In the 19th century, J. Diffenbach performed the first successful transplantation of hair into skin. In 1939, Okuda showed that hair transplantation could be successfully performed with the use 2- or 4-mm punch grafts transferred to the scalp, eyebrow, moustache, and pubic areas. In 1952, Norman Orentreich demonstrated the first successful use of hair-bearing autografts for the correction of male pattern baldness. Orentreich is duly recognized as the “father of hair transplant surgery.” In the 1970s and 1980s “mini-micrografting” was performed using large graft sizes containing 12-20 grafts. Although each of these grafts contained many hairs, they also contained a large amount of non-hair bearing tissue which resulted in dimpling of the skin during healing and a tufted unnatural “dolls hair” appearance. A hair transplant of this type was referred to these as “hair plugs”.
Dr. Bob Limmer in the late 1980s began using microscopes to remove the excess non-hair bearing tissue from the grafts, resulting in a much smaller graft which contained the follicular unit and only a small amount of non-hair bearing tissue. This protocol modification eliminated the “hair plug” appearance. The technique was refined further and became known as follicular unit transplantation (FUT).
The availability of special stereo microscopes used in FUT enabled meticulous dissection of grafts such that the transplanted hairs looked completely natural and were indistinguishable from normal hair. Removal of larger strips in FUT allowed the number of hairs transferred in a procedure to increase significantly.
The main disadvantage of FUT, however, was the linear scar in the back of the scalp that results after removal of the strip. Follicular unit extraction (FUE) is a less invasive than FUT and does leave a scar on the posterior scalp. The desire of many patients to avoid scar and stitches has fueled more interest in FUE over the past 10 years. FUE is slower than FUT since the grafts are individually harvested from the posterior scalp, and the harvest time has been rate-limiting with regard to the number of hairs that can be transplanted.
Numerous devices have been invented to shorten the time and decrease the number of person-hours it takes to harvest grafts. These can be divided into non-automated, partially automated, and fully automated. There are many non-automated devices, and although they are all clever and underscore the breadth of human ingenuity, none of these have significantly shortened harvest times. The most significant partially automated device is the Neograft.