HISTORICAL OVERVIEW: 181 YEARS OF HAIR RESTORATION SURGERY
The first written record of successful hair transplantation to treat baldness in humans was published in 1822 in Wurzburg, Germany. A medical student named Diffenbach described experimental surgery performed by himself and his surgeon mentor Professor Dom Unger in animals and in humans. They successfully transplanted hair from one area of a patient’s scalp to another area. Professor Unger was said to believe that hair transplantation would make baldness a rarity.
Few additional mentions of hair transplantation appeared in surgical literature over following decades, however, and few if any surgeons adapted Professor Unger’s technique to treat androgenetic alopecia (inherited pattern baldness). Surgical procedures using hair-bearing skin flaps and grafts were first adapted to the treatment of traumatic alopecia (baldness caused by burns or other physical injury) in the late 19th Century.
Male pattern baldness was not neglected in the 19th Century. It had the attention of “medicine men” who sold various concoctions and nostrums purported to be cures for baldness when rubbed on the scalp or sipped from the bottle. The “medicine man” famous in Western lore is the top-hatted snake-oil salesman who traveled from town to town in his painted wagon. Newspapers of the 19th Century carried advertising for nostrums claimed to do everything from curing cancer to putting hair back on the bald scalp.
The modern surgical techniques of hair transplantation were first developed in Japan in the 1930s and 1940s, but did not come to attention outside of Japan until after World War Two. In 1939, Dr. S. Okuda, a Japanese dermatologist, described the use of full-thickness grafts of hair-bearing skin from hair-bearing areas to hairless areas to correct hair loss on the scalp, eyebrows and upper lip. While most of the 200 patients he reported were treated for traumatic alopecia, his technique was almost identical to that first reported in the United States in 1959 to treat androgenetic alopecia. Other Japanese surgeons reported successful hair transplantation to areas of the body other than the scalp throughout the 1940s and 1950s; as with Dr. Okuda’s reports, these were written in Japanese and were not seen outside Japan for many years. See Okuda Papers.
Hair transplantation as a treatment for androgenetic alopecia took its modern shape in 1959 with a paper from Norman Orentreich, MD. The paper presented a hair transplantation technique, but just as importantly it presented a physiologic basis for successful hair transplantation-the concept of “donor dominance” and “recipient dominance”. The donor dominance concept explained the contradictory results of many previous hair transplantation studies.
Dr. Orentreich showed that the success of hair transplants for androgenetic alopecia is dependent on donor dominance. Donor dominant transplants continue to show the hair-growing characteristics of hair from the donor site after transplantation to the recipient site. Research published in the 1950s and 1960s also confirmed that so-called “male pattern baldness” is an inherited condition, treatable by hair transplantation. These findings put to rest other hypotheses regarding the cause of male pattern baldness-among them, the theory that movement of the scalp muscles would, over a long period of time, incapacitate hair follicles and cause baldness.
Dr. Orentreich’s 1959 paper marks the beginning of modern hair transplantation. The science and art of hair transplantation have progressed together-the science developing techniques for harvesting and transplanting even single hair follicles, and the art following in the steps of science, refining the placement minigrafts (3 to 5 hairs) and micrografts (1 to 3 hairs) to create an entirely natural look on the transplanted scalp.
Progressing side by side with hair transplantation were surgical techniques for treated baldness by:
- moving flaps of hair-bearing skin to cover bald areas;
- using tissue expanders to facilitate bald scalp reconstruction; and,
- using scalp reduction surgery to eliminate bald scalp and “pull up” hair-bearing scalp to replace it.
Hair Transplantation Today
While hair transplantation has been a well-accepted procedure for decades, scientific and technical advances have helped hair restoration surgeons create a new era of consistent, safe, effective, and – most importantly, natural-looking results. The obvious-looking ‘plug-type’ transplants of the past have been replaced with living and growing results that truly defy detection. Microsurgical techniques and instrumentation, and artistic appreciation of how hair naturally grows, has led to these advances. The identification of naturally-occurring follicular-units (groups of mostly one, two or three follicles) in the skin, and the ability to successfully transplant literally thousands of these groupings, allows for the restoration of hair in the vast majority of men and women who suffer from hereditary hair loss. For men or women suffering from hair loss, a detailed consultation with a physician specializing in hair restoration is highly recommended in order to determine what treatment (or combination of treatments) will most efficiently and effectively help them achieve their hair restoration goals. For more detail, go to About Hair Loss.