The Elton John movie Rocketman doesn’t shy away from the star’s concerns with going bald, even during his early years of fame.

Throughout the story, lovers and family members are seen referring to the issue, mentioning that his hair loss is speeding up. At one point, during his youth when he aspires to an Elvis Presley style, his mom tells him to enjoy it while he has it, because he’ll probably be “bald as an egg” by the age of 20. In private moments John himself is portrayed as fretting about his head, quickly but repeatedly.

Pictures of John throughout his career show a rapidly receding hairline; then, sometime in the mid ‘80s, he began displaying increased growth. For some time now he’s sported a healthy off-blond head of hair. What’s never been specific about – in Rocketman or in real life – is what he actually did to achieve his new look.

The main culprit of a receding hairline in men is male pattern baldness (androgenic alopecia), believed to be a combination of genetics and hormonal activity. In John’s case, it’s possible that his condition was made worse by his well-documented drug and alcohol abuse. The use of cocaine is known to stop hair growing, medical experts the Belgravia Centre reported, while poor diet in general can also make matters worse.

“Elton John claims to have been drink and drug free since 1990, since when his hair loss may have stabilized,” the Centre said. “However, it is unlikely that this alone can account for the extraordinary recovery of his hairline.”

In 1978, at the of 30, John blamed “messing around with my hair – pink, green, orange dyes” for the loss, and confirmed he’d undergone two 90-minute surgical procedures on his scalp. He told People it had been “a hundred percent vanity." “I’ll just be grateful if it grows," he said. The surgery tied in with a “no junk food, no booze regiment,” the article reported.

Throughout the ‘80s John displayed a variety of hairstyles, some apparently more artificial than others. That might suggest that his ‘70s surgery didn’t work out – perhaps partly because his new diet regime didn’t last, leading to his period in rehab in the early ‘90s (when some reports suggest he had further surgery). In that case, he might have turned to hairpieces for a solution. Today, they range in price from $50 to $3,000. A good-quality synthetic wig will cost up to $400, but wigs made of real human hair will cost much more. They also need daily maintenance, just like attached hair, while a good-quality synthetic piece can hold a style.

In 2011, hair transplant surgeon Samuel M. Lam suggested that John had made use of a high-quality hairpiece because “his hair loss is extensive enough that a hair transplant would not be able to fix the problem with sufficient cosmetic density for him.” He voiced his approval for whatever John had done to achieve his look.

“I am a strong advocate in combining hair restoration with a hairpiece in those individuals who lack sufficient hair for a full hair transplant and have become accustomed to the density provided by a hairpiece," he said. "Good donor hair can cover a lot of sin, and it is one of the most important parts of a clinical evaluation.”

By the 21st century, of course, surgical techniques had improved. Usually, living hair follicles from the “horseshoe” of the back and sides of a man’s scalp are transplanted to the areas where follicles have stopped growing. In 2011, Dr Maurice Collins told the Daily Mail he charged £7.60 ($9.60) for each individual follicle move, and said a team of 18 people would work on a patient for up to six hours to transplant up to 4500 follicles. "There's always a 'horseshoe,'" he explained. "We take little strips of skin from there, meticulously dissect each hair follicle and transplant them one by one, using microscopes. Thus, surgery could cost a minimum of £7,000 [$8,850] and in some cases as much as £30,000 [$38,000]. I'm pleased to say 98 percent of the transplanted hairs go on to thrive.”

Collins added that the visual result were also much better than in the ‘80s. “It's not like the old days where you got all of these sprouts sticking up,” said another expert, Professor Andrew Messenger. “If the procedure has been carried out by a decent surgeon, I would probably not be able to tell without a close examination.”

Medication can also be used to encourage natural regrowth, though some are known to have serious side-effects such as causing temporary infertility. That’s more of a problem in the type of medications that must be taken continuously – for the rest of the patient’s life – otherwise all the regained hair will fall out.

John proved that he knew a certain amount about the available medication during a 2011 interview with BBC presenter Chris Evans. In a lighthearted conversation where Evans discussed his own hair loss problem, John – with at least a suggestion that he’d rather not be involved – said, “I had mine dyed red once by Vidal Sassoon … it all fell out about three weeks later.”

“It’s what is called ‘getting older,’ it’s called ‘maintenance,'” he said, joking that he didn’t have the head shape appropriate for a bald look, like he said actor Patrick Stewart has. “I’d look like Shrek,” he noted. He also mentioned both the Propecia and Rogaine medications.

Watch Elton John Discuss Hair-Loss Treatment

Yet another option is scalp pigmentation, where color – similar to tattooing – is placed into the scalp to reinforce the look of coverage. “Sir Elton John’s scalp could have benefited from this clean and precise method for hiding hair loss,” Scalp Clinic reported.

“Whatever combination was used, the work performed is certainly of great quality. It inspires viewers by informing them that such work is possible. Anyone who is gathering information on the success of hair transplants may look to Sir Elton John’s example. Hopefully, this can give an added boost to anyone deciding to seek treatment for alopecia.”

 

Elton John Albums Ranked