafts are usually done in a session?
  • How many hairs would there be per graft?
  • How many sessions will I need?

When you consult with dermatologists, ask the same questions. Some might try to hurry you out, but be persistent. Get all questions answered to your satisfaction. Be warned– while going to clinics is often a free consultation, going to see dermatologists means you’ll usually be charged a for an office visit. Consider that part of the overall price. It’s tough to drop fifty to a hundred bucks to ask questions, but it will help you get the best answers and will give you an impression of the doctor and his or her abilities. Plus, a lot of them deduct the consultation fee from your first hair transplant. Also, I found it helpful to ask dermatologists and plastic surgeons about other skin procedures I was interested in, such as chemical peels once my electrolysis is done, and the repair of a couple of small scars and blemishes. None of the doctors with whom I spoke were shocked when I said I was a transsexual (beyond a raised eyebrow or two), but I thought it was important to tell them since it might change some of their answers. The main thing is to make the most of each visit.

Finally, you might consider a couple of things concerning hair. Start growing it out now. It will take a few years. You might also consider trying something to arrest your hair loss, such as Rogaine (generic minoxidil is half as much). My hair loss was not quite as pronounced as yours, but it was significant. You may not have regrowth, but it should halt further recession. Growing your hair out is not only free, it saves you haircut money. Use that money for minoxidil.

Some people eventually decide to get a small hairpiece for the front, or wear their hair in a style that covers the forehead. I chose a surgical option, and it was the right choice for me. However, I wouldn’t wait till you have money for hairpieces or surgery. Start doing something now, start growing that hair and working on the voice. But most of all, find a way to get therapy.

APPENDIX: OTHER USEFUL REFERENCES:

Besides the methods described in Appendix B, you may find the following numbers useful for answering general questions as well as getting information on specific doctors.

If you are considering flaps or scalp advancement, the following doctor also has innovative procedures that have produced good results for some transsexuals:

  • Dr. Toby G. Mayer
  • The Beverly Hills Institute of Aesthetic and Reconstructive Surgery
  • 416 N. Bedford Drive
  • Beverly Hills, CA 90210
  • Phone: 310-278-8823

American Academy of Dermatology, (708) 330-0230doctor referrals and verification of board certificationAmerican Society for Dermatologic Surgery (800) 441-2737consumer hotlineAmerican Society of Plastic and Reconstructive Surgeons (800) 635-0635information service, doctor referrals and specialties, verification of board certificationAmerican Board of Medical Specialties, (800) 776-2378verification of board certificationAmerican Board of Plastic and Reconstructive Surgery, (215) 587-9322verification of board certificationAmerican Medical Association (312) 464-5000general reference

FINAL THOUGHT: You and everyone who ever looks at you will be looking at your transplants or hairpiece every day for the rest of your life. Make your choices with that in mind.