The hair-raising cost of hair transplants

Dr Catherine Davies leans back in her leather chair after another long day in surgery. Davies does hair transplants and has a waiting list of several months. Her clients are mainly men.

Everywhere in the swish Winston Ridge clinic in Johannesburg are photographs of attractive male icons with lush hair. It's the last thing many clients will see before they're sedated.

Follicular unit extraction involves transplanting between 2,000 and 4,000 of your own hairs from the horseshoe ring at the back of the head, to the balding area. "Hairs here are very strong so wherever we put them, they're there for good," says Davies. "It's your own wealth; you're just redistributing it."

You can't use another person's hair unless it's an identical twin.

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Davies says the technique has revolutionised the industry because it is less invasive than the old "strip harvesting" method, which involved cutting and stitching.

But it's still no trip to the salon. I cringe as Davies extracts hairs with a cylindrical punch that penetrates 2mm to 3mm into the skin. Extraction takes about half of the five- to eight-hour procedure. Davies says she goes into a meditative state. "It's very satisfying getting the hairs out."

Each hair or group of hairs is threaded through a needle and implanted. "You have to be precise. Too deep and you end up with holes like on a doll's head." Davies says that in the future it may be possible to bank follicles the way we do stem cells as a form of insurance.

She has a gentle, calm bearing, a plus in her profession as she often finds herself counselling her clients. "There's a lot of anger. One client was furious with his father from whom he inherited his hair loss. Every client has a story."

Some blame their exes for their hair loss. "I often see divorcees. One patient whose wife passed away wanted a transplant as he was re-entering the dating scene after many years."

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Clients pay big money - between R40,000 and R80,000 (at R20 a hair). It's no quick-fix either, taking about a year for the hair to grow. Davies often has to placate clients. "They phone me after 10 days to say it's taking too long."

Many meticulously document the process. ("And here's my hair from a frontal view," says one man, scrolling through an extensive photo gallery.)

The odds of the hair "taking" to its new environment are high since only "happy, healthy follicles" are used (nurses manually count each hair). Davies also gives clients a "vampire treatment for hair", platelets taken from the client's blood are injected into the scalp to stimulate growth.

"If the client has a bushel of their own hair to donate, I can perform miracles," Davies says. "But sometimes men with thin hair bring me photos of a glossy-haired model." She sighs.

Davies closed her GP practice to do hair transplants full-time 10 years ago because of the demand. She does one transplant a day. Many of her clients fly in from overseas - Saudi Arabia, the UK, Germany. "I used to get a specific kind of person. Your CEO type. Now I get all sorts, which shows that hair loss affects everyone."

She says she's one of a handful who perform follicular unit extraction in South Africa. "Most plastic surgeons find it too repetitive."

She finds it fulfilling. "The best is getting SMSes from clients who are so grateful. They often report people saying, 'You're looking so youthful. Have you been on holiday?'"

Davies says the way some men are "severely affected" by hair loss has been a learning curve. "They can remember the day someone said they could see a bald patch. They felt they got more attention when they had hair, and stop going out. It affects their self-esteem."

Male pattern baldness - or androgenetic alopecia - is the most prevalent form of male is the most prevalent form of male hair loss. It's thought to be caused by a genetic susceptibility to androgens. Davies says it affects as many as four in 10 men in their 40s.

Factors like stress and toxins can bring on hair loss prematurely. "Something like weight you can control; with hair you're helpless," she says. The quote on her e-mail signature - "I wish you enough" - is telling.

Hair loss is not just a loss of hair, but masculinity and virility, says one transplant client I'll call Baldy. "Take away a lion's mane and you have a pathetic creature that's more likely to get eaten. You're exposed, wearing your vulnerability."

Another client, Ryan Hindson, says the psychological damage of hair loss runs deep. He was 33 when, four years ago, all his hair fell out. Doctors diagnosed him with heavy metal poisoning.

"I couldn't stand to look at old photos." He speaks of his former "beautiful, blonde" hair the way you would a lost lover, his eyes welling up. "After losing my hair, people said I looked like I was in my 40s. From being an extrovert, I became withdrawn and depressed. I didn't feel I was part of the greater tribe anymore."

He heard about Davies through a friend. "I cried all the way through the first treatment. This is why I'm prepared to speak about getting a transplant. I want to give people hope."