Hair transplant surgery has evolved over the last few decades and emerged as one of the most demanding cosmetic procedures in men. Its results have improved dramatically from the old unnatural plugs to undetectable natural-looking hair lines.

History

The story of hair transplant started in 1822 when a young German doctor successfully transplanted skin containing hair from one area to another in animals. Although the experiment was successful; it took almost a century till hair transplant was practically used for cosmetic hair restoration.

Just before World War II, the Japanese succeeded punch grafting hair into burn scars and the movements of single hair grafts into eyebrows. Results were not consistent and the idea of using hair transplants for balding men did not come to the forefront until many years later.

In 1952 a New York doctor realized that hair would grow in a bald area. He defined the use of hair from genetically un-impacted scalp (around the side and back of the head) for transplantation into the balding front of the head. The back of the head was drilled with a hollow drill and plugs of hairy skin were re-implanted in the bald front. Although the results were less than cosmetically acceptable, the fact that hair could be grown in a bald part of the scalp propelled the hair transplant industry over the next 30 years.

Further need of refinement in hair grafts lead to the development of minigrafting and micrografting in the mid 1980s. The new technique was used to camouflage the large plugs. In 1993, the first published article defined the use of mini and micrografts on an exclusive basis. Very large sessions allowed these smaller grafts to be effective at replacing the larger plugs.

The concept of Follicular Unit Transplant (FUT) was published in 1995. This breakthrough allowed hair follicles to be re-implanted in their natural groupings of 1-4 hairs each. FUT is currently accepted as the gold standard for hair transplantation and can completely match a normal head of hair.

Procedure

Hair in the back and sides of the scalp (donor hair) is known to be resistant to genetic balding. When donor hair is moved into balding and thinning areas, it can replicate the normal appearance of the lost native hair that originally grew in the balding area.

Conventional method of FUT consists of three main steps: Removing a strip of skin from back of scalp, harvesting follicular unit grafts from the excised scalp, and transferring the grafts to the pin sized holes, which are made by surgeon in the bald, recipient area. The wound in the donor area is suture closed after removing the strip.

Making grafts: Making follicular unit grafts (usually contain 1 to 4 hair follicles) are carefully dissected under a microscope by an experienced team trained and skilled to minimize damage during the removal process. As a rule, the rate of hair damage during this procedure should be less than 5%. Follicular grafts are cooled when they are outside the body to increase their survivability.

Placement: Recipient site distribution, direction, and the type of instrument used determine the final look of the hairline. The graft direction and distribution reflect the experience of the surgeon. Improper direction or distribution will produce less-than-ideal aesthetic results. Grafts can be placed close together to mimic the original fullness. The patient's supply of hair, extent of the bald area and quality of the hair determine whether one or more procedures are necessary to achieve the fullness that the patient desires.

Result: Today's modern hair transplant can be completely indistinguishable from a non-transplanted head of hair. The key to a good hair transplant reflect the experience of the surgical team. Performing follicular unit transplantation takes a coordinated teamwork of 3-6 people working together for several hours, so the surgeon's team is as important as the surgeon. The skills of a surgeon can easily be offset by inexperienced technicians in the surgical team or sloppy processes.

Conclusion

Within the last 30 years, the field of hair restoration has progressed from a pluggy unnatural look to a completely normal look which can not be differentiated from normal, non-transplanted head of hair. Surgical techniques, the experience of the surgeon experience and the surgical team are key factors that can impact the result of hair transplantation.