Hair transplant or hair replacement?

Andreas Krämer Hair4life



Hair loss sufferer, consultant since 2004, co-author of the book “Hair Transplantation Guidebook” by Alliance4Hair, founder of Propatient with lawyer Chr. Bomke, co-founder of the HTTC training center for doctors. Known from SWR, SAT 1, ZDF, Spiegel and many others. About Us

Hair transplant or hair replacement – hairpiece (toupee) for men and women? Information on integrative hair transplantation – transplanted hairline and forehead line in combination with a hair replacement

People who suffer from hereditary hair loss (AGA, androgenetic alopecia), usually also worries about what will happen to their hair status. Will the situation gradually worsen so that there is hardly any natural hair left? What can be done if therapies do not work and there is no improvement? The receding hairline may already be an enormous eye sore and the psychological burden increases for both men and women, especially for affected women. But especially young people, regardless of whether they are women or men, feel very burdened by the loss of hair, and in comparison to friends and colleagues with a full head of hair, they feel uncomfortable and generally very disadvantaged, especially since, especially at a very young age, the appearance is the only way to present oneself as fit, healthy and attractive at work, in private life, as well as with regard to finding a partner. But men in the so-called “best age” also suffer greatly from losing their hair. Not everyone looks good with a bald head or a “mm hairstyle”; moreover, the appearance often expresses a certain “hardness” which is by no means intended. In many professions, it is important for those affected to convey a sense of sovereignty and sophistication overall and also by means of an attractive hairstyle.

Even very young women and men are already affected by hereditary hair loss

It is becoming clear that hereditary hair loss in women and men can occur as early as puberty and that the age limit is steadily decreasing, as reports from those affected confirm this, among other things, in relevant Internet forums on this subject. But what are the realistic options if the affected person is too young for a therapy with medication or if this cannot bring about any improvement?

Hair transplantation or hairpiece – hair replacement (formerly: toupee) for women and men?

Man with hair replacement hairpiece (toupee) man

Haarersatz- Haarteil (Toupet) Mann
Hair replacement hairpiece (toupee) man
Resultat einer Haartransplantation beim Mann
Result of a hair transplant for a man

It is almost impossible for a third party to assess for another person which of the two solutions to remedy hair loss/hair replacement could be the optimal treatment. Whether hair transplantation or hair replacement (hairpiece/toupee) for women and men – both options have a number of factors that need to be carefully weighed in the pros and cons. First and foremost, however, is the person concerned, because he or she must first consider whether both options – hair transplantation or toupee (hair replacement/hairpiece) – could be an option for improving the hair situation. In the following, a comprehensive consultation should take place to find out whether a person affected by hair loss is at all eligible for a hair transplant, because unfortunately not every person affected by hair loss can be treated with an autologous hair transplant.

When can a hair transplant not be performed?

First of all, various general conditions must be met in advance, for example, before you discuss the planning of your own hair transplantation with a consultant or directly with an experienced hair surgeon. Important and decisive are:

  • The cause of the hair loss must be diagnosed as androgenetic alopecia (hereditary hair loss). Only with this background is it guaranteed that a donor zone is available at all, from which the follicular units (natural hair bundles, FUs) to be transplanted can be obtained. In the case of other causes of hair loss, such as alopecia areata (extensive hair loss on the entire head) or a diffuse pattern of hair loss with or without findings, transplantation of the patient’s own hair cannot be considered
  • The donor area is too thinned out and does not offer sufficient donor hair
  • The patient’s state of health must permit the procedure. If there is an extreme tendency to scarring, a cardiovascular disease, an intolerance to anaesthetics or, for example, haemophilia (haemophiliac disease, mainly in men), then hair transplantation is also not possible or (depending on the condition) only possible in absolutely exceptional cases

In order to examine the possibilities of hair surgery and custom-made hair replacement more closely and to be able to make a balanced decision, those affected by hereditary hair loss (both men and women) should inform themselves in detail about the essential differences and special features. There are serious differences between hair replacement/hairpiece/toupee and hair transplantation.

In contrast to a hair transplant, one should know about a hair replacement/toupet (hairpiece):

In earlier times, hair replacements were only known as theatrical wigs and toupees for men – apart from the “official” wigs, which were worn in higher offices, as is still practised today in the British House of Commons, for example. But these did not fit, neither then nor now, and aesthetically they are absolutely no feast for the eyes. In the meantime, however, hair replacement has left its niche existence and, just like hair transplantation, has become a modern, very appealing option to achieve new hair splendour in case of hair loss. Today, there are only two main types of wigs: custom-made hair replacements with various frames (bases) and complete wigs, which are designed to cover the entire head and are usually worn on top of the patient’s own hair. As a rule, it is women who are fitted with wigs, but both sexes are also fitted if there is complete hair loss. The most optimal hair replacement in the case of hereditary hair loss (androgenetic alopecia) and also in the case of a diffuse pattern of hair loss are custom-made hairpieces. They are made on foil or lace. Which of these options is used depends on the wishes and habits of the user. Lacemontures (tulle-like net underlay) are available in many different variations. From “a little coarse and very resilient” to “delicate and quite sensitive”. A mix of materials can also be configured for ordering, but here too it depends on what exactly and individually is required and how one’s own needs can be optimally met, taking into account the best possible price-performance ratio. This results from a comprehensive consultation with renowned hair replacement studios.

The special features of hair transplantation and hair replacement (toupee) can already contribute to the decision in advance when it comes to choosing the best possible own supply for men or women.

Pros and cons of hair transplantation compared to hair replacement/toupet (hairpiece)

  • Renowned experts in hair surgery achieve first-class results
  • As a medical procedure, there are risks associated with hair transplantation
  • A hair transplant offers a permanent result which can be treated like own hair
  • With a hair transplant, there are no restrictions after 12 months (final result), such as the daily procedure with hair replacements
  • In case of a positive outcome, after the final result has been achieved, no one notices that hair has been added through a hair transplant, keyword naturalness
  • A hair transplant can significantly rejuvenate the appearance
  • Hair transplants are expensive
  • After a hair transplant, the final result requires about 12 months of “waiting time”
  • Hair transplantation is a procedure on the human body and therefore carries some risks
  • Hair status may deteriorate due to the progression of hereditary hair loss, making follow-up procedures necessary
  • Significant costs may be incurred in the event of follow-up treatments

Example result of a successful hair transplant with 7305 grafts

Pros and cons of toupees – hair replacement (hairpiece) compared to hair transplantation

  • Hair replacement is not a surgical procedure like transplanting your own hair and therefore does not carry any risks
  • A custom-made hair replacement can achieve an excellent, natural result (prerequisite: successful selection and some skill in applying it when self-supplied)
  • Unlike a hair transplant, a toupee/hairpiece/hair replacement can achieve an opaque result
  • Hair replacement can “grow with” the patient. If the hair loss continues, the next hair replacement will be adapted to the current thinned out area
  • A hairpiece can be worn in the case of any cause of hair loss
  • Made-to-measure hairpieces allow for an extremely precise fit, so that there is usually no “foreign body feeling”
  • The fitting (substructure) can be adapted to the needs of the affected person
  • The length of the hair can vary, so that one can gradually move from short to long hair in what appears (to outsiders) to be a natural way
  • A toupee is much cheaper than a hair transplant, but the person usually needs a hair replacement for a longer period of time, so that after a certain period of time, new purchases are necessary
  • Custom-made hair replacements should be glued to the scalp to ensure the best possible wearing comfort
  • Adhesives and removers can cause unpleasant skin reactions under certain circumstances
  • With a toupee (hairpiece), one has to live with certain restrictions – depending on which hobbies are preferred and whether, for example, one takes care of the hair oneself or has to visit a studio for care, which is associated with not inconsiderable costs

Successful example of hair replacement – hairpiece (toupee) for men

What to do if a hair transplant or a toupee “only” is not an option for a woman or a man?

Although many of those affected by hereditary hair loss have already been treated with today’s modern and sophisticated methods of hair transplantation and toupees/hair replacement, it has become apparent that a certain and special clientele can unfortunately not be served and satisfied with any of the possibilities. Especially in the presence of the very often occurring receding hairline, this is perceived as a very stressful problem. Who are these people and when can such a case occur?

  • When a hair transplant had to be rejected because there is not enough donor hair available for a large-scale, successful treatment
  • When several hair transplants have already been carried out and the hair loss still progresses incessantly and drastically
  • If a “large” hair transplant is out of the question (personal attitude, financial concerns, etc.) and hair replacement alone is not satisfactory
  • If hair replacement is desired, but the front attachment is not pleasing or keeps coming loose due to sweating or oily scalp
  • If a toupee (hairpiece/hair replacement) has been chosen, but the person concerned absolutely wants to wear a hairstyle in which the frontal part is styled upwards, so that “non-recognition of the hair replacement” can hardly be guaranteed

For all those people who are still looking for an adequate replacement for their lost hair, there may be another option that has recently emerged. Consultants for hair transplants and hair replacement, as well as hair surgeons, have started to think about how to help those for whom none of the mentioned measures can be a successful option. A combination of both options, namely “hair transplantation + hair replacement”, can be a worthwhile and very appealing alternative here.

The integrative hair transplant – or hair replacement/toupet (hairpiece) + transplanted front

Is this perhaps a new, forward-looking path that will gradually establish itself as a stand-alone measure in terms of “hair replacement”? It seems at least that this possibility is becoming increasingly popular among women and men (affected women and men), who unfortunately could not be helped in the ways known up to now. It has to be said quite clearly: the frontal hairline (hairline on the forehead) is unfortunately still weakening in the solution of hair replacement.

It would be conceivable and feasible to have the hairline filled in or redesigned by means of a hair transplant and to place the hair replacement behind it. If present, the receding hairline is also eliminated in this way and a new, natural hairline is formed. The front part can be combed into the toupee/hairpiece and the overall look is designed in such a way that despite the hair replacement, a natural hairline is always visible and by no means the beginning of the hair replacement. The hair grows out of the scalp and no outsider gets the idea or sees an occasion that a hairpiece could contribute to this new hairstyle.

At this point, some people may think that many celebrities and film stars wear a toupee/hairpiece/hair replacement in their roles or in their private lives, which, according to appearances, is completely “invisible” even at the base of the forehead. Apart from the fact that almost every hair replacement provider’s website confirms that the front is invisible. Hand on heart: Which supplier of a product would highlight the negative sides and not rather emphasise all the advantages – even if the statements may not always be tenable? In reality, it looks like a so-called “film attachment” can indeed be obtained with hair replacement. However, this is comparatively extremely expensive and also not necessarily suitable for everyday use. It is such a delicate workmanship that those affected usually do not enjoy it because it very quickly becomes unsuitable. In film roles, the front part of the hairpiece is not recognisable as such because make-up artists and make-up artists know their craft and create first-class visions by means of make-up utensils and special products. No example should be set here, because this handling does not correspond to that of a normal citizen who wants to master his everyday life with hair replacement in the best possible way.

Conclusion and procedure whether hair replacement/toupet (hairpiece) or a hair transplant

Hair transplantation still offers men, as well as women (see also hair transplantation for women), the most effective and natural results in the case of hereditary hair loss – especially with regard to natural aesthetics. Anyone who wants to make a decision about hair surgery or a hairpiece/toupee should not make a hasty decision and at least get detailed information and advice in all directions. The new alternative mentioned, “integrative hair transplantation”, also requires very intensive consultation, as is the case with holistic hair transplantation. It may even be possible for patients who suffer from diffuse hair loss to undergo this procedure, provided that the volume of the hair crown allows it according to a professional assessment. Among the experienced and recommended experts for hair surgery, some have specialised in hairline shaping or have already made a name for themselves in this respect. Your consultant will advise you on which specialist may be a first-class choice for your individual case. First of all, it must be clarified whether and when the hairline can be filled in by means of transplantation. Only then, in the second step, can the hair replacement order be made to measure. Since there is a waiting period of about 12 months until the transplanted hairline is fully formed and can therefore only be measured exactly at that moment, there is a sufficient time window after the hairline hair transplantation to visit several renowned second hair studios and decide on the basis of the possibilities there how the later toupee/hairpiece should be explicitly designed. In this way, you are well on your way in terms of planning and preparation and can look forward to an appealing and aesthetically very successful hair situation.

Are you interested in hair surgery but worried about your ability to socialise after the transplant?

Read here about the possibility of a hair-transplant without shaving the hair.