Hair loss affects most men and women, but we all deal with it in wildly different ways. While many accept hair loss as a fact of life, others are profoundly shaken by their change in appearance.

Those who struggle with hair loss find that their self-esteem plummets, and they may withdraw socially. “Studies investigating the impact of hair loss have shown that people experience a significant level of emotional distress related to hair loss with resulting social anxiety, poor self-esteem, negative body image, but also the psychological sense of powerlessness,” explained Dr. Ashwini Nadkarni, an assistant professor of psychiatry at Harvard Medical School.

Slowing or reversing hair loss can help people feel significantly better, improving quality of life, self-esteem, body image and overall psychosocial functioning, she said. There are various ways of addressing it, including medication and laser therapy.

But hair transplants are growing in popularity. They’re effective, have high success rates, are relatively safe and have few complications. The downside of the procedure is that it is expensive and, according to Este Nove hair transplant surgeon Dr. Yücel İskender, the full results usually aren’t apparent for 12-18 months.

Nevertheless, hair transplant patients are usually happy once they see the results. But not everyone …

Sometimes, a hair transplant fails because the recipient wasn’t a good candidate in the first place, perhaps because they were too young or because their hair loss was occurring too rapidly and hadn’t yet stabilized. Other times, hair transplant surgery fails because qualified technicians did not perform the surgery and patients wind up with odd hairlines or insufficient growth.

Helene Zupanc, a therapist at Outsmarting Anxiety and OCD who has had a hair transplant, explains that sometimes patients believe their successful surgery failed either because they had unrealistic expectations or suffer from body dysmorphic disorder, which causes them to fixate on perceived flaws that can’t be addressed by a hair transplant.

Below, we spoke with two men who shared their experiences.

‘There’s no way to go from balding to fully hairy.’

Stand-up comedian Shaun Eli Breidbart saw his father and older brothers losing their hair and wanted to avoid their fate. According to Breidbart, “looking better for women was a prime reason” he didn’t want to go bald.

First, Breidbart started using Rogaine, a medication to prevent hair loss. The medication helped, but he was still losing hair and started looking for other options. When he was 42, Breidbart went to his dermatologist for advice and came away with a suggestion to try a hair transplant.

Breidbart underwent the half-day process shortly thereafter. First, the surgeon used a tiny needle to poke holes in Breidbart’s scalp “and then squirted liquid many, many times in many, many places” to numb the area where the transplant would take place. “It burned,” he told HuffPost.

After that, the surgeon “shaved part of the back of my head, then cut a strip of skin and sewed up the gap. He gave the strip to two nurses who, working with magnification, cut out each individual hair follicle while he poked more holes in my head with a needle. Then, he planted the follicles,” Breidbart explained.

Breidbart went home the same day but had to be careful not to disturb the newly inserted follicles. He was not allowed to shower or exercise for several days. He also had to sleep with his head elevated. After he healed, Breidbart had to wait to see the results. “The hair grows back, but some of it falls out and then regrows. So it’s months and months before it’s noticeable,” he said.

Although Breidbart was ultimately happy with the results, he said, the impact was subtle. “It’s not like you go from bald to Demitri Martin or Fabio,” he explained. After the hair transplant surgery, others noticed a difference in Breidbart’s appearance. However, they often couldn’t put their finger on what had changed. “People didn’t realize it was hair. It’s common to get asked if you’ve lost weight,” Breidbart said.

After a few years, Breidbart decided he wanted more coverage. He’s since had two more hair transplants. “I still look like I’m losing my hair, but it’s been stable for probably a decade,” he said. Breidbart would like a fuller head of hair but doesn’t think a fourth surgery is in his future. “If they could clone hair and give me a full head of hair, I’d probably have another hair transplant, but absent that, there’s no way to go from balding to fully hairy,” so it’s not worth the trouble, he said.

Although Breidbart doesn’t think his hair transplants have made him more confident, he thinks that they helped him “from getting less confident.” Although Breidbart cites the high cost and “taking a day off, plus having to be careful about head-related stuff for a while” as downsides to his hair transplants, he has no regrets. Although Breidbart doesn’t know what his life would have been like if he hadn’t had hair transplants, he thinks they had a positive impact. “We don’t tend to see bald men as sex objects unless they’re still otherwise attractive or have some other quality,” he said.

‘My appearance is no longer just an unfortunate quirk of nature but is the result of poorly done work completed under false pretenses.’

Tutor Christoper Moore started losing hair in his 20s, causing him to “obsess terribly over photos and mirrors and different lighting.” He was desperate to find a solution to help him regain his confidence. By the time Moore turned 30, he had already tried two types of medication to prevent hair loss. When those didn’t work, he turned to hair transplant surgery as a “last resort.”

Moore researched various clinics before settling on a clinic in London that was “supposedly reputable.” He explained that “the clinic had excellent reviews, and I was impressed by the photos of other people’s results on their website.” Before his surgery, Moore had a consultation. He found the staff “helpful and reassuring” and was confident that the procedure would be a success. However, despite the clinic’s stellar reputation, things didn’t go as planned, although the extent of how badly things went was not apparent until months later.

According to Moore, the procedure went off without a hitch. “The transplant itself took a few hours and consisted of several stages,” he explained. First, parts of his head were shaved, his head was numbed, and he was given an anti-anxiety medication. Then, “grafts were harvested from the donor area with a punch tool and sorted into different types,” he said. Once technicians harvested donor follicles, the surgical team made incisions where the new hair would be implanted. “This didn’t hurt, but the sensation of the tool going in and out of my scalp was a strange one,” Moore explained. After a lunch break, the harvested grafts were planted into the recipient area, Moore said.

“I was woozy and semi-conscious for quite a lot of this, a combination of the medication, the anesthetic and emotional exhaustion,” he said. Once the surgery was complete, “my head was wrapped in gauze and cling film, and I was sent home,” he said.

That’s when the problems started. Shortly after the surgery, Moore noticed that the transplanted hair “grew punishingly slowly and did not at all give the coverage or density that I had been assured it would.” After 18 months, it was clear to Moore that the surgery had not only failed but had made his appearance worse. Moore now wears a hat almost everywhere he goes, even when he’s indoors. “This is embarrassing, but the alternative, going without one, is almost literally inconceivable to me,” he said. “My appearance is no longer just an unfortunate quirk of nature but is the result of poorly done work completed under false pretenses. This rather intensifies my discomfort,” he explained.

The clinic offered to refund half the cost of Moore’s transplant, but only if he signed a nondisclosure agreement that would stop him from discussing his experience with anyone, including close friends, family or other medical professionals. Moore was uncomfortable with these terms and disappointed that the clinic was not interested in acknowledging his pain or apologizing. Therefore, he declined their offer.

Later, Moore learned that images of successful transplants that led him to select the clinic were not the work of the surgeon who performed his surgery. “The clinic had used old photos to promote their current surgeon,” he said. As a result, Moore said, he “thoroughly regrets this surgery.” Not only is Moore still not comfortable with his appearance, but he “finds it very difficult to trust medical professionals.” He also feels ashamed that he was taken advantage of by the clinic and angry about the way the clinic handled the situation.

Although Moore acknowledges that his situation is probably unusual, he cautions that it’s important for anyone considering a hair transplant to know that unethical hair clinics exist. “To go into a hair transplant clinic is to display your insecurity. There are people, even in expensive, modern-looking, friendly sounding clinics who will take advantage of this,” he said.

As Breidbart and Moore’s experiences show, “researching the clinic’s credentials and the medical team’s experience,” as well as having realistic expectations, are vital to a successful hair transplant, İskender said.