Hair transplantation began in the United States in the late 1950s. When doctors examined bald men, they could see that there was hair on their heads but it was just located in the wrong places. So doctors became very creative in finding ways to redistribute the hair. In this new field, they used tools adapted from other procedures that dermatologists and surgeons commonly performed at the time.
This section explains the three procedures targeted the removal of part of the bald portion of the scalp and rearranging the existing hair.
Punching out plugs
One of the most popular instruments used in early hair transplants was a circular biopsy punch measuring between 3-4 mm. Readily available, it became the standard way to remove donor tissue from the back of the scalp for the transplant. This hair-bearing tissue was referred to as a plug and soon gained both positive (physiologic) and negative (aesthetic) connotations.
Because these plugs were large, skin had to be removed from the front of the scalp (the recipient area) to make room for them. In fact, the same size punch used to remove tissue from the back of the scalp was also used to remove bald skin from the front. It was replaced with hair-bearing circles of skin from the back and sides of the head where the hair was permanent.
This punch graft technique was the standard procedure for all hair transplants for many years. It was responsible for the extremely noticeable “pluggy doll” look that people commonly associate with the older hair transplant procedures.
Flapping it over
Rather than punching out pieces of scalp and moving them around, an Argentine plastic surgeon, Dr. Jose Juri, had the idea of directly rearranging the scalp by moving one part of it to another. He would partly incise a banana-size piece of hair-bearing scalp, keeping one part of it connected to its blood supply. Within a few weeks, the healed flap of skin could be lifted up and moved, provided that the blood supply was maintained on one edge. The flap was rotated so that the hair-bearing skin covered an area of bald scalp that was removed to make room for the flap.
The defect in the scalp at the donor area was repaired by stretching the hairy sides of the scalp almost to the ears and pulling the two sides together to close the defect, and if the defect could not be closed, the wound would be left open to close on its own.
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1. Small versus large hair grafts
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