The History of Hair Transplant Surgery

The first successful hair transplants were performed in Japan in the 1930’s. Physicians were able to remove hairs and graft them onto the face, head, and pubic area. Both single and multiple hairs were successfully transplanted by these Japanese physicians. Unfortunately, the reports of these transplants were not available to western civilisation until the 1950’s. This is because the reports were written in Japanese and also due to the turmoil of World War II.

The first successful hair transplant performed in the western world was achieved by Norman Orentreich in 1959. The New York dermatologist successfully harvested and grafted hairs from the back of a patient’s head and transplanted them to balding areas at the top and sides.

The original hair transplants were done via 3-4 millimetre grafts which consisted of around 12 to 20 hairs a piece. The grafts were round and frequently referred to as plugs. These plugs were the standard form of hair transplantation for the first 20-25 years of the procedure’s history. The size was optimal because it was large enough to be easily moved, but small enough that the graft would receive proper blood flow. Despite the relatively small size of these transplants, occasionally the hair at the centre of the graft would not receive proper blood flow and die. This created a hole in the middle of the transplants that was referred to as donutting.

A number of other issues arouse with the early form of hair transplantation. The round grafts of hair created an unnatural appearance on the scalp. The grafts would tighten during healing and create dense groupings of hair. These groupings often created the appearance of rows and were similar to the appearance of doll hair. The look of these early transplants was extremely unnatural. Casual observers could identify individuals with hair transplants because they did not blend seamlessly with the existing hair.

An additional issue with the early transplants was scarring from the grafts. These scars caused the scalp to appear bumpy or patchy. Early hair transplants also consisted of grafts that were inserted to face the same direction. All the hairs jutted out at right angles, despite the fact that hair grows in a variety of directions depending on its location on the scalp. This created an unnatural appearing and style limiting hair transplant.

In the early years of hair transplantation, the procedures could not be completed in one session. It would take around four or five sessions to complete the transplants. This lead to awkward and embarrassing stages of hair transplantation, requiring that patients leave the surgery with hair that looked unnatural and incomplete.

The procedures were not very efficient because the punch tool used to harvest the hairs frequently damaged surrounding follicles. Physicians would accidentally split the hairs that touched the edges of the instruments. This lead to the destroy and waste of a large number of healthy hair follicles. Smaller tools were invented in an attempt to resolve the problem, but these tools resulted in more damage to hairs rather than less.

Due to the problems with the 3-4 millimetre grafts, smaller grafts were utilised beginning in the 1980’s. These smaller grafts included minigrafts, which are 1-2.5 millimetres in diameter and transplant 5 to 10 hairs at one time. Micrografts are another option and were just 1-1.5 millimetres in diameter and transplant only 1 to 3 hairs at the same time.

These smaller grafts appear much more natural than the large plugs of early hair transplantation. Hair grows in small sections which face a variety of directions. Small transplants allow the hairs to be implanted facing more than a single direction. This ensures that the hairs appear natural even when pushed to one side, back, or forward.

The minigrafts and micrografts are not perfect. The small grafts tend to create the appearance of thin hair. This is caused by the transplantation process, which removes a larger amount of tissue than would naturally surround the hairs. This occurs because the tool will sometimes pull hairs from several different follicles in a single extraction, despite the fact that hair naturally grows in groupings of 1 to 3 hairs per follicle. Pulling hair from a number of follicles also hurts the survival rate of the grafts. Despite the technological advances, the minigrafts and micrografts still frequently create the appearance of hair that grows in rows on a bumpy scarred scalp.

An alternative form of hair transplantation called scalp flaps were created by plastic surgeons. These flaps were removed from locations which contained hair and rotated to cover areas that were balding. The original blood supply of the flap remained partially connected in order to promote healthy hair growth after the transplantation. Unfortunately, these grafts frequently have a scarred appearance due to the large size of the transplants. The grafts also have a tendency to die after transplantation, which results in the loss of a number of healthy hairs.

Flap procedures require hospitalisation due to the risks of bleeding and infections. Some patients prefer flap procedures because they provide instant hair growth in areas that were previously bald. It is not a procedure with slow results like those that require the hair to re-grow. For some people, however, this creates embarrassment. The sudden change in hair growth makes it abundantly clear that a hair transplantation procedure has occurred. Another issue with flap procedures is that it forces hair to grow in unnatural directions. This can create a strange and unappealing appearance.

Another set of procedures rely on scalp reduction. This is achieved by removing a portion of the scalp to reduce the size of the balding area. The results from this procedure are relatively positive, but the back of the scalp is pulled forward on the head, which reduces the density of hair. Because the hair is thinner after the procedure, transplantation to the remaining bald portions frequently results in an over-all appearance of unnaturally thin hair.

Some forms of scalp reduction are performed in one large procedure. The arteries are tied off to prevent haemorrhaging, which results in partial or complete loss of sensation in the scalp due to damage to the occipital nerve. The procedure also requires a hospital stay, extensive recovery processes, and anaesthesia.

Implantations are necessary for these major procedures. The implants are inserted beneath the scalp in order to stretch the skin to create more useable area. This prevents tightness after the scalp reduction procedure.

One significant problem with scalp reduction procedures is that they create scarring. The severity of scarring ranges from moderate to severe and hair loss around the incision site is a common issue. Sometimes hair can be grafted over the scarred area to reduce its visibility. Scalp stretching or slipping is an additional issue associated with the procedure. Because skin is elastic, it will sometimes slip back to its original position after the scalp reduction procedure.

Due to the many flaws of the original procedures, most have been abandoned in favour of the much more effective FUT and FUE micrograft hair transplant procedures. These newer procedures can provide a fuller, more natural looking head of hair.