The history of hair transplant procedures’ latest technique, the follicular unit excision (FUE), has been sixty years in the making. 

Spawned from such countries as Japan, the United States, and Australia, the history of hair transplant latest technique is rife with ingenuity, discovery, and much rediscovery.

From the Land of the Rising Sun

In the 1930s, Japanese dermatologist Dr Shojui Okuda dedicated much of his time to look for ways to restore the hair of burn victims. He experimented with transplanting hair from everywhere in the body into the burned scalps. 

Out of all his experiments, he ended up finding the best result using a “punch” technique. By using a scalp with a 2.5 mm diameter, he could extract patches of hair to implant in the desired area. 

The patches will take and start growing as if it was in its original site. Dr Okuda wrote and published the “Okuda Papers” based on his experiments in 1939. Okuda noted that the best results came from using scalpels of 1 mm or less, but this required much skill.

Dr Hajime Tamura picked Dr Okuda’s research years later. Unlike Dr Okuda, Dr Tamura did experiment with hair transplants for balding men and used 1 mm scalpels.

He also added an extra step. By dissecting and trimming the graft to improve its looks, he pioneered the FUE hair transplant technique. He published his own papers in 1943, but the events of World War II prevented it from reaching out of Japan.

The “Hair Plug” Era

It was not until much later in New York City during the year 1952 that Dr Norman Orentreich entered the scene.

He successfully performed the procedure that year and published his detailed paper about it in 1959. Dr Orentreich coined the term “donor dominance.” 

It defines the ability of the hair grafts to retain the growth patterns of the zone where it came from. This, in order to take that hair from the back of the scalp, was actually thinning-resistant even when grafted on the receiving site.

However, Dr Orentreich used a 4 mm scalpel, making the grafts too big, which gave an odd look. People called them “hair plugs” and said that it closely resembled the synthetic hair on a doll’s head, not a good look. Due to its appearance, hair plugs maligned and tarnished the hair transplant procedure for decades to come. They were better left forgotten This, unfortunately, was how hair transplants were for much of the ’60s and ’70s

Mini and Micro Grafts and Strip Surgery

It was not until 1984 that the surgeons began experimenting with smaller grafts again. They did this by extracting a strip of donor tissue and later dissecting it, creating small minigrafts and even smaller micrografts. 

Minigrafts would go into the crown area while micrografts will go into the hairline, masking the minigrafts. The results were an improvement over hair plugs.

Ten years later, in 1994, Dr William Rassman and Dr Robert Bernstein came up with the follicular unit transplant (FUT), often called “strip surgery.” In it, they took a strip of hair from the back of the patient’s scalp. The strip is then harvested for follicular units to graft into the receiving site. The results were much more natural-looking, but it left a noticeably long, straight scar in the donor area. Thus, FUT is no longer commonly used.

Follicular Unit Excision

Also, in 1994, an Australian doctor by the name of Dr Ray Woods began performing hair transplant using a 1 mm scalpel directly into the donor site. 

This was a rediscovery of exactly what Dr Okuda wrote about in 1939, and Dr Tamura performed years later, which would later be called FUE. With the help of influential hair loss author Spencer Kronen, Dr Woods drew attention to the idea of making microincisions.

Some surgeons heard his call. Americans Dr Feller and Dr Jones started practising their own styles of FUE since Dr Woods was secretive of his technique. Both of them drew the attention of the inventors of strip surgery, Dr Rassman and Dr Bernstein, who soon published a paper about it. Their endorsement brought FUE to the limelight, where it has stayed to this day.

Manufacturers raced in developing new tools for the job, creating the SAFE system and many others. Robotic surgical tools are also available, successfully deployed, and continue refinement to this day. The future of FUE looks very bright indeed.

But let us not forget that the history of hair transplant began with Dr Okuda and Dr Tamura back in the 1930s and 1940s. Only later did Dr Woods rediscover it in 1994.

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