Hair Transplant Surgery

Hair Transplant Surgery

The hair on your head has been important throughout history, with deep sociological meaning. In men, hair on the head is a symbol of youth and virility; with women it carries connotations of youth. Hair loss on the head is seen as a sign of aging and death. Thus, for centuries, men and women alike have tried to reverse hair loss, using all sorts of measures. This includes hair restoration procedures which has become one of the most sought after cosmetic surgery procedures in the United States and indeed the world.

Hair transplantation  involves removing viable hair (grafts) from where they naturally grow (donor area) and replacing them where the patient lacks hair (the recipient area). Traditionally hair is removed from the back and sides of the head and moved to the top and front.

Hair Transplant Surgery| Donor Area - Post Extractions

Donor area immediately following FUE hair transplant.

Hair transplant procedures have gone through a number of major evolutions, beginning in the early 1900s in Japan and progressing to today, with research continuing. Hair transplantation has evolved into a more and more cosmetically acceptable procedure, moving through the early punch grafts and mini and micrografts to the current “gold standard” of follicular unit extraction of “FUE.”

This procedure does not leave any of the linear scarring associated with traditional strip graft surgery. Rather, the FUE method leaves very small wounds that heal with no significant scarring. Advanced FUE can be used in extracting hair follicles from areas of the body other than the head, such as the chest or beard. This is known as body hair transplant or BHT. Dr. Umar is a pioneer in this field and has successfully performed mega-sessions that capitalize upon an expanded donor pull from BHT to give hair to extremely bald patients previously considered poor candidates for the procedure.

Hair Transplant Surgery |Thinning Hairline|Patient Photo

Hair transplant patient showing a depleted hairline and temple points

Hair Transplant - After Restoring Hairline With FUE

Natural looking hair transplant results after FUE surgery














Earlier Hair Transplant Methods

The first hair replacement method was based on the punch graft. This was originally attributed to the American Dr. Norman Orentriech, however it is now generally accepted that this technique was used earlier by Japanese dermatologists. Dr. Shoji Okuda first used the punch micrograft in 1939 on the scalp, mustache and eyebrows. In 1943, a paper by Dr. Hajime Tamura detailed the use of elliptical excision, akin to the modern strip excision procedure and foreshadowing the trend toward smaller and smaller grafts. In 1952, Dr. Orentreich popularized the punch graft using 4mm punch grafts. This was the standard until the mid ‘70s, but gave an unpleasant “doll’s head” appearance. When hair was lost around the graft “plugs” became visible. Unfortunately, for decades that followed, the general populace equated hair transplant results with the doll’s head look. Dr. Orentreich also originated the theory of donor dominance, where hair taken from the back of the hair and transplanted to the front continued to grow, thus exhibiting the behavior of the donor hair. “Donor dominance” is a theory currently undergoing modification due to experiments in the field that show donor area might not be the determining factor. Dr. Umar believes that some characteristics such as graft survival is innate in the hair itself and that the place it is pulled from plays only a secondary role.

Hair Transplant Surgery Methods Today

    1. Strip excision also known as follicular unit hair transplant – FUHT or follicular unit transplant FUT is the most commonly practiced method of hair transplantation today, with an elliptical strip donated from the back of the head and split into smaller grafts. The best donor area is right above the occipital bump or below an imaginary line that runs 1cm above the top of the ears. This invariably leaves a linear scar with a chance of stretching. If the width of the incision is less than 1cm, it would reduce the chances of strip scar complications. Tricophytic closure is a recent innovation that gets hair to grow through the scar. In this procedure, a 1mm ledge of the outer layer of skin is cut off as well as an edge on the donor site before the wound is closed. This results in a smaller and less apparent scar.
Hair Transplant Surgery

Linear scar resulting from strip surgery.

  1. Follicular Unit Extraction is the latest innovation in hair transplantation that has gained in popularity. It entails the extraction of individual follicular units one at a time. The harvesting is done using 0.8 – 1.2mm punches. Unlike follicular unit hair transplant method, there is no linear scars created in this technique, making it ideal for those who prefer to have short hair. The procedure is skill dependent, however, meaning that only an experienced and qualified surgeon should perform the technique. It is a longer and more labor-intensive procedure. Because of this, many surgeons don’t wish to perform it. However, it is becoming more popular because it leaves less scarring and patients are demanding to have it done instead of the strip excision method.
Manual FUE Punch | Hand Held

Manual, handheld FUE extraction tool.


FUE Extraction Punch | Powered Handheld

Powered, handheld FUE extraction tool.

The idea that FUE is only suitable for small procedures has been shown to be a myth by FUE pioneers like Dr Umar:

Here is a video illustrating the difference between follicular unit extraction – FUE vs FUT also called follicular unit strip surgery:

Hair Transplant Tomorrow


Many automated hair transplantation machines are in the market today. Examples include the Neograft and the more robotic Artas. The Neograft incorporates a punch mounted on a rotary device as well as an optional suction device that removes the grafts as they are cut free from surrounding tissue. Concerns have been raised about the dessicating effect of the suction. However, physicians have the option of switching the feature off. The patient should participate in this decision. Artas as presented in the latest ISHRS meeting in the Bahamas, is a true robot that comes with computer enables sensors that enable the robotic arm to determine which grafts to dissect. The physician can participate in this process as well. However, the patient would have to keep still once positioned and has to be repositioned every time the robot is done with a one given area. The physician would still need to remove the grafts manually after the robot has made the incisions which separate the hair follicle from it attachments. No suction is used.

For physicians seriously considering adding FUE to their menu and services, even with the aid of the aforementioned machines, Dr Umar advises spending some time in training with Experienced FUE practitioners.

Hair Cloning and Hair Transplantation

One of the most exciting developments in the world of hair transplantation is the idea of cloning hair. The hope with hair cloning is to remove the limits placed by the donor area. A single biopsy punch could restore hair to the entire head, removing the fears of running out of donor hair.

Current Issues in Hair Restoration

A hair transplant procedure today is quite different from their invention in turn of the century Japan. Grafts are smaller, techniques are more precise and problems such as unnatural appearance have been resolved. New technologies present new issues, however, such as automation and genetic developments.

One of the most important details in a hair transplant surgery is the hair line. Others can often tell if a person has had some type of hair loss procedure based on just looking at the edge of the hair that borders the face.  For more information on hair line transplant, click here to read more.