Since the beginning of time, people have appreciated the beauty of lush, full, and thick hair. Biologically, beautiful hair is a sign of health, vitality, and fertility—traits that we look for both consciously and subconsciously when we are searching for our ideal partner. It’s no surprise then that hair restoration treatments have been around for centuries for patients to preserve the health and beauty of their hair. In this article, we will discuss the history of hair restoration techniques over the last 200 or so years.
Hair Restoration in the 19th Century
It was during the 1800s that the foundational principles of hair restoration were discovered and refined. The earliest innovations in hair restoration were based on a process called skin grafting, which is a reconstructive practice used in surgery for a variety of concerns. The first ever hair transplant surgery was performed in Istanbul, Turkey, in 1897 by Dr. Menahem Hodara. This surgery was performed on a patient with a fungal scalp disease, Favus, which resulted in severe Alopecia. He successfully grafted scalp tissue containing hair to the affected part of the scalp, but only a small portion of the transplanted hair was able to grow. However, this was still a massive accomplishment, which received international acclaim, and Dr. Hodara went on to repeat this procedure several times with other patients. In each case, only some of the donor's hair would successfully transplant, while the rest would fall off. He concluded that for this technique to be truly successful, it had to be further refined.
Hair Transplantation in the 20th Century
In the first half of the 20th century, shortly before the first World War, further innovations in hair transplantation were made in Osaka, Japan. A faculty member of the University of Osaka, Dr. Shojui Okuda, researched and developed hair transplant techniques for the eyebrows, eyelashes, and pubic region. He perfected a novel punch graft technique, which took and transplanted small punches of skin with hair with a diameter measuring 1mm to 4mm. A few years later, in the 1940s, this punch technique was further refined by the Japanese dermatologist Dr. Hajime Tamura. Dr. Tamura used smaller incisions to separate the punch graft into smaller units for transplantation—this method would eventually revolutionize modern surgery, but well after Dr. Tamura’s lifetime.
In 1952, Dr. Norman Orentreich, a dermatologist based in New York, performed the first-ever hair transplant surgery to treat male pattern baldness. This procedure was fundamental in shaping the knowledge of hair science because it proved that the donor scalp tissue, and the donor's hair, would remain in place along the transplanted area (the affected part of the scalp). Before the procedure, it was thought that the donor hair would act in the same way as the recipient's hair and eventually shed—this procedure proved that this wasn’t the case and that hair transplant surgery could be a viable and successful method of hair restoration.
Armed with this knowledge, medical experts would spend the next century refining the process of hair plugs. Hair plugs were the dominant form of hair restoration surgery for the later part of the 20th century. Relatively (as in, compared to earlier methods), hair plugs achieved results that were acceptable, although they were very obvious looking. The 2mm to 4mm plugs looked very much like doll hair because of their obvious pattern and hair distribution.
The 1980s saw the development of two more innovations in surgical hair restoration. One was strip excisions, which took a strip of donor grafts from the back, unaffected area of the scalp to restore the bald, affected portion of the scalp. The other novel method involved the use of micrografts. The micrograft process consists of dissecting strips of donor grafts into even smaller grafts with the aid of a microscope (remember Dr. Tamura’s earlier technique!). These innovations are the foundations of the modern Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) seen in clinical practice today.
Hair Restoration in the 21st Century
Over the last 20 years, further refinements of FUT and FUE techniques have enabled the dramatic improvement of the natural appearance of hairlines. FUT and FUE procedures are effective because they pay attention to the angle of the hair follicles, as well as their placement and position, which simulates natural hair growth. Of course, as with all surgical techniques, these procedures come with a hefty price tag and the possibility of obvious and permanent scars.
However, these decades, along with innovations in the 20th century, also saw the rise of effective non-surgical, non-invasive hair restoration techniques. Pharmaceutical innovations, including the drugs Minoxidil and Finasteride, have made waves in modern hair restoration. However, there are still troublesome side effects and inconsistent results.
An emerging, non-surgical treatments that are considered to be gold standards in nonsurgical medical aesthetics is platelet rich plasma (PRP) and Exosomes Therapy. These have been used in a variety of medical specialties for decades. However, since 2006, these have been explored in research and practice as a potential treatment for Alopecia. Now, almost 20 years later, it is one of the most popular non-surgical treatments for hair restoration in men and women and Exosomes Therapy follows close behind. Both options are popular because they are incredibly safe, affordable, and highly likely to produce results.