Hair plugs can be explained as bundles of grafts (follicular units), which contain up to 20-30 hairs.
One graft (follicular unit) contains 1-5 hairs, but on average only 2. Such follicular unit is less than 1mm in size.
On the other hand, hair plugs can range from 1mm 5mm in size, which makes them look very obvious when implanted on the frontal hairline for example.
Their robust look is created mainly due to grouping of several multiple follicular units (units containing 2-4 grafts) and implanting them way too far from each other. This increases the see-through effect and unnaturalness.
Hair plugs were first introduced back in the 1950´s by Dr. Norman Orentreich, who utilized the hair plug experiment in his office. His goal was to find out whether the hair plugs (extracted from the occipital region of the scalp) could survive once they are implanted on the balding front.
After the grafted hair successfully grew back on previously bald area, more and more doctors started utilizing this hair transplantation method until the late 1980´s.
In the late 1980´s Dr. Limmer introduced stereo microscope to dissect a single donor strip into small micro-grafts (micro follicular units).
These micro-grafts were much smaller in size and also contained way few hairs per graft compared to the ancient plugs.
Joe Biden had plugs done back in the 1980´s. Since then, he has done several hair transplants incl. small hair transplant repair surgeries using modern hair transplant techniques like FUE to make his hairline more refined and softer-looking.
You can check out my Hair Transplant Analysis of Joe Biden on YouTube if you want to know more about his hair transplant journey.
After the introduction of stereo microscope in the late 1980´s, FUT/FUSS (follicular unit strip surgery) started to take off. Simultaneously, there was Dr. Ray Woods in Australia performing the very first FUE (follicular unit extraction) as we know it today.
FUT and FUE are two most widespread types of hair transplants while FUE being the younger one.
Both – FUT and FUE have achieved a significant state of art over the last 30 years, in fact there are doctors out there nowadays who can perform the one or the other with almost no detectability.
Low detectability of hair transplant results comes usually as a result of surgeon´s skill and experience, use of stereo microscope to refine and trim more robust-looking follicles, as well as using very thin follicles from the nape area for temporal and hairline hair restoration.
BHT (body hair transplant) is another form of FUE hair transplant which allows surgeons to successfully extract the body hair follicles from the chin, beard, chest, back and armpit areas.
Such hair follicles can be additionally utilized for scalp coverage in cases when the person doesn´t have enough donor hair in the donor area (back side of the scalp).
DHI (direct hair implantation) is also sometimes falsely classified as a hair transplant technique, but in reality it´s just a different graft placement technique.
DHI can be utilized during FUE or FUT. This placement technique allows the surgeon to place the hair follicle into the recipient area without needing to create a channel in it first.
Hair plugs initially proved that the extracted hair follicles from the donor area (back side of the scalp) can successfully grow on the recipient area (balding area of the scalp). Dr. Orientreich in 1950´s.
It doesn´t mean though, that hair plugs should be utilized for hair restoration for ever. Because of their robust look and unnaturalness (if placed on the hairline) many people know them as “Doll hair.”
With the introduction of the FUE, FUT in combination with stereo microscope use, hair restoration became modernized.
Nowadays, hair plugs are not being performed anymore because of the two superior hair transplant techniques – FUE and FUT.
The constant development of these modern hair transplant techniques allows patients to achieve sometimes even undetectable hair transplant outcomes. Outcomes, which are so natural-looking it is hard to distinguish them from non-transplanted hairlines.
Hair plugs were also known for leaving large rounded scars on the donor area (sometimes 2-5 mm broad) due to using a punching tool with a large diameter. With the modern FUE though, the surgeons use punches of 0.6 – 1mm which do leave much smaller rounded scars.
The difference in punch size by hair plugs vs FUE is obvious. In case you´re interested how the donor area from the photo below looks like several weeks/months later, make sure you check out my post-op progress after my 2nd hair transplant.