Modern hair restoration surgery involves the use of single hair, micro and mini hair follicular transplants

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History of Hair Restoration surgery

Hair Restoration Surgery-The Japanese influence

The history of hair restoration surgery dates back to the late 1930s with most of the initial work in the direction of hair restoration surgery done in Japan, as noted by the distinguished hair transplant surgeon Domnic Brandy.

• A Japanese dermatologist named Okuda performed the first true hair restoration surgery by the use of small auto-grafts (auto means “from self”) of hair bearing skin for the hair loss restoration of scalp, eyebrows and mustache areas in 1939.

• In 1943, Tamura published an article on the use of hair restoration surgery for the reconstruction of the female pubic area in Japan.

• Fujita in Japan used a similar technique to bring about the hair loss restoration of scars, eyebrows, eyelash defects, and pubic areas in 1953.

However, because of the Second World War, the contribution of Japanese dermatologists and surgeons ( which were in Japenese) the development of hair transplant techniques was not recognized until many years later.

Hair Restoration Surgery-A brief review

In 1959, New York dermatologist Norman Orentreich reported that hair-bearing scalp (auto-grafts) could be successfully transplanted from the back of the head to the balding front and top. For his hair loss restoration experiments he also took biopsies of scalp on the sides of the head of balding men and transplanted these into balding areas.

The success of these pioneering efforts of hair restoration surgeries led to the conceptualization of the theory of donor dominance and opened the gates for a new discipline 'Surgical Hair Restoration' in the Western world. Donor dominance is the key principle of the hair transplant surgery, and to understand it one needs to know a little bit of bilogy of hair follicle and hair loss restoration .

In short, the principle states that if the hair follicles are harvested from the "permanent zone" of the scalp and are transplanted into to the balding areas, they retain the hair characteristics of the donor area to dominate over the character of hair follicles in the recipient (bald area), which are otherwise programmed for the greatest amount of hair loss.

Based upon the hair loss restoration experiments of Orentreich, hair restoration surgeries were carried out all over the Western world using 20-30 hair follicles in each punch graft during (1960s & 1970s). And hair transplant surgery using plug grafts consisting of 12-20 hairs was most commonly performed hrough out the 1980s.

Although the surgical hair restoration as a new method for hair loss restoration seemed to have a lot of potential, the results of hair restoration surgeries were not so pleasing from the cosmetic and aesthetic angle.

Hair Restoration Surgery - Evolving Aesthetics (1980-1990)

The 3-4mm (millimeter) round plug grafts used in the initial years of hair restoration surgery, were thought to be optimal size grafts in terms of density (hairs per square mm) and also in terms of blood flow (nourishment) to the tissues of the graft.

These circular 12 to 20 hair-grafts (also known as quarter grafts) implanted through the hair transplantation surgery provided a high density to the recipient (balding) area initially. But they were difficult to maintain because of problems in re-establishing the blood flow to them, especially toward the center of the grafts. Eventually, the hair follicles in the very center of the graft would often die to give an appearance of a hole without hair in the middle.

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Other cosmetic problems associated with the original plug-graft hair restoration surgery technique were soon recognized. As the graft healed and the scar contracted, it gave a very typical look to the bald scalp, which came to known as 'dolls hair' or 'tooth brush appearance'. Even otherwise, the unnatural hair lines and unnatural direction of the hair growth gave very a obvious look to the people who had undergone hair restoration surgery.

But innovations in hair transplant surgery during (1981-1984) soon overcame these initial problems of hair restoration surgery by using smaller size mini-and micro-grafts.

Besides the improved hair transplant procedures, the decade also saw the development of newer methods of surgical hair restoration other than the hair transplant surgery as described below.

Hair Restoration Surgery - Some other Methods (1980-1990)

Scalp flaps: This hair restoration surgery technique involves the moving of tissue from one area of the scalp to another, such as a strip of scalp from the hair bearing temple moved forward to the bald frontal hairline.

Scalp reduction: A hair restoration surgery technique where baldness is reduced by cutting out a segment of bald scalp skin.

Both of the above mentioned hair restoration surgeries were successful only in certain selected patients with the ideal hair and scalp characteristics, who were of the optimal age, and were highly motivated. But problems of stretching (stretch-back) and pulling of the scalp due scalp reduction in some of the patients, or visibility of the scars due to scalp flap surgical techniques in many of the patients, led to the abandonment of these hair restoration surgery techniques by most hair restoration surgeons.

A few surgeons are still using these methods of hair restoration surgery with some modification like the scalp expansion techniques for the surgical hair restoration of hair loss. However, all the recent and most developed hair restoration surgery techniques are based on follicular hair transplant which is the state-of-art technique that has helped the hair transplant surgeons to perform superior hair restoration surgeries. This is the technique due to which the hair restoration surgeries in recent years are giving their patients more natural (undetectable) and esthetically pleasing results.


1. Dominic A. Brandy, MD: ‘The The Art of Mixing Follicular Units and FollicularGroupings in Hair Restoration Surgery’, Dermatol Surg 30:6:June 2004, 846-856

2. Richard C. Sheill, M.B, BS: ‘Modern Hair Restoration Surgery’, Clinics in Dermatology , 2001;19:179-187

3. Jefferey S.Epstein, MD: ‘Hair Transplantation for Men with Advanced Degrees of Hair Loss’, Plast Reconstr Surg, Vol. 111, No. 1 , 414-421

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