Hair transplantation has advanced by leaps and bounds in the last few decades. The technique was initially popularized byOrentreich, who had also proposed the theory of donor dominance. In the initial phase, hair restoration was done using plugs, strip grafts or flaps. It involved removing “plugs” of hair bearing skin from the safe donor area and transferring them to the recipient site. These plugs were about 4-5 mm in diameter. Vallis strip graft and Juriflaps were also methods used to correct baldness and improve hair line. The plug method produced tufts of hair which resembled the dolls head look. The Juri flap had the disadvantage of the hair growing in an unaesthetic direction. Though hair growth occurred by these methods the aesthetic appearance was far from desirable.
Once the excitement of seeing hair growth had died down, It was natural to look for improvement in aesthetics. From the plugs, there was a shift to minigrafts which were 2-3mm in diameter and even to micro grafts. Further instead of planting them in rows as was done for plugs, minigrafts were planted randomly. The number of grafts planted also increased as the sessions became longer. Initially the donor sites in the plug method were allowed to heal by secondary intention. To minimize the scarring the donor site was excised as an ellipse and closed.
The use of the stereo microscope helped to identify the follicular unit. Bob Limmer popularized dissection and slivering under the microscope. This helped to separate individual follicular units. These separated units were then transplanted. Wastage was minimal on account of magnification. Megasession and gigasession were performed with the help of a good and well trained team.
The donor site scarsfollowing the strip surgery made the surgeon look for harvesting individual follicles rather than by a strip. This led to the development and increasing popularity of the FUE method. It started outby drilling follicles manually using a hand punch and progressed to use of motor driven devices with a variety of punch optionsvarying from blunt to sharp, serratedor funnel shaped punches. With practice, it has been possible to extract a good numbers of follicles in one session and this method has shown a tremendousincrease in the number of patients undergoing hair restoration on account of being less invasive and requiring no stitches. One needs to use discretion while choosing either of the methods. Problems associated with FUE include possibly higher transection of follicles especially in early stages of learning, and moth eaten appearance of the donor area due to over harvesting. Further, harvesting outside the safe donor area has often been seen which would result in early loss of the transplanted follicles,these being under the influence of DHT.
However the extension of this technique to harvest body hair has opened up non scalp donor sites like beard and body hair, which were otherwise not used. This has provided significant additional supply of follicles.
Research into cloning of hair and culture will certainly be the direction to go forward. This will happen in the near future.

Dr. K. Ramachandran


Senior Consultant Cosmetic surgeon

President:- Association of Hair Restoration Surgeons, India.

Past President:- Indian Association of Aesthetic Plastic Surgeons (2009 – 2011).

Member of the Executive Committee:- Association of Plastic Surgeons of India (2003-2006).