The History Of Hair Transplants: 200 Years In The Making
Hair transplantation passed its two hundredth birthday in 2022. The first recorded attempt was made in 1822, in Würzburg in Germany, which puts it a long way ahead of most of the cosmetic procedures people assume are older.
It was carried out by a medical student, Johann Dieffenbach, working under Professor Unger. Dieffenbach moved hair follicles from one part of the skin to another in animals and then in people, and it worked. Unger declared that male pattern baldness would soon be a thing of the past.
He was right in principle and wrong by about a century and a half.
A long gap, and a lot of snake oil
Nothing much followed. Transplantation crept into use towards the end of the eighteen hundreds, but almost entirely as reconstructive surgery, for burns patients and for people whose hair had been lost to injury rather than to genetics.
Meanwhile everyone else was sold lotions and potions. Tonics to rub in, tonics to drink, and a great deal of confident advertising. None of it regrew hair, and the trade in it was enormous.
That has never really stopped. It reappears today as thickening shampoos and conditioners that promise regrowth and at best coat the hairs you still have, making them look temporarily fuller until you next wash them out.
The idea that changed everything
Modern hair transplantation begins in Japan in the nineteen thirties, with Dr Shoji Okuda, who used small skin grafts to relocate follicles and was treating burns and scarring patients with real success. His work was published in Japanese, war intervened, and the West did not read it for decades.
So the field was effectively invented twice. In 1959 Dr Norman Orentreich, working in New York, arrived at the principle independently and gave it the name that stuck: donor dominance.
The insight is simple and it is the reason a hair transplant works at all. A follicle keeps the characteristics of where it came from, not where it is put. Hair at the back and sides of the head is not sensitive to the hormone that causes male pattern baldness. Move it to the crown and it stays insensitive, and it carries on growing there for as long as it would have grown where it started.
Everything since has been refinement of that one idea.
From plugs to follicles
Early transplants took hair in round punches of a dozen or more follicles at a time. They grew, which was the point, but they grew in tufts. This is the era that gave hair transplants their reputation, and it is why so many people still picture doll hair when the subject comes up.
The change came with magnification. Once surgeons could see and separate the follicular unit, the natural grouping of one to four hairs that hair actually grows in, grafts stopped being plugs and started being individual units placed in the pattern hair grows in naturally.
Follicular Unit Extraction took that further by removing each unit individually from the donor area rather than taking a strip of scalp, which means no linear scar and a far easier recovery.
Where it stands now
A present day procedure moves many hundreds or several thousand follicular units, each placed by hand at the angle and density that matches the hair around it. Done properly the result is not detectable as surgery, which is a considerable distance from where Dieffenbach started.
What has not changed is donor dominance. Every hair transplant performed anywhere in the world still rests on the principle Orentreich described in 1959, and on the fact that your donor supply is finite. That is why an honest clinic plans for the hair loss you have not had yet, not just the hair loss you can see.
You can see what current techniques achieve in our before and after gallery, or read about the procedure itself on our hair transplants page. To find out what would work for you, book a free video assessment.
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