The history of hair is littered with the accounts of balding legends from Socrates, Julius Cesar to Charles Darwin, Winston Churchill and Elon Musk. The point is being rich and famous doesn’t mean that you cannot go bald. And so, the quest for the ultimate cure started long before. You may thank the heavens for not having applied bird faeces on your scalp to “cure” baldness. Then there were the infamous snake oil charlatans. So, knowing the history of hair transplants will make you appreciate it a little more.
Because, boy oh boy, you have gotten away from some ancient hair loss “treatments” only by the skin of your teeth! Did you know that there were once these magic “thermocaps” that could cure hair loss with the heat of a light bulb? If only things were that simple, human beings who wore that would have never gone bald in the first place. Because, really, our very own heat ball, the sun, should have been enough for thick and long hair.
Then there were these “suction helmets” people wore for hair loss. They worked similar to the pore vacuums. The idea was simple: force the non-existent hair out of the follicle. Really, it shows that people didn’t exactly know what was causing the hair loss. Maybe they thought that the hair follicle was in hiding so, vacuuming would force it out. Imagine having Alfalfa’s hair from The Little Rascals, only there’d be cowlicks all over your head. Also, obscurity and unfortunate delays didn’t make hair transplants commonplace till the 80s. So, what happened?
As Always, Germany Was Way Ahead of Time
This time, it wasn’t the engineers, though. The history of hair transplants started with surgeon Johann Friedrich Dieffenbach, who is also known as the father of plastic surgery. His doctoral dissertation titled “Nonulla de Regeneratione et de Transplantatione“, published in 1822 gave the world the first blueprint for hair restoration surgery. Known for its fine wines, Würzburg, Germany, should also have a repute for being the birthplace of hair transplant.
Dieffenbach took six hair follicles from his scalp, poked holes in his arms, and witnessed hair growth from two transplanted follicles. Together with his teacher, Dom Unger, he dug deeper into the concept of autologous hair transplantation. Autologous is just a fancy way of saying that the hair follicles were taken from the same balding individual. The researchers believed that with this surgery, bald heads would become rare. However, hair transplantation didn’t become widely popular till the 20th century. But at that time, the world was in turmoil.
In Comes Japan
As countries were reeling towards World War II, Japanese dermatologist Dr Shoji Okuda was busy developing modern hair transplantation techniques. It was in 1939 that he started treating patients with traumatic alopecia. Using a circular scalpel, he took autografts from the areas that had thick hair. These he put in the balding regions. Thanks to his work, we know that smaller hair grafts give more natural-looking results. However, with his surgical technique, scarring was a huge problem.
That’s where usually Japan’s contribution to the history of hair transplants begin. However, not many know about Dr Masao Sasakawa, who also performed experiments on animals and humans. His researches on hair transplant were published back in the 1920s.
Other than that, Dr Hajime Tamura published a study on the transplantation of pubic hair in females in 1937. Here, he took the hair grafts from other people. Eyebrow hair transplantation was explored by Dr Keiichi Fujita in a paper he published in 1953. Since many nations were reeling from the impacts of the World War, not many in the West knew about these studies.
Formally, a dermatologist based in New York – Dr Norman Orentreich- gave the concept of “donor dominance”. He established the use of hair on the back and sides of the head for transplantation.
The first successful transplantation on a patient with androgenetic alopecia took place in 1952. And in 1959, he presented the theory of donor dominance in androgenic alopecia. His studies showed that it wasn’t the lack of muscle movement in the scalp that caused hair loss. It was his work that, for the first time, indicated genetic predisposition of certain hair to fall.
However, with his technique, the most common complaint was that the hair looked “pluggy.” It was just like the head of a Barbie doll. That’s because the size of each hair graft was 4mm – the size of a pencil eraser. Needless to say, it looked “unnatural.” If your scalp looked like that, it was a dead giveaway that you had a hair transplant.
So, How Did We Come to This?
Well, there was a lot going on. Not only was the hair restoration surgery coming into being, but also the surgeons were busy refining its techniques. They are as follows:
Scalp Flap Surgery: Many people can think of it as the Follicular Unit Transplant (FUT) technique. According to the ISHRS, in this, a “flap of skin” from the donor area is put into the recipient area.
Alopecia Reduction Surgery: In this, the surgeon removes the balding regions of the scalp and then pulls the skin up. There were many problems with this technique, which Dr O’Tar T. Norwood (of the Norwood-Hamilton scale), Richard Shiell, and Ian Donald Morrison showed in their paper “Complications of scalp reductions.” The shape of the bald area changed, and the scalp had the capacity to “stretch back.” This surgery never became popular for good reasons.
Mini & Micro-Grafts: Dr Orentreich’s punch graft method was replaced in 1984 by mini-grafting. The surgeon did not punch out the hair grafts from the donor area anymore. In fact, they cut long strips of skin from the donor area and cut out hair grafts from them.
With a greater reduction in size, micro-grafts became the norm. They only had 1-2 hair follicles in them. Of course, the procedure itself became much more labour intensive. However, they allowed the surgeons to place the grafts closer together. This achieved better hair density with a more natural appearance.
Follicular Unit Transplantation (FUT) to the Rescue
It may be thought outdated now, but once, it was all the rage in the history of hair restoration. Developed by Dr William Rassman and Dr Bernstein in the 1990s, it uses stereo-microscopic for dissection of grafts for hair transplant.
The surgeon removes a horizontal piece of skin from the back or sides of the scalp and then creates grafts from it. This technique improved the survival rates of the grafts. However, FUT did leave the patient with a horizontal scar on the back. But since the results were far better than ever before, it became “the” surgery that everyone wanted.
Follicular Unit Extraction – No More Scarring Woes
Instead of taking the strip of skin and then getting hair grafts out of it, surgeons thought of punching the follicles directly out of the donor area. Now, the punches are as small as 0.7mm. Therefore, it does not leave prominent scars. Follicular units, with 1-4 hair strands, get extracted from the donor area. Then the surgeon makes small incisions in the recipient area, inserts the grafts and voilà!
With time, technological advancements in FUE hair transplants have also improved their results. There is Neograft hair transplant and ARTAS. The robot takeover of the field of medicine is yet to come. However, till then, humans are reigning pretty well. Since the procedure had much better cosmetic results, these days, FUE is the choice of many patients.
We already have a DHI hair transplant, the next logical step in the evolutionary ladder or history of hair. In this, the surgeon takes out the hair grafts. But the incision in the donor area and insertion takes place simultaneously.
What’s next? Maybe the surgeons extract and insert hair grafts simultaneously. That would significantly reduce the overall time of the surgery. The name given to it is “Instant Follicular Hair Unit Transplant (IFHUT).” With this one, the execution is really important. The surgeon has to know what they’re doing. Otherwise, the results can be disastrous. However, it is a very small study, so there’s much more to know about it and the surgical success rates.
So far, there’s no self-sufficient robot that can perform a whole hair transplant on its own. Different technological advancements are assisting surgeons in improving the overall results. We believe that this is what the future of hair transplants is going to be like. AI is not the sole remedy to human error. Humans have the upper hand as long as they are the ones making the robots.
To Sum Up The Above
Throughout history, men and women have dealt with hair loss. You can thank your lucky stars for not being in the era where castration was thought to cure pattern baldness. Still, Greeks had the right idea that it had something to do with hormones.
However, it took us a long time to figure that out. But even before understanding the cause of hair loss, the game for developing hair restoration surgery was afoot. And we have certainly come a long way since the early 1800s, but FUE is definitely not the end of the story.