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What are Hair Plugs and Are They Still Used in 2022?

hair plugs

Most people confuse hair plugs with hair transplantation, and it causes a lot of misinformation and prejudice.

It’s natural for people to call hair transplantation hair plugs since it was the only method for hair transplants for half a century.

But not knowing how far the hair transplant industry has come providing patients with much better results and processes that are easier to get through can discredit the industry and cause prejudice.

In this blog, I’ll help you distinguish hair transplants and hair plugs, and explain how hair plugs were done, and if they’re still being used:

Let’s understand how the process works first.

What are Hair Plugs?

Hair plugs were the first hair transplantation method to be used worldwide to treat human patients. In a hair plug surgery, the surgeon would extract a donor tissue at least a dozen hair follicles from a donor area and implant the tissue in the recipient area to treat balding.

History of Hair Plugs

In 1952, Dr. Norman Orentreich performed the first modern hair transplant operation with the hair plugging method he developed in his years at NYU’s Dermatology Department.

He’s noticed that the hair that was extracted from the back of the scalp and implanted into the bald areas didn’t act like the hairs originally from the bald areas; instead, it kept acting like the hair from the donor areas which are not influenced by pattern balding.

After this breakthrough of observation, he has helped numerous patients treat hair loss with hair plugs over the following years.

dr norman orentreich hair plugs
Dr. Norman Orentreich

How were Hair Plugs done?

Basically, in a hair plugs surgery, the surgeon would use a punch tool with a 4mm diameter to extract round-shaped tissue from the donor area containing more than a dozen hair follicles.

Then, these tissues would be inserted back into your scalp, in the bald sections which are called a “recipient area”.

Patient’s scalp following the second session of hair plugging (source)

I know it sounds simple to do, and based on your knowledge of modern transplantations, you’d think all this would be done in a matter of hours. But a complete hair plug surgery for an average AGA patient would actually take four different sessions and 16 weeks to complete

In one session, a maximum of 75 plugs were inserted, so it makes sense for the whole process to take months to complete.

Thousands of patients got hair plugs for the following couple of decades, and even if the results weren’t natural for this method, it was the only technique available until the early 1990s.

Are Hair Plugs Still Used in 2022?

The majority of clinics worldwide stopped using hair plugs by the early 2000s as new techniques that offered much better and faster results were developed. In the late 1980s and early 1990s, both FUT and FUE were developed as improved versions of hair plugs and quickly replaced hair plugs.

So no, hair plugs aren’t used by any clinic or surgeon today.

Why Hair Plugs aren’t used anymore

Even though hair plugs were the method that kickstarted a billion-dollar industry, it wasn’t ideal at all compared to today’s standards.

There are two main reasons they were dropped as soon as better alternatives came along:

Results

The results from hair plugs were nowhere near natural.

In the majority of the cases, it was obvious that you got hair plugs from the doll-like hair you’ve had and the numerous scars both on the donor and recipient areas.

In fact, the pictures of these results still circulate on different platforms, causing prejudice against modern hair transplant techniques.

Procedure

And the secondary reason hair plugs were ditched is the procedure. As I’ve mentioned above, a full hair plugging process would take more than 4 months and 4 sessions to complete.

This was too much of an investment in unnatural results, and having to go through the recovery of four different surgeries would be exhausting.

In short, the effort and time you’ve invested into getting a hair plug would be nowhere near the unnatural results you’ve got. 

What’s the Difference Between Hair Plugs and Hair Transplants?

Many of my patients thought that hair plugs and hair transplants are the same things at first.

Well, are they?

Are hair plugs and hair transplants are the same thing?

Yes, and no.

If you’re thinking of hair plugs as the general category of medical procedure that is aimed at harvesting hair from a certain area of your scalp and implanting it into another part, yes, they are the same thing.

But if you’re thinking of the medical procedure where they transfer dozens of grafts from the back of the scalp to the front using relatively larger equipment that produced results looking like a doll’s hair; no, they aren’t the same thing.

The phrase “hair transplant” is generally used to describe any surgery done to transfer hair follicles from one side of the scalp to the other which includes hair plugs, FUT, and FUE.

So, hair plugs are the early technique used for hair transplantation that was dropped after FUE and FUT came along.

FUE and FUT

FUE and FUT, developed by Dr. Bobby Limmer (1988) and Dr. Masumi Inaba (1989) respectively, were the improved versions of hair plugs that would be the golden standard of hair transplantation moving on.

Both of these surgeries provided improvements in both extraction and implantation parts of the surgery, implanting individual follicles in much more precise steps to provide perfect hairlines indistinguishable from your natural hair.

hair plug fue fut

In Follicular Unit Transplantation (FUT), a strip of tissue is cut and removed from the donor area before the grafts in this tissue are removed and individually implanted into the recipient area.

In Follicular Unit Extraction (FUE), however, both harvesting and implanting are done on a smaller scale where instead of removing tissue, hair grafts are extracted individually too, resulting in scar-free natural results.

Improved precision and better results in FUE surgeries resulted in the majority of clinics picking FUE as the main hair transplantation technique and developing even more advanced technologies for this method.

Advancements in Hair Transplantation

New methods in hair transplant surgeries are developed using the Follicular Unit Extraction technique.

Even though FUE sounds perfect compared to hair plugs and even FUT, there is still a lot of room to improve in areas of results, procedures, and healing processes. Further improvements to this technique are developed with these three areas in mind.

Direct Hair Implantation

Direct Hair Implantation, also known as DHI, was invented in 1999 by the DHI Medical Group. It improves the FUE technique through an implanter pen that removes the need for making an incision or carefully placing hair inside this incision.

Instead, the DHI pen directly pushes individual follicles directly inside the skin.

DHI pens
DHI Pen

These pens make the implantation part of the procedure easier and quicker while giving the surgeon more control. These pens even allow surgeons to control the angle of implantation of the transplanted hair, resulting in the perfect-looking hairline.

Sapphire FUE

During a regular FUE hair transplant surgery, steel blades are used to make incisions in the recipient area.

In recent years, surgeons have started using sapphire-tipped blades instead. These blade tips are much sharper and smoother at the same time, allowing surgeons to make more precise and even smaller incisions that reduce trauma on the scalp, improve the results, and promote faster healing.

sapphire FUE

Many clinics such as UnitedCare have adopted Sapphire FUE to provide better results for their patients.

Robotic Hair Transplant

Developed by Dr. Bernstein and Dr. Rassman in 2007, the robotic technique using the ARTAS robot is a great step to the next era of hair transplantation.

With the ARTAS system, the need for a surgeon in the extraction part of a hair transplant surgery is eliminated as the system maps out your hair and extracts the needed amount of hair automatically.

Also, with the ARTAS system, medical teams can create a 3D projection of the patient’s scalp and even simulate the results to draw the best hairline.

robotic hair plug
The ARTAS robotic system performing graft harvesting on the donor area.

The implantation part is still done by a surgeon, but since the surgeon is saved from the wear that would be caused by the harvesting, they can focus more on restoring the hairline.

There will definitely be further improvements to ARTAS and new uses of robotics in hair transplantation, reducing operation times and improving hair transplant success rates. 

Bio-enhancements

Described as the icing on the cake for successful hair transplant surgeries by Dr. Jerry E. Cooley, bio-enhancements aim to better support hair grafts’ survival.

Recently, more and more hair transplant clinics have started using and supplementing harvested hair grafts with liposomal ATP, ACell, and HypoThermosol.

Bio-enhancements used in hair transplant surgeries

Using these three together provides much better results as explained in this study and what we’ve achieved over at UnitedCare.

Expertise Meets Top-of-the-Line Equipment and Techniques – why UnitedCare?

Hair plugs became outdated decades ago, and new hair transplant techniques have already replaced them.

Another reason people still think hair plugs are the main hair transplant technique and the results of these surgeries are unnatural and ugly-looking can be the much more improved natural results we’re getting from advanced variations of FUE.

With experienced dermatologist surgeons, top-of-the-line equipment, and attentive care UnitedCare offers you the future of hair transplantation, today.

We’re just a click away: 👇

Restore your natural look with a Dermatologist:

UnitedCare and its expert dermatologist doctors provide you with a holistic approach to FUE surgeries.

Frequently Asked Questions (FAQs)


Do hair plugs actually work?

Yes, hair plugs, also known as hair transplants work according to numerous studies and countless success stories of patients worldwide.


Do hair plugs last forever?

Based on the donor dominance theory of Dr. Norman Orentreich, hair plugs extracted from the back of your scalp are immune to the effects of DHT and AGA. So yes, hair plugs are supposed to last forever.


Do hair plugs hurt?

During a hair plug surgery, aka hair transplant, you will little pain thanks to the local anesthesia that is applied by your surgeon to your scalp. Following the surgery, if you’re getting a FUT transplant, you might feel pain and tightness around the donor area since there is a surgical cut there. If you’re getting an FUE, however, you’re not likely to experience any pain after 2 to 3 weeks after the operation.

Dr. Utkan Kiziltac

Utkan Kızıltaç, MD

Chief Physician and Dermatologist Hair Transplant Surgeon of UnitedCare, a dermatology clinic helping patients become the best version of themselves.

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