The History of Modern Hair Surgery
Hair transplantation has become one of the most widely sought-after aesthetic procedures for patients experiencing hair loss. Thanks to continuous advances in medical science and surgical technology, modern hair surgery now offers results that are more natural, permanent, and safe than ever before.
From the first experimental grafts performed over a century ago to today’s highly refined follicular unit techniques, hair surgery has undergone a remarkable transformation driven by scientific innovation.
This blog traces the complete history and evolution of hair transplantation, from forgotten 19th-century hair transplant pioneers to the development of today’s dominant FUE and FUT procedures. It highlights the key breakthroughs and visionary physicians whose work established the principles behind the natural, permanent results that define modern hair restoration.
A Forgotten Pioneer: Dr. Menahem Hodara and the First Hair Transplant (1897)
The history of hair transplantation date back much further than is commonly believed. In 1897, Dr. Menahem Hodara (1869 – 1926), an internationally respected dermatologist practicing in Istanbul during the Ottoman era, laid the foundations of modern hair surgery.
Dr. Hodara made several groundbreaking contributions to dermatology, including:
- Identifying the bacterial causes of acne comedones
- Describing a unique form of trichorrhexis nodosa, later known as Hodara’s disease
- Introducing the dermatological use of glycerin gel
The 1897 Hair Transplant Experiment
Dr. Hodara’s most remarkable achievement was the transplantation of healthy hair follicles into scarred, hairless areas caused by favus, a fungal infection of the scalp. At a time when reconstructive dermatology was still in its infancy, this work was revolutionary and established the fundamental concept that transplanted hair could survive and grow in a new location.
Historically, this also highlights that the roots of modern hair restoration trace back to Istanbul, Turkey – the country now known as the hair transplant capital of the world.
Scientific Foundations of Hair Restoration
Although early surgical ideas related to tissue transplantation were proposed as early as 1822 by Johann Friedrich Dieffenbach, systematic scientific research in hair restoration did not emerge until the 20th century.
Dr. Shoji Okuda and the Punch Graft Technique (1939)
In 1939, Japanese dermatologist Dr. Shoji Okuda published the first scientific studies demonstrating successful hair transplantation using the patient’s own follicles. He showed that punch instruments measuring 2-3.5 mm in diameter could preserve follicular integrity and allow consistent regrowth.
Dr. Okuda:
- Performed transplants of scalp hair, eyebrows, mustache, and pubic hair
- Supported his work with both clinical and histological evidence
- Published five pioneering scientific papers
Due to World War II and limited access to translations, his research and contribution to the history of hair transplantation remained largely unknown in the Western world for many years.
The Birth of Modern Hair Surgery: Dr. Norman Orentreich (1959)
Modern hair transplantation is widely considered to have begun in 1959, when Dr. Norman Orentreichintroduced the macrograft technique and formulated the principle of donor dominance, a cornerstone of contemporary hair restoration.
The Principle of Donor Dominance
- Transplanted hair retains the genetic characteristics of the donor area
- Hair resistant to androgenetic alopecia remains permanent after transplantation
- Hair transplanted from another patient (heterografts) does not survive
During this period, large 4-5 mm punch grafts were commonly used, often producing an unnatural “plug” or “doll’s hair” appearance.
Refining Aesthetics: Mini- and Micrografts (1980s)
The 1980s marked a significant improvement in naturalness:
- Micrografts containing one to two hairs were placed along the hairline
- Larger grafts were positioned in the mid-scalp and posterior regions
- Hairlines became softer, denser, and more anatomically accurate
These refinements laid the groundwork for modern hair transplant techniques.
FUT in the 1990s: The Follicular Unit Era
The 1990s ushered in what is considered the modern era of hair transplantation. Terry Headington’s definition of the follicular unit, natural groupings of one to four hairs, formed the basis of Follicular Unit Transplantation (FUT).
What is FUT Hair Transplantation?
The concept of FUT can be summarized as:
- A narrow strip of scalp is harvested from the donor area
- The tissue is dissected under high-powered microscopes into individual follicular units
- Grafts are implanted to achieve high density and natural growth patterns
By the early 2000s, FUT was widely regarded as the gold standard in surgical hair restoration.
The 2000s and Beyond: The Revolutionary Follicular Unit Extraction (FUE)
Introduced in the early 2000s, Follicular Unit Extraction (FUE) represented a major technological leap:
- Individual follicular units are harvested using micro-punch instruments
- The procedure is sutureless and leaves minimal visible scarring
- Postoperative recovery is faster and more comfortable
With the development of motorized and robotic systems, FUE has become the most commonly performed hair transplant technique worldwide.
Abandoned Hair Transplant Techniques: Laser Therapy and Scalp Reduction
Laser-assisted transplantation and scalp reduction procedures, explored mainly in the 1990s, are now rarely performed due to:
- Unnatural aesthetic outcomes
- A high risk of visible scarring and distortion of hair growth patterns
Pioneers and Institutions That Shaped Modern Hair Surgery
Key figures who have shaped the history of hair transplantation include:
- Norman Orentreich: Founder of modern hair transplantation
- Shoji Okuda: Pioneer of punch graft surgery
- O’Tar Norwood: Author of the first comprehensive textbook on hair restoration
- Walter Unger, Bluford Stough, Jay Barnett, and Tom Alt: hair transplant pioneers who refined surgical planning, graft handling, and aesthetic design
Founded in 1993, the International Society of Hair Restoration Surgery (ISHRS) is a key institution that plays a central role in:
- Establishing scientific and ethical standards
- Advancing education and research
- Elevating the global quality of modern hair restoration surgery
Modern Hair Surgery in Turkey: Civas & Akpınar Continuing the Legacy
Founded in 1999 by Dr. Ekrem Civas, the clinic is one of the earliest doctor-led, academically based hair restoration centers in Turkey.
Dr. Civas, a Clinical Associate Professor of Dermatology, is internationally recognized for his role in modern hair surgery and was the first Turkish doctor to be certified by the American Board of Hair Restoration Surgery (ABHRS) and to receive the Fellow of the International Society of Hair Restoration Surgery (FISHRS) title.
His scientific work has contributed to defining safe donor management and evidence-based surgical indications in the following areas:
- FUE instrumentation and follicular unit preservation
- Cicatricial (scarring) alopecias
- Alopecia areata
- Hair transplantation in burn and traumatic scars
Dr. Ümit Akpınar later joined the clinic after graduating with high honors from Hacettepe University and completing his dermatology training at Ankara Numune Training and Research Hospital.
As a published academician, his research supports evidence-based hair transplantation, and his presentation titled “Graft Distribution, Patient Characteristics, and Transection Rates in 154 Hair Transplant Patients: A Retrospective Observational Study” was awarded First Prize at the 10th Dermatologic Surgery and Cosmetology Days.
Together, Dr. Civas and Dr. Akpınar represent a modern continuation of Turkey’s long-standing tradition in hair surgery, uniting academic leadership with meticulous, doctor-driven clinical practice.
To benefit from this level of academic expertise and physician-led care, schedule your consultation with Civas & Akpınar Hair Transplant Clinic and take the first step toward a scientifically planned, natural, and permanent hair restoration..
History and Evolution of Modern Hair Surgery: FAQs
Q: What are the latest innovations in hair transplantation?
A: Motorized FUE, refined implanter pens, high-magnification graft handling, and regenerative therapies have significantly improved precision, graft survival, and naturalness in hair restoration.
Q: What is the most advanced technique in modern hair surgery?
A: Follicular Unit Extraction (FUE) and its variants, including DHI, represent the most advanced, minimally invasive techniques used today for natural, scar-minimized results.
Q: Who is considered the father of modern hair transplantation?
A: Dr. Norman Orentreich is regarded as the father of modern hair surgery for establishing the principle of donor dominance in 1959.
Q: How has hair transplantation improved over time?
A: Techniques have evolved from large punch grafts to microscopic follicular unit transplantation, resulting in higher density, natural hairlines, minimal scarring, and better long-term survival.
Q: What is the future of hair transplant techniques?
A: Ongoing advances in AI, robotics, regenerative medicine, stem cell research, and bioengineering are expected to further enhance density, healing, and potentially enable hair cloning in the future.
