A Brief History of Hair Transplant Procedures
In 1952, New York City dermatologist Dr. Norman Orentreich performed the first modern hair transplant surgery to treat male pattern baldness. Through this experimental procedure and those that followed (the results of which were finally published in 1959), Dr. Orentreich demonstrated his breakthrough principle that a hair follicle will survive and display the same characteristics even after it is moved from one area of the head to another. Thus, a stable hair follicle on the side of the head can be transplanted to the top of the scalp where hair loss has already occurred, and the moved follicle will continue to be stable and grow as if it were still in its original location. He termed this principle "donor dominance," referring to the ability of the moved side hair, i.e. the "donor" hair, to continue expressing its own characteristics despite its relocation to an area where previous and surrounding follicles display different characteristics. We now understand that this principle works because certain hair follicles are genetically more susceptible to the effects of the hormone Dihydrotesterone (DHT) no matter their location, while others, such as those typically on the side of the head, are far more resistant. (See General Information on Hair Loss for more details.)
Although the principle of donor dominance is still the key concept behind today's cutting-edge hair transplant procedures, the hair transplants that were performed in the years that followed Dr. Orentreich's breakthrough were far from cosmetically ideal. Hair graphs in the early years were extremely large (4mm, approximately the size of a pencil eraser). Into the 1970s, these large graphs or plugs were directly punched out of the back of the head, and when they were implanted in the front scalp the results never looked natural.
In the mid-eighties a technique called mini-grafting was introduced, where a narrow strip of donor tissue was removed from below the stable hairline in the back and side of the head, and smaller grafts of hair were cut from it. Eventually this technique supplanted plugs, with larger grafts cut from the donor strip being placed in the center of the scalp and smaller grafts being placed in front of them to create a more natural look. The combination of these two types of grafts was called mini-micro grafting and remained the standard through the mid-1990s.
In addition, for a period of time in the late 1980s and early 1990s, a technique called scalp reduction was also used. It involved the surgical removal of the balding area at the rear of the head and the rotation of strips of skin from the sides of the scalp to front hairline. Due to the risk of scarring and unnatural hair growth it quickly fell out of favor with the introduction of Follicular Unit Transplantation (see below). During the 1990s, lasers were also touted as a breakthrough, a high-tech way to make the holes in the scalp for the placement of donor hair grafts. But the laser caused skin damage, scarring, and inhibited successful hair growth from the transplanted follicle. Like scalp reductions, laser hair transplants are now rarely, if ever, performed.
In 1995, the technique called Follicular Unit Transplantation was introduced, and it has revolutionized hair transplant surgery thanks to the completely natural-looking results. The chief difference from the earlier mini-micro graft techniques is in the way the hair follicles to be transplanted are removed from the strip of donor hair. In mini-micro grafting a surgeon arbitrarily cut graft sizes, which could contain as many as twelve hairs. Follicular Unit Transplantation uses special stereo-microscopes and tools to extract the hairs in the naturally occurring follicle groups (of one to four hairs) in which they grow. These far smaller grafts allow much smaller recipient sites, causing less damage to the skin and allowing the surgeon to transplant many more hairs in one procedure. In the hands of an experienced surgeon with both microsurgery and aesthetic expertise such as Dr. Rawnsley, Follicular Unit Transplantation is the most powerful technique available to permanently solve problems with hair thinning and hair loss in an undetectable, completely natural-looking way.
But what if you've already undergone a hair-transplant procedure using one of these less-than-satisfying earlier techniques? Follicular Unit Transplantation can be used to replace large grafts, to camouflage scars, and to repair many of the other problems that arise from the old techniques. See the article on Hair Transplant Corrective Procedures for more information.
