The evolution of Hair transplant

1 – Classic technique - Standard grafts - Early days

Hair transplant in the west was first announced in 1959 in a publication by a New York City dermatologist. The rudimental technique consisted in removing small circles of hair (around 5mm) containing 7 to 12 follicular units each, from the donor area (backside of the scalp). After extracting, the hair was implanted in the bald areas. He used a Surgical instrument called punch that besides taking off the round 5 mm units, also extracted a similar size round area from the receiving area in which the units would be placed.

Classic Technique. made in another clinic.

Later on, the size of the grafts became as small as 1.5 or 2mm wide (mini graft). It was a huge improvement, but the frontline aspect however, was still rough and artificial. After all, each graft of implanted hair held 3 or 4 UFs (6 to 12 hairs).

It was okay for those days, even incredible to be able to actually do that in the 50’s, but the final result had clumsy aspect that soon was baptized not positively at all as “doll hair”. Nevertheless, it was a great achievement to transplant hair units and make them grow naturally again.


Classic Technique. made in another clinic.		Classic Technique. made in another clinic.

2 – Mini-micro grafting – The popularization of hair transplant

Much later, though, in the 80’s, the improvements were finally made. The new technique called micro-grafting consisted in using 1 to 3 one-hair samples, usually placed in the first lines of forehead, resulting in a more natural look. By this time, Follicular Units (UFs) had not being mentioned yet, anywhere. A superficial look could make one believe that each micro-grafting consisted in implanting a single hair. When, as a matter of fact follicular units with 4 hairs each were being implanted in the frontline of the scalp. Some years later the technique known as mini-micro grafting which combined de mini grafts transplant (6 to 12 hairs each) with the finishing of micro grafts (1 to 3) landed in Brazilian soil where it gained an euphemistic designation of “hair to hair” transplant. This name brought confusion and misunderstanding once many people took the name literally, believing that the transplant was made by placing one hair at a time. Obviously, this misunderstanding generated dissatisfaction and frustration to some potential patients specially those with thicker, darker hair with white skin, as the contrast makes the finishing a little more evident. The media reacted as badly, feeling confused and misinformed about the technique. In spite of all these failure of communication, it was a great aesthetic advance, no doubt about it, with results generally satisfactory.

Hair-by-hair. In zoom, previous line of the transplant. Carried through in another clinic.

3 – Partial Follicular Transplant – The quality emerges

The advances obtained by another group of doctors consisted in the use of follicular units in great scale (50% of the transplant) was divulged in 1995 by the American surgeon-doctor Ron Shapiro. Doctor Shapiro became known by the artistic character conferred to the new follicular technique. Two other that split time were Dr. William Rassman – by the exclusive use of follicular units and Dr. Bobby Limmer, pioneer in the use of 3-D microscope to separate the UFs.

Hair-by-hair. In zoom, previous line of the transplant. Carried through in another clinic.

On February, 1996, Dr. Arthur Tykocinski visited Dr. Shapiro’s Clinic in Clearwater, Florida in order to get in touch with the new technique in order to deepen his knowledge. Back in Brazil, Dr. Tykocinski started preparing to make the technique immediately available to his clients. The follicular transplant revolutionized not only the technique, with the use of various 3-D microscopes and a highly specialized team of pros (about 6 people), but also created a new aesthetic standard in relation to what would be, in fact, an excellent result.

4 - Total Follicular Transplant – A consistent change

In 1998, a group of doctors (among them, Dr. Tykocinski) led by Dr. William Rassman, defended the exclusive use of Follicular Units (UFs) in hair transplant, following a simple logic: If the normal hair is naturally divided in UFs, why trying to make something other than that? As the time went by and the technique was acquired by many, the sessions became larger with more UFs transplanted. The team started working with one thousand UFs and soon reached the mark of Two thousand. We are talking about 4.500 hairs transplanted in only one day! The small aggression made by the new grafts made possible that almost every new follicle was properly integrated. The Tykocinski Medical Group, as a pioneer, joined the group of clinics around the world able to perform transplants using exclusively follicular units, guaranteed in contract firmed with the patients.


Total Follicular Transplant.		Total Follicular Transplant.

Total Follicular Transplant. Pre-Surgery.


Donor area. Transplant carried through in another clinic..		Transplant carried through in another clinic.

5 – Coronal (Lateral Slit) Follicular Transplant – The evolution of the revolution

This is the name of the technique which allowed us to reach a new level of quality. A genius association of two simple conceits that put together makes all the difference.

A 90º rotation in the axle of follicular unit placement, Instead of guiding them in the direction that goes from the forehead to the nape of the neck, we started using the horizontal direction, from ear to ear. Thus, we improve the covering and the naturally of the result.

Incredibly small Orifices: from 0.55 to 0.7mm width. With it, we magnify the density of hair, creating, at the same time, a compact and voluminous aspect. The cicatrisation is faster, with minimum appearance of crusts during recovering, reflecting the fact that the procedure is minimally invasive. The marks of transplant become soon, imperceptible. The post-transplant period, which used to cause a certain constraint to the patient, was reduced to only a few days.

In practice what happens is that many times, finished the process, the doctor himself is not able to distinguish the place where the transplant was made. Well, if highly trained eyes failure to identify the place of the transplant, what to say about the less prepared look of the patient’s peers?

To achieve this level obviously had its cost: the teams got bigger, more technical and even more specialized. The transplant, at the same time complex and artistic, demands much more devotion and ability from the team once the consumed time increased considerably. But if the real objective of the team is quality, everything is worthwhile. After all, all this effort has only one goal: the satisfaction of the patients.

COMPARATIVE TABLE

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