Although topical and oral pharmaceutical treatments such as minoxidil (Rogaine ®) and finasteride (Propecia ®) can temporarily reduce the thinning of scalp hair associated with male-pattern baldness and hormonal hair loss in women, hair transplantation is the only permanent method of hair restoration. When properly performed, modern hair transplantation techniques can achieve significant improvements for a wide variety of hair-loss patients.
With all methods of hair transplantation, hairs are taken from a donor site(s) in the back of the scalp and transplanted to thinning or balding regions. The hairs “remember” where they came from and continue to grow as if they were in their original location. The first hair transplant for male-pattern baldness was performed in 1952 by Dr. Norman Orentreich, a dermatologist. Since then major advances have been made in hair transplantation technology. The “hair plug” technique commonly used in the 1970s gave way to mini-grafts and micro-grafts in the following decade. In 1995 an improved technique of micro-grafting was developed: follicular unit transplantation.
To comprehend the difference between mini- and micro-grafting and follicular unit transplantation, it is necessary to understand the natural patterns of hair growth. Contrary to common belief, hair grows not in evenly-spaced single strands over the entire scalp, but in small groups of about one to four hairs each. A “follicular unit” consists of one of these groups of hairs and their accompanying oil glands, muscles, and connective tissue.
The term “mini-graft” refers to small plugs that are placed into holes or tiny slits made in thinning or balding areas of the scalp. These grafts are taken from strips of skin removed from donor sites on the back of the head. But because a mini-graft consists of multiple follicular units, the hairs tend to be compressed together as healing occurs, giving the unnatural appearance of a tuft of hair in surrounded by bald skin. Micro-grafts (consisting of one or two hairs each) came into use at about the same time as mini-grafts, and were intended primarily for use along the front hairline. Micro-grafting led to the development of follicular unit transplantation.
In follicular unit extraction, follicular units are removed individually from the donor site using a very small surgical instrument called a “punch.” The surgeon selects the follicular unit to be removed, places the punch over the unit to make a small circular incision, and then extracts the unit from the scalp. Once the follicular units are prepared, the surgeon carefully places them in thinning or balding areas in a manner that will result in the most natural appearance. Unfortunately, surgeons inexperienced in follicular unit extraction who use this technique may damage up one-third of the hair follicles extracted. To minimize such damage, Dr. James A. Harris developed the Harris SAFE (Surgically Advanced Follicular Extraction) System, which uses a patented instrument called the SAFE Scribe™ to remove the follicular units. Since its introduction in 2004, numerous surgeons have started using this system.
Compared to earlier hair transplantation methods, follicular unit transplantation offers significant advantages—a more natural-looking result, faster healing time, and reduced post-operative pain. In addition, the new techniques work well for African-American and gray-haired patients, who formerly were not considered good candidates for hair transplantation.
Interestingly, the widespread adoption of follicular unit transplantation by the hair transplant community was largely driven by patient demand—chiefly due to patients communicating about their great results over the Internet.