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THE HISTORY OF HAIR TRANSPLANT SURGERY

Part 2 of an Info Series on Hair Transplants

For as long as there have been people, there has been a fixation with hair. Whether it’s a mild interest in keeping it tidy or a borderline obsession with achieving the perfect look, everyone can understand the importance of hair. It’s tied to personal confidence, and has a cultural significance in nearly every human civilization that has existed on the planet.

As you can imagine, surgical options to repair, improve, and perfect hair have been around for quite some time as well.

Hair transplant surgery is a set of medical procedures that involve extracting hair from one area of the scalp and implanting it into another. Like any good medical procedure, today’s hair transplants are the result of a long process of research and improvement.

We’ve put together this brief history of hair transplant surgery to give you an idea of how mankind has attempted to prevent hair loss across time. Along the way, you’ll see how hair transplants have evolved over the years, and how the newest versions of the procedure have improved upon earlier methods.

1800s: Early Attempts at Hair Transplant Surgery (The 1st Generation)

1800s: Early Attempts at Hair Transplant Surgery

Dr. Unger and his students conduct the first recorded hair transplant. Others follow suit, performing transplants with grafts and hair-bearing skin flaps.

The earliest reported success in the field of hair transplantation was published in 1822, when a medical student described experimental hair transplant procedures performed in Wurzburg, Germany.

These experiments were carried out by the medical student and his mentor, Professor Dom Unger, whose efforts resulted in the first successful hair transplant in human history.

Few other records of hair transplant surgery would be reported until the late 19th Century, when techniques involving the implantation of hair grafts and skin flaps had become relatively more common.

1930s to 1940s: Japanese Innovation

1930s to 1940s: Japanese Innovation

Dr. Shoji Okuda develops a method for the transplantation of large punch grafts, and early mini-graft surgery is developed by Dr. Hajime Tamura.

In 1939, Doctor Shoji Okuda released a visionary set of notes and observations on his experiments with hair transplantation. His published works describe a range of techniques and findings which the West would not discover until well over a decade later.

Dr. Okuda’s papers were revolutionary to say the least. He described the first punching technique for graft extraction, used to treat patients suffering from traumatic alopecia. This would go on to become a technical feature in today’s most advanced procedures.

The outbreak of World War 2 prevented these findings from reaching the global medical community, and the science of hair transplantation would proceed to advance without the fine example of Dr. Okuda’s work. The Okuda Papers achieved an almost mythic status among hair restoration specialists until their translation into English in 2004.

Japan would produce another hair transplant visionary in the form of Dr. Hajime Tamura, who set out to minimize the size of hair grafts to be used for transplant procedures. Like Dr. Okuda, his works were lost to the chaos of the Second World War.

1951: The Hamilton Scale For Male Pattern Baldness

1951: The Hamilton Scale For Male Pattern Baldness

Dr. James Hamilton introduces a measurement scale for male pattern baldness.

1952: Western Punch Graft Surgery (The 2nd Generation)

1952: Western Punch Graft Surgery

Dr. Norman Orentreich develops a method for transplanting 4.0mm hair grafts, resulting in doll-like “hair plugs”.

In 1952, Dr. Norman Orentreich was the first to re-discover the technique for punching grafts into recipient sites. His procedure involved the transplantation of 4.0mm grafts and aimed specifically to treat androgenic alopecia (hereditary pattern baldness).

Unfortunately, the size of the grafts involved resulted in unreliable implants and an unsightly, doll-like appearance – hence the common pejorative used to describe the outcome: ‘hair plugs’. The fault for this lay mainly in Dr. Orentreich’s choice to align with Dr. Okuda’s methods rather than those of Dr. Tamura.

Nevertheless, the widespread use of Orentreich’s method made it the most popular surgical option for patients suffering from major hair loss until the mid-1970s. The West’s early days of modern hair transplant surgery saw other practices, such as the grafting of skin flaps, though these were known for even worse complications.

1959: Donor Dominance Theory

Dr. Orentreich is the first to discover a concrete medical basis for hair transplant surgery.

Dr. Orentreich’s primary contribution to the history of hair transplant surgery was made in 1959, with the publication of his groundbreaking study on the characteristics of transplanted hair. In it, he presented a major discovery: that hair keeps its permanence, growth patterns, and morphology when transplanted to a recipient site.

Simply put, hair extracted from a healthy part of the scalp would remain healthy after being implanted into areas which suffer from hair loss.

This principle of “donor dominance” solved a source of great confusion within the field and, along with other studies during the time, paved the way for a concrete understanding of the nature and causes of baldness.

1970s: The Hamilton-Norwood Scale For Male Pattern Baldness

1970s: The Hamilton-Norwood Scale For Male Pattern Baldness

Dr. O’Tar Norwood improves upon the Hamilton scale, resulting in today’s Hamilton-Norwood Scale for male pattern baldness.

1970: Founding of DHI in Palo Alto, CA

1970: Founding of DHI in Palo Alto, CA

Dr. Konstantinos Giotis of Athens founds Direct Hair Implantation (DHI), a center for research, treatment, and innovation.

Inspired to change the world by restoring lost confidence to those suffering from hair loss and scalp disorders, Dr. Konstantinos Giotis founds DHI in Palo Alto.

Owing to his vision of an organization premised on research and constant improvement, DHI has reached over 60 countries, trained hundreds of doctors and medical staff members, and elevated the practice of hair restoration with innovations like the Unique Diagnostic System for Alopecia and the DHI Total Care System.

1977: Alopecia Reduction Surgery

1977: Alopecia Reduction Surgery

Scientists develop a method for the removal of balding areas on the scalp to provide the illusion of naturally thicker hair.

Where most other transplant methods seek to revitalize balding areas of the scalp, alopecia reduction surgery attempted to solve hair loss by removing those areas entirely.

It would take over a decade to correct the cosmetic problems that came with reduction procedures (like the scalp’s tendency to stretch and reveal surgical scarring and the initial baldness). That correction came in the form of Dr. Patrick Frechet’s “triple flap” procedure, and the Frechet Extender.

Further developments in alopecia reduction surgery were dwarfed by improvements to micro-grafting, such as FUE and the DHI method.

1977: The Ludwig Scale

1977: The Ludwig Scale

Dr. E. Ludwig develops the first measurement scale for female pattern baldness.

1980: Micro-Grafts

1980: Micro-Grafts

The medical community shifts to the use of smaller grafts (4-8 hairs), providing much thicker and somewhat more natural results.

To address the global demand for natural and invisible hair transplant outcomes, many of the world’s hair restoration innovators focused their efforts on developing ways to reduce the size of grafts.

1994: Follicular Unit Transplantation (FUT)

Drs. Bernstein and Rassman develop a method of removing strips of donor scalp to extract smaller follicular units.

1999: The DHI Implanter

1999: The DHI Implanter
1999: The DHI Implanter

The DHI Medical Group unveils the patented DHI Implanter, a revolutionary handheld tool for the precise implantation of follicular units.

In line with the shift towards microsurgery among hair restoration specialists, Drs. Choi and Kim invented a handheld, pen-like device for the implantation of hair grafts. This automated tool allowed a surgeon to “push” hair grafts into a recipient site without the need for pre-made incisions.

This would later serve as the inspiration for the patented DHI inserter, which allowed DHI’s doctors to implant between existing hairs and achieve a completely natural result. For patients, this means improved degrees of accuracy and reduced trauma to each follicular unit.

2001: Follicular Unit Extraction (FUE)

Along with some of the world’s most prominent hair restoration specialists, the DHI Medical Group develops the FUE method.

Follicular Unit Extraction was a major shift away from the standard, gruesome extraction methods. It involved the use of microscopic blades under a millimeter in diameter, and resulted in far less visible scarring along donor areas of the scalp.

The most notable area for improvement in the traditional FUE method was the fact that small incisions needed to be made prior to the implantation of grafts. This fact makes the success of an FUE operation highly dependent on the skill and concentration of the doctor –and even the most highly trained specialists are only humans, with the potential to make mistakes.

2002: Abandoning FUT

DHI’s founder, Dr. Konstantinos Giotis, is the first to abandon the brutal FUT technique in favor of FUE, a less invasive surgical procedure.

DHI Founder Dr. Konstantinos Giotis was first to choose the FUE procedure over FUT, and his early adoption of the method allowed him and the DHI Global Medical Group to begin innovating the process while other clinics had only just begun to offer it.

2010: Direct Hair Implantation Surgery (The 3rd Generation)

DHI unveils the next phase in the evolution of hair restoration surgery.

DHI took the bold step of innovating hair restoration surgery even further in 2010, with the introduction of the Direct Hair Implantation method.

Inspired by the inherent flaws of FUE surgery (i.e. the need for pre-made incisions and the lack of control over the angle and depth of follicular insertions), the DHI medical group integrated the full use of the DHI implanter, as well as the DHI Total Care System which standardized patient care from diagnosis to recovery.

The end result is DHI as we know it today: a minimally invasive, pain-free, and natural procedure with guaranteed natural results and follicle retention of over 92%.

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