Finding ways to produce more natural results
In spite of many missteps, the drive to develop better surgical techniques to move hair around the head led to procedures that were more cosmetically beneficial for the patient. The usefulness of very small grafts (called micrografts) in hair transplantation was first recognized in the early 1980s. These grafts of a few hairs each were mostly limited to placement in the very front of the hairline because of considerable difficulties in handling and placing them into the bald scalp.
A hair transplant that relied entirely on the use of micrografts was first introduced in 1982 in Brazil by Dr. Carlos Uebel. He reduced the size of the grafts (sometimes called plugs), but he wasn’t able to master the graft survival issues. Although he succeeded in making the results look more normal and natural, the survival of the hairs wasn’t great, and the final result looked very thin.
Over the following two decades, transplant surgeons working on ever smaller grafts figured out ways to handle these fragile grafts without killing them. The secret lay in preventing the grafts from drying and in delicate handling during the harvesting and placement process. In refining the technique, doctors came to understand that moving more hair in the transplant would eventually lead to fuller and better aesthetic results. The technique defined by Dr. Uebel evolved into what’s now called the megasession, large session transplant surgeries.
In 1994, Dr. William Rassman refined the process and published the first medical articles on the megasession. He also started to show off the procedure’s results at medical meetings by bringing patients as part of his academic presentations.
In 1995, he demonstrated that grafting large sessions of small grafts wasn’t just theoretical, but practical by bringing 23 patients to the International Society of Hair Restorations Surgeons meeting; the patients had experienced considerable balding and had undergone transplants with thousands of very small grafts.
In articles published in 1995 and 1997, Drs. Bernstein and Rassman defined what’s now the gold standard in today’s hair transplant field: They developed a hair transplant procedure that could, in many respects, replicate nature by moving hair follicles in their normal anatomical groups of one, two, three, and four hairs — the follicular unit in one or two surgical sessions.
Finally transplanting hair as it grows in nature made the results identical to nature’s own. This technique they defined is now known as follicular unit transplantation (FUT).
The Newest Transplanting Techniques
In hair transplantation, size does matter! In this case, it’s the size of the grafts that make the difference, and smaller is better. To make up for the small grafts with less hair, large sessions of grafts became necessary. In this section, we look at the refinements that have made hair transplants less detectable than ever before.
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1. Follicular unit transplantation
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