The appearance of alopecia implied the development of research in the field of medicine in order to obtain suitable techniques to control the disease. Currently, hair transplantation is the most efficient technique against baldness. For this reason, we are going to carry out a general revision regarding the origins and The origins and history of hair transplants, as well as its contribution to combating alopecia.

history of hair transplantsCurrently, there are various techniques to control baldness, some older and more efficient than others. Within this group, we see hair transplantation, which is one of the most sought-after solutions by the patients due to the development that has taken place in the last few years, when the procedures for its execution has been perfected more and more.

Hair transplantation is basically divided into two modalities: firstly, we have follicular unit transplant, also known as microtransplant, and later we see the free-flap modality.

The technique and its evolution

The first public appearance of hair transplantation dates back to the year 1939, when dermatologist Shoji Okuda published in the Japanese Journal of Dermatology a particular method to transplant follicles on the scalp, the eyebrows and the moustache.

The method consisted of extracting follicles from the lower area of the head (the area close to the nape) and then implanting them in those areas that were bald. However, this procedure only worked in people with cicatricle alopecia and not in patients with androgenic alopecia.

However, this technique did not come to be known by specialists until after the Second World War as communications were interrupted. This explains why, about 70 years after the publication of Okuda, the method still kept being applied in almost exactly the same way practised by the dermatologist.

Treatment for androgenic alopecia

After carrying out much research and various tests towards the end of 1950s, Dr Norman Orentreich discovered the figure of the dominant donor, which made it possible to apply the transplant method as a treatment for androgenic alopecia.

Orentreich conducted experiments by extracting scalp hair from the nape area and inserting the hair in the bald spots of the head. As a result, he observed that these follicles were resistant to androgenic alopecia and that they could then be used in the area of the follicle origin as well as in the bald spots of the scalp. These type of follicles are known as dominant donors.

This was one of the most important discoveries in the scientific sphere in the field of alopecia as it made it possible to conclude that baldness did not necessarily need to be a problem regarding the blood supply. Because if this were true, the follicles would not be able to resist in those bald spots of the scalp. On the other hand, it made it possible to establish the modern hair transplant principle, which ensures the effectiveness of a follicle transplanted from one area of the head to another.

Three types of grafting

During the development of follicular unit transplant, many different types of grafting was carried out, specifically between the sixties, seventies and eighties. These grafting techniques could be classified into three types: punch-grafts, minigrafts and micrografts.

Punch-grafts were grafted from large scalp hair, where ample distance was left, which produced an effect of islands on the scalp, or the so-called toothbrush effect. Despite the unnatural effect of the treatment, it received a lot of popularity among patients with alopecia.

Towards the middle of the eighties, a change occurred in the way of conducting hair transplants with the use of the minigrafts and micrografts technique. In order to conduct this technique, a complete strip of scalp was cut, which was distributed in small grafts onto different regions of the head. This was possible thanks to the use of smaller tools that were easy to handle, something that had not been possible in the period of the punch grafts.

The difference between minigrafts and micrografts was that the former were used in high-density areas (like the crown), while the others were employed in scalp regions where a more natural aspect was desired (like the hairline and the frontal area). These two types of grafting certainly required a bigger quantity of follicles and their application was more complex than the case of the punch.

Follicular unit transplant

Follicular unit transplant is the modality of hair transplant that is currently used. This technique was perfected as of the nineties and its application is directed towards simulating the natural growth of scalp hair. The follicular units are the small points of growth on the head. Therefore, each one can have one to four strands of hair.

For that reason, the procedure requires a lot of precision to extract each unit with the help of a microscope. During the procedure, the presence of a technician or assistant is also needed in addition to the participation of a specialist in surgery. This method was developed by Dr Robert Besstein, who proposed to graft only follicular units on the scalp as a treatment for alopecia.

Currently, this is the official method for conducting a hair transplant, but some doctors continue to apply the technique of micrografts and minigrafts. The result will depend on the precision with which the incisions are done on the scalp and on the distance between the follicles.

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The origins and history of hair transplants