Transplants: Old vs. New

The principle upon which all hair transplant procedures are based is called “donor dominance.” This concept, that hair retains the characteristics of the donor area when it is moved to a new location and will continue to grow, was first described by the New York dermatologist, Dr. Norman Orentreich in 1959.

Unfortunately, getting the newly transplanted hair to grow is not the only challenge. For years the procedure was performed using large grafts that did not look natural. Over time, the grafts became smaller; however, with this technique, doctors were still not able to achieve a totally natural look.

Today, hair is transplanted as individual follicular units — tiny, naturally-occurring groups of 1 to 4 hairs each. Using follicular units, rather than the larger grafts, enables a properly-designed hair transplant to appear completely natural and undetectable. This procedure, pioneered by Drs. Bernstein and Rassman in 1995, is called Follicular Unit Transplantation (FUT).

In FUT, the hair is harvested from a donor strip using the stereo-microscopic techniques developed by Dr. Bobby Limmer. Although this procedure still produces the best quality grafts and the highest yield of hair, it leaves a fine-linear scar in the donor area that can be visible if the hair is cut very short. Because of this concern, Dr. Ray Woods in Australia developed a technique where individual follicular units could be removed directly from the scalp.

Unfortunately, Dr. Woods did not share his method with the medical community and, in 2002, Drs. Bernstein and Rassman worked out their own variation of this technique and called it Follicular Unit Extraction (FUE). They published their research in the peer-reviewed journal Dermatologic Surgery in 2002. Since that publication, there have been many improvements to the technique and Follicular Unit Extraction continues to evolve with Robotic FUE as one of Dr. Bernstein’s main interests.

New research using techniques of regenerative medicine may allow hair to be multiplied in the not too distant future. With this technology, the limited supply of hair in the donor area could be increased so that more hair would be available to achieve fuller results.