This is a basic article about how modern hair transplantation works with a little review of the history of hair restoration to understand how far we have come today. When many of my patients come to see me they are simply confused about how a hair transplant works and what they will need to do to maintain their result over time.
Let’s go back to the beginning. Back in 1939 and 1942, Okuda and Tamura in Japan found out that hairs transplanted from the back of the head to recreate pubic hair loss would survive and grow. Because of public bathing rituals in Japan and a condition of disease in young Asian women who suffered from pubic hair loss, this type of transplantation proved to be an important step in knowing that hairs transplanted from one area of the body to another would thrive and survive. However, it was not until the famed New York dermatologist Norman Orentreich in the 1950s did we know that hairs moved from the back of the head to the front of the head where there is baldness would not be lost over time like the original hairs there. He called this phenomenon “donor dominance” meaning that the hairs moved from the back of the head to an area of genetic susceptibility for hair loss would retain the characteristics of the donor hair and not be lost over time. This was the brilliant breakthrough we needed to know that results would continue to survive despite being transplanted into an area that was predisposed toward hair loss.
If you wonder then why are hairs in the back of the head not susceptible to hair loss? Well, that only God knows. However, it is the case. Think of the baldest man that you know (who has not shaved off the hair on the back of his head). He still has a patch of hair back there. Even the baldest man has a retained horseshoe of hair in the back of the head. The only trick when performing a hair transplant then is to know what area is “safe” for transplantation, i.e., what area over time will not be lost when the person becomes older. That is one major reason why transplanting an individual at 20 years of age can be problematic. We simply do not know how much hair in the back of the head will not fall out over time. Plus, we may simply run out of donor hair to transplant the front of the head and maintain a natural result as more hairs (that were not transplanted) fall out as one ages.
This judgment is really one of the major attributes that separate an experienced hair-transplant surgeon from a novice. Knowing whom to operate on (that is who is safe and who is not) is a cardinal prerequisite to performing safe hair transplant work. With the laws of supply and demand, someone who has tremendous donor hair density, i.e., there are a lot of hair follicles per square centimeter in the donor area, can cover a tremendous degree of baldness naturally and impressively in many cases. A surgeon’s use of grafts wisely in a good pattern distribution with good angulation will help ensure that the result is both natural and dense given a particular person’s degree of hair loss and usable donor hair supply.
The other question that is oftentimes posed is “Will the hair transplanted be just like the other hairs that I have there that were not transplanted? Will I cut it the same as my other hairs?” The answer is an emphatic yes. I explain further that a hair transplant procedure is simply moving hair from one side of the head to the other like taking a flower out of one pot and moving it to another. It will grow in its new environment just like in its previous one. Even though the number of hairs transplanted will not exactly equal the hairs lost, the use of good technique by the surgeon can make 5,000 transplanted hairs (a typically big session) loo