History of hair restoration
Early days of hair transplant
Hair transplant surgery is not what it used to be. Ugly, unnatural looking plugs have been replaced by indistinguishable and seamless hair lines. It’s undeniable that hair transplant surgery has not just evolved but improved over the decades. No wonder hair transplant is the most rapidly improving cosmetic surgery that men seek (Ref). It is also one of the most demanding and demanded cosmetic surgery for men.
The first successful hair transplantation was completed in 1822. The experiment showed that skin grafts with hair still attached could be successfully transplanted from one area to another in animals. The young German doctor who conducted the transplant, however, was a bit ahead of his time; it took about one hundred years for his experiment to inspire surgeons to use hair transplants for practical cosmetic hair restoration.
The next development in hair transplant history did not occur until before World War II, when Japanese scientists discovered a way to insert single hair grafts into burn scars in eyebrows, using punch grafting—although the results of this particular method were not consistent. It’s important to note that the transplants done in Japan were for burn victims in particular. Hair transplant surgery for balding men would not be considered for a few more years.
Hair transplant for cosmetic purposes
A New York doctor in 1952 made one more step toward successful hair transplantation, when he discovered that hair can, in fact, grow in a bald area. In this procedure, hair from the back and the sides of the head is removed using a hollow drill, which results in “plugs” of hair available for transplant. The hair plugs are reattached in the bald recipient region. While this procedure produced less than favorable results cosmetically, it was the first successful transplant surgery for cosmetic hair restoration. More importantly, the discovery that hair can grow in bald portions of the scalp helped further medical advancements in this field significantly for the next 30 years.
In the 1980s, a new hair transplant procedure was discovered that allowed surgeons to disguise the large plugs used in prior surgeries. This technique, called minigrafting and micrografting, represented a major step in the refinement of hair grafts, as larger sessions allowed tiny grafts to effectively replace larger plugs.
But hair transplant surgery was still limited. Surgeons could not recreate a completely normal head of hair, not even using mini and micrografts, until 1995, when the concept of Follicular Unit Transplant (FUT) was published. FUT allowed surgical teams to transplant individual hair follicles in their natural groupings: 1-4 hairs each. Currently, this technique is the standard used by hair transplant surgeons everywhere.
How does hair transplant work?
Scientists and hair transplant surgeons have known for some time that the hair on the back and the sides of the scalp is resistant to genetic balding. Hair taken from this area for hair transplants is called “donor hair.” Surgically transplanted to balding and thinning areas, donor hair can successfully replicate what the patient’s natural hair once looked like.
Different methods of hair transplant
There are a few ways to conduct an FUT procedure, but the conventional method used in most cases involves three steps:
- A strip of skin is removed from the back or side of the scalp
- Follicular unit grafts are harvested from the excised scalp
- The grafts are transferred to pin-sized holes made by the surgeon in the bald-recipient region. There is a small wound in the donor area, which is sutured closed after removing the strip
The process of step 2 is actually quite complex, requiring the surgical team to carefully harvest tiny follicular unit grafts—usually made up of only 1-4 individual hairs—and then dissect them under a microscope. Follicular grafts must be kept at a refrigerated temperature during the surgical process, which increases the probability of successful grafting. The team of surgeons performing the FUT must be a highly skilled group of people, who are trained to minimize damage to the new hair during the surgical removal. Well-trained surgical teams should achieve a rate of hair damage under 5%.
Aesthetics of hair transplant
When the follicular unit grafts have been successfully harvested, they are placed in the recipient region. Many things affect the final look of the hair transplant and new hairline, including recipient region distribution, direction, and the type of instrument used to transfer the grafts. To recreate the look of natural hair, grafts should be placed close together, but if grafts are improperly placed or distributed, the result will not be as aesthetically pleasing and will not mimic natural-looking hair. A surgeon’s skill level and experience is reflected in the proper graft direction and distribution in an FUT procedure. Sometimes, in order to achieve complete fullness of hair, more than one procedure will be necessary. This is determined by the physician, after assessing the patient’s natural hair supply, the size of the bald region, and the quality of the donor hair available.
Natural and undetectable
Today, it is possible for a head of transplanted hair to look virtually identical to a head of natural, non-transplanted hair. An effective hair transplant is only possible with a skilled surgical team. Follicular Unit Transplantation is a complicated procedure that requires 3-6 experts working together for many hours, and the experience of the surgeon’s team is just as important as the skill of the surgeon. Even a strong surgeon can be set back by technicians who do not know the proper procedures or haven’t received adequate training.
It’s important to note that not all hair transplants are successful, and the final result of a hair transplant procedure can be affected by surgical technique as well as by the experience of the surgeon and his/her surgical team. Only 30 years ago, patients requiring hair restoration had only the unnatural hair plugs to look forward to. Now, surgical teams can provide patients with natural looking hair that cannot be differentiated from non-transplanted hair.