Hair replacement methods have made leaps and bounds since the days of hair plugs and the “doll’s head” look.

Surgeons now can achieve results that are more natural than in the past, explains Cleveland Clinic plastic surgeon Steven Bernard, MD. “The way we do it now, it’s hard to tell who’s had a hair transplant,” he says.

But is a hair transplant procedure for everyone? Dr. Bernard describes what’s involved — and what patients can expect from the procedure.

What’s new and improved?

Hair plugs used to be much larger — at least four millimeters or an eighth of an inch. Now, the technology has evolved to the point where surgeons can transplant tiny plugs or even individual hair follicles into the scalp instead.

“Ideally a person’s head of hair might have 80 hairs sticking out in a square centimeter or so,” Dr. Bernard says. “If we can get in the 20- to 50-hair range in a transplant, it looks essentially normal.”

Are transplants just for men?

New methods can benefit men and women. Men are a little easier to work with, however, because the transplants can be inserted in a smaller, tighter area.

“You can put the hair in and make it look denser, more natural,” Dr. Bernard explains. For example, a 50-year-old man may only need a transplant to cover the top of his head.

On the other hand, women tend to have thinning hair on all areas of the head, not just on top. “It’s a more demanding kind of transplant. You have to cover more space.”

What results can you expect?

Consider several things if you’re interested in a hair transplant, Dr. Bernard says.

First, how young were you when you started to go bald? If you starting balding in your 20s and get transplants in the middle of the head, you may have issues as balding spreads outward, including the crown of the head.

“They need to know going into this that they may need repeat grafting,” Dr. Bernard cautions.

Consider how dense your hair is and the pattern of your baldness, too. A transplant focusing on the front may look thick and natural. But covering an area from hairline to crown is more challenging, and may result in a thinner-looking transplant, Dr. Bernard cautions.

Even hair and skin color factors into the success of a transplant. Jet-black hair and pale skin lead to a tougher transplant than light hair and skin, because the contrast between hair and scalp is greater, he says.

Is the surgery painful?

Not really, Dr. Bernard says.

“It’s pretty easy to numb the skin, and this is a skin-only procedure.” Surgeons generally use local anesthesia, but patients can opt for other forms of sedation. Even after surgery — which may take part of a day or a whole day — there’s not much pain.

Is it ever covered by insurance?

Very rarely, unless you have lost hair due to serious burns. The cost of grafts varies depending on how many you need, and what area of the country you live in. The price may be as low as $4 a graft and up to a high of $10 a graft, Dr. Bernard estimates.

How long does it last?

A hair transplant lasts indefinitely.

“You’re taking it from an area of the hair that would not have gone bald, so it should be permanent,” Dr. Bernard says. Once the graft is in place, it will grow out and fall out in various phases — just like normal hair does.