Everyone has heard of or even seen hair transplant horror stories, maybe in a magazine, online or even worse seen the obvious ‘plugs’ in a elderly friend or relative. However hair transplant surgery has jumped leaps and bound in recent years to make it a viable, safe and not too risky option for those suffering with male pattern baldness, many celebrities such as Nicholas Cage, Brendan Fraser Mather MOcanhey, Dwayne Johnson (‘the Rock’,WWE) Salman Khan (Bollywood) and even Italian Prime Minister Silvio Berlusconi are believed to have had hair transplantation surgery, although such is the stigma attached that none of them have admitted to it publicly, it only becomes obvious when studying before and after pictures.
History of Hair Transplant
The origins of hair transplant surgery stem from Japanese dermatologist, Dr. Okuda, who in 1939 published a revolutionary method in a Japanese medical journal of using small grafts that were similar to the way hair transplantation is performed today. This method involved using hair transplant grafts to correct lost hair from various body areas, including the scalp, eyebrow, and moustache areas.
In the late 50’s one physician in particular, Dr. Norman Orentreich, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas. Dr. Orentreich’s experiments showed that when bald resistant hairs from the back and sides of the head were relocated, they maintained their bald resistant genetic characteristic regardless of where they were transplanted.
This principle, known as “Donor Dominance”, established that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation. During the 60’s and 70’s hair transplants grew in popularity. However, the standard of care involved the use of larger grafts that were removed by round punches and often contained many hairs.
In the 80’s hair restoration surgery evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This “combination mini micrografting” hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts.
Types of Hair Transplant
There are two main methods of Follicular unit hair transplant surgery. Follicular unit Transplant commonly known as FUT or ‘strip surgery’ and Follicular unit extraction, commonly known as FUE The main difference is the method of extracting the transplanted hair. FUT and FUE are really complimentary forms of HT, not competing methods of which one must make a choice.
FUT versus FUE
The 90’s saw the gradual introduction of a very refined surgical procedure now known as “follicular unit hair transplantation” or “FUT”. This exacting and labour intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair “follicular unit groupings” in which they grow naturally.
The concept of creating the entire hair restoration using exclusively follicular units was proposed by Dr. Robert Bernstein and was described in the 1995 Bernstein and Rassman publication “Follicular Transplantation”. Critical to the success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer of San Antonio Texas in the late 1980’s.