Beard transplants and facial hair trends: Why men are motivated to have surgery

Over the past few years, an increasing number of men have received surgery to enhance or restore facial hair. This came at a time when beards re-entered mainstream fashion. Drawing on the research literature, this article explores the apparent link between facial hair fashion and rates of beard transplants, and considers deeper-seated psychological explanations for the trend, including perceptions of masculinity, social dominance, age and attractiveness. The question of whether beard transplants will continue to proliferate is also explored.


Introduction
Facial hair surgery has gained in popularity in recent years. In 2012 an estimated 4,700 men underwent the treatment globally, rising to 14,000 in 2014. In Europe, the figure rose from 618 to 2,454 in this timeframe (International Society of Hair Restoration Surgery Practice Census Results: 2013;2015). Unfortunately, no remotely reliable beard-wearing data among men exists, but it's plain to see that full 'hipster' beards have held firmly in fashion for the past few years. Clooney, Affleck, Gosling and co. sporting bushy beards at the 2013 Oscars may have marked the watershed, with the vast numbers of bearded footballers at the 2016 European Championships representing critical mass. The fashion link may seem obvious, but perhaps there is more to explain the surge in beard transplants. This article will present and explore reasons why men might seek facial hair surgery, and contemplate the future of beard transplants.

Understanding the procedure
Facial hair surgery is similar to follicular unit extraction, where small groups of hair are extracted one by one from a donor site via a small punch excision of roughly 1 mm in diameter. In the case of facial hair surgery, hair is typically taken from the side or back of head where it grows finer and is less prone to balding. The procedure takes 3-9 hours depending on the amount of hair transplanted (e.g. for a goatee, sideburns or a full beard), and tends to cost between £3000 and £7000 (Foundation for Hair Restoration, 2017). Transplanted facial hair falls out after roughly 2 weeks, but regrows around 3 months later and can then be treated as natural facial hair (Foundation for Hair Restoration, 2017)

Men's motivation
Advances in transplant technology go some way to explaining the procedure's increased popularity, but the underlying question remains: why do men want facial hair surgery in the first place? For some, it may offer restoration of facial hair and with it restoration of self-image, for example in men who have lost hair due to surgery, trauma such as burns, acne scarring, radiation therapy, trichotillomania (obsessive hair-pulling), cleft lip repair scarring or even the natural ageing process. In the case of scarring, facial hair may be desired to cover the affected area and manage appearance anxiety and/or reactions from other people. It can also be used as part of gender reassignment surgery.
These motives seem self-explanatory. But what about those who in all likelihood, due to the procedure's cost, constitute the bulk of facial transplant recipients: men who, due to genetic hair growth patterns, simply can't grow beards to their satisfaction? Various reasons, some of which may be held more consciously than others, can be put forward.
Research has consistently linked three related characteristics to fuller facial hair: perceived masculinity, social dominance and greater age (Dixson & Vasey, 2012;Muscurella & Cunningham, 1996;Neave & Shields, 2008). Masculinity is partly socially constructed but also biologically hardwired (Martin & Finn, 2012), so a fuller beard may represent an easy way for men to enhance their masculinity.
The perception of social dominance conferred by fuller facial hair has been explained by Muscarella and Cunningham (1996) in evolutionary terms. Facial hair, located as it is around the chin and jawline, may have evolved to pronounce the jaw and hence the threat presented by the teeth. As with chimpanzees, this jutting jaw signals dominance, which means a higher social rank and enhanced reproductive success as a result (Fox, 1972;Guthrie, 1970;Lorenz, 1966;Zillman, 1984).
It's an interesting idea, but hard to prove. Regardless of the explanation, the evidence suggests a beard transplant could increase perceived social dominance, which may be appealing to some.
Perceived older age, and with it perceived experience, may particularly explain the desire to undergo a beard transplant for younger men. Especially during economic downturns like post-2008, emanating seniority could help men feel more confident amidst a contracted job market (Janiff, Brooks & Dixson, 2014).
There is also the idea that some men believe they will be perceived as more attractive with a beard. A commercial survey in 2015 found that just over half of 1,000 men living in New York reported feeling more attractive to women with a beard versus without, and 77% of those without a beard gave their inability to properly grow a beard as their reason for not having a beard (Braun, 2015).
Scientific studies on the topic, which typically present participants with pictures of men's faces with each face shown at different levels of facial hair, has revealed mixed findings (Dixson & Brooks, 2013). For example, in one study women reported being more attracted by men with light stubble (Neave & Shields, 2008), in another women were more attracted to men with heavier stubble (Dixson & Brooks, 2013) and in another still, all other facial hair types were considered more attractive than full beards (Dixson, Tam & Awasthy, 2013). However, these studies didn't tap into features amenable to facial hair surgery: uniformity and coverage. The most recent and large-scale study on the subject did address this question, and found that in a group of 3,805 women, men with more evenly and continuously distributed facial hair were rated as more sexually attractive than men with patchier facial hair (Dixson & Rantala, 2016).
Each person of course will have their own unique reasons for getting a beard transplant, but the above factors are likely to represent the key psychological motives. It also can't be discounted that some especially fashion-conscious, beard-light but cash-rich men have undergone surgery to keep up with grooming (or lack thereof) trends through surgery. It may at least be the catalyst for many. Certainly the centrality of media-mediated appearance ideals encountered by men as well as women has been increasing across many countries and cultures, and the body comparisons and influence of appearance on self-esteem this encourages, means greater pressure on men to conform to appearance norms (Frederick et al. 2007;Jonason, Krcmar & Sohn, 2009;Karazsia & Crowther, 2010).

Facial hair trends
As is their way, fashions come and go, but researchers have unearthed an intriguing link with facial hair trends. Using data compiled by Robinson (1976) of men photographed in the London Illustrated News magazine from 1842 to 1972, the aptly name Barber (2001) found that periods characterised by fuller beards coincided with smaller pools of romantically eligible women, suggesting the level of male competition determines the premium of beardedness.
This leads to the question of whether the apparent upward trend in facial hair transplants will continue its trajectory, or whether it will fade with fashion. An interesting perspective comes from the evolutionary biological concept of negative frequency-dependent sexual selection, which, in the case of facial hair, holds that perceived attractiveness of full beards will reduce as it becomes the norm. One recent study supported this theory, finding that both women and men rated full beards as more attractive when rare among the pictures presented, and likewise for clean-shaven faces (Janiff et al., 2014).

Conclusion
With the UK seemingly having reached 'peak beard' status, perhaps the attractiveness advantage will now start to sway in the favour of lighter facial hair. It will be interesting to see whether this is reflected in the number of facial hair transplants, or whether ever-improving TUE technology such as robotic TUE (Avram & Watkins, 2014), combined with the hardwired perceptual correlates of beardedness, will ensure the only way is up.