The hair transplant procedures and the techniques employed to achieve them have seen a spectacular evolution since the first days. What was an experimental and punishing-looking operation with odd results is now a very reliable procedure.

Moreover, a common concern in the past was that the results of the procedure would be off-putting to look at. That was the case for a while, but it’s not anymore. A hair transplant result nowadays is very difficult to identify.

It wasn’t always that way, though. Much has changed since the early days and would likely keep evolving in the future. For now, let’s take a look at how much it has changed.

Hair Transplant Evolution: Japan, the 1930s to 1940s

The procedure first came to be in Japan by the hand of Dr Shoji Okuda, a dermatologist that sought to restore hair to burn victims. He devised a method of extracting hair from elsewhere in the body using a scalpel of 4 mm to 1 mm diameter. He was successful, and he wrote a paper about it but never performed the procedure for balding patients.

Around 1946, another Japanese doctor, Dr Hajime Tamura, picked up Okuda’s papers and performed the procedure himself. He employed 1 mm scalpels and successfully restored hair for balding patients. He also added an extra step to dissect the extracted hair follicle, pioneering what would be later called FUE hair transplant.

However, due to WWII, their investigation did not reach outside of Japan until decades later.

Hair Transplant Evolution: New York, 1950s

Regardless, others also tried. In the 1950s, in New York, Dr Norman Orentreich extracted hair follicles from the back of the scalp with a 4 mm scalpel and grafted them into the balding site. He published extensive research detailing his methods and observations.

Chief among them was the definition of “donor dominance.” This is the ability of the extracted hair to continue growing the same way on another site. Unfortunately, the results of his transplants were questionable. Due to the 4 mm grafts used, it ended up looking like a doll’s hair.

They were derisively called “hair plugs,” and it was, sadly, how the procedure was performed for decades.

Hair Transplant Evolution: 1980s

A new approach arose, incorporating trimming of the hair follicles despite not being based on Dr Tamura’s research. Minigrafts and micrografts appeared on the scene. The idea was simple: Use hair plugs a bit smaller in the crown area and mask them with more trimmed grafts in the hairline. The result was less noticeable than the hair plugs of the past. It was a step forward.

Hair Transplant Evolution: 1994

In ’94, a newer, more inventive procedure came to be. Called strip surgery, it had a simple premise: to extract a strip of hair from the patient and dissect it for hair follicles. The individual hair follicles obtained this way go through trimming and make natural-looking grafts.

The results of the procedure were great and were lauded as a giant step forward for the field. But the procedure left a large horizontal scar from the extraction of the strip of hair.

Hair Transplants Evolution: 1999 to 2000s

Since its inception, strip surgery concerned many surgeons because of the scar it left. Dr Ray Woods from Australia was one of them. Dr Woods preferred to extract the hair follicles one by one using a scalpel with a diameter of 1 mm or less. He thought it was best, and everyone should know it. 

Dr Wood teamed up with influential hair loss writer Spencer Kroner and used his platform to call this method into attention. A couple of surgeons heard the call. And among them were the creators of strip surgery, Drs Bernstein and Rassman.

With their endorsement, it did not take much time for the procedure to start catching up in the field. Baptised as follicular unit excision (FUE), a rediscovery of the procedure pioneered first by Dr Okuda and Dr Tamura came to be.

These days, FUE is a much sought-after alternative to the scar-leaving strip surgery, the reason why many prefer it. The evolution of hair transplants up to this point took around 60 years, and who knows how many more ahead. Robotic tools are being refined today, and the future holds great promise in further improving this procedure.

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