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The evolution of hair replacement is a fascinating story. The technique was discovered by accident when a New York City dermatologist transferred skin bearing hair from the back of the scalp to the front of the scalp to fill in a cancer he had removed on a male patient. Years later, the transferred hair was still alive and well even though the patient lost all the surrounding hair to male pattern baldness.
A few more patients had similar procedures and the observant dermatologist initiated hair plug transfer. By today’s standards, the plugs were “doll like” but for years this was the standard.
A modern day hair transplant can be performed on both men and women. The hairs from the back of the scalp are genetically different from the hair on the top of the head. As the front and top hair falls out, permanent hair can be transferred from the back to fill in the front and top.
The donor area is closed so no defect is visible. Essentially we borrow from “Peter to pay Paul.” As the techniques have become more sophisticated, high power microscopes can be used to remove and transfer individual hairs instead of the plug looking grafts. The hairs actually grow in 3 to 6 months. Often, several sessions (3 to 6 months apart) are required to adequately fill in the bald areas.
Other techniques have been used and some are rarely performed today. Some of these include:
- Mobilizing large flaps of hair bearing scalp to cover the bald area. The advantage is that the procedure is performed in one stage instead of requiring several sessions. However, if the flap of tissue does not survive, a large area of hair bearing scalp is permanently lost forever.
- Balloon expansion was popular in the 80′s. Doctors would insert synthetic round balloon-like medical implants in the hair bearing area. Over 6 weeks, the balloons were inflated with air or saline (salt water). As the hair bearing area stretched, the additional stretched scalp with hair was rotated to fill the removed bald area after removal of the medical balloon expanders. Unfortunately, the male patients looked like “Mickey Mouse” for 6 weeks while the implant size was increased along the left and right scalp.
- Scalp Reductions are still performed today. Center areas of baldness can be excised or cut out and the hair bearing areas are brought closer together. Several staged procedures are required to bring the hair bearing areas close together.