by Vlad Ratushny, MD, PhD

Hair transplantation in the US originated with Dr. Norman Orentreich, a NYU Dermatologist who performed the first hair transplant to treat male pattern hair loss in 1952. At that time, doctors were using the hair plug technique. This technique involved taking large punch grafts in which they would harvest dozens of hairs from the back of the scalp and then transplant those hairs to the front of the scalp. Since this was the first technique available, there was nothing to compare it to. Unfortunately, the results of this technique gave an unnatural appearance of dozens of circular hair tufts separated by large spaces rather than the normally spaces individual hair follicles of the natural hairline.

The modern hair transplantation procedure was pioneered in the early 1990s by Dr. Bobby Limmer who was the first to perform hair transplantation using follicular unit transplantation (FUT). Modern hair transplantation is based on transplanting follicular units, which are natural groups of hair follicles which grow in groups of 1 to 4 hairs, with the average group of about 2 hairs. FUT involves doing a strip excision on the posterior scalp and then using a stereomicroscope to dissect the strip into individual follicular units. Simultaneously, recipient sites are carefully created by a hair transplant surgeon on the recipient area on the hairline or vertex scalp. The follicular units are then carefully transplanted into the recipient area using specialized forceps. There are no sutures required and the body’s clotting factors hold the hairs in place.

Another modern technique which was developed after FUT is called FUE, or follicular unit extraction. In this technique, individual follicular units are harvested from the posterior scalp using either a manual or a motorized instrument. These follicular units are then transplanted into the recipient sites in the frontal hairline/vertex scalp in a similar fashion as in FUT procedures.