Hair Transplant Surgery – Advancements in Hair Restoration

First off, what is hair transplantation? It is a medical procedure that literally relocates healthy growing hair from the back of your head to balding and thinning areas on top of your head. It is literally exactly like it sounds. So you may ask, how is this done?  Healthy hairs are removed from the back of the head, the donor area, with their follicles attached. They are then surgically implanted into the front and/or crown of the head – the areas where hair loss occurs. The newly implanted hair ultimately takes to the new location, growing naturally and permanently in the new areas which have experienced thinning or balding. It is a procedure that has made great strides in recent years. If done correctly, the hair grafts can result in very realistic and natural appearance.
With male pattern baldness, the hormone dihydrotestosterone (DHT) is responsible for hair loss. Hair that grows on the sides and the back of the head is resistant to DHT. Hair follicles that grow on the top and front of the head, due to genetics, can fall out as a result of this hormone. Therefore, hair transplantation is performed to surgically ‘transplant’ the DHT resistant hair from the back of the head to the areas of balding. Once these DHT resistant follicles are implanted to the balding areas, they still maintain their resistance and thrive in their new location.

Hair loss is genetic and can be inherited from either the mother or father or combination of both. Balding is triggered when the DHT molecules chemically bond with special receptor sites on hair follicle cells. This causes the hair follicle to weaken or miniaturize and eventually to die. Once these follicles die, they cannot be brought back to life again.
Hair transplantation used to be commonly known to the general public as ‘hair plugs’. Even to this day, the term is used somewhat  disparagingly when hair transplantation is discussed. The new term for the procedure is generally known as hair restoration. As a personal recipient of a hair transplant, I can say that most people don’t have the slightest clue about hair restoration. Even some of the barbers and hairdressers that I have used don’t even have the smallest inkling that I have had a transplant.  I can tell you that my hair transplant was the best thing I ever did and is my most treasured investment.

Hair transplantation was first adopted in the western world in the late 1950’s. New York dermatologist Norman Orentreich began to experiment with free donor grafts to balding areas in patients with male pattern baldness. It was first thought that even though DHT resistant hair would be relocated to the recipient areas(balding areas), the new location of the hair would cause the DHT resistant hairs to perish, just as the previously follicles did when they weakened and died. Dr. Orentreich demonstrated that such grafts were ‘donor dominant’, meaning that the transplanted hair grew and lasted as if they would have in their original location. Today, Dr. Orentreich’s practice still performs hair transplantation procedures.

For the next twenty years, surgeons tried unsuccessfully with transplanting smaller grafts. The results were only minimally successful, using 2-4 mm grafts or ‘plugs’, often leading to a doll’s head-like appearance. In the late 1980’s thru mid 1990’s, surgeons introduced ‘follicular unit transplantation’, where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces of excised portions of the rear scalp, individual follicular units containing 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas.
In the last ten years, surgeons have devoted more attention to the angle and orientation of the transplanted grafts. It has become more of an art than just a surgical procedure. The placements of each grafts and talent of the surgeon plays a huge part in whether one’s hair transplantation takes effect in a natural way.