Learn the History and Evolution of Hair Transplant Surgery


History of Hair Transplant Surgery - Learn the History and Evolution of Hair Transplant Surgery


Hair transplant surgery began in the United States in the 1950s, but it wasn’t until the past 20 years that the procedure began to consistently produce realistic outcomes.

The origins of hair transplant surgery

Hair transplant surgery originally began in Japan. In 1939 a Japanese dermatologist, Dr. S. Okuda, developed a technique that extracted small sections of hair-bearing skin and then implanted these into small holes in the area of hair loss. Once these grafted areas healed, they began to produce hair in the areas previously bald. Although hair transplants were groundbreaking, the results were not impressive. The grafts were so large that the results were often comical and completely unnatural.

Hair transplant surgery in the U.S.

It wasn’t until the 1950s that hair transplant surgery became accessible in the United States. In 1952, New York dermatologist Dr. Norman Orentreich completed the first hair transplant for male pattern baldness using a technique similar to Dr. Okuda’s procedure. Because the results were still not very natural looking, Orentreich faced much criticism. Throughout the 1960s, hair transplants were a sought-after procedure, but a negative stigma was attached because of the poor results.

“From the 1960s into the 1990s, transplantation was performed using unnaturally large, 10- to 20-hair grafts commonly referred to as plugs,” says Dr. Marc Avram, section chief of dermatology at Downstate Long Island College Hospital in Brooklyn. “Plugs appeared unnatural because they were unnatural in size.”

In 1984, minigrafting was introduced. Instead of grafts being punched out from the back of the scalp, the technique used smaller grafts cut from strips of donor tissue. Minigrafts were used to create density and fullness, while micrografts — smaller grafts of just one or two hairs — were implemented to maintain a feathered hairline. In the 1980s and 1990s, mini- and micrografting became the industry standard, gradually overtaking the previous plug technique.

Hair transplant surgery today

“Old methods included what is called punch grafting,” explains Dr. Michael Kaminer, member of the American Society for Dermatologic Surgery (ASDS). “These were large ‘plugs’ taken from the back of the scalp that tended to look very noticeable when moved to the front, and gave hair transplantation a bad name. These plugs are now a thing of the past. Now nearly 100 percent of transplants are done with small follicular unit-style grafting, not the pluggy look of the past.”

Follicular hair transplantation was introduced in the 1990s. With this labor-intensive procedure, hairs were transplanted in naturally occurring follicular unit groupings. The procedure consists of the identification of these groupings (generally groups of mostly one, two or three follicles) in the skin, then the transplant of thousands of these groupings during long sessions. This hair transplant procedure results in attractive, natural-looking, full hair — not the doll-like hair plugs of yesteryear.

“Follicular unit transplantation has corrected the unnatural appearance of large grafts performed in the past,” says Avram. “Placing a large number of follicular units between the larger, unnatural plugs results in an increased density and a more natural appearance of transplanted hair.”

Hair transplant surgery methods

Today’s hair transplant techniques can produce amazing results for hair loss sufferers. The surgery is a viable option for men and women.

“There are essentially two methods used: strip harvesting and follicular unit extraction (FUE),” says Kaminer. “Both have advantages and disadvantages, but strip harvesting is considered the gold standard. Both methods create natural results, without the pluggy look of the past. The advantage of FUE is that it does not leave a linear scar in the back of the scalp, but the disadvantage is it can be difficult to transplant as much hair in one treatment session as can be accomplished using strip harvesting. Regardless of which method is used to harvest the donor hair from the back of the head, the goal is to obtain small grafts to place in the recipient area — usually the front of the scalp, hairline or crown (vertex). The strip harvesting and FUE methods are excellent for obtaining small, natural-appearing hair transplant grafts.”

Hair transplant surgery risks

Infection and bleeding are the two most common complications of hair transplant surgery, but Kaminer notes that both are rare. The biggest risk in the past was a poor outcome. With the modern techniques available today, however, unsatisfactory results are unlikely, especially when the procedure is done by a qualified doctor.