I tried to make this website as medically accurate as I can, without getting into too much technical detail. This is a non-commercial website. Any statements I make on this website are my opinion.

The punch graft procedure was the way that almost all hair transplants were performed, between 1955 and 1990.

A small handfull of doctors were adopting other techniques in the late 1980's, but by far, the vast majority of hair transplants were done with punch grafts, up until approximately 1991-1993. That's OVER THIRTY FIVE YEARS of "Doll's Hair" transplants, performed by the hair transplant "industry".

Even though it was obvious that tens of thousands of men were being mutilated by this technique, hair transplant clinics continued to deliberately lie to the public, in order to lure in additional patients and keep the money flowing.

Hair transplant doctors originally used hand-held punches in their surgical procedures. However, in the late 60's and early 70's, doctors began to adapt regular power drills to drive their punch tools. On the left, we see a "Dremel" grinding machine, commonly used by woodworkers and craftsmen. Some hair transplant surgeons adapted the "dremel" tool after regular power drills (Black & Decker, etc) proved to be too bulky in the operating room. The dremel was adapted by doctors to drill round punch-holes into the patient's scalp. The doctor then uses a scissors to snip each round "plug" and cut the connective tissues, so that the plug can be removed from the scalp. This photograph is taken from an article written by Dr. Jirayr Tezel called "Miniature Drill Expedites Hair Transplantation"(CUTIS, Vol.6, No.4, April 1970). The use of power tools allowed doctors to speed up the hair transplantation process, which led to mass marketing and the growth of franchised clinics, and the use of non-medical salesmen ("consultants") to sell the surgery to the general public. Before the use of power drills became popular in the 70's, hair transplantation was a small sub-specialty of cosmetic surgery. After power drills sped up the surgical process, hair transplantation grew into a multi-million dollar business, where the emphasis was on speed and profits. Speed of patient turnover is STILL one of the major goals of the hair transplant industry, and today, speed and profits dictate which surgical procedures are popular, among hair transplant surgeons... "Best results" are secondary to the doctor's profits. Other than the use of hand-held power tools, the punch-graft procedure we are about to see is essentially the exact same process used by the majority of hair transplant clinics until the early 1990's (and beyond, in some cases). Imagine that there is a drill being used to harvest the grafts, if you prefer, rather than the hand-driven punches we will see.

On the left we see the hand-driven punches used in punch graft procedures. The "Stough" punches were designed to be twirled more than the Orentreich punches, which relied less on spinning and more on harder pressure to cut through the scalp. The sharp end of the punch is facing us, and the handle is facing away. These crude punches destroyed a large percentage of the follicles in a patient's donor area, by "transecting" them (cutting into them, damaging the follicles). Hair follicles are an organ, and like any other organ they cannot be randomly damaged by surgical tools, and then be expected to survive. A typical technique was to start with the hand punch perpindicular to the scalp, and barely cut the uppermost tissue, then to change the angle of the punch to match the direction of the hair that was being harvested. This is obviously a very imprecise way to harvest grafts, and the amount of permanent damage caused to the patient's donor area is significant. Look above at the Dremel tool again, and you will see it is holding a punch tool locked into it's "chuck".

The following images are from Dr. O’Tar Norwoods's 1973 medical textbook “HAIR TRANSPLANT SURGERY. Hand-driven punches were still common and popular well into the 70's, until clinics began using power drills and dremels to drive their punches.

Notice that the author says the "entire maneuver should be completed with force, speed and dispatch." This crude technique makes surgical precision impossible. Notice the lack of gloves during the procedure.

A hair-bearing donor graft, after removal. The punch tool only cuts a circular incision, but it does not actually detach the graft tissue; After several grafts have been punched, a sharp, angled scissors is used to reach below the scalp surface and cut each cylindrical "plug" away from the scalp. Notice the vague advice to "try changing the cutting maneuver" if it looks like the punch is destroying precious hair follicles.

Notice how close together these punch grafts are being cut. This will leave very little hair remaining later, to cover up the big pock-mark scars that will be created. Also notice that the author advises to check the graft quality after "ten to fifteen grafts". Why not do a quality control check after every graft, or every third graft? Because that would take too much time, and time is money at a hair transplant clinic. The emphasis is on patient turnover, not quality results. An unscientific randomness and a lack of precision are hallmarks of this surgical procedure.

The donor area, after punches have been used to create a cylindrical incision, and a scissors has snipped the plugs loose. Blood pools in the holes where the hair-bearing donor plugs used to be. When power drills or dremels are used, it can cause a "pneumatic spray of blood" when the scalp is drilled into.

Notice the double hole, as well as the tiny spacing between the other holes. The double hole will heal into an even larger scar than the single holes. Even with the single holes, the small "bridge" of remaining scalp left between holes will not provide much hair to camoflage these large scars, later. The doctor will leave these holes wide open, to heal on their own. This is called the "open donor" method. The patient is sent home with gaping open wounds, which are oozing blood. These gaping surgical wounds will eventually "fill in" with solid scar tissue... known as "open donor scarring". According to the false advertising of the hair transplant "industry", these scars will be "undetectible". However, DONOR SITES FROM PUNCH GRAFTS DO NOT "SHRINK" OR BECOME "UNDETECTIBLE". See some of the examples of FALSE ADVERTISING on this website, to see how doctors LIED to patients about "open donor scarring".

In the recipient (frontal, balding) area, plugs of scalp need to be removed, in order to make room for the large donor (hair-bearing) plugs harvested from the back of the scalp.

It is typical to make the recipient site holes slightly smaller than the hair-bearing donor plugs. Excess tissue in the grafts causes the graft to compress during healing, which adds to the resulting horrible tufty "Dolls Hair" look of these hair transplants.

"Again it should be emphasized that plugs should be cut as deeply as possible in order to make room for the thicker hair bearing grafts." Images like this were NEVER shown to a potential patient. Instead, the clinic would sell a potential customer with bogus claims like "It's just like going to the dentist".

Notice that during the trimming of the grafts, there is a lack of any sort of visual aides or magnification. If there are no visual aides (loupes, magnifiers etc) being used during this step of the surgery, I would assume that there are also no loupes being used at any other time during the surgery. Remember that when this book was published, the hair tranplant already had a 15 year history. Modern clinic now tend to use visual aides when handling the grafts.

Notice how the large tweezers seem to be distorting the graft. Rough handling of grafts can distort or damage the precious hair follicles, and can result in poor hair growth for the patient.

Here the author suggests that transplanted hairs will somehow ALIGN THEMSELVES to the correct angle and direction, later during the healing process (!) That is a ridiculous and dangerous claim to put into a medical textbook that other doctors will refer to.

Why weren't photos like this included in the "patient education material" from Cleveland Hair Clinic? Isn't THIS the REAL "Plain Truth About Hair Transplants"? The VAST MAJORITY of the estimated one million patients who underwent punch graft hair transplants between 1955 and 1993 were not given a clue about just how INVASIVE or CRUDE this surgery would be. Instead, patients were LIED TO and told that "getting a hair transplant is like going to the dentist," that hair transplants are a "natural solution to hair loss" and that the patient can "return to work the next day". Do you think this fellow in the photo returned to work the next day?

Notice the comments about tight bandages. After my first surgery, I had to pull the car over on the drive home. My head had started to swell up, and the bandages became so tight, that I almost passed out while driving on the expressway. I returned to the Cleveland Hair Clinic where the technicians adjusted my bandages. When I removed my bandages a day or two later, I was SHOCKED at how invasive the surgery was. It was much more severe than I had been led to believe. There are no mirrors in the operating room. After surgery, the clinic covers up your head as quickly as possible, as if to hide what they have done, until after you get home.

Notice the comment about an alternate way to wrap the bandages, which includes a "chin strap".

Again, the biggest difference between the operation pictured above (from the early 70's) and a punch graft procedure performed 10 or 15 years later, is the addition of power drills and dremels, that speed up the process.

POWER TOOLS are the biggest difference between a punch graft procedure performed in 1965, and a punch graft procedure performed in 1985.

"The art of surgical hair restoration has been widely practiced in the United States for about four decades, but it could be said that many of the major innovations in the field have largely taken place only during the past ten years.
http://www.forhair.com/Chapter_18.htm

See the section of this website "A DOCUMENTED HISTORY OF DECEPTION AND LIES" and "False Ads #1 - #4" for specific examples of FALSE CLAIMS and DECEPTIVE ADVERTISING intentionally used by the hair transplant "industry" in order to boost their profits.

"The "Barbie Doll" appearance of hair transplant plugs is unfortunately nearly always quite conspicuous, and worse, permanent." "Even more unfortunately, some hair transplant doctors still utilize these larger grafts." www.premierehairdoc.com/ history.html "The practice of using plug grafts is uncommon today but the technique was widely used until 5-10 years ago." Dr. James E. Vogel Journal Plastic and Reconstructive Surgery, April 2000 "(But) some time in the early 1980s, the balance in the field of hair replacement changed, and the number of people trying to take advantage of hair clients grew, eventually appearing to constitute the majority in the field. As this balance shifted, the profession of surgical hair replacement was transformed into a business, with the search for profits—not a search for healing—as the driving force." "Since the 1980s, over 50 percent of our patients have come to us in need of repair and reconstruction because of poor results from inferior transplant surgery. Many of these patients just wanted to look normal enough to be seen in public. This was truly sad, because their disfigurements could have been prevented." The Hair Replacement Revolution A Consumer’s Guide to Effective Hair Replacement Techniques James Harris MD and Emanuel Marritt MD "Hair transplantation evolved slowly during the first several decades of its existence...The most obvious problem of traditional hair transplants was the tufting of the hairline... Occasionally the results would appear normal." Edmond I. Griffin MD "Combination Micrografting with Strip Harvesting for Male Pattern Baldness" p178-179 "It is difficult to say with complete confidence why such bad business practices have invaded the field of hair replacement. It appears that a combination of greed and declining standards have conspired to help the invasion..." "Why do some doctors choose an unethical path? Perhaps it is because they have little incentive to change. In addition to the money they can make, the system of medicine is set up in such a way that it almost discourages doctors from changing. The concept of voluntary compliance means that it is the individual doctor alone who decides which new ideas he will or will not incorporate into his own private practice." The Hair Replacement Revolution A Consumer’s Guide to Effective Hair Replacement Techniques James Harris MD and Emanuel Marritt MD

While this made the grafts smaller and slightly less obvious, it also destroyed many more of the hair follicles in every plug. The hair yields from these "split grafts" was poor, even worse than the yield from full plugs. And doctors still sent the patient home with bleeding open holes in the "donor area" that would form into scars.

Instead of trying to improve the cosmetic results by re-thinking the punch graft procedure, doctors took a fundamentally bad idea (punching of large grafts, leaving open wounds on the patient) and made variations on it. This is what passed for "innovation" in the field during the 80's. I think of these kinds of experiments as "garbage research" as practiced by the crooks, incompetent bumblers and fools who called themselves doctors.

Unbelievably, hair transplant surgeons did not understand the BASIC ANATOMY of the scalp, and how hair follicles naturally grow in "groupings", until Dr. Limmer began researching this aspect in the late 1980's. That means for over 30 years, hair transplant surgeons operated on patients without understanding the BASIC ANATOMY of "follicular groupings".

In the "Strip Excision Procedure" section of this website, I discuss the slow and awkward transition that the hair transplant industry made between "traditional" punch grafting and the "modern" strip excision procedure.

Even though the strip excision concept was introduced in the mid-70's, it didn't catch on with other doctors until the early 90's.

Most hair transplant surgeons are concerned with mass-marketing and profits, and not in science or progress, in my opinion. The result is that for decades, the crude Punch Grafting technique continued to be the standard approach.

Crooked and incompetent doctors were satisfied to churn out thousands of crude punch graft surgeries, because they were making a lot of money. Like any other corrupt business, making a lot of money is the number one priority of the hair transplant industry.