Keep It Growing: The History and Evolution of Hair Restoration

Hair procedures have come a long way since our grandparents’ day. Over just a few decades, hair transplantation technology has dramatically evolved to become a minimally invasive procedure that requires less downtime and improved comfort compared to earlier procedures while achieving compelling, natural-looking results. But exactly how far has it all come? How do today’s top hair restoration procedures compare to those of the past?

The History of Hair Transplantation Procedures

According to the International Society of Hair Restoration Surgery, and most accounts today, the traditional hair transplant procedure dates back to the 1930s. While Dr. Norman Orentreich has often been dubbed the father of hair transplantation, Dr. Shoji Okuda has more recently been attributed with the development of the punch graft hair transplant procedure, as proven in The Okuda Papers. In the 1930s, Dr. Okuda established the procedures to help burn victims restore their hair growth. However, with the beginning of World War II, Okuda’s research and work did not make it outside of Japan until 2004, when The Okuda Papers were located and translated to English.

The Early Years: Hair Plug Procedures

In North America, Dr. Norman Orentreich is credited with establishing the beginning of a revolution in aesthetics and the beginning of hair transplantation procedures. More specifically, in 1952, Orentreich performed the first known transplantation for the treatment of male pattern baldness. Initially, Orentreich’s findings were not widely accepted until his landmark study was published seven years later. In this paper, Orentriech pioneered the donor-dominance concept that proved hair follicles on the back and sides of the head are often more resistant to balding and will sustain healthy growth when harvested and implanted in areas that follicles have become dormant or damaged.

Unfortunately, Orentreich’s method required large circular skin grafts, equivalent to the size of pencil erasers, to be harvested and transplanted. Think of it like a cut and paste function. Often, the results looked unnatural or, as the Wall Street Journal described it, the procedure resulted in a “toothbrush” type look, with circular sections of hair compared to the rows of bristles on a brush. Nevertheless, the popularity of the procedure grew into the 1970s. Being the only surgical hair transplantation option at the time, those wanting a more impactful hair restoration solution didn’t have much of a choice.

Changing Times: Follicular Unit Transplantation

From the 1980s to the 2000s, strip harvesting—also known as follicular unit transplantation (FUT)—replaced hair plugs as the industry’s gold standard. Using the FUT technique, physicians harvest a strip of skin from the back of the scalp. For optimal results, the physician carefully plans these cuts to ensure intact and healthy hair follicles will be removed. The area from which the strip is taken is then stitched closed while the physician’s assistants separate naturally formed groupings of hair follicles (follicular units) from the harvested strips. In the process, excess tissue is removed as much as possible without damaging the follicles. The physician then creates micro-puncture sites for transplanting the grafts with follicles placed in a predetermined arrangement to better match the patient’s natural hair density and growth patterns. 

While the results of strip harvesting may appear more natural than hair plugs, the procedure results in linear scarring in the donor area. Downtime is shortened to approximately two weeks, but patients may have to wear their hair long enough to cover any potential scarring and stitches.

Today’s Gold Standard: Follicular Unit Excision and Robotics

Improving upon the FUT method, follicular unit excision (FUE) harvesting first came about in Japan in 1988 but didn’t take hold in the hair restoration industry because the method required extensive time and costs to learn, and the technology had not yet been developed to support physicians in this process. With time, it saw progress with FUE procedures now the gold standard in hair transplantation.

Using the FUE technique, individual follicular units of one to four hairs are excised using simple local anesthesia with micro-punches no more than one millimeter in diameter. The physician then creates suitable micro-puncture sites to transplant the grafts based on the density and pattern of the patient’s hair growth. Because FUE uses small, circular incisions to separate the follicular unit from its surrounding tissue, tiny holes are left in the scalp in donor sites that don’t require stitches and naturally heal in just a few days with no risk of linear scarring. Patients of FUE hair restoration procedures may expect up to a week of downtime with minimal pain and discomfort expected, though you can explore more of what to expect during an FUE procedure here.

While the first hair restoration procedures using the FUE technique took a substantial time to complete and required a steady hand—physician fatigue was certainly a risk during a procedure—new technology has allowed for greater patient comfort, safety, accuracy, and optimal results. To begin, unlike the more traditional harvesting methods by hand, the NeoGraft® FUE hair restoration procedure skips the scalpel for an automated handpiece that features advanced technology to gently incise and remove donor follicles, resulting in little to no patient discomfort during the procedure. Using the device, physicians are better able to sort and implant hair follicles at an angle and in a pattern that offers more natural-looking outcomes in less treatment time.

More recently, robotics have also entered the mix with the ARTAS iX™ robotic hair restoration device. In particular, the ARTAS iX™ utilizes the FUE technique alongside Artificial Intelligence (AI) technology to deliver precise, natural-looking results. The ARTAS iX™ system starts by tapping into 3D technology to help your physician customize and plan your personalized hairline design based on your own hair growth and density patterns. Using a high-definition stereoscopic vision system, robotic arm, and ARTAS Artificial Intelligence™ algorithms, your physician can use the ARTAS iX™ system to identify and select the best hair follicles for transplanting while flagging low hair density areas and blocking them out from harvesting, reducing the risk of over-harvesting. Selected donor follicles are then intelligently harvested with robotic precision and speed to preserve the natural look of your donor area. Using 3D technology and your customized hairline design, the physician can then tap into the ARTAS iX™ system’s advanced technology to accurately identify and create optimal recipient sites while simultaneously implanting the harvested hair follicles. In all, existing healthy hair is protected, and a natural appearance remains in both the donor and implantation areas. The system’s robotic method enables precision and speed for a faster procedure than more manual FUE methods.

Interested in learning if you’re an ideal candidate for an ARTAS iX™ or NeoGraft® FUE hair restoration procedure? Locate an expert near you to learn more about the technology, the technique, and a customized hair restoration treatment plan that’s right for you.