Hair transplantation involves removing small pieces of hair-bearing scalp grafts, or plugs, from a donor site (often from the thick hair on the sides and back of the head) and relocating them to a bald or thinning area.
Before we examine specific hair replacement techniques, let's look at the history of hair transplantation. Historians say that the hair restoration field probably had its roots in the 1930s in Japan, where experiments focused on taking skin, hair and roots from one area of the body and moving them to areas of the body disfigured by accidents and war injuries.
In the 1950s, American dermatologist Norman Orentreich published articles on how hairy skin can be moved from one area to a bald area and actually take the genetics with it. Contrary to what most people believed, Orentreich was able to prove the theory of donor dominance, which says that hair, when moved, will continue to grow as it would have in its original site. (That's why the permanent, "lifetime" hair on the sides and back of the head are often used as donor sites in transplants.) He is credited with being the first to come up with the idea of using transplantation to replace the hair that a balding person is losing.
According to Dr. Stephen Cotlar, hair transplantation ranks as the number one cosmetic procedure performed on men today. The reason for the transplant explosion of the past six or seven years is that the results gained from the procedure are so much better than they once were. And the results are better because techniques have been improved. However, Cotlar says, the basic concept of hair transplantation is pretty much the same as when it was first performed. The major difference in hair transplantation today is related to graft, or plug, size.
Someone whose transplants were done by a doctor using the older technique can be easily identified by the "garden patch" appearance of his hair. These larger grafts were the standard until about a decade ago, when transplant surgeons looked critically at their work and the correlation between their results and graft size. They decided that smaller grafts would provide better results, because smaller grafts contain fewer hairs and, therefore, less clumping (of transplanted hairs), which is responsible for that characteristic sprout-like look. That began the era of mini-grafts and micro-grafts. Let's look more closely at these as we learn how hair transplantation works.