The Patient's Guide to Hair Restoration - New Hair Institute

Chapter 6
What is a Hair Transplant?
The basic concept of hair transplantation is straightforward and easily
understood. The hair growing on the sides and lower part of the back of the
head is permanent in most people. It persists even in advanced degrees of male
pattern baldness because follicles in these locations are not subject to the
deleterious affects of the hormone DHT, a byproduct of testosterone. The
characteristics of the individual follicles move with them when they are
transplanted. Therefore, permanent hair will remain permanent regardless of
where it is transplanted, a phenomena termed “donor dominance.” This is the
basis of hair transplantation.
In the process of hair restoration surgery, permanent hair is redistributed
to cover the areas of the head where the hair has thinned or has been lost. No
new hair is actually created; existing hair is just moved around. Therefore, there
is never a “net” increase in total hair volume. In spite of this, a skillfully
performed hair transplant procedure can make a person “look” as though he or
she has more hair, often considerably more.
The process of hair restoration is an aesthetic exercise as well as a
technical feat. Re-distributing hair on a person’s head is like painting a portrait.
The physician should attempt to create a natural looking result that is consistent
with the hair supply, the specific hair characteristics of the patient, and most
important, the patient's goals.
As with other forms of cosmetic surgery, the art is at least as important as the
surgical technique. The hair transplant surgeon must have a thorough
understanding of human facial anatomy; good basic surgical skills and a
thorough knowledge of different hair transplant techniques. The physician must
know the physiology of hair in depth, and understand basic medical conditions
that affect the scalp. He must be aware of, and be able to critically evaluate, new
developments in the field. Finally, the specialist must study each patient carefully
and tailor each procedure to the patient's unique attributes and needs.
History
Transplantation of portions of hair-bearing skin from either animals or
humans has been done with varying degrees of success since the early 1800’s.
However, significant modern developments in hair transplantation did not occur
until the next century. In 1939, a Japanese dermatologist named Okuda first
described the punch technique of hair transplantation. Dr. Okuda, working on
severe burn patients, transplanted round grafts of skin containing hair follicles
from the permanent hair-bearing areas into slightly smaller round openings in
scarred areas of scalp. The grafts continued to produce hair in their new
locations. In 1943, another Japanese dermatologist, Dr. Tamura, used 1-3 hair
micrografts to restore female pubic hair. These very small micro-grafts were
obtained from a single elliptical incision taken from the donor area. Interestingly,
his techniques were very similar to those we are using today. The work of both