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History of the Procedure: Pioneering work in modern human hair restoration surgery by Okuda, Tamura, and Fujita largely remained unrecognized until the work of Orentreich in 1958 became the basis for worldwide restoration methodology. The punch autografting methodology of Okuda and Orentreich became the world’s standard for hair transplantation with few changes over 30 years. Nordstrom and Marritt added micrografting to improve the aesthetics of the frontal hairline, and Bradshaw quartered plug autografts to produce minigrafts. Stough changed the pattern to slit minigrafts, and Vallis introduced the multibladed knife to donor harvesting during the 1980s.

The quantum leap to total micro/minigrafting should be credited to Uebel, who simultaneously introduced single-blade donor harvest with rapid graft production and insertion methods, limiting the grafts to micrografts and small minigrafts. The Uebel method remains one of the most popular methods of hair transplantation and currently is used by many hair restoration surgeons worldwide. Recognizing that normal hair growth occurs in groupings of 1-4 terminal and 1-2 vellus follicles referred to as follicular units, Limmer developed the methodology of follicular unit transplantation, which subsequently was adopted and popularized by Seager, Norwood, and others. When properly performed, follicular unit transplantation consistently and predictably produces the most natural-appearing surgical hair restorations.

Problem: Androgenetic alopecia (MPB) is a progressive disorder of loss of hair of the dorsal scalp sparing the lateral and occipital fringes. The degree of loss is determined genetically and produced hormonally by the androgenic hormones testosterone and dihydrotestosterone. Starting after puberty, the disorder may require from a few to 40 or more years to establish the genetically coded pattern. When planning surgical hair restoration, it is essential to plan and design procedures anticipating that the patient may progress significantly in baldness pattern. This especially is important in youthful candidates who have not had time to define their genetic pattern fully. Failure to properly plan for future loss may result in unnatural patterns as baldness progresses and surrounds previously grafted areas.

Frequency: Approximately 70% of adult American males develop some degree of MPB. Hamilton was the first to classify MPB in 1949. Norwood used Hamilton’s data and organized his own evaluation resulting in a system that currently remains in use. The classification system is helpful in planning procedures and forms the usual basis for discussion of the degree of alopecia present. Approximately 30% of cases of MPB progress to patterns VI and VII.


Hair restoration to alopecic zones is an elective option. Only patients who lack adequate donor hair to reach their goals and are unwilling to compromise those goals to be compatible with available donor hair are unsuitable candidates. Because results of follicular unit transplantation methodology are natural and predictable, few candidates with realistic goals need to be excluded.


Contraindications: Unattainable and unrealistic goals based upon degree of alopecia and available donor hair are an absolute contraindication.

Young age, psychological instability, and coexistent medical problems that may influence healing or predispose the patient to bleeding and infection are relative contraindications.


Lab Studies:

  • MPB is a clinical diagnosis based upon history and physical examination. In females, endocrinologic studies may be helpful and may, in select cases, include the following:
    • CBC
    • Serum iron studies
    • Thyroid profile
    • Testosterone total and free
    • Dehydroepiandrosterone sulfate (DHEAS)
    • Androstenedione
  • Rarely, scalp biopsy may be indicated if the diagnosis is uncertain.



Hair Loss information on this site has been contributed by hair loss specialists and surgeons who have years of experience in the field of hair loss.

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