Hair Transplant Surgery - The Basics

The History of Hair Transplantation

The modern technique of hair transplantation, widely used today, began in 1939 in Japan, when a dermatologist named Dr. Okuda, working with burn patients began to transplant grafts of skin with hair from healthy sections of the scalp to regions of the scalp that had been burned. He noticed that these grafts continued to produce hair, even after having been transplanted. Dr. Okuda died during World War II and his discovery remained lost for many years. What is interesting is that he never considered using this technique for treating baldness.

The principles of modern hair transplantation were rediscovered in the early 1950’s by a dermatologist from New York named Dr. Norman Orentreich. His papers were rejected on several occasions as scientists did not believe it could work. Dr. Orentreich was the first person in the world to use hair transplantation to treat hair loss. He discovered that hair, when transplanted, maintains the same characteristics of the area from which it was removed. This meant that hair taken from an area that did not have a genetic code for hair loss, would maintain this characteristic when transplanted to a bald region. Modern hair transplantation was born.

After experimenting with countless instruments to extract the hair, Dr. Orentreich opted for punches, 4mm in diameter, which nearly corresponds to the width of a pencil eraser (see photo below).

With the punches he would remove round fragments of skin containing the hair roots from the donor area and after, with the same instrument, would make orifices in the areas where the grafts would be transplanted. These fragments contained approximately 10 hairs and at most 20-30 grafts would be transplanted, in other words a maximum of 300 hairs.

Punch and Pencil Eraser

As the years went by, the punches became increasingly smaller, however there was a problem. Damage to the roots at the moment of extracting them was greater, as the number of incisions was greater. This resulted in a high incidence of root transection. In other words, the hair was captured, but not their roots. Not to mention that, despite improvements, the aesthetic aspect left a lot to desire, with results looking quite artificial, like a doll’s head.

Punches

Result Photo – Tufts

This is why, until today, we condemn the use of punches, the hand engine, etc. Because besides damaging the roots at the moment of extraction, they damage the donor area, leaving it less dense with obvious sections of missing hair.

* Donor Area post-Punch

The problem was partially resolved when they began to remove the donor area with scalpel to later cut it into smaller fragments. Thus began the era of mini and micro grafts, which lasted from the mid-1980’s to the end of the 1990’s, bringing significant improvement to the results, both in terms of appearance and reduced damage to the donor area.

This technique was only replaced upon the introduction of the microscope to hair transplantation, although some doctors still practice this technique.

Hair Transplantation Today

In 1994, Dr. Limmer, a dermatologist from San Antonio, described his technique of separating follicular units using a microscope.

He noted that the hairs did not grow from the scalp one by one as one might believe, but in groups in 1, 2, or 3 hairs, which he called follicular units.

*normal scalp magnified 50x under a microscope and Folicular Units

This revolutionized the technique of hair transplantation.

- As loss from the donor area is nearly zero when using the microscope to separate the hairs, a thinner strip could be removed.

- Grafts became 10 times smaller. Further, incisions of the transplanted area are 10 times smaller, meaning less trauma, and the very small scabs in the post-operative period are imperceptible. Finally, there are more transplants per square centimeter, resulting in greater density and a much more natural appearance, as we are imitating what we see in nature.

In other words, doctors today who do not work with microscopes in hair transplant surgery are obsolete.

Therefore one cannot compare the technique of all micro follicular unit transplantation with the conventional technique of mini and micro grafts, performed with the naked eye or magnifying glasses. The difference is comparable to traveling on horseback versus flying in first class.

A follicular unit, to be produced under a microscope takes ten times longer than a graft produced with the naked eye. Therefore a sizable team is necessary to perform this procedure.

In the technique of mini and micro grafts, three or four persons, maximum, are sufficient to perform the surgery, which lasts a maximum of three hours.

In all micro follicular unit transplantation, for a session average of 2000 FUs, at least six or seven persons are required (at Ruston Clinic we work with an 8 person team for each surgery) for a period of no less than five to six hours.

Think about this before choosing the right surgeon for your hair restoration.

*IMPORTANT: See here some tips in choosing the right surgeon for your surgery.

Comparison Table demonstrating the evolution of Hair Transplantation.

	PUNCHES	MICRO GRAFTS	FOLICULAR UNITS
Scar
Technology/ Instruments
Micro Grafts
Scabs
Post-op	- Traumatic, with lot of pain, especially in the donor area. - Scabs take one month or more to fall out. - Use of compressed bandage. - Quite visible. - Hair that already existed falls out.	- A little traumatic, medium level of pain. - Scabs take one month to fall out. - Use of bandage. - Rather visible for one month. - Hair that already existed falls out.	- No trauma and very mild pain in the donor area in the first 24 hours. - Mini-scabs fall out in 7-10 days. - No use of bandage. - Virtually indectable. - Hair that already existed does not fall out.
Results