Evolution of Hair Restoration – Beyond Plugs

Hair restoration in general has come a long way. Specifically, techniques in the various procedures and processes for harvesting grafts have evolved.  The “old" process involved harvesting large cylindrical pieces of hair bearing tissue (3-5mm in diameter), euphemistically called "plugs", using a cylindrical tool called a punch and then placing into circular holes in the scalp. The holes were slightly smaller than the pieces of tissue to allow the tissue to stay in place. This process created the appearance of doll's hair or corn rows and the grafts could appear to be quite prominent. The process did not produce natural results if the patient did not have surrounding hair to blend in the larger grafts.

Over time surgeons and patients became increasingly concerned about the unnatural appearance. Various methods were devised to create smaller grafts. This led to mini grafts or quartered grafts, placing some single hairs in front of the larger grafts.

Then a change in the harvesting method was a shift from producing round grafts to obtaining a ribbon or strip of hair bearing tissue and then dissecting it down into the grafts sizes that were needed.  Even with these methods it was difficult to achieve a truly natural look.

In the early nineties several physicians recognized using naturally occurring clusters of hairs in the scalp as grafts would create a truly natural appearance. For example, in the typical scalp there are single, two, three, four and five hair clusters. The cluster of hair follicles is referred to as follicular units whether these are 1 or more hairs. This led to the modern technique referred to as Follicular Unit Transplantation (FUT).

An important aspect of FUT is that the grafts are dissected out from the donor tissue with the use of a microscope to avoid damage to the hair and avoiding wasting hair.

It should be noted that even prior to the group that promoted FUT, a physician Dr Bobby Limmer had advocated a similar approach and was using microscopic dissection of the donor tissue and the use of single hair grafts.

While FUT remains a state of the art technique another technique termed Follicular Unit Extraction of Follicular Isolation Technique is gaining popularity. With this technique, small punches are used to harvest individual follicular units. An advantage is that a linear scar in the donor area is avoided but there are disadvantages as well to be discusses with your physician.

In some cases, these latest techniques could provide restoration to your scalp hair the way it was prior to hair loss. However in cases where significant hair loss has occurred, the patient would not have enough remaining donor hair to make up for the amount lost to achieve the original scalp hair appearance.

It is apparent that the use of follicular units for grafting is the highest point that can be achieved in terms of the type of graft to utilize. The areas that continue to evolve for hair restoration procedures include methods for harvesting, techniques for placing, anesthesia, storage and handling of grafts, adjunctive pre and post operative medications to enhance survival of grafts and provide more rapid growth.

Additional research that may impact hair restoration could involve the replication of hair by various means to create an endless supply of hairs for later transplantation.

Eventually the need for surgery will diminish markedly due to the early use of medications and gene manipulation. However there will still be a need for surgical intervention with cases of trauma, cosmetic reconstruction or some diseases that prevent the use of medical treatment.


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