According to experts, the first documented case of a hair transplant took place in wurzvburg, Germany, in 1822 by J. Dieffenbach. He experimented with transplanting hair from other parts of the body… though he also used feathers and animal skins. Primitive, yes, but someone needs to take the first steps.
There have been other irregular accounts of hair transplants in europe and Japanese literature in the late 19th century, but the beginning of modern hair restoration began in 1939 with a Japanese dermatologist, Dr. Okuda. In working with severely burned victims, he transplanted skin grafts and noticed they continued to grow hair. Later, he introduced small round grafts of skin containing multiple follicles into smaller balding sites. He focused on using smaller groups for better cosmetic results—a principle that still applies today.
In 1952, Dr. Orentreich did the first hair transplant for male pattern balding. He coined the phrase donor dominance indicating that hair grafts from the back and side of the head (donor sites) continue to grow hair when transplanted to bald or recipient sites.
By the late 1950s doctors became very creative at re-arranging the hair of men with male pattern baldness. Three procedures dominated the field until the mid-1990s when improved techniques took over.
The punch graft technique is known now for the “pluggy” look or so called dolls hair, and this is still what many people think of when the idea of restoration surgery comes to mind. While it was a great physiological advancement, the procedure was aesthetically poor, and the method has long been replaced even though many clinics are still correcting these surgeries as the hair still grows even though it’s aesthetically unpleasing.
Another technique involved removing segments of the scalp itself and relocating them where needed. This was developed by Dr . Jose Juri, an Argentine plastic surgeon. While the technique yielded certain benefits, including a thick hairline, the disadvantages strongly outweighed them. Using this method, hair often grew in improper directions, scalp segments often had unsightly spaces between them, and the surgery often caused scarring.
The third antiquated procedure is scalp reduction, in which a portion of the bald scalp was removed and portions of the scalp still with hair were pulled over to replace it. Drawbacks included the need for multiple surgeries, high complication rates, and bald spot recurrence. Scalp reduction is still used in special cases and can be beneficial, for example where a patient has a small bald area with damaged shin which is unlikely to respond to hair implants such as certain types of scar tissue.
During this time, in 1975, Dr. O’tar Norwood, a dermatologist and hair transplant surgeon, developed the classification system still used today for male pattern hair loss—the Norwood Classification System (covered in Chapter 3).
By the mid-1990s, new, modern technique that still dominates the modern hair transplant and is known as follicular unit transplantation (fut) finally arrived and replaced the above procedures. Thank goodness! Hair restoration is now a surgical procedure that physicians and patients can be proud of and excited about – and the advances are truly remarkable.