Doctors generally want to help people and doctors use what tools are available to do just that. Unfortunately, the hair transplant technology that was available prior to 1992, was a very limited technology. It was used by hundreds of doctors over decades and consisted of two types of surgical procedures. The scalp reduction, which removed the balding scalp on the top and back of the head, and hair transplant plugs that were removed from the back of the head and placed in the front of the head. As these patients grayed, their plugs became less detectable so time worked in favor of the patients who were deformed by some of the old technology.
The Scalp Reduction: Conceptually, removing the bald scalp behind the hairline from front to back might have made sense if the hair on the sides could be stretched to cover the removed scalp. As the hair on the sides never balded, this side hair might theoretically have done the trick. This, however, was not what really happened. I, for example, had three of these procedures done on my head in 1992 and this caused me no end of grief. A scar was present in the center of my head and my scalp was paper thin, bleeding from the slightest touch. That alerted my perception of that this procedure that it was a bad procedure and I made it a personal campaign to stop it from being done. I even went as far as to publish an article and present it before the international society telling all the doctors that this was a bad procedure and if any patient wanted to take legal action against any doctor performing it, I would act as an expert witness when asked. That did not make me popular, but I succeeded in stopping this procedure from being done. Thousands of people had been victimized by it. The doctors; however, did not really understand the consequences of this procedure and as it was the “Standard of Care” at the time, they just continued to offer it and did in on those people who seemed, to them, to be good candidates. The lesson here is that doctors must always think twice about what they are doing and listen to their patients. Anyone, like me, could have told their doctors about the evils of the scalp reduction. Unfortunately, there is a herding instinct in people and doctors are just people, but doctors are special people who are intrusted to be better than the ‘herd’, and must always think twice, or more than twice about what they are doing. Maybe I was responsible for stopping the scalp reduction from being done, but it should have happened well before I became a victim of it.
The Hair Plug: What a marvelous innovation it was. A hair from the back of the head would live as long as the patient lived, even if it was moved elsewhere. It started in 1959 on a commercial level and doctors and the public quickly became enthusiastic about it. Imagine hair in front of a bald mans head! As a person started to thin from genetic balding, doctors became aggressive as patient wanted to stop the balding process and surgery seemed to be the answer, so doctors put these plugs behind the hairlines to make it look fuller, and it worked, at least for a while until the progressive nature of balding continued and the thin hair disappeared, leaving the large plugs behind. Doctors quickly picked up on this and started to fill in between the plugs so more plugs were needed. Some doctors used parts of a plug, so that they were smaller to fit better into the large white spaces created by the original surgery, but no matter what was done, it was never perfect because the plugs just could not be disguised for what they were. Many doctors tried to fix the problem, but they nevertheless continued to create more of the same problems.
Innovation to fix this problem really started in the late 1980s. I am not sure why it took so long considering that hair transplants were going gang-busters since 1959. A friend of Frank Sinatra who I performed hair transplants on in 1994, told me of the hatred that Sinatra had for his hair transplant surgeon. He was ‘plugged’ and had to wear a hair piece, a wig, for his entire life because of it. He could never graciously accept balding once he started the hair transplant process. In the late 1980s, Dr. Manny Marritt figured out that smaller grafts could look more natural and that if these smaller grafts were kept to the forelock area, even a very bald man might look good. He spoke at medical meetings about his idea. But just how small? That was the problem. Dr. Ubel in Brazil offered small grafts in larger sessions in about 1990 along with the Mosher Clinic in Germany and patients flocked to their doors. After doing my research, I entered the hair transplant field in late 1991 and knew that small grafts in large quantities were the way to do this surgery. But how small and how many were the questions I had to answer. So I visited Dr. Marritt and saw what he was doing and I knew that they had to be smaller than he created them. That required a completely new technical skill that I had to develop and perfect, so that is how it all started. By 1992, I was doing 1000 grafts, by 1993-4 I had gotten to as many as 4000 grafts of very small grafts, essentially the follicular units that we use do today. Publications by Dr. Bobby Limmer in Texas helped me focus on graft size. Once I got going, the line-up at my office was massive and bingo, I became a successful hair transplant surgeon. Other doctors saw my success and they quickly adapted the techniques that I published in medical journals along the way. The old plugs had died.