Depending on a number of extremely important factors, a hair transplant can be one of the best or worst decisions you can make. Today we are going to discuss the pros and cons of surgical hair restoration, euphemistically called hair transplant or hair transplant. Indeed, the most detailed description is “autologous skin graft”. This is because in the actual procedure areas of skin are removed from a hairy part of the scalp (donor) and moved to a bald part (recipient) of the same person. A skin graft between twins other than genetically identical does not work.
The technique of moving hair tissue grafts from one part of the scalp to another goes back at least 50 years. In the 1950s, a pioneering surgeon by the name of Dr. Norman Orentreich with the idea of experimenting on consenting patients. Orentreich’s groundbreaking work revealed a concept known as donor addiction or donor identity, meaning that skin grafts with scalp hair outside of the loss pattern continued to produce viable hair, even though the grafts had been moved to previously bald areas. to become.
Over the next two decades, hair transplantation gradually shifted from curiosity to a popular cosmetic procedure, especially for bald men in the late Middle Ages. In the 1960s and 1970s, practitioners such as Dr. Emanuel Marritt in Colorado, Dr. Otar Norwood, and Dr. Walter Unger made hair restoration feasible and inexpensive. A standard of care has been developed that has led to reasonably consistent results in experienced hands.
At that time, the most common technique was to use relatively large grafts (4mm to 5mm in diameter) which were individually removed from the donor site with round swabs. As a result, the occipital scalp resembled a Swiss cheese field and severely limited the performance available for movement in the bald areas above and in front of the patient’s scalp.
During several surgical sessions, grafts with slightly smaller punches were inserted into defects that had arisen in the recipient area (bald area). After healing, the patient returned to follow-up exams where the grafts were placed in and between previous grafts. Due to the relative coarseness of this technique, the results were often quite obvious, and the patient had to walk around with a doll-like appearance that was especially noticeable on the frontal hairline and especially on windy days. These patients were usually quite limited in the way they could style their hair, and due to the unnecessary donor extraction method, many people ran out of donor hair long before the process could be completed.
In the 1980s, the hair restoration operation gradually began to evolve, moving from the use of larger pre-cut grafts to smaller and smaller mini and micro grafts. Mini-grafts were used behind the hairline, while one and two micro-hair grafts were used to approximate a natural transition from forehead to hair. Management of donor sites has also extended from extracting round pads to harvesting strips – a much more efficient technique. The pioneers in this field were skilled surgeons like Dr. Dan Didocha, Dr. Martin Tessler, Dr. Robert Bernstein and others. The concept of creating a more natural appearance developed in the 1990s with the advent of Follicular Unit Extraction (FUE), which was first developed by the very talented Dr. Robert Bernstein. was developed in 1995 in the publication “Follicular Transplantation” by Bernstein and Rassman.
The 1990s also brought new tools to the mix, such as the introduction of binocular or “stereoscopic” microdissection. Stereoscopic microdissection allowed the surgeon to clearly see where one hair follicle begins and another ends. In the 1990s, many transplant surgeons did not use larger grafts in favor of one, two, and three hair follicle units.
These “micro grafts” were very useful in the hairline area, but were not always optimal for restoring density behind the hairline.