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From 1932 “Plugs” to the modern “FUE” Era
Last Updated: 8 Nov 2025
The history of hair transplantation is not just a timeline of techniques—it’s a cautionary tale of ambition outpacing wisdom, and a testament to how medicine matures through reflection. What began as crude experimentation has evolved into a precision-driven discipline grounded in biology, ethics, and long-term patient outcomes. Understanding this journey is essential: the wrong technique doesn’t just fail—it leaves permanent regret.
At our clinic, this history isn’t academic—it’s the bedrock of our “No Regret” philosophy: to deliver results that are natural today, sustainable tomorrow, and never compromise your finite donor supply.
1822: German surgeon J. Dieffenbach first described autotransplantation of hair, feathers, and skin in animals—laying conceptual groundwork.
1930–1939: Dr. Shoji Okuda, a Japanese dermatologist, pioneered modern punch-graft hair transplantation, successfully restoring hair in the scalp, eyebrows, and pubic regions using 2–4mm punches. His 1939 paper documented follicular survival—but due to World War II, his work vanished from Western medical discourse for decades.
→ A stark reminder: progress can be lost when knowledge isn’t shared.
1952: Dr. Norman Orentreich ( New York ) performed the first documented hair transplant for male pattern baldness, establishing the Principle of Donor Dominance: transplanted hair retains its genetic resistance to DHT. This proved hair restoration could be permanent—but permanence without artistry became a curse.”
Technique: 4mm circular grafts containing 15–25 hairs were punched directly from the donor zone and placed in rigid rows.
Result: The infamous “Barbie Doll” or “corn row” look—obvious, unnatural, and irreversible.
→ This era created the first wave of “hair transplant regret,” much of which still requires repair today.
Key Insight: Permanence ≠ success. Without respect for natural hair patterns, even scientifically valid procedures can fail patients.
Driven by the failures of plugs, surgeons sought refinement:
Micrografts ( 1–2 hairs ) and minigrafts ( 3–8 hairs ) emerged, softening hairlines but often creating spotty density.
1984: Introduction of strip harvesting — a single donor strip replaced multiple punch scars.
1988: Dr. Robert Limmer performed the first true Follicular Unit Transplantation ( FUT ), transplanting naturally occurring 1–4 hair units under magnification.
1994: Dr. Bobby Limmer refined microscopic dissection, enabling pure follicular unit isolation—ushering in the gold standard for natural results.
While FUT dominated, a scarless alternative quietly emerged:
Mid-1990s: Dr. Masumi Inaba ( Japan ) performed the first documented Follicular Unit Extraction ( FUE ) using a 0.7mm punch, detailed in his 1996 textbook Androgenetic Alopecia.
Around the same time, Dr. Ray Wood ( Australia ) reportedly used a similar method—later dubbed “Wood’s Technique”—but never published or disclosed his approach.
Late 1990s: Dr. William Rassman and Dr. Paul Beinstein (USA) independently developed and published the FUE technique, coining the term Follicular Unit Extraction. Their key innovation: using sub-1mm punches to extract individual follicular units—not clumps—dramatically reducing scarring and improving aesthetics.
Critical Difference : Plug grafts used large punches ( 4mm ) with many follicles per graft; FUE uses tiny punches ( 0.6–0.9mm ) with one follicular unit per extraction.
Why FUE Largely Replaced FUT:
2003 : Based on historical accounts from the hair restoration community, the pivotal visit by Dr. Paul Rose ( USA ) and Professor Dae-Hyun Kim ( South Korea ) to Mr. Konstantinos Giotis’s clinic in Greece, which was crucial for the international promotion and validation of the DHI technique ( Direct Hair Implantation ). This however was not the invention of a new surgical method, but the adaptation and popularization of a specific tool : the Choi Implanter Pen.<br>
Dr. Jim Harris ( USA ) introduced the two-step S.A.F.E. System using a dull punch to reduce transection—forming the basis for robotic FUE.
Global Spread : FUE exploded in popularity—especially in Turkey—where non-medical technicians began performing procedures, leading to widespread donor depletion, poor planning, and irreversible damage.
Response: The ISHRS formed the FUE Committee, standardized terminology ( renaming it Follicular Unit Excision to emphasize its surgical nature ), and launched the “ Fight the Flight ” campaign against medical tourism risks. World Hair Transplant Repair Day is now observed annually on 11 November.
2008 : Dr. Bertram Ng ( Hong Kong ) published the first peer-reviewed article on FUE in the Chinese population, addressing unique scalp density and hair characteristics.
Sequential FUE : Dr. Ng also pioneered a method in 2008 where scoring and extraction occur simultaneously, improving efficiency and reducing follicle stress.
The focus moved from how many grafts to how wisely they’re used :
2010 : The ARTAS Robotic System launched, automating FUE extraction. Though precise, its high cost and limitations led to declining adoption, even as newer machines emerged in China.
2013 : Dr. Ng introduced :
2016 : The term “Follicular Unit Extraction” (FUE) was officially renamed to “Follicular Unit Excision”
As stated in ISHRS communications:
“‘Excision’ better describes the nature of the wound created and reinforces that this is a surgical act requiring physician oversight.”
2018 : FUE-HD : Precision Tools Meet Biological Science
High Density FUE is a contemporary technique which has evolved far beyond simple extraction. Today’s gold-standard protocols combine ultra-fine punches ( 0.6–0.8mm ) with partial follicular unit harvesting—minimizing trauma while preserving the delicate perifollicular vascular network critical for graft survival.
Long-Hair FUE: Grafts retain visible hair length, eliminating the need for full shaving.
Non-Shaved FUE : Ideal for professionals who cannot take visible downtime.
COMBO Procedures : Strategic blending of FUT + FUE to maximize yield while preserving donor integrity.
The arc of hair restoration bends toward naturalism, sustainability, and ethics — but only for clinics that learn from the past. The “plug” era failed not from lack of science, but from lack of foresight.
At our clinic, every decision — from graft count to hairline design — is filtered through 75 years of hard-won lessons. Because in hair restoration, the greatest risk isn’t failure — it’s regret you can’t undo.
That’s why we built the “No Regret” standard — so you don’t have to become a footnote in hair transplant history.
conditions of use
Information provided on this website is for educational purposes only and is not intended as medical advice. It should not be interpreted as promotional material or as claims of superiority over other techniques or providers.
Individual results may vary, and no outcome can be guaranteed. Always consult with a qualified healthcare professional before making any decisions about medical treatment.
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At Dr. Bertram Hair Transplant, we only offer what aligns with natural results, minimal risk, and realistic expectations. Since 2009, our FUE protocols are in strict accordance with evidence-based guidelines from ISHRS and WFI. Every procedure is internally audited against ABHRS surgical benchmarks,
International Society of Hair Restoration Surgery is the leading global medical association that establishes international practice standards and patient safety protocols.
The American Board of Hair restoration Surgery represents the highest standard. To maintain rigorous certification requirements the physician must demonstrate surgical expertise.
Worls FUE InstituteI serves as the premier educational body focused exclusively on Follicular Unit Extraction methodology. The institute ensures consistent application of safe FUE.
