Basics


A Brief History of Hair Transplantation

Dr. Jae Pak holding a Hair Graft

The science of hair loss has been studied for centuries, and nearly all historical records show that civilizations made their best attempts at hair restoration. From the boiled hedgehog spikes of Ancient Egypt to today’s herbal remedies, almost everything has been tried.

But things took a different turn about halfway through the 20th century with the introduction of a surgical solution to hair restoration. Transplantation was experimental at the time and had a long way to go from the outset, but the medical community has made significant strides toward more effective and efficient procedures.

Let’s walk through a brief history of hair transplantation and see just how far we’ve come.

Initial Discovery

The first hair transplants were administered in Japan in the 1930s with the goal of restoring hair for people who had suffered traumatic injuries to the scalp like burns.

Doctors in this era made the important discovery that hair-bearing areas of the scalp – now referred to as the donor areas – can be successfully harvested, processed, and implanted into recipient zones as necessary, whether it’s the hairline, eyebrows, or beard.

These surgeries began to improve with time, and patients with genetic baldness – androgenetic alopecia – were soon receiving treatment alongside those with injuries.

Due to the events of World War II, Japanese research did not reach western medicine until much later, and doctors in the United States had already made key findings on their own.

Refining Techniques

New York dermatologist Dr. Norman Orentreich is credited with making major discoveries in the 1950s, including the idea of “Donor Dominance,” which surgeons continue to rely on today.

This proved to the medical community that hair along the side and back of the head are highly resistant to balding and can be a reliable source of donor hair during the transplantation process. Orentreich’s work is still referenced in modern techniques to ensure that patients receive the most resilient and long-lasting hair in each procedure.

Despite this important discovery, physicians of this era were limited in their technology and were forced to use large grafts to transplant hair, some bigger than pencil erasers.

The problem was the low number of grafts that could be accomplished in a single surgery (between 20 and 30) and the unsightly “plug” look that turned some people away from the idea of transplantation in its early days.

As tech progressed and the planning process for procedures became more measured and deliberate, surgeons decreased the graft “punch” size of each individual transplant. This gave patients a much more preferable and natural look that provided better coverage on the scalp’s key areas like the hairline and temples.

With small punches came a new problem, however: damaged hair. Doctors in the late 70s and 80s began to shift over to the “strip surgery” technique that is familiar today. This began with “mini-micro grafting” methods that reduced transection rate but had issues of their own.

The next advancement came in the mid-90s with the introduction of follicular unit transplant techniques, pioneered by doctors who wanted to preserve as much healthy hair as possible. This method used very precise measurements for the density of donor hair, allowing surgeons to harvest the exact number of quality hairs necessary for complete coverage.

This technique also had the advantage of giving surgeons the ability to perform “mega sessions” in which hundreds – in some cases, thousands – of individual follicle transplants could be completed in a span of just a few hours.

Patients who undergo FUT are more likely to hold onto healthy hair in the recipient area, enjoy greater density in key areas, and are not compelled to return for repeat surgeries in the future. While many doctors still perform micrografting, FUT became more popular as the 21st century progressed and is now considered the gold standard of hair transplantation.

Modern Technology

Today, hair transplantation is extremely precise, with high rates of patient satisfaction. Methods like FUT have advanced further, allowing surgeons to graft up to 50 hairs per square centimeter depending on the quality of the follicles – far more than previously possible.

Because follicular units have been identified as so durable and predictable, we’re seeing a return to the old-school graft technique with a modern touch. The method known as Follicular Unit Excision has become increasingly popular for patients who want to avoid the horizontal “strip” scar across the back of the neck that usually comes with FUT.

With FUE, surgeons can identify individual follicle units within the donor area and pinpoint them for extraction in a patchwork pattern. The result is a more aesthetic look for patients who shave the back of their head and prefer a slightly quicker recovery time.

FUE still has a ways to go and remains a bit more pricey than FUT, but more clinics are investing in the tools and skills required. Expect to see FUE methods become more comparable to FUT in efficiency and cost-effectiveness over the coming years.

Consultation is Key

Hair transplantation is nearly universal at this point, with clinics worldwide practicing FUT and FUE methods with great success and satisfied patients. For men and women looking to undergo hair transplant surgery, it’s vitally important that they take the time to perform adequate research and find a medical professional with a track record for excellence.

Rather than falling into the trap of self-diagnosing based on internet pictures and speculation, patients should always speak one-on-one with a hair restoration specialist to determine the best game plan for their unique circumstances.

Hair loss experts are not only skilled in surgical techniques, but they also help guide patients through the post-op recovery process and ensure that results stay in place for the long term.

Transplantation is just a part of the hair restoration journey, and the best doctors will provide a complete blueprint for results rather than just a single procedure.

Sources:

Norman Orentreich, 96, Force Behind Hair Transplants, Dies | NY Times

Follicular Unit Extraction Hair Transplant | National Center for Biotechnology Information

Hair Transplant | Healthline

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