Hair Plugs – And Why We Don’t Use Them Anymore

by Vlad Ratushny, MD, PhD

Prior to the advent of modern hair transplantation, hair transplant surgeons performed hair transplants using hair plugs.  In 1939, Dr. Shoji Okuda of Japan described using hair plugs to treat alopecia areata, leprosy, and scarring alopecia.  Dr. Norman Orentreich, a NYU dermatologist, performed the first hair transplant to treat male pattern baldness using hair plugs in 1952.  You may have heard of the term hair plugs but may not be familiar with what they really are.  Hair transplantation using hair plugs involves a surgical technique where the hair transplant surgeon uses a round punch device to remove an approximately 3-4 millimeter cylindrical portion of scalp and hair.  This hair plug is transplanted from the “donor” area on the back of the scalp to the “recipient” area on the frontal scalp or hairline. Prior to the advent of modern hair transplantation in 1994 by Dr. Bobby Limmer, hair plugs were the gold standard in hair transplantation.  The reason hair plugs have such a bad reputation is that they produced non-natural results in which the transplanted hair had a tufted or doll’s-hair appearance.

Follicular Unit Transplantation

As a much-needed improvement on the hair plug technique, Dr. Limmer described modern hair transplantation using micrografting or follicular unit transplantation.  In follicular unit transplantation, follicular units the size of 1 to 4 hairs are individually transplanted, resulting in a natural appearance that mirrors non-transplanted hairs.  Dr. Vlad Ratushny only performs the modern techniques of hair transplantation at Boston’s MassDerm Hair Transplant Institute such as follicular unit transplantation / strip excision.