The history and evolution of hair transplantation

Since the time of our grandparents, there has been a significant advancement in hair operations. In the space of just a few decades, hair transplantation technology has seen a significant transformation, becoming a minimally invasive treatment that requires less downtime and increased comfort when compared to prior operations while yet generating compelling results that look natural. But exactly how far have we come with it all? How do the leading hair restoration techniques of today stack up against those of yesteryear? In this article we would be looking at the history and evolution of hair transplantation.

The History of Hair Transplantation Procedures

The conventional method of performing a hair transplant may be traced back to the 1930s, as stated by the International Society of Hair Restoration Surgery (as well as by the majority of stories available today). In spite of the fact that Dr. Norman Orentreich has frequently been referred to as the “father” of hair transplantation, Dr. Shoji Okuda has more recently been credited with the discovery of the punch graft hair transplant process as contained in the Okuda Papers.

Dr. Okuda was the first person to develop the techniques that are used to assist bunt victims in regaining their hair growth and hese procedures were developed in the 1930s. On the other hand, due to the outbreak of World War II, Okuda’s study and work were unable to be disseminated outside of Japan until 2004, when The Okuda Papers were discovered and translated into English.

Hair Transplantation Attempts in the 19th Century

Even though the most significant advancements in hair restoration date back only a century, the fundamentals of hair restoration may be traced back to skin grafting, a surgical procedure that has been employed for reconstructive purposes ever since the beginning of time. In 1897, a Turkish surgeon named Dr. Menahem Hodara was responsible for carrying out one of the very first hair transplant surgeries. Dr. Hodara was effective in treating hair loss caused by favus by taking hair and scalp tissue extracted from areas of the scalp that were not affected by favus and placing them on the scars.

Innovations in Japan between the 1930s and the 1940s

In the early part of the twentieth century, Japan pioneer additional advances in the field of hair restoration. Dr. Shojui Okuda pioneered hair transplant procedures for the genitalia, eyelids, and eyebrows in the 1930s. He developed and mastered the punch graft method, which involves taking tiny punches of skin with hair anywhere from 1mm to 4mm in diameter.

When hair loss occurred in other areas of the body, these punch grafts were implanted there. Incisions were used to divide the punch graft into smaller units for transplanting. An improvement on this was made by a Japanese dermatologist named Tamura in the 1940s. It took decades for Tamura’s procedure to become standard practise, but it ultimately became an important surgical method.

Hair Plug Procedures in the Early Years

Dr. Norman Orentreich is widely regarded as the man responsible for kickstarting the aesthetic revolution and hair transplantation techniques in the United States. Orentreich, in particular, was the first to successfully treat male pattern baldness with a transplant in 1952. However, after seven years, when his key study was released, Orentreich’s conclusions finally gained widespread acceptance. In this work, Orentriech pioneered the donor-dominance idea that proved hair follicles on the back and sides of the head are often more resistant to balding and will sustain healthy development when collected and transplanted in locations when follicles have become inactive or damaged.

Unfortunately, the size of pencil erasers was the minimum graft size that could be harvested and transplanted using the Orentreich procedure. It’s kind of like a copy-and-paste tool. Results often looked artificial or, as described by the Wall Street Journal, “toothbrush-like,” with circular portions of hair resembling rows of bristles. Nonetheless, the method’s popularity skyrocketed throughout the 1970s. At the time, surgical hair transplantation was the sole alternative for people seeking an effective hair restoration therapy.

Follicular Unit Transplantation: A Changing Practice

The practise of strip harvesting, often referred to as follicular unit transplantation (FUT), overtook the use of hair plugs as the gold standard in the business throughout the 1980s and continued until in the 2000s. A strip of skin is removed from the back of the scalp during the FUT procedure so that it can be used for transplantation. The doctor meticulously prepares these cuts to guarantee that only whole and healthy hair follicles will be removed, which is essential for achieving the best possible outcomes.

After the strip has been removed from the skin, the incision that was made to remove it is closed with stitches while the physician’s assistants separate naturally produced clusters of hair follicles into follicular units from the harvested strips. During the procedure, any extra tissue that could potentially harm the hair follicles is cut away as much as possible. The physician next constructs micro-puncture sites for transplanting the grafts with follicles set in a planned order to better mimic the patient’s natural hair density and growth patterns.

In spite of the fact that the outcomes of strip harvesting may look more natural than those of hair plugs, the donor area will be left with a linear scar after the process. However, the recovery time was cut down to about two weeks, although patients may be required to keep their hair long enough to conceal any potential scarring and stitches.

Follicular Unit Excision and Robotics, Today’s Gold Standard

  1. Follicular unit excision (FUE)

Follicular unit excision (FUE) harvesting, an improvement over FUT, was invented in Japan in 1988, but it didn’t catch on in the hair restoration market since it required a lot of time and money to learn and the technology wasn’t yet established to assist doctors in this process. As technology advanced, FUE techniques became the industry standard for hair transplantation.

With the FUE procedure, tiny micropunches no larger than one millimetre in diameter are used to remove individual follicular units of one to four hairs under simple local anaesthetic. Based on the patient’s hair growth density and pattern, the doctor then designs optimal micro-puncture sites to implant the grafts. Small holes are left in the scalp at donor sites due to FUE’s use of small, circular incisions to separate the follicular unit from its surrounding tissue.

These holes don’t need to be stitched and heal on their own in just a few days without the danger of linear scarring. Patients undergoing FUE hair restoration operations should anticipate up to a week of recovery time with little to no pain or discomfort. Despite the fact that the first FUE hair restoration procedures took a long time to complete and required a steady hand new technology has made it possible for patients to be more comfortable, safe, accurate, and to achieve the best results possible.

  1. The NeoGraft® FUE

The NeoGraft® FUE hair restoration procedure, in contrast to more conventional manual harvesting techniques, foregoes the scalpel in favour of an automated hand piece with cutting-edge technology that gently incises and extracts donor follicles. As a result, the procedure causes the patient little to no discomfort. With the aid of the machine, doctors are better able to arrange and implant hair follicles in a pattern and at an angle that produces more natural-looking results in a shorter amount of time.

  1. ARTAS Robotic

The ARTAS iXTM robotic hair restoration system has more recently added robotics to the mix. In particular, the ARTAS iXTM delivers accurate, natural-looking results by combining the FUE procedure with AI technology. As a first step, the ARTAS iXTM system uses 3D technology to assist the doctor in customising and planning your unique hairline design based on your specific hair growth and density patterns.

The doctor can use the ARTAS iXTM system to identify and choose the best hair follicles for transplanting while flagging low hair density areas and blocking them out from harvesting, reducing the risk of over-harvesting. It uses a high-definition stereoscopic vision system, robotic arm, and ARTAS Artificial IntelligenceTM algorithms. To maintain the natural appearance of your donor area, robotic accuracy and speed are used to intelligently harvest the chosen donor follicles.

Can then use the ARTAS iXTM system’s cutting-edge technology to precisely identify and construct ideal recipient sites while concurrently implanting the harvested hair follicles using 3D technology and the patients personalised hairline design. The robotic approach of the technology offers accuracy and speed for a quicker treatment than more manual FUE techniques.


From the beginning in Japan to the many years of development that made hair transplant into what they are today, numerous doctors and scientists have worked over the course of time to refine the techniques that are currently employed. The history of hair implants can be traced back to Japan particularly the FUE procedure, which has evolved into the most dependable approach now in practise.

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