Nip & Tuck: Hair Transplant 101

AN INTRO TO HAIR TRANSPLANT. Dr. Michael Pavlos gives the low-down on hair transplant procedures and the list of things to consider

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Everyone has heard of or even seen hair transplant horror stories, maybe in a magazine, online or—worse—seen the obvious “plugs” on an elderly friend or relative. However, hair transplant surgery has jumped leaps and bound in recent years to make it a viable, safe and not too risky option for those suffering with male-pattern baldness. Many celebrities such as Nicholas Cage, Brendan Fraser, Matthew McConaughey, Dwayne “The Rock” Johnson and even Italian Prime Minister Silvio Berlusconi are believed to have had hair transplantation surgery, although such is the stigma attached that none of them have admitted to it publicly.


The origins of hair transplant surgery stem from Japanese dermatologist Dr. Okuda, who in 1939 published a revolutionary method of using small grafts similar to the way hair transplantation is performed today in a Japanese medical journal. This method involved using grafts from various areas of the body, including the scalp, eyebrow and moustache, to correct hair loss.

In the late ’50s, Dr. Norman Orentreich began to experiment with the idea of relocating or transplanting hair from the back and sides of the head to balding areas. Dr. Orentreich’s experiments showed that when bald-resistant hairs from the back and sides of the head were relocated, their genetic immunity to balding were still very much in place, regardless of where they were transplanted to.

This principle, known as “Donor Dominance,” established that hair could be transplanted from bald-resistant donor areas to balding areas and that these transplanted follicles would continue to grow for a lifetime. This laid the foundation for modern hair transplantation. During the ’60s and ’70s, hair transplants grew in popularity. However, the standard of care at the time involved the use of larger grafts that were removed by round punches and often contained many hairs.

In the ’80s, hair restoration surgery evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini- and micro-grafts. This new procedure no longer used the punch to extract bald-resistant grafts. Instead, a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini- and micro-grafts.


There are two main methods of hair transplant surgery: Follicular Unit Transplant, which is commonly known as FUT or “strip surgery,” and Follicular Unit Extraction or FUE. The main difference between the two is the method of extracting hair to be transplanted. FUT, a very refined surgical procedure, was gradually introduced in the ’90s. This exacting and labor-intensive procedure transplants hairs in their naturally occurring one, two, three, and four hair “follicular unit groupings,” in which they will then grow naturally.

The concept of hair restoration by using follicular units exclusively was proposed by Dr. Robert Bernstein and was described in the 1995 Bernstein and Rassman publication “Follicular Transplantation.” Critical to the success of the follicular unit hair transplant procedure was the introduction of the binocular microscope by Dr. Bobby Limmer in the late 1980s.

Dr. Limmer found that by using the microscope to examine donor tissue, he and his staff were able to successfully isolate and trim naturally occurring follicular units into grafts. He then shared his techniques and findings with his colleagues and, together with Drs. Bernstein, Rassman and Seager, became a persuasive advocate for follicular unit hair transplants.


These two methods are actually complementary forms of hair transplantation, not competing methods. If you need a large area covered, then you most likely want to go for FUT because it is more economical in terms of price per graft. However, FUT will create a narrow line across the back of your head, whereas FUE will leave little un-pigmented dots across the back of your head. In other words, scars from an FUE procedure are not concentrated together and therefore less visible.

“Nicholas Cage, Matthew McConaughey and even Silvio Berlusconi are believed to have had hair transplantation”


I recommend considering hair transplant surgery only after you have tried non-surgical treatments on the market. Then, when you are certain you wish to get a hair transplant, I would advice researching reputable doctors thoroughly. Of course, price is always an issue, but in the case of hair transplants, it should not be the most important factor. Indeed, any amount of money saved is nothing compared to the trauma caused by having to live with a badly scarred scalp for the rest of your life. If you decide to go for a more affordable surgeon, please do insist on seeing photos of the surgeon’s previous work and do not be afraid to ask for contact details of their previous patients.

Michael Pavlos is the practice manager and patient advisor at the Australian Institute of Hair Restoration, a clinic that performs hair transplants in Sydney, Australia. He has over eight years of experience in all areas of hair transplant and cosmetic plastic surgery.

Photography Haruns Maharbina
Styling Triska Putri
Grooming Ria Sambuaga
Model Joao Mahl/21MM Management