The Role of Technology in Enhancing Hair Transplant Results

First Methods Used in Hair Transplantation

As a student in the Department of Dermatology in the late 1940s, Dr. Norman Orentreich became interested in helping patients with baldness and bald spots on the scalp. His studies sparked his interest in this field and he conducted several experiments. In one of his research, he realized that hair transplanted to a certain area of the scalp from other areas did not have the characteristics of the hair where it was transplanted. Instead, the newly transplanted hair retained the characteristics of the hair from which it was taken. This finding was the basis Orentreich later used to further his research and develop the concept of “donor sovereignty”.

In 1952, the world’s first modern hair transplant operation was performed on a patient suffering from male pattern baldness. This operation started a process called “Hair Plugging”, which has led to the creation of a billion-dollar industry where millions of operations have been performed to date.

Generally, in these operations, the surgeon uses a round puncture instrument (4 mm wide) to remove tissue filled with hair grafts. These punctured tissues are called “plugs” which are then implanted into the bald areas. Although the results are not acceptable even by today’s hair transplant standards, it was a prominent hair transplant technique for decades.

Due to the transplantation of the entire tissue as a large whole, the transplanted hair is placed in groups, leading to a doll-like hair appearance. With this technique, the hairline is difficult to repair and can leave visible scars in the donor area.

For a typical male patient with Androgenetic Alopecia (AGA), the process can take about 16 weeks with 4 sessions 4 weeks apart. The surgeons’ removal and implantation of large amounts of tissue can cause pain and the repetition of the same procedure every month can be mentally draining for the patient. Fortunately, new and improved techniques were introduced in the early 1990s.

FUT Method Today

The first hair transplantation method introduced was FUT (Follicular Unit Transplantation). Dr. Bobby Limmer performed the first FUT surgery in 1988, introducing the concept of placing individual grafts in bald areas to achieve a natural look and how the hairline would look. In this method, tissue is taken from the donor area (but in linear form), but hair follicles separated from this tissue are harvested during the transplantation phase. The surgeon would then implant these individual follicles into the bald areas after making small incisions. FUT became popular and quickly replaced hair plugs around the world in the late 90s. In the early 2000s, many celebrities such as Elon Musk, John Travolta, Ben Affleck and David Beckham had hair transplants, most likely opting for the FUT method. However, by 2024, the FUT surgical technique had become significantly outdated and significantly less common.

The FUE Method Today

The first FUE surgery, performed by Dr. Ray Woods in 1989, waited until 2002 when Dr. William Rassman and Dr. Robert Bernstein introduced it to the world in a paper before the method gained popularity. Although FUE was completely similar to FUT in the transplantation phase, it involved the removal of individual hair follicles from the donor area, resulting in minimal or virtually undetectable scarring. FUE requires more precision and expertise, but because it does not leave any linear scars behind the scalp, it has started to replace FUT in some clinics. Over time, many clinics started to prefer FUE to FUT due to excellent results and according to hair loss statistics, 2 out of 3 hair restoration surgeries worldwide are FUE. Therefore, the latest technology and techniques in the field of hair transplantation often focus on FUE.