Historical Developments

Early work with hair, skin, and feather transplantation dates back to the 1800s.

Hair follicle transplantation was performed in Japan in the 1930s. Dr. Okuda used small punches to transplant hair-bearing grafts from the scalp to areas in the scalp, eyebrows and moustache in 1939. In 1943, Dr. Tamura transplanted single hairs to the pubic area. Because of World War II, this information did not receive worldwide attention.

In 1959, Dr. Orentreich in New York proved that transplantation of hair from a long-lasting donor area into an area affected by male pattern baldness would grow and would last. He developed a method in which cylinders of bald skin were removed and replaced with cylinders of hair bearing skin that had been removed from the “safe” donor area. His goal at the time was to move as much hair per graft as possible without jeopardizing the survival of the hair in the middle of the graft. The ideal graft size was felt to be 4 mm in diameter. This method became known as punch grafting or standard grafting and, with modifications, punch grafting was in common use until the early 1990s.

In the 1970s, Dr. Juri described surgical rotation of a flap of hair-bearing skin for the treatment of baldness and Drs. Blanchard and Blanchard described surgical excision of bald skin that became known as Alopecia Reduction or Scalp Reduction.

In the late 1980s and 1990s a few surgeons used smaller grafts to create a more refined and less pluggy look in the hairline. They first dissected standard grafts into smaller “minigrafts” then changed their method of donor harvesting. Instead of punching out grafts they excised strips of skin and then dissected them into small groups of 3 to 8 hairs called minigrafts and inserted the minigrafts into slits or slots made in the skin. Dr. David Seager was one of the first hair transplant surgeons to abandon punch grafts to perform total minigraft hair transplantation. Small grafts containing one to three hairs were called micrografts were used to further refine the hairline.

Older methods including punch grafting, surgical flaps, scalp reductions, minigrafting and mini-micrografting are described in more detail here. Laser hair transplantation, although introduced in the mid 1990s, is not popular and is discussed with the older methods.

In 1987, Dr. Bobby Limmer introduced microscopic dissection of grafts to obtain grafts containing naturally occurring follicular units of 1,2,3 or rarely four or five hairs. This was a much more labor-intensive method that required more training and more time but provided extremely natural results and preserved donor hair. Only a few surgeons, including Dr. David Seager, became skilled at follicular unit hair transplantation.

Using standard grafting, minigrafting or mini-micrografting, multiple sessions of hair transplantation were required to complete an area. Dr. David Seager and others started placing more and more follicular unit grafts in one session, closer and closer together.

Dr. David Seager thus pioneered dense-packing of follicular unit grafts to complete an area of baldness in one session. The Seager Hair Transplant Centre has been performing dense-packed follicular unit hair transplantation since 1995 and is constantly researching and improving the technique.

In 2001, Dr. Seager was recognized for his contributions to hair transplantation, and specifically for his “signature” one pass, (3000 graft) technique, when the International Society of Hair Restoration Surgeons presented him with the Golden Follicle Award.

Since follicular unit hair transplantation uses nature’s bundles and mimics the appearance of natural non-transplanted hair exactly, there are no major improvements to hair transplantation on the immediate horizon.

Some surgeons feel that follicular unit extraction, without surgical strip excision, may be the next significant development in hair transplantation but the majority of hair transplantation view this as a step backwards.

Future hopes lie with cloning or gene therapy to provide limitless donor hair. Work is being done in these areas but both are very difficult and will be many years away if they can ever be done.

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