Background: Frustrated with the embarrassing appearance, patients with androgenetic alopecia (AGA) suffer from poor quality of life and low self-esteem. Moreover, several researches indicate that self-esteem is an important factor affecting outcomes of cosmetic surgery.

Objective: This retrospective study aims to investigate the impact of hair transplantation on patients' self-esteem and satisfaction with appearance, as well as relationship between self-esteem and patient satisfaction which includes preoperative and postoperative satisfaction.

Methods: The preoperative and 9-month postoperative self-esteem were evaluated by Rosenberg Self-Esteem Scale (RSES), and preoperative satisfaction indicators (satisfaction with appearance, visual age and expected visual age) were assessed by Face-Q scale. At the same time, postoperative satisfaction indicators (satisfaction with appearance, visual age, satisfaction with decision, psychological well-being, and social function) were reevaluated as well.

Results: Of the 1106 male AGA patients, 875 completed a 9-month postoperative questionnaire. Compared with preoperative scores, postoperative scores of self-esteem and satisfaction with appearance showed an increase of 1.56 and 30.25 respectively (P < 0.05). Subgroup analysis showed that patients with high self-esteem level trended to have higher scores of postoperative satisfaction with appearance (P = 0.129), psychological well-being (P = 0.168), social function (P = 0.027), and satisfaction with decision (P = 0.043) compared with patients with low and average self-esteem level.

Conclusion: Hair transplantation significantly elevated self-esteem level and increased satisfaction with appearance of AGA patients. Meanwhile, patients with low self-esteem level trended to have worse postoperative satisfaction. Thus, apart from ensuring the quality of operation, plastic surgeons should offer guidance based on patients' psychological state to improve postoperative satisfaction.