Commentary

Dr. Jeffery Epstein thoroughly covers the history and evolution of hair restoration surgery from the early 1990s to the present. I could not agree more with his analyses of the great advancements and increasing prestige that have been achieved in this area of plastic surgery.

I might add that when I came on the scene in the early 1970s, plug grafting as devised by Dr. Orentreich and popularized by several clinics was the standard surgical alternative for the bald man who wanted to have hair. The other options at that time were a hairpiece or the shaved head look popularized by icons such as Yul Brynner. The flap procedures that I was instrumental in developing and introducing in this country represented a viable alternative to provide frontal hairline density, especially for men who wanted to have long hair in the front like many rock stars of the 1960s and 1970s. The scalp reductions that came soon after the introduction of flaps became more a technique of historical interest; however, there are a few people, such as Dr. Frechet, who have developed their scalp reduction techniques in conjunction with flaps and follicular unit grafting. Despite the limitations of these older procedures, there was a lot of extremely useful information learned in that era about subgaleal scalp flap surgery that will sadly not be passed on to most hair restoration surgeons. I occasionally come across reconstructive patients that, even today, benefit from such surgeries.

We now understand that hair loss is progressive in its nature, and our patients must be educated on the need for long-term treatment and follow-up. The medications we use today are quite effective in slowing the balding process, and we are hopeful that newer drugs will continue to show a benefit without untoward side effects. The prospects of hair cloning will provide a tremendous benefit to the current supply and demand problem that we surgeons face in finding sufficient donor hair on our patients.

Natural and undetectable results and artistry have been the highlights of the past 15 years of progress in hair restoration surgery and, as Dr. Epstein points out, have made the procedure highly acceptable. The complication rate is low and serious complications are rare. The marketing of hair restoration surgery is exceptionally well covered, and being of the old school where our referrals came from other physicians and satisfied patients, I have been forced to master the Internet, which I believe holds the future for hair restoration and other plastic surgery marketing.