What are Hair Plug Transplants?

Sometimes simply referred to as “plugs”, hair plug transplants were first used in 1952 by Dr. Norman Orentreich, who is considered the ”Father” of surgical hair restoration. Despite its many limitations, this primitive hair transplant method continued for decades until its subsequent replacement in the 1990s by the far superior follicular unit strip surgery (FUSS). Although it is now extremely outdated, this is still a landmark procedure that serves as the prototype of modern hair solutions today.

How do Hair Plug Transplants Work?

This procedure is performed using the following steps:

  • A surgical punch device removes a 2-4 millimeter piece of tissue (the hair plug) from the traditional donor zone (an area towards the back of the scalp), where the most preferable hair grows.
    • Each plug contains twenty or more hairs depending on the density of the donor zone.
  • A second incision of equal size is made to remove a circular piece of tissue from the area experiencing hair thinning or loss (also called the recipient site).
  • The donor zone tissue is transplanted into the recipient site.
    • This step is repeated as necessary until the desired hair pattern in developed.
  • The open wounds where the plugs were harvested are not stitched or sutured, but left to heal on their own.
    • Sometimes the surgeon would use stiches or sutures, though this was not necessary.

What are the Problems with Hair Plugs?

Hair plug transplants are no longer popular because of the undesirable consequences that accompany even the most “successful” procedures. Although hair plugs can yield fairly positive results in terms of hair density, there are still much better treatments for hair restoration than this type of invasive surgery.

  1. First, the amount of tissue being removed during a hair plug transplant is gigantic compared to today’s standards. The large circular scars that every procedure leaves are difficult to hide, especially at the donor site. Sometimes the scars would not fully camouflage with the transplanted hair at the recipient site, which can bring unwanted attention. This also severely limits the recipient’s hairstyling options. Shorter haircuts are off-limits.
  2. Second, the hair plugs constrict at the recipient side, which causes the hairs to grow closely bunched together as the scalp heals. This effect is known as “doll head hair” because the hair more closely resembles the neatly prearranged rows of doll hair rather than real hair’s natural growth.

How are Modern Hair Restoration Methods Different than Hair Plug Transplants?

Technology has advanced a great deal over the past sixty years since hair plugs were originally invented. Nowadays, the donor sites can be as small as the individual hair follicles themselves. This technique, known as follicular unit extraction (FUE), leaves minimally invasive scarring that enables patients to wear their hair short, if they choose. Follicular unit strip surgery (FUSS) is another way to transplant hair without scarring the scalp as drastically as hair plugs. Sometimes referred to as “FUT” or “strip”, this technique inflicts much less trauma on the recipient scalp while yielding a far greater degree of naturalness.The downside is that there is still the potential for undesirable amounts of scarring in the donor zone.

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