History of Hair Loss Treatments

THE CONCEPT IS BORN
In 1939 - Dr. Okuda, a Japanese dermatologist, published a revolutionary method of hair transplantation in a Japanese medical journal.  This method was very similar to the way it is done today, but it did not make an impact in that era due to interruption by World War II.  This method involves using hair transplant grafts to correct lost hair from the scalp, eyebrows, and moustache areas. 

HAIR RESTORATION – BECOMES WIDELY ACCEPTED
In 1959 - the first hair transplant surgery was performed by Norman Orentreich in New York City.  Dr. Orentreich had published his work only to have the first few submissions describing his technique rejected. The term “donor dominance” was coined by Dr. Orentreich to explain the basic principle of hair transplantation – that when bald resistant hairs were relocated, those hairs continued to display the same characteristics of the hair in the donor site. The downside of this technique was that it created an unnatural “corn row or doll’s hair” look.

“Donor Dominance” became the principle establishing the fact that hair could be transplanted from the bald resistant donor areas to the balding area, and it would continue to grow for a life time.  From this - the foundation for modern hair transplantation was solidly laid.

Over several decades, many superstitions, old wives tales, and guess work has gradually been replaced by solid science and millions of living testimonials by people that have had successful hair transplantation surgeries.
During the 60’s and 70’s - hair transplantation grew in popularity.  However, the standard of care still involved using larger grafts that were removed by round punches, and often contained many hairs.  This still produced the corn row or doll’s hair appearance and the patient had to complete all sessions and was limited in the way they could style their hair. It was not uncommon for a patient to run out of donor hair before completing this process.

FROM FEW TO MANY GRAFTS
In the 80’s - hair restoration surgery evolved dramatically with the use of more refined techniques that produced much better results. The large punch grafts method was replaced with mini and micrografts in combination and also eliminated the punch method of extraction. The new technique involved a strip of bald resistant hair, surgically removed from the back of the head and then trimmed into mini and micrografts with typically 4-8 hairs per graft.  This created fullness and density while the use of one, two, and three hair micrografts were used to create a refined and feathered hairline in the front.  This combo procedure required several hundred grafts per session instead of the fifty to one hundred grafts used with the old punch method.

THE GOLD STANDARD EMERGES – Follicular Unit Hair Transplantation
It mimics the way hair grows naturally
The 90’s ushered in the very refined surgical procedure called “follicular unit hair transplantation” or FUT.  This technique is labor intensive and requires meticulous attention to detail.  Hairs are transplanted in their naturally occurring grouping – of one, two, three, and four hairs called follicular units.  Dr. Robert Bernstein created this concept and then described it in the 1995 Bernstein and Rassman publication titled: Follicular Transplantation.  The binocular microscope, invented by Dr. Bobby Limmer of San Antonio, Texas, was critical to the success of this transplant method.

In the 1980’s - Dr. Rassman and his team discovered that using a microscope enabled them to examine the donor tissue and successfully isolate and trim the naturally occurring follicular units into individual grafts. After sharing his findings and techniques with his colleagues, Dr. Rassman, jointly with Drs. Bernstein and Seager, became a successful advocate for this procedure. Over time the procedure became widely accepted and is today’s “Gold Standard” for surgical hair restoration.

In the 1990’s - use of the laser came and went quickly. The laser was used to make the holes into which the graft was placed and was touted as being the “high-tech” method of the era.  It worked but not well.  The laser also damaged the skin, caused scarring, and resulted in poor hair regrowth.  After Bernstein challenged this method, in a paper he authored in 1996, this method was soon abandoned.

Another method used in the 90’s called “scalp reductions,” involved rotating a strip of skin from the side of the head to the balding, frontal hairline, after cutting out the bald area.  This was short-lived as it too created scarring and unnatural hair growth.

FUT – Follicular Unit Transplantation Proves to be the Method of Choice

With the fame and success of the FUT method of hair restoration, many thought there could be no more worthwhile advances in hair restoration.  However, persistence and science have never quit in the search for more advanced and refined methods and technologies.  Such is the case with hair transplantation.  Today, some leading hair restoration surgeons – including all members of the Coalition of Independent Hair Restoration Physicians – perform an ultra refined follicular unit hair transplant procedure, using very tiny incisions, that enables them to safely “dense pack” tiny grafts when it is appropriate to do so. This produces cosmetic density, in a given area, after only one surgical session.

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