Ever wondered where and how hair replacement surgery started? Well, here is a brief history of how the technique came to be. From here, we will know how far we are in the development of the surgery.

The nature of male pattern baldness has been the underlying basis of hair transplantation. It has also been used to predict treatment programs for each pattern and stage. The work of Norwood, Ayers, and Stough defined candidates for hair transplantation and state-of-the-art methodology for the 1960s and 1970s using hand punches, graft sizes, and patterns of replacement. Objective observations by Dr Walter Unger, with meticulous hair counts, defined the ideal graft size of 4.0-4.5 mm for maximum hair growth. Additionally, particular patterns for best aesthetic results were reviewed. Microphotography by Dr Tom Alt clearly demonstrated which grafts were ideal and defined the techniques necessary to produce these ideal grafts. Innovators such as Uebel developed the approach of micrografts (1-3 follicles) or minigrafts (3-8 follicles) to improve the natural appearance of the grafts.

Richard Shiell designed the very best grafts were produced with a mechanically rotating power punch using a carbon steel trephine. Saline injected into the donor area to produce the proper tissue turgor for graft harvesting clearly produced superior grafts because the punches cut cleanly through the rigid scalp tissue. Cluster harvesting and closure of the donor site became the normal procedure, producing the least amount of scars in the donor area. These innovations in graft harvesting produced superior quality hair grafts for greater density and coverage of the recipient sites.

From there further aesthetic concerns for hairline placement, growth and direction of hair grafts, and hair angulation in the recipient sites was refined for major grafting techniques. But the basic technique was still at work and becomes the basis of further enhancements in todays techniques.