Alopecia (excessive or abnormal hair loss) is a concern not only for men but for women as well (approximately 40%). As we know, in the past, men and women experiencing extensive hair loss relied on wigs or toupees, which in some cases created artificial results. Fortunately, there are hair restoration techniques available for both men and women to help re-grow hair, including hair restoration surgery (HTS).
The first HTS was performed in Japan in the late 1930’s by a dermatologist named Dr. Okuda, who created a “punch” technique for burn victims. This technique involved extraction of round sections of skin with hair that were then placed into small holes perforated into burn areas. The expected outcome after these “skin grafts” healed was that they would continue to grow hair in previously bald areas, including the scalp.
In 1943, HTS was refined by another Japanese dermatologist named Dr. Tamura, who took Dr. Okuda’s technique a step further by using smaller grafts of skin containing 1-3 hairs from areas of “donor tissue.” These two techniques were put aside during World War II, but in 1952, a New York dermatologist named Dr. Norman Orentiech performed the first HTS in the U.S. on a male patient who suffered from male pattern baldness.
In 1959, Dr. Orentiech published his findings in a New York science journal stating that the back and sides of the head were the most resistant to hair loss. But for all his research and work, Dr. Orentiech’s technique and teachings were soon categorized as a cosmetic procedure, and in starting in the early 1960’s, hair loss surgeries were being performed by numerous doctors, but the outcomes usually resulted in unsuccessfully natural looking hair.
However, HTS became more refined in the early 1990’s due to modern technology. One procedure that came out of the 1990’s is follicular unit micro grafting, or, follicular unit transplantation, which was derived from Dr. Tamura’s technique and created virtually undetectable results.
HTS is performed by transferring DHT-resistant hair from donor sites of a person’s own body, usually the crown and sides of the head (where the hair continues to grow). These areas of donated skin are called grafts that contain 1-3 hair follicles and are placed into areas on bald parts of the head through surgical incisions.
Once these grafts are placed, they will become one with the scalp. The length of surgery time is between 5-10 hours per appointment and can require either local or general anesthesia. Frequency of visits will vary depending on factors including the size of the transplant area, individual hair loss patterns, hair density and color of hair vs. skin.
Most male patients require 1-2 appointments, while females may need several more to achieve desired hair density. These appointments can be spread months apart, depending on each individual. Diagnosis for HTS candidates include diagnostic tests such as scalp biopsy, hair pull, total iron binding capacity (TIBC) and complete blood count (CBC). These should be performed by the hair surgeon prior to surgery to determine individual hair loss pattern.
How to find a surgeon for HTS? The best source is from the American Hair Loss Association, since surgical hair restoration is unregulated by the government and medical community. Avoid referrals from hairstylists, radio or TV, infomercials, yellow pages, family, friends and medical doctors. Only a handful of surgeons are qualified to perform HTS in the U.S. During a consultation, the surgeon should examine each patient’s head by using a Hair Densitometer and take a detailed medical history.
The patient can ask to see at least 15 before and after hair implants or ask to speak to 6 patients that the surgeon has treated. The surgeon should also mention possible risks such as infection, scalp numbness, bleeding and scarring or the possible re-do if the grafts don’t “take”. Procedures to avoid include thinning of the scalp, scalp expansion and reduction, flap/ hair flaps, linear or line grafts, round or square grafts and hairlifts, since these techniques are outdated.