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The Evolution of Hair Transplantation: A Brief History from Hair Plugs to FUE


Hair transplantation has evolved exponentially in recent decades. Centuries ago, people used wigs or clever cover-ups to hide bald patches, leading to early attempts at hair restoration using skin grafts and hair plugs. 

Years of successful experiments showed evolution in hair restoration techniques with less scarring and natural growth—thankfully, creating a path for non-invasive procedures like FUE. Let’s delve into the brief history of hair transplantation and why FUE is an effective hair restoration procedure.

Table of Contents

Hair Transplant Timeline

The 19th century is when transplantation attempts began; recent innovations prove how far we’ve come. This timeline of restoration procedures depicts the progress.

 Early 19th century

Before avant-garde hair transplant techniques:

In 1822, a German medical student Dieffenbach, published the first successful record of hair transplant in humans under the mentorship of Professor Dom Unger. (1) The procedure involved using skin grafts and flaps to treat androgenetic alopecia. 

In 1897, Turkish physician Dr Menahem Hodara performed the first-ever hair transplantation surgeries using scalp tissues from unaffected scalp parts. It was used to reconstruct scars left by favus. 

From 1930 to the 1940s

The early 20th century steered more innovations in Japan. In the 1930s, Japanese dermatologist Dr. Shojui Okuda made ground breaking progress with punch graft procedures for World War II burn victims. It involved skin grafts bearing thick hair to restore hair loss on eyebrows and upper lip. (2) Despite hair growth, the procedure left scars.

Another Japanese dermatologist Dr. Tamura refined this primitive method and used strips with smaller strands of hair divided into grafts. Although this method was published in various Japanese journals, it remained unknown to the west due to war.

Innovations during the 1950s

In 1952, New York-based dermatologist Dr Norman Orentreich performed surgical hair transplantation to treat male baldness. He realised that not all scalp hairs are susceptible to baldness. His breakthrough transplantation proved how resistant is the hair behind and side of a head. 

He pioneered the donor-dominance concept of harvesting healthy hair on damaged areas for sustained hair growth and avoiding shedding. This method involved using a circular graft with 20-30 strands of hair, making the hairline look unnatural, known as the Barbie doll effect.  

The 1980s and beyond

In the 1980s, surgeons started using smaller grafts to avoid that effect. Unfortunately, it didn’t solve the problem. Dr Carlos Oscar Uebel, a Brazilian scientist, began using thin bands instead of grafts from the donor area to reintegrate those in the damaged areas. 

In the early 1990s, Dr Bobby Limmer discovered that hair grows in small groups and not individually, which led to using micrografts instead of grafted hair for natural-looking results. He was the first to perform hair transplantation using the Follicular Unit Transplantation (FUT) technique with strip excision.

Meanwhile Australia doctors Angela Campbell and her brother Ray Woods invented a method for extracting hair follicles. Bernstein and Rassman introduced the concept of Follicular Unit Extraction (FUE) in 2002 in their publication titled Follicular Unit Extraction: Minimally Invasive Surgery for Hair transplantation

This technique gained momentum when Harris introduced a specialised tool called dull punch in in his paper (2005). This tool helped minimise the damage caused to the follicles during extraction. This two-step process doesn’t scar the donor site. Even today, FUE is preferred over FUT, although many advancements have happened in these techniques. 

Hair Transplantation Today 

In contrast to centuries-old hair transplantation, today’s techniques are incredibly advanced and less invasive. The Robotic FUE System (ARTAS) is an automated yet physician-controlled hair restoration concept introduced in 2011. The robotic arm is accurate and extracts hair grafts using a dual-needle punch. 

In 2015, the Long-Hair Robotic FUE technique was introduced to harvest hair follicles without shaving the donor area, which minimises scarring while extracting. Another major upgrade in ARTAS was released in 2019 that included software and hardware modifications such as white LED light, improved harvesting and scar detection. The ARTAS 9x yields better outcomes thanks to Artificial Intelligence. 

In future, we might have a potentially advanced treatment involving cloning or multiplication of stem cells, thanks to ongoing research.


Hair loss might be a thing of the past owing to the recent innovations and developments in the field of hair restoration. Depending on the individual requirement, the dermatologist can suggest FUT or FUE, among other hair restoration methods. 

While FUT involves strip harvesting and implantation using local anaesthesia, FUE uses a small punch tool to harvest and place individual grafts on the damaged area to fill gaps or create a new hairline. Both methods are beneficial to combat hair loss and prevent further hair shedding. 

If you are suffering from hair loss and looking for a minimally invasive technique, talk to your dermatologist for advice on your hair growth journey. FUE is a reliable technique with less downtime that shows dramatic results and natural-looking hair growth. 

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