The first form of hair transplant initially performed over 60 years ago now. Since the 1950‟s many changes and advances have been made to enhance the results of hair transplantation; in summary here is a brief explanation of the evolution in surgical hair restoration techniques.
Scalp Reduction – This is considered to be an aggressive form of hair transplant surgery, removing the bald skin from the top of the scalp and pulling the sides and back up, thus reducing the size of the bald area. Scalp reductions were never a popular form of hair replacement and were used mainly in the 1990‟s, but due to the potential complications in performing a scalp reduction, it never became mainstream. There is the
potential for the skin to stretch back leaving a visible large scarring and an unnatural pattern of hair loss. The donor area can be pulled into unnatural directions causing the density to be reduced and impairing future procedures.
Flap Surgery – The cutting out of a bald area of skin along the hairline normally, then the same cut but of a hair-bearing area from the sides, this “flap” remains attached to the skin and is twisted to sit in the area removed and then sutured. The flap procedure is ag- gressive and can be very painful with a high potential for the hair not to grow. Flap procedures invariably will leave severe scarring in the donor and re- cipient and an unnatural orientation of hair growth along the hair line.
Minigrafting Hair Transplants – This technique evolved from the first “plug grafting” techniques and was being per- formed in the 1990‟s. This involved the use of small groups of hair, an improvement of the 30-40 hair groups once used. The technique was a significant improvement in performing a more natural looking hairline, although it did leave larger spacing between each group of hairs but was the first real step to the techniques of today with refined Follicular Unit grafting.
An Evolution in Surgical Hair Restoration
A major evolution in creating a natural look and preserving good donor management has been being able to harvest natural growing groups of hairs known as Follicular Units or “FU‟s”. FU‟s can contain one to four hairs and placed strategically in the recipient area to create a natural appearance. Careful alignment of each follicle that follows the natural direction of the native hair and placing them to ensure they do not overlap and placing them in an asymmetrical manner has helped to achieve natural hairlines, maximum coverage and natural looking density from a relatively small amount of hair compared to the surface area that needs to be covered and considering the limitations of the finite donor resource.
The Newest Techniques Now Demand Advanced Skills from Surgeons
The techniques from days gone by have been greatly improved; the knowledge and understanding as well as the technology at the time considerably hindered the abilities of the doctor to give their hair transplant patients artistically natural-looking results.
As patients have demanded more natural results from surgical procedures the hair transplant techniques have evolved, the doctor must master the intrinsic art of hairline design and temple closures, as perfection is now asked as standard. Hairline design now is an art, to create the natural irregularities we have rather than a sharp obtuse line of unnaturally placed hair, refined FU groupings that give a gradual increase in density, and hairline design that has been thought out to frame the individual person‟s face rather than one design suits all.
With a greater understanding of the anatomy and body pro- portions this has aided surgeons to be able to mimic nature and create natural hairline results for patients, with skills such as recognising angulation, orientation and spacing and the importance they all play. These medical and artistic skills will determine how the hair will grow in creating a look that is natural.