History of Hair Transplants of Follicular Unit Extraction

Written by: Dr. Carlos Puig

A full head of hair has, for centuries, been associated with attractiveness, youthfulness and, in the case of men, even virility. The physical strength of the biblical character Samson was, for example, directly related to the length of his hair. Unfortunately, many men and women, experience a loss of hair as they age. Hair transplanting is one method of dealing with alopecia, or loss of hair, and in modern times this procedure has become highly refined into several practices, with one notable procedure being follicular unit extraction.

The Quest for Hair

Records referring to the need for “additional hair” go back to the period of the Roman Empire. The first attempts to actually transplant hair were believed to have taken place in the 1700s, but these have not been authenticated. The first transplants involving hair being moved from one location to another on the same person took place in Japan in the early 1940s. The procedure was based on principles developed a few years earlier by a Japanese dermatologist. However, these methods were intended to treat wartime wounds rather than natural baldness, and involved transplants of only one and no more than three hairs at a time. The first doctors and patients of these humble beginning probably had no idea about the refined practice treating hair loss would become, with follicular unit extraction leading the way for hair restoration.

The process of transplanting hair as a specific treatment for alopecia was first accomplished in the early 1950s by Dr. Norman Orentreich, who practiced in New York City. Hair transplantation was not immediately accepted by the medical community, although a paper outlining the procedure was officially published later in the decade. The technique employed by Dr. Orentreich proved that hair taken from the back or sides of a person’s head will continue to grow in the same manner even when transplanted to another location. It was this principle of “donor dominance” that made possible the successful relocation of healthy hair from what is known as a “safe donor zone” to areas where hair had been lost or at least become very thin.

These early successes led to the general acceptance and increasing popularity of hair transplants in the 1960s and the youth-oriented 1970s. The technique used during this period involved ever-increasing larger grafts.

The Refining of Hair Transplant Surgery

The early methods of hair transplantation had drawbacks due to the size of the grafts. The procedure could take a number of sessions and some patients can ran out of transplantable hair before the treatment was completed. The introduction of more powerful microscopes played an important role in the further improvement in what became known as follicular unit extraction, or the relocation of individual hair follicles. The increased magnification made it possible to identify and trim these units, which in turn were used to create individual grafts. Small grafts being transplanted in large numbers became the normal practice in the 1980s, and late in the decade an even more powerful stereo microscope was used to break a single strip of donor hair into tiny grafts.

Moving into the new century, hair transplantation reached the point of development where it became possible to orient follicular units so they could grow in a completely natural manner. The new techniques allowed for a more complete coverage of a person’s head and did not create the unnatural appearance of earlier transplants.
Once thought to be reserved only for the rich and famous, hair transplant surgery has become widely accepted by even middle class individuals. Hair transplants can make the recipients feel better about themselves and can improve the way others see them.