Kapsul Buka Aura

 

SEJARAH TRANSPLANTASI RAMBUT

The History of Hair Transplantation
Walter P. Unger

Dermatologic Surgery 26  (3), 181-189
 

I HAVE BEEN ASKED to write a “history” of hair restoration surgery. It is inevitable when one is given such a task that either someone will be forgotten, because his role in expanding this field was brief, or some will feel they should have been included but weren't or that the space devoted is inappropriately too short or too long. Numerous physicians have played substantial roles in expanding the field of hair transplantation, but space limitations prevent me from describing their backgrounds and contributions as fully as I would like. I ask for their understanding. Prominent among them are Robert Auerbach, Jay Barnett, Robert Berger, Nick Brandy, Jim Burks, George Farber, Robert Fosnaugh, Leonard Lewis, Mario Marzola, Hill Pearlstein, Sorrel Resnick, Henry Roegnick, Paul Straub, Carlos Uebel, and John Yarborough. Like most English-speaking people, I have also been “handicapped” by my native tongue, reading only scientific articles published in English. I hope that nobody worthy was left out because they did not publish in English. History must also end somewhere, so I have arbitrarily not included those who entered the field after 1975—with one exception. Finally, I will not deal with practitioners of flap surgery or tissue expansion. Flap and tissue expansion experts such as Jose Juri, Louis Argenta, Reed Dingman, Bernard Alpert, Ernest Manders, Sheldon Kabaker, Toby Mayer, Richard Fleming, and Richard Anderson have played important roles in hair restoration surgery, but only a small percentage of patients are appropriate candidates for flaps and/or tissue expansion, and our space here is limited.


History

The history of hair restoration surgery begins in Wurzburg, Germany, with a doctoral thesis written in 1822 by J. Dieffenbach. His teacher, Carl Unger, suggested he investigate the concept of autotransplantation of hair, feather, and skin in animals and fowl—which Dieffenbach proved possible using goose quills as trephines. (The author has struggled—unfortunately in vain—to confirm a relationship to Carl Unger, who lived within a few hundred miles of my father's family home city). For more than a century after that, examples of hair transplantation were sporadically published, primarily in the medical literature of Germany, England, France, and Japan. In most cases the reports describe the successful transposition of relatively large grafts or pedicle flaps. Notable exceptions were a German article on eyelash transplantation of single hairs in the early 1900s and Okuda's 1939 article in the Japanese Journal of Dermatology on punch grafting of hair for alopecia of the scalp, eyebrow, mustache, and pubic areas.

Despite the foregoing, however, the idea of hair restoration surgery for male pattern baldness (MPB) clearly belongs to one of dermatology's most distinguished and accomplished members—Dr. Norman Orentreich (Figure 1). If at one time “all roads led to Rome,” no discussion of the origins of hair transplantation as a treatment for MPB or any of the men who first practiced this technique can begin without homage to this extraordinary clinician and scientist who gladly—and from the beginning—shared his knowledge with colleagues from all over the world. As is so often the case in science, his discovery of “donor dominance” (a term he originated) of MPB was accidental. According to Dr. Hiram Sturm, who was working with him at the time, Dr. Orentreich was doing a study on vitiligo, using a transfer of punch skin grafts in an attempt to determine whether vitiligo was “donor” or “recipient” area dominant. The patient and Dr. Orentreich noted that a punch graft that had been taken from a hair-bearing area, when placed into a non-hair-bearing area, grew hair at the new site. Subsequently, according to Sturm, in Dr. Orentreich's busy hair clinic, a persistent patient with severe frontal MPB asked, “Isn't there anything you can do for me? I'll try anything!” Hair transplantation to treat MPB was “born” that day, when 10 4-mm grafts were removed from the hair-bearing occipital area and transferred into 10 punch graft sites in his alopecic frontal area. The year was 1952. Dr. Orentreich's first article on hair transplantation was submitted to the Archives of Dermatology. The reviewers said that the reported results were “not possible” and the article was rejected. Ultimately it was published by the New York Academy of Sciences in 1959 and the rest, as they say, is history.

The true “fathers” of hair restoration surgery for MPB all emerged as a result of working with or friendships with Dr. Orentreich. They include Dr. Hiram Sturm (1955), Jim Burks (late 1950s), Blu Stough (early 1960s), Jean Aroute (1961), Sam Ayres III (1961), Robert Fosnaugh (1961), Jay Pinski (1961), Patrick Rabineau (1963), Robert Auerbach (1963), Robert Berger (approximately 1963), and Hillard Pearlstein (approximately 1965). The latter three worked with Dr. Orentreich in his private clinic, and in fact it was they who taught many if not most of the 1965–1970 “visitors”—O'Tar Norwood, Pierre Pouteaux, Richard Shiell, and the author among them.

A second and larger wave of hair transplant surgeons came in the period from 1970 to 1975. They learned their craft either at the Orentreich office or from those who had been taught there. Many of the most important teachers and several of the “giants” of hair transplantation are in this group. They include Robert Limmer, Rolf Nordstrom, Manny Marritt, Martin Unger, Tom Alt, Ted Tromovitch, Sam Stegman, Harold Pierce, Marvin Chernovsky, Henry Roegnick, Edward Krull, Douglas Torre, Wayne Simmonds, Fred Castro, Charles Vallis, Pierre Bedard, and the Blanchard bothers. A brief biography of some of these men follows.


Biographies

History  Conclusion 

Norman Orentreich

A towering figure in dermatology for most of his 47 years in practice, Dr. Orentreich has consistently been on the cutting edge of innovations in the field of dermatology and cosmetic surgery—hair transplantation being only one of a seemingly endless list. He was one of the founding members and the first president of the American Society of Dermatologic Surgery (ASDS), which now includes more than 2500 members. In addition, he is a member of the editorial board of many dermatologic publications, advisor to numerous medical facilities, and holds memberships in more than 50 medical societies.

He received his MD in 1948, and after becoming a dermatologist joined the skin and cancer unit of the NYU postgraduate medical school, where he spearheaded the establishment of the first medical hair clinic in the United States and has been a clinical professor for many years. He is the director of the Orentreich Foundation for the Advancement of Science, a biomedical research organization which he founded in 1961. Under his guidance this foundation has produced countless scientific publications of significance in the areas of aging, cancer, and dermatologic research. Currently he practices with his son and partner, Dr. David Orentreich, who joined his practice 12 years ago, and his daughter, Dr. Catherine Orentreich, who joined them 2 years ago.



Hiram Sturm

Dr. Sturm (Figure 2) graduated from the University of Tennessee School of Medicine, and after serving as a naval flight surgeon during the Korean War he applied for and was accepted to a 3-year basic science/fellowship training program at the NYU Skin and Cancer Clinic in New York City. One of the young professors with whom he worked was Dr. Norman Orentreich. As indicated earlier, he assisted Dr. Orentreich in the experimental work that led to the development and publication of the data that formed the basis of hair restoration surgery, and worked with him in his private office for a year before moving to Atlanta, Georgia, in 1958, where he remains today, now practicing with his son, Richard.

Although Dr. Sturm has always been a teacher, he was particularly active in teaching dermatologic surgery as well as hair transplantation for two decades. It was he—as chairman of a medical meeting—who invited me to deliver my first paper on hair transplantation to an audience of dermatologic surgeons. As with Dr. Orentreich, his interest and proficiency in dermatology extends far beyond hair transplantation. In particular, he was an early activist in developing and promoting dermabrasion and has served as the president of the Atlanta Dermatologic Society, the Georgia Society of Dermatologists, chairman of the Dermatology Division of the Southern Medical Association, the Noah Worcester Dermatologic Society, and the ASDS.



Sam Ayres III

Dr. Ayres received his MD in 1944 from Stanford University and became a diplomate of the American Board of Dermatology in 1949. He worked in association with his father, Samuel Ayres, Jr., until 1962. Thereafter he had a solo practice limited to dermabrasion, chemical peeling, and hair transplantation. Eventually he limited his practice to the latter, and continued until he was forced to retire because of a near fatal illness incurred while traveling in China in October 1993. He learned hair transplantation from Norman Orentreich and began performing the procedures in 1961, working in his office with his wife, without any other assistants.

His meticulous work and results were admired by all and he became “hair transplanter to the stars” as well as a “star” among hair transplant surgeons. At the Los Angeles County/University of Southern California Medical Center, he established the dermabrasion clinic in 1955 and the hair transplantation clinic in the early 1960s. He was the author of a large number of published articles and textbook chapters on dermabrasion, chemical peeling, and hair transplantation. His article “Conservative Surgical Management of Male Pattern Baldness” published in the Archives of Dermatology in November 1964 should be “must” reading for every hair transplant surgeon. Although he employed 3.5 mm diameter grafts for the most part, and thought they were optimal, he often used 2.5 and 3 mm punches and at times used “a 1.5 or 2.0 mm punch providing grafts containing only 2 or 3 follicles placing them in a random fashion immediately anterior to the frontal hairline which has previously been established by the 3.5 mm grafts.” Thus he described “micrografting” and “minigrafting” decades before it was generally accepted and named. In the same article he noted “taking advantage of localized bunching of the follicles when obtaining the grafts,” drawing attention to what would later be referred to as “follicular units,” and omitted pressure bandaging in many of his patients. Every article I saw that was written by this man, every lecture given by him that I attended, stimulated me as no other speaker in hair transplantation has ever done since. If Norman Orentreich was the originator of the technique, certainly Sam Ayres III was the perfectionist who all of us strived to mimic.



Blu Stough

In the early 1960s Dr. Stough heard that a dermatologist in New York City, Norman Orentreich, was transplanting hair. He thought this procedure could not only help him with his own MPB, but might also be an important adjunct to his practice. After two or three visits to Dr. Orentreich's office, Dr. Robert Berger performed the first transplants on him, and he returned to Hot Springs, Arkansas, ready to begin his own transplanting practice, beginning with several local physicians who were anxiously awaiting his help.

By the early 1970s he began teaching the technique, organizing the first hair transplant symposium sponsored by the ASDS (of which he was one of the original founders) and the American Academy of Facial, Plastic, and Reconstructive Surgery in Hot Springs, Arkansas. Subsequently he chaired at least a dozen more hair restoration symposia that were the breeding ground of many of the next wave of hair transplant surgeons. Physicians came from around the world to learn the latest developments in the technique at these conferences.

His list of honors is long and includes the presidency of the American Association of Cosmetic Surgeons, as well as membership at one time or another on the boards of virtually all of the dermatologic surgery societies. His son, Dr. Dow Stough, who worked with him in private practice for a number of years, has in turn become one of the most influential members of the community of hair restoration surgeons. (More about him later.)



Jean Arouet

Dr. Arouet began his medical studies in 1952 with the intention of becoming an orthopedic surgeon. However, his stepfather was a very famous dermatologist, Edwin Sidi, who influenced him to become a dermatologist instead. During his medical studies he developed considerable experience in general surgery and plastic surgery, and soon after starting his dermatology practice was appointed the chief of the Department of Dermatologic Surgery at the Rothschild Foundation. In 1961, when Dr. Orentreich visited Paris at the invitation of Dr. Sidi, he discussed his initial work on hair transplantation with Dr. Arouet. A few days later, excited with what he had heard, Dr. Arouet carried out his first hair transplant procedure. Subsequently he began doing a steadily increasing number of hair transplants and teaching his colleagues. He developed a scalp tourniquet for controlling bleeding that allowed him to do 100 or more grafts per session long before most transplant surgeons were able to master such large sessions, and he popularized the procedure with the public as well as the medical profession in Europe. Always highly regarded, in 1989 he published his first textbook on hair transplantation entitled Manuel Pratique de Greffes de Cheveux. He has been and remains one of the major figures in the field of hair transplanting in Europe.



Patrick Rabineau

Dr. Rabineau (Figure 3) began transplanting in 1963 after visiting with Norman Orentreich. He, Jean Arouet, and Patrick Rabineau form the triumvirate of early European leaders in hair transplanting. He was born in 1926 in Oran, Algeria, and did his undergraduate studies at the University of Paris and his dermatology training at the St. Louis Hospital in Paris. He has been president of both the French Society of Dermatologic Surgery and the French College of Scalp Surgery, and for the last 20 years has been an assistant professor of dermatology. At age 70 he is still carrying out a variety of cosmetic dermatologic procedures, but 70% of his time is spent on hair replacement surgery. He has written numerous articles and has lectured on hair transplantation at countless meetings.

The story of how he began hair transplanting is reminiscent of that of many of the early hair transplant surgeons and in brief includes a reluctant surgeon and a determined patient. His first patient was a policeman who had already had his first transplant carried out by an American surgeon and wanted additional grafting. After putting the man off several times, Dr. Rabineau called Norman Orentreich and went to visit him in New York, staying for 3 weeks to learn the technique. (He considers Dr. Orentreich to be not only his master in hair transplanting, but also in dermabrasion and the use of silicone in soft tissue augmentation.)



James Bernard Pinski

One of dermatology's intellectual stars, Dr. Pinski's history includes being the president of his graduating class in high school, his junior class in medical school, and the student council while in medical school. His other academic honors are too numerous to mention here, however, happily he decided to become a dermatologist and became a diplomate of the American Board of Dermatology in 1964.

His interest in hair transplantation was first tweaked by Dr. Howard Maibach during his residency in San Francisco in the early 1960s. After reading Norman Orentreich's original article he began performing hair transplantation during his residency and during his military service in Heidelburg, Germany. He did this primarily on his own, learning from trial and error. Later, after beginning his practice in Chicago, he visited dermatologic offices where hair transplantation was being performed and gathered “pearls” from each office, modifying his procedure accordingly. He has actively taught the technique of hair transplantation and scalp reduction over the years by publishing articles and textbook chapters, and conducting numerous courses nationally and internationally and taking part in many more. He is currently a clinical professor of dermatology at Northwestern University Medical School. Like Drs. Orentreich, Sturm, Stough, and Limmer, he has been doubly blessed by having his son, Kevin, join him in his dermatology and hair transplanting practice.



Pierre Pouteaux

Dr. Pouteaux (Figure 4) studied medicine at The French University in Algeria and trained in otolaryngology and maxillofacial surgery. He moved to Paris during the War of Independence in Algeria to specialize in cosmetic surgery of the face. In 1967 he heard of hair transplantation and phoned Dr. Orentreich's office to see if he could come and observe the procedure. He was welcomed with open arms and was impressed by all he saw. He began carrying out an ever-increasing number of procedures until finally his practice was limited entirely to hair transplantation. At the time he began his work only Drs. Jean Arouet and Patrick Rabineau were engaged in hair transplantation in Europe. Dr. Pouteaux spoke English and Italian quite well and had the novel idea of opening clinics in London and Milan, which he visited once every 3 months to interview potential patients. He soon became widely known for the procedure. He was active in lecturing and received many physicians in his office, passing on to them what he had learned over the years. He was insistent when he sent me his biography that I mention his head nurse, Denize Leleue, who worked with him for 25 years and to whom he gives credit for a large part of his success. Unfortunately Dr. Pouteaux was forced to retire from practice in 1997 after three operations on his spine.



O'Tar Norwood

Dr. Norwood's influence on hair transplantation is as broad and as deep as anyone who has ever been in the field (Figures 5 and 6). As Richard Shiell has said, “His presence in hair transplant surgery is everywhere.” He graduated from the University of Arkansas Medical School in 1957 and did his dermatology residency at the University of Oklahoma, where he trained from 1961 to 1964. During his residency he visited Drs. Blu Stough and Norman Orentreich to have his own hair transplanted. He did his first hair transplant during his first year as a dermatology resident in Oklahoma City in 1961. It seemed so simple that he carried out three to four grafts on an unsuspecting welfare patient. The man had come in for something else and he told him that he “had to do this little operation” on his scalp. He never saw him again. He began transplanting seriously sometime between 1965 and 1970.

The list of his honors in dermatologic surgery seems endless. Some of the highlights include being a founding member of the ASDS, author of the first textbook on hair transplant surgery (1973), and development of a classification system for MPB which is used even today. He was founder, editor, and publisher of Hair Transplant Forum International from 1990 to 1995, probably the most important publication in the field of hair restoration surgery today, and was cofounder with Dowling Stough of the International Society of Hair Restoration Surgery (ISHRS). He is the only individual to have been awarded both the Golden Follicle and Platinum Follicle by the ISHRS; awards that recognize outstanding achievement in clinical and investigational hair restoration surgery. His wife, Mary-Ann, was a major influence in his career. Unfortunately she passed away several years ago, but she is remembered and missed by all of us who were lucky enough to have known her.



Charles Vallis

Charles Vallis, a plastic surgeon, began hair transplanting in the late 1960s. I do not have much biographical information on him because I was unable to contact him. However, in the late 1970s he published a textbook on hair restoration surgery and began lecturing on the subject at plastic surgery meetings. Most plastic surgeons who began hair transplanting during the 1970s and 1980s did so because of their contact with him, but the technique apparently appealed to few of them until the 1990s.



Richard Shiell

Richard Shiell began transplanting hair as a 29-year-old general practitioner in a tiny town called Rupanyup in the Victorian Wimmera District of Australia—”an oasis of perhaps 200 houses and a few shops in the vast Australian wheat lands.” The exact date was Thursday, September 27, 1967. His patient was a balding businessman in his mid-30s who had seen an article on hair transplanting in a Readers Digest magazine. Once again a persistent patient forced a reluctant doctor into doing his first transplant. During Dr. Shiell's next trip to Melbourne he went to the university medical library and looked up three articles on hair transplanting—written by Norman Orentreich, Sam Ayres III, and Philip Lebon. “Armed with his do-it-yourself manual of three brief papers,” he went to a nearby instrument supplier and bought the suggested instruments. He hoped that the patient would change his mind, but on the appointed day he appeared and Dr. Shiell carried out his first transplant, consisting of thirty-five 4 mm round grafts taken from the occipital area and transplanted to the vertex area, where he thought “they would be the least likely to cause the fellow cosmetic problems in the future.” Bleeding was copious and the operation took approximately 3 hours. When his wife asked him how the operation went that day, he replied, “It was O.K. darling, it made a bit of a change, but you wouldn't want to do that for a living!”

For better or worse, however, word soon got out that the procedure was available in Australia and within 2 years Dr. Shiell gave up his general practice and moved to Melbourne. He began attending meetings and lecturing in the early 1970s and also started writing articles, which combined with the lectures became the cornerstone of the learning experience of countless hair transplant physicians. As with other members of this pioneers list, his honors, articles, and lectures are myriad. Among the more important of his writings is coediting the second edition of Hair Transplant Surgery with O'Tar Norwood in 1984 and being the editor of Hair Transplant Forum International from 1995 to 1998. Under his stewardship “The Forum” became the preeminent mode of communication for hair transplant surgeons throughout the world.

One cannot think of the term “giants” in hair transplanting without his name immediately coming to mind. The breadth of his experience and analytical assessment of all techniques and approaches, his openness to new ideas, friendliness, and eagerness to teach are legendary.



Walter Unger

I began transplanting in 1967. I observed the procedure on a fellow resident during my dermatology residency. He had asked me to accompany him to Norman Orentreich's office and drive him back after he had his hair transplant. Subsequently I assisted at several transplants at the Skin and Cancer Hospital, but was not impressed with the results. My first hair transplant patient had type VI MPB. He was referred to me by a dermatologist with whom I was working. He was one of those individuals who combed rather sparse hair from a very narrow rim of hair forward and across the bald area, using spray to hold it down in a pathetic attempt to make himself look as if he had a head of hair. I told him that he was a poor candidate for the procedure and outlined all the disadvantages of somebody like him trying to grow a presentable head of hair. The patient returned three more times, finally persuading me to carry out the procedure. To my horror, the result was as bad as I thought it would be. The patient, however, was thrilled.

If I had not started a second patient who had heard about the first one, I probably would have never done another hair transplant. This second patient was a very good candidate with fine, dense, blond hair, and a relatively good donor:recipient area ratio. By the time I saw the mess that I produced in the first individual, I was well along in the treatment of the second and saw that indeed there could be a future for hair transplantation.

I delivered my first paper on hair transplanting at the invitation of Hiram Sturm in 1972. I had tried a number of innovations and thought my results were worthwhile presenting. Subsequently I have delivered at least 100 more papers at various meetings, written 92 articles for medical journals, edited and wrote most of three textbooks, and contributed 24 chapters on hair transplanting to other textbooks. I have been active on the boards of a large number of professional societies and publications, and currently serve on the Board of Hair Restoration Surgery and as the chairman of the Committee on Standards for Hair Transplanting of the American Academy of Dermatology. I have been an associate professor of medicine (Dermatology) at the University of Toronto since 1972 and cochair of the division of Dermatologic Surgery at that institution.

Richard Shiell has called me “the outstanding giant of our profession in this first half century.” This is a far-too-kind assessment of my importance—but it's nice being able to quote it here anyway.



Rolf Nordstrom

Rolf Nordstrom is a professor and chief of the Department of Plastic and Reconstructive Surgery at the University of Helsinki, Finland. He began hair transplanting in approximately 1974 and almost immediately started doing scientific studies on hair survival in grafts of various sizes placed into recipient sites of various sizes and in various patterns. Subsequently he did similar critical studies on the long-term effect of alopecia reductions (AR) that have provided useful fodder to the group of hair restoration surgeons who are not in favor of AR. (Rolf still carries out AR regularly and finds them very useful.) In 1981 he published an article describing single hair grafts and used the term “micrograft” for the first time. Three years later this publication was followed by an article by Manny Marritt, and some years later Dr. Carlos Uebel started using, writing, and speaking about micrografting.

Dr. Nordstrom is the author of more than 300 publications on scalp surgery, surgical hair replacement, tissue expansion, cleft lips, and palates, and other fields of plastic surgery. Eighty-eight of the articles describe original studies and reviews in the field of hair transplantation. He is also the editor of six international textbooks and monographs on various subjects. In 1997 he received the Platinum Follicle Award for the best scientific research in hair pathophysiology and anatomy from the ISHRS. Nobody has done more to advance the scientific basis on which we do hair restoration surgery than Dr. Nordstrom, and nobody is more respected by his colleagues.



Martin Unger

Martin Unger, the author's brother, graduated from the University of Toronto in 1968, obtained a fellowship in general surgery in 1973, and trained in plastic surgery at Queen's Victoria Hospital, East Grinstead, England, from 1973 to 1975. He is a member of the American Board of Cosmetic Surgery and the American Board of Hair Restoration Surgery. He began hair transplanting while in East Grinstead and in 1978 published “The Management of Alopecia of the Scalp by a Combination of Excisions and Transplantation” describing AR. The article, coauthored by myself, was initially rejected by the Journal of Plastic and Reconstructive Surgery in 1976 as “representing nothing new” (shades of Dr. Orentreich's first rejection), and thus lost for us the right to claim the first published article on the subject. Since that time he has become one of the staunchest and continuing supporters of AR, writing 34 articles or chapters on the subject for various medical journals and textbooks.

He has served as a member of the board of numerous medical societies in the United States and Canada, and is an editorial advisor to several medical journals. His medical achievements and honors fill two and a half pages, and one hardly knows where to begin or end in listing them. They include membership on the Advisory Board of the ISHRS, chairman of the Governing Council of the American Society of Hair Restoration Surgery in 1995, membership on the Advisory Board of the Italian Society of Hair Restoration Surgery, the Japanese Society of Hair Restoration Surgery, the American Board of Cosmetic Surgery, and honorary membership on the board of governors of the European Society of Hair Restoration Surgery. A list of the meetings that he has attended or chaired is almost without end. Few surgeons have spent more time teaching both hair transplanting and AR.



Tom Alt

Tom Alt began hair transplanting in 1972 after visiting with Blu Stough and then Norman Orentreich and Jim Burks. From the beginning of his dermatology practice he was interested in dermatologic surgery and cosmetic dermatologic surgery because he “foresaw the advance of government control in medicine” and simply wanted to be “out of it.” For many years he was a fixture on the circuit of surgeons who went from meeting to meeting teaching hair transplantation and AR. In addition, he has written numerous articles on the subject, and was one of the editors of two editions of a textbook on dermatologic surgery—the second one published in 1998. He continued in clinical practice until late spring 1999, when he retired. He was active in many professional societies, including being a board member of the American Society of Dermatology Surgery and the president of the American Academy of Cosmetic Surgery.



Robert Limmer

Dr. Limmer graduated from the University of Texas Medical School in 1968 and became a diplomate of the American Board of Dermatology in 1973. He began hair transplanting in the early 1970s, and for many years his practice has been limited entirely to this field. He began experimenting with various forms of smaller grafts in the 1980s until finally, on October 21, 1988, he carried out the first “pure” follicular unit transplant. He waited to report the results of this work until 1991 when he was absolutely certain that he had a procedure that was “foolproof.” The article was published in Hair Transplant Forum International.

The first physician to adopt and practice it outside of his office was Dr. Marcelo Pitchon of Brazil, and others (in sequence of training with him) were Drs. Agha of Cairo, Egypt, Tom Rosanelli, Edmund Griffin, and David Seager (in 1995), Bill Parsley and O'Tar Norwood (in 1996), Mario Marzola and Michael Albom (in 1998), and at least 75 other physicians who have spent 1–3 days with him but who he hesitates to describe as having had hands-on training. Follicular unit transplanting has taken the entire field of hair transplantation by storm. There are many who believe this is the future of hair transplantation, while others believe it is an important advance but not “the end of the evolution” of the procedure. However, it is certainly one of the most important innovations in hair transplanting since it began, and Dr. Limmer is destined to be remembered as its founder.

Dr. Limmer has a distinguished history in general dermatology as well. The list of society and association offices held, professional organizations to which he belongs, and scientific presentations that he has given fills many pages. He has also published 66 scientific articles or chapters, and is a clinical professor in the division of dermatology at the University of Texas Health Center at San Antonio, Texas. His son, Bradley Limmer, joined him in his practice of hair transplantation 3 years ago.



Manny Marritt

Dr. Marritt obtained his MD at New York University in 1967 and did a psychiatry residency from 1968 to 1972. In 1975 he decided to specialize in hair transplanting. At that time he visited seven offices including those of Peter Goldman, Jay Barnett, Norman Orentreich, Sam Ayres III, and the author. In fact, he stayed with me for periods of 1–2 weeks on two separate occasions, absorbing everything that he could and watching me more closely than I think anyone ever has before or since. Subsequently he started his practice in Denver, Colorado, and rapidly developed a legendary skill, producing extraordinary results with the old “standard” 4 mm grafts. Since 1993 he has been a clinical professor in hair transplanting in the Department of Otolaryngology Head and Neck Surgery, University of Colorado. He has written 13 articles and 3 chapters for various texts on hair transplantation, and despite relatively few publications is one of the most well-respected theorists and members of the hair restoration surgery community. His speaking talents have also made him a favorite of the media and he has appeared on numerous radio and TV shows as well as in local and national lay publications. He is so articulate (and often funny) that his lectures are always among the highlights of the meetings he attends.



Dowling Stough

Dr. Dowling Stough, Bluford Stough's son, began hair transplanting under the tutelage of his father in 1985. He joined his father in private practice after becoming a diplomate of the American Academy of Dermatology and immediately started practicing and innovating in hair transplantation and AR. In 1987 he and O'Tar Norwood founded the ISHRS, an organization that has become the foremost international association of hair restoration surgeons in the world. In addition, in 1996 he edited one of the standard reference textbooks on the subject. Dr. Stough has been president of the ISHRS, a member of the board of the American Board of Hair Restoration Surgery, and is an editor of the Journal of Dermatologic Surgery. Although he came into the field far later than the other members in this historic survey, his clear and growing importance merited his inclusion in this history.


Conclusion
 

Once again I must apologize to anyone who has been inadvertently omitted in this history. It would have been nice to have mentioned many of those who have entered the field in the last 10–15 years and who are rapidly taking over the mantles of those discussed earlier. While most of the leaders in the teaching and practice of hair transplantation in its first two decades were dermatologists, the new group are a more varied breed coming from backgrounds in plastic surgery, otolaryngology, orthopedic surgery, family practice, and other fields. They also come from many countries where hair transplantation has developed over the last 10–15 years. They include James Arnold, Marc Avram, Michael Beehner, Robert Bernstein, Guillermo Blugerman, Pascal Boudjema, Robert Cattani, Y. C. Choi, John Cole, Paul Cotterill, Yves Crassas, Shelly Friedman, Marcello Gandelman, Constantine Giotis, Robert Haber, Takeshi Hirayama, J. C. Kim, Russell Knudsen, Ray Konior, Matt Leavitt, Tony Mangubat, Bill Parsley, Marc Pomerantz, William Rassman, William Reed, Tom Rosanelli, Daniel Rousso, Arturo Sandoval-Camarena, David Seager, Ron Shapiro, Carlos Uebel, James Vogel, Bradley Wolf, and others. This new group is putting the technique on far firmer scientific ground. The camaraderie of individuals from different countries and many different areas of interest and training is, I believe, unique in medicine. Its benefits will hopefully serve as an example to other fields of medicine.

 









 

 

Walter P. Unger

 

Affiliations
Toronto, Ontario, Canada

 

Image Previews


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Figure 1.  Dr. Norman Oreintrich, the “father” of hair transplantation, at about the same ...


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Figure 2.  Hiram Sturm, MD, 1969....


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Figure 3.  Dr. Patrick Rabineau, approximately 1978, with the hairline and hair we'd all ...


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Figure 4.  Dr. Pierre Pouteaux in a relaxed mode after sailing in Tangiers....


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Figure 5.  Dr. O'Tar Norwood in 1969 prior to his own hair transplantation....


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Figure 6.  Dr. O'Tar Norwood with Mary-Ann in 1977....

 

 

 

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