The History of Hair Restoration

Hair loss is by no means only a recent concern. For centuries hair has been seen as a sign of youthfulness, vitality, and power, and for just as long, humans have been seeking ways to prevent hair loss and restore their hair. The causes of hair loss have been widely misunderstood by humans and efforts to reverse hair loss have produced all manner of lotions, rituals, and often painful inventions. Serums and tonics concocted by various cultures in an attempt to cure thinning or balding hair have been in use since before the rise of the Roman Empire. When lotions failed, wigs and headpieces of various styles were used to disguise thinning hair. By the 19th century, purported hair loss remedies were being sold by “snake oil” salesmen who sold a variety of lotions and potions which claimed to cure all manner of illnesses and ailments including hair loss. [1]

The history of hair restoration techniques is full of methods by which people have attempted to restore their hair. Though some of these techniques seem preposterous by modern standards, hair loss has always been a concern for men and women, and it is clear that a solution to hair loss has always been valuable. The only lasting form of hair restoration is the hair transplantation which was pioneered in the 1930s.

1930s

The preliminary groundwork for modern hair transplantation techniques was developed by Dr. Shoji Okuda, a Japanese dermatologist in the 1930s. In a 1939 article in the Japanese Journal of Dermatology, Dr. Okuda documented the method by which he extracted grafts of hair using a round punch method and transplanted them to hairless areas on the scalp, eyebrows and face of burn victims. These methods were further adapted by other Japanese surgeons throughout the 1940s, and evolved to use even smaller grafts in hair transplantation procedures. Due to the outbreak of the Second World War, these monumental advances in hair restoration therapies remained unknown outside of Japan. [2]

1950s 

Hair restoration procedures took a major leap forward in the 1950s, with the work of Dr. Norman Orentreich in New York City. In 1959, Dr. Orentreich’s study on hair transplantation procedures was published, in which he described his technique of removing grafts of hair from a patient’s head using a punch method and re-implanting these follicles into balding areas. He also described the principle he coined “Donor Dominance” which meant that transplanted hairs maintained their growth characteristics even once re-implanted, which meant that hair transplant procedures could produce lasting hair restoration results in patients. [3]

1960s and 1970s

The mass popularity of hair transplants began in the 1960s and 1970s as a number of plastic surgeons and dermatologists began to perform the procedure. These procedures became more popular and even well-known celebrities were beginning to use these procedures to gain fuller heads of hair, and included patients such as Frank Sinatra and Elton John.[4]

These hair transplantation procedures involved the use of large grafts of hair known as “plugs” which were often the size of chickpeas and often contained up to 30 hairs. Surgeons continued using the concept of donor dominance and extracted hair from the back and sides of the scalp and transplanted it to the hairline and crown where hair was sparse. The plugs were spaced far enough apart to allow adequate blood flow which would enable the grafts to thrive. [5]

Due to the large size of the grafts, and the space between each graft, these early hair transplant surgeries often left patients with an obvious and “pluggy” look. Furthermore, because of the size of the grafts, and the way in which they were harvested, it was often difficult to restore a full head of hair, and often only partial restoration was possible. Furthermore, several sessions were necessary in order to try and disguise the obvious look of the procedure, which often left patients with a depleted donor supply.

1980s

In the 1980s, hair restoration procedures began to improve with a technique known as mini/micro grafting becoming the standard. The large grafts of the 1960s and 1970s were replaced by smaller grafts of hair. Mini grafts that contained up to 8 hairs were implanted into larger areas on the top of the scalp, while micro grafts containing 1-3 hairs were transplanted into the hairline to produce a more natural result.

Hair harvesting methods were also less traumatic to the scalp, and strip excision began to be used, whereby a section of the scalp was surgically removed and mini and micro grafts were cut from it. This left patients with less scarring in their donor area and the results proved to provide a more natural look than the round plug grafts of the previous decades.[6]

1990s and beyond

The most recent advances in surgical hair restoration, which are currently used to this day, occurred in the 1990s.

Dr. Robert Bernstein’s study on Follicular Unit Transplantation was published in 1995, and advocated for the use of singular naturally-occurring follicular units consisting of 1 to 4 hairs, rather than multiple follicular units containing larger amounts of hair and tissue. The use of such small grafts would allow the surgeon to keep the donor and recipient site as small as possible. This technique would also allow for larger areas of scalp to be transplanted, and enable large-scale hair restoration procedures to take place in one session, rather than the multiple sessions needed in the past.

Dr. Bernstein also advanced the use of Follicular Unit Extraction as an alternative method of extracting donor hair when strip excision was not used. This method was put forward by the publication of a study in 2002 entitled “Follicular Unit Extraction.” [7]

These procedures pioneered by Dr. Bernstein pushed forward the artistry and technique of hair restoration from the 1990s to the present. Most of these initial techniques have by now been refined to an art and Follicular Unit Transplantation is now considered to be the “Gold Standard” in hair restoration procedures.

 

[1] Segrave, Kerry. Baldness: A Social History. Jefferson NC: McFarland and Company Inc., 1996. )

[2] http://www.americanhairloss.org/surgical_hair_restoration/history.asp, accessed on May 2, 2015.

[3] Ibid.

[4] Segrave, 111-115.

[5] http://www.hairdoc.com/hair-loss-answers/chapter-11-history-of-surgical-hair-restoration/, Accessed May 2, 2015

[6] http://www.shapiromedical.com/education/basic_principles_of_hair_transplantation/history_of_hair_transplants/. Accessed May 2, 2015

[7] http://www.bernsteinmedical.com/research/follicular-transplantation-summary/. Accessed May 2, 2015.