Historical Developments

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

Hair transplantation was performed in Japan in the 1930s. Dr. Okuda used small punches to transplant hair-bearing skin 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 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 circular patches of bald skin were removed and replaced with same sized patches of hair bearing skin that had been removed from the “safe” donor area. The goal at the time was to move as much hair per graft as possible without jeopardizing the survival of the hair graft. Dr. Orentreich considered the ideal graft size to be 4 mm in diameter. This became known as ‘punch grafting’ or ‘standard grafting’ and this method of 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 a few surgeons used smaller grafts to create a more refined and less pluggy look. They dissected standard grafts into smaller “mini-grafts” 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 mini-grafts and inserted the mini-grafts 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 mini-graft hair transplantation. Small grafts containing one to three hairs were called micro-grafts were used to further refine the hairline.

Older methods including punch grafting, surgical flaps, scalp reductions, mini-grafting and mini-micro-grafting 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 although it has seen an increase in use in the recent years, although what scientific evidence supports this revival remains as vague and sparse as it ever has.

In 1987, Dr. Bobby Limmer introduced microscopic dissection of grafts to obtain grafts containing naturally occurring follicular units of 1, 2, 3 and 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. This was the concept that Dr. David Seager advanced and led him to become the first advocate for and most skilled at follicular unit hair transplantation.

Using standard grafting, mini-grafting or mini-micrografting, multiple sessions of hair transplantation were required to complete an area. Dr. David Seager started placing more and more follicular unit grafts in one session, closer and closer together. Dr. 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. To date, this has been the biggest advance in the field of hair transplantation and set the stage for the results enjoyed today by patients worldwide.

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.

Follicular unit extraction or FUE, without surgical excision of a donor section, is the latest significant development in hair transplantation providing us with a second technique for donor harvesting.

Automated FUE involves using robotic devices to aid the doctor in the extraction of the grafts. These robots can be programmed to score around the individual grafts to allow for easier removal.

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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