Hair replacement surgery is not new technology and procedures such as grafting as well as scalp flaps dates back to the early 19th century. The more modern replacement procedures that help arrest and correct lost and thinning hair originated in Japan in the 1930’s. At that time surgeons used smaller follicular unit grafts as a hair replacement technique for restoring eyebrows and eyelashes. Additionally, they were not using these procedures to treat male pattern baldness at this time.
Unfortunately, the worldwide trauma resulting from World War II interrupted further research in the development of hair replacement techniques and the original efforts never achieved much acclaim. It would be another two decades before research was resumed and it wasn’t until the late 1950’s when the hair transplantation was born thanks to Norman Orentreich, a New York City dermatologist. At that time, he began experimenting with transplanting donor follicle grafts to balding areas of his patient’s scalps who had succumbed to male pattern baldness.
Prior to Orentreich’s experimental hair replacement surgeries, the consensus was that there could be no benefit resulting from transplanting existing hair follicles to balding scalp areas. However, Orentreich clearly demonstrated that these donor grafts had to be “donor dominant” in order for the procedure to be successful. He proved that donor dominant hair follicles not only grew but they lasted as long as they would have in the donor area. His surgical practice still exists today and successful transplants are continually being performed.
Over the next couple of decades, there would be significant advancements in hair replacement technology such as the transplantation of smaller follicular grafts using 2 to 4 mm sized grafts. Unfortunately, this led to results which made the person’s hairline and scalp resembling that of a doll’s. The concept of using smaller hair grafts to avoid this didn’t arise until the 1980’s when Uebel in Brazil introduced using larger quantities of smaller grafts to prevent that doll’s head appearance from happening.
With the birth of Follicular Unit Transplantation in the mid 1990’s, hair replacement surgery became much more refined. Today, the procedure is more commonly referred to as Follicular Unit Extraction (FUE) and is now widely used throughout the US. It is oftentimes said that FUE is the “gold standard” of all hair transplantation procedures. The reason for this is the fact that a square centimeter of scalp tissue can be implanted with over 50 of these follicular grafts.
