Hair transplant history began in the 1800s with the first hair transplant that would have been carried out by a Japanese dermatologist.
In 1943, doctor Tamura used micro hair grafts to transplant them on the pubic area. Those first hair transplants are a success in Japan. However, doctor Okuda is also a pioneer in hair transplants in the 1930s.
Fast forward to the 1950s, a new yorker doctor, Norman Orentreich, introduced a hair transplant technique using extracted grafts of 4 millimeters. In those years, doctor Norman Orentreich said men could do a hair transplant because the occipital area of the scalp is not sensitive to testosterone action. The non-action of the masculine hormone on this area would create androgenic alopecia on the frontline, temples, and the vertex.
Using this theory, he states that hair has its genetic expression. This genetic expression would remain even if the hair is transplanted. The grafts would have the specificity of the hair from the donor area, even once they are set into the recipient area.
In 1991, doctor Uebel, a Brasilian physician who is one of the founding fathers of modern hair transplant, was the first to carry out a full transplant on a bald scalp. He used mini-grafts and micro-grafts to cover a bald area during this transplant. In just one session, he transplanted more than 1000 grafts.
Hair transplant history from 1950 to 1980: the punch technique
In the early 1950s, hair transplants became more and more recognized in the medical world. However, the medical community rejected the first projects. In 1952, doctor Norman Orentreich carried out a hair transplant in New York.
To perform this first transplant, doctor Norman Orentreich used the punch technique he created.
The punch technique involves harvesting hair with a 4-millimeter punch (as big as a pen). Each graft contained 10 to 20 hair follicles to transplant in the recipient area. The doctor could transplant 50 to 100 grafts per session because the technique needed high blood pressure in the area.
This method was the only one for years. The results were not natural as the grafts were implanted like hair on a Barbie doll, and it caused many visible scars.
Patients did not have many hairstyle options because they must hide the scars of the procedure. Moreover, this technique did not mind the balding process, and the scars were more and more visible as the patient grew older. The limit between the grafts and the natural hair was visible and not natural.
In addition to this technique’s esthetic issues, there were several medical risks: blood pressure, skin issues, and skin healing.
Regardless of those issues, doctor Norman Orentreinch performed more than 200 hair transplants with this technique. Even if it was not perfect, this technique proved the donor dominance theory: the hair keeps its characteristics even when grafted.
In 1959, a scientific article explained how this technique worked. It was a significant discovery in the medical community. The punch technique remains untouched until the 1970s. The only change in this time was the size reduction of the punch: from 4 millimeters to 2 millimeters to get less visible scars.
Hair transplant history in the 1980s: the strip method associated with mini and micro transplant
From the 1970s, the large hair transplant procedures were known as “plugs.”
Since 1984, a new technique has been available for hair transplant: the strip method, also known as mini-transplant and micro-transplant. This method improves until the late 1980s.
This technique involves harvesting strips of flesh at the back of the head. This revolutionary method offers a much more esthetic result. The scars are no longer circular but look like lines.
The doctor harvests strips of flesh then cuts them to get mini-grafts (7 to 12 hair follicles) and micro-grafts (1 to 4 hair follicles).
This new technique lets the surgeon implant more grafts in a single session (400 to 1000). It also significantly reduces the space between the grafts. This technique offered a slightly more natural, and this method became popular in the 1985-1995 decade.
The downside of this technique is the graft survival rate: many grafts got damaged and could not be used in the process. A new tool solved this problem: the high-resolution microscope.
Hair transplant history in the 1990s and the 2000s: FUT and FUE hair transplants
In 1995, doctors Bernstein and Rassman proved that hair does not grow alone, but in 2 to 4 hair follicles. The doctors called those hair groups “follicular unit.”
Thanks to this discovery, doctors may better understand hair growth and life cycle. The grafts became more natural because the surgeons could make more refined and precise hair transplants: FUT and FUE hair transplants.
Those two new techniques use the same principle of harvesting then implanting grafts. Those methods let the surgeon to implant 1500 to 2500 grafts per session. However, the results dramatically vary between those two methods.
- The “Follicular Unit Transplantation” method (FUT) uses the strip extraction technique.
- The “Follicular Unit Extraction” method (FUE) involves extracting grafts using a circular micro punch.
At first, the American physicians discussed those methods, arguing it was not new techniques. However, it quickly appeared they were far more efficient than the previous ones. Among the advantage, we can mention:
- Pain-free surgery
- More natural result
- More dense hair
- Less visible scars
FUT then FUE became the new standard hair transplant procedure. Since 2003, surgeons can graft a lot of hair in a single session. FUT hair transplant may involve up to 3500 grafts and FUE 6000 grafts.
Most doctors gave up using FUT in the last years, as the scars are very visible and the post-surgery period is harsh for the patient.
A new technique, DHI, offers the best results. This Direct Hair Implantation technique is the ultimate evolution of hair transplant methods.
Other methods, such as robot-assisted hair transplant or hair cloning, are currently experimental. It is no longer hair transplant history, it is the future of hair transplant techniques.
