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Hair surgery, like any technology, has evolved dramatically from its origins 50 years ago. For the first three decades, large plugs were the only option. The late 1970s brought about scalp reduction, which faded from prominence by the early 1990s. It still remains an important skill in repair surgery. It is during the last 15 years, though that perhaps the most significant evolution has occurred: the development of small, natural graft technology. Micro/Minigrafting was the first step forward from plugs. It uses single hair grafts (micrografts) and mini grafts, which were a fraction of the size of the old 30 hair plugs. The next technical development was follicular unit grafting, and then more recently multi-follicular-unit grafting.

What Has Changed in Hair Loss Treatment Compared to the Past?

Better surgery and better medication. Hair restoration surgery has evolved the ability to give results that are natural, but also thicker than ever before. This means that not only do you look like you never had transplants; you can also get a thicker result faster. With effective medications, most patients can also stop getting balder.

What Are “plugs”?

When hair transplants were first done 15 or more years ago, large cylinder-shaped grafts with up to 30 hairs in them were taken from the donor scalp and put into round holes in the thinning areas. When they grew, they gave a coarser, less natural look than the original hair. Modern transplants use grafts as small as a single hair and duplicate the appearance of the un-grafted hair.

What Is a Scalp Reduction (a.K.a. Alopecia Reduction)?

This is a procedure where an area on the top of the scalp is removed and the scalp from the sides pulled up and closed together. Originally developed to remove areas that were bald or thin, it has been largely replaced by transplants. It remains an important surgical skill in some patients, particularly those needing repair surgery like scar removal or revision.

What Is a “flap”?

It is a surgical procedure where a long strip or flap of hair-bearing scalp is raised up from the back and sides of the donor area, turned, and surgically put down into the area of loss, usually the hairline. The flap remains attached to the original scalp in the temple so it continues to receive blood flow. There are only a very small number of men who would want this procedure or are good candidates for it. Dr. Elliott does not perform flap surgery but has helped many patients who have needed correction of some aspect of the flap.

We Have Talked About Scalp Reduction, and I Realize That Transplants Are Usually the First Option. Are There Different Types?

Yes, there are. The two major surgical approaches in modern hair restoration are follicular unit transplants (FUT) and FUT in combination with multi-follicular-unit grafting (MFUG). Each has advantages and disadvantages and some patients will be better candidates for one approach or the other. In addition, there is now another option for donor harvesting; Follicular Unit Extraction (FUE), for situations where strip harvesting is not possible or desired. Dr. Elliott is an expert in all these approaches and will be able to advise you on which best suits your goals and hair and skin type.

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