The history of hair restoration, at least as it’s performed today, is a brief one, dating back just over half a century. While hair transplants have been around for a brief amount of time, the procedure has seen a great deal of evolution since its early days. Earlier techniques produced results that were not aesthetically pleasing, not natural appearing. Continued evolution of the techniques used during hair transplantation has lead to the development of automated devices to harvest the grafts from a person’s scalp. With the development of these automated devices comes the question, will the human touch soon be a thing of the past when in comes to hair restoration?
Hair Restoration Through the Years
Hair transplants work because of a concept known as “donor dominance.” Hair will keep on growing, even if the follicle is taken from its original spot and moved to another area of the scalp. Follicles that are not usually susceptible to DHT can be transferred to areas of the scalp where the hair follicles are susceptible to DHT and continue to grow.
While the original concept for hair restoration remains the same, the method of performing the procedure has changed dramatically over the years. In the early days, back in the 1960s, large donor areas, up to 4mm in diameter, were punched out of the scalp, then transferred to holes in areas of the scalp where hair loss was occurring. While the procedure did restore hair, the results were very visible and often unsightly.
With the development of follicular unit grafting, the results became more and more natural in appearance. Instead of transplanting large plugs, hair follicles were placed one by one in the scalp. The surgeon performing the procedure worked up close, using a microscope, and making sure to position the hairs so that they fell in a natural pattern.
FUG might produce a more natural look than earlier methods, but it has what can be considered a major drawback, particularly for men who wish to keep their hair cut short — the donor hair is removed from the scalp through an incision that ultimately leaves a scar on the back or sides of the head. The scar can be covered up with surrounding hair, but its presence can make it difficult for people to wear their hair short.
Follicular Unit Extraction or FUE, developed about a decade ago, combines the best of FUG with the best of earlier methods. The punch method of harvesting follicles is back, except this time, the follicles are removed in single units, not in large 2 to 4 mm diameter punches or plugs. FUE eliminates the need for the excision of a strip of scalp and eliminates the resulting long scar. Since the punches are so small, any scars that develop are tiny, barely visible dots. People who decide to have FUE can shave their heads later on or wear their hair very short without feeling self-conscious about scarring.
Ways of Harvesting Grafts
Surgeons who are harvesting grafts during a FUE procedure can do so in a number of ways. The oldest method is the manual method, which means that a surgeon removes each follicle one by one, by hand using a hand-held punch. The original option, manual extraction, is generally not preferred by surgeons today for several reasons. It takes a long time and there are fewer quality grafts.
A motorized method of extraction is generally the preferred method for many doctors today. Typically, a motorized method uses a drill to gently cut through the scalp and remove the follicle, without damaging it or affecting its quality. Although the process involves a tool, a motorized extraction method still relies on the human touch, as the surgeon is using the drill and deciding which follicle to extract, how much pressure to use, and what angle will work best. The process of extraction is considerably quicker than manual extraction, with a surgeon able to remove up to 400 to as many as 700 grafts per hour.
Automated extraction can be a slightly more advanced form of motorized extraction, meaning it still needs a human to guide the device. Or it can be completely robotic, meaning the device picks the follicular units, chooses the appropriate angle, and decides how much pressure is needed to extract them. Some automated hair restoration devices can also create the recipient sites, effectively removing the doctor from the process entirely.
Human vs. Automation
It might be too early to say whether automated devices will ever fully replace the human touch during a hair restoration procedure. While quickly extracting hair grafts is a worthwhile feature of automated devices, in some ways the automated devices are no faster or more accurate than a pair of experienced surgeons working in tandem.
The art of hair restoration lies not in how well the hair is harvested, but in how well the hair is transplanted into the recipient area. While a few automated devices do create the recipient sites, not all of them do just yet. That task still falls to the surgeons, and it’s up to them to provide the human touch and to create a natural look.
Hair restoration surgeon Dr. Jeffrey Epstein has more than two decades of experience performing hair transplants. He has great hopes for the future of hair restoration while recognizing that human talent and artistry will continue to play an essential role. Dr. Epstein sees patients at his practices in New York City and Miami. For a consultation in New York, call (212) 759-3484. To schedule an appointment in Miami, call (305) 666-1774.