Hair transplantation was first developed for burn victims in 1939 in Japan and introduced in the United States in the early 1950’s. Thankfully, we’ve come a long way since then. The days of unsightly clumps of hair are long gone. Today, our techniques create a scar-free, natural-looking result. But it has been a long road of innovation and discovery to get to that place.
In 1939, the Japanese dermatologist, Dr. Okuda, began transplanting grafts of skin containing hair follicles on burn victims. When he saw that the hair continued to grow on the grafts, he published his findings in a Japanese medical journal. Still, he never used his method to treat hair loss. Then, unfortunately, he passed away during World War II, and his techniques never became universally known.
Then came Dr. Tamura in Japan, who began to use small grafts to restore female pubic hair. In these days of bikini waxes, it may seem like a strange practice, but at the time, hair loss in the area was considered a problem. His findings remained unknown in the U.S., however, because of World War II, during which Japan and the U.S. were enemies.
From Hair Plugs to Follicular Strip Extraction
It was the early 1950’s when Dr. Norman Orentreich initiated hair transplantation practices in New York. He was the first to use it for treating male patterned baldness. Initially, publishing about his work was a problem because the doctors reviewing his paper didn’t buy that hair transplants could work. Finally, his article was published in the Annals of the New York Academy of Science in 1959.
Dr. Orentreich discovered that if he took hair from the permanent zone on the back of the head, it would maintain its characteristics rather than adopt the characteristics of the area where it was transplanted. He called this “Donor Dominance.”
Dr. Orentreich experimented with different sizes of grafts and settled on a size about equal to that of a pencil eraser. He found that clusters of hair in larger sizes often didn’t grow in the center. He would transplant about 20-30 grafts in a session, which is a small amount by today’s standards.
These early hair transplant techniques involved what have traditionally been called “hair plugs.” Today, the size of a pencil eraser is considered a large cluster of hair. While it may have been a revolutionary procedure at the time, the results were far from natural-looking.
Over the years, the grafts have become smaller and smaller with the number of grafts increasing per session. The techniques eventually became known as mini-micrografts and follicular strip extraction. They created a more natural look in the front, but there was still a problem of unsightly scars on the back of the head.
Modern Hair Transplantation with Follicular Unit Extraction
A breakthrough occurred in 1993 when a Dr. Rassman developed the Densitometer, a device that can measure hair density. This allowed the surgeon to more accurately plan the transplantation procedure.
Then, a physician named Limmer published a paper in 1994, describing a technique he had developed that allowed him to transplant large numbers of smaller grafts. Drs. Rassman and Bernstein further pioneered the method of transplanting small follicular units that grow together naturally in small clusters.
It was 2002 when follicular unit extraction was first done without the need for a linear incision at the donor site, using follicular units of only 1-4 hairs. This requires more work – fewer hairs taken at a time and more grafts in total – but the results are well worth it. With follicular unit extraction and transplantation, we can provide a non-detectible outcome without the damage and scarring of the past.
Some doctors still use follicular strip extractions or “slit grafting” techniques, as well as scalp reductions and scalp flaps, but none of those techniques is as successful as follicular unit extraction (FUE).
With FUE, there is no feeling of numbness in the donor sites like in the past, and while it may take more effort, it is less invasive than earlier methods.
In today’s world of hair transplantation, the donor sites heal very well, and there is an excellent restoration to the front of the scalp for flexibility in choosing hair styles.
Read more about Follicular Unit Extraction (FUE).