Growing bald gracefully appears to be on the decline with body image issues on the rise among men

There are lots of men wearing headbands. Not the thin, fashionable ones frequently sported by long-haired footballers. No, these are the thick elasticated cotton type, reminiscent of the 1980s. The ones that tennis ace John McEnroe used to wear; the ones popularised by breakdancers and body-poppers. This headband-wearing isn’t, however, a revivalist fashion statement. These headbands are being worn by recovering hair transplant patients. I’m in Istanbul and everywhere I look, I see members of the headband gang, men bearing the painful signs of freshly performed follicular transplantation.

Istanbul has become a popular destination for hair restoration. Wearing a headband after the surgery helps prevent swelling of the forehead and eyelids, a common post-operative consequence. Some of the headbands, I observe, are emblazoned with the names of the clinics, or the celebrated surgeons who performed the procedures – branded headbands. Hair transplantation is apparently big business and Istanbul, by all accounts, boasts some excellent surgeons and state-of-the-art facilities. A quick walk around Taksim square, a popular tourist area in Istanbul and you will see that the hair restoration industry is booming.

A recent survey conducted by the International Society of Hair Restoration Surgery (ISHRS), based on figures from 300 doctors, states there were 635,189 hair restoration procedures performed worldwide in 2016, a 60 per cent increase from 2014. The survey also indicates that the market grew from $2.5 billion in 2014 to $4.1 billion in 2016. As a region, the Middle East accounts for the largest number of facial hair transplants and is second in hair restoration procedures overall. The vast majority (86 per cent) of patients are male and, surprisingly, nearly one in five of them are still in their 20s. Half are under the age of 50.

As a body image issue for men, male pattern baldness, or androgenetic alopecia, is ranked number one. Number two is weight gain. Thomas Cash, emeritus professor of psychology and author of The Body Image Workbook, suggests that our hair as a body part holds particular significance for wellbeing. Across cultures, hair has been used to indicate gender, status, values and group membership. In short, hair can be an essential part of our self identity. Things that threaten our identity, such as hair loss, can disturb our wellbeing.

Previous research has associated hair loss with low self-confidence, impaired quality of life and even psychological disorders, including depression, anxiety, trichotillomania (hair-pulling disorder) and body dysmorphic disorder, or extreme appearance anxiety. Of course, not everyone who loses their hair experiences such severe distress but some do.

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If people feel this badly about their appearance, they might be inclined to opt for a surgical procedure, the most common being hair transplant with follicular unit extraction. This procedure is not for the fainthearted as it can take 20 hours to complete and involves the doctor (sometimes robot-assisted) plucking thousands of hairs from the back of the head and re-inserting them one by one where they are needed most. The target site is typically towards the front of the scalp although eyebrows and beards are sometimes the beneficiaries too. I’m told it is painful and it is obviously bloody.

For some of us though, this ordeal is worth it and growing bald gracefully appears to be on the decline. Body image concerns and appearance anxiety among males are on the rise. Sixpacks and a full head of hair are increasingly pursued with a relentlessness bordering on obsession. This increase in physical appearance concerns has also coincided with a rapid rise in the rate of eating disorders among males.

Have we become appearance-obsessed? Is “looking good” really synonymous with feeling good? The technological improvements in hair restoration procedures make staving off baldness a reality, albeit a painful and costly one. However, if we were less appearance-obsessed, male pattern baldness would be less of an issue.

In 1989, Andre Agassi, then a 19-year old, headband-wearing tennis ace, stepped out of a white Lamborghini, lowered his sunglasses, looked to the camera and mouthed the immortal phrase: “Image is everything”. He was shooting an advertisement for Canon cameras. This advertisement has proven almost prophetic. In the coming decades, I suspect the headband gang is only going to expand.

Dr Justin Thomas is an associate professor at Zayed University