The doll’s hair or pluggy appearance was the result of using grafts typically 4 mm in diameter. These plugs contained 15-20 hairs and usually were harvested with a circular punch, then transplanted into 4-mm circular recipient sites in the bald scalp. Once transplanted, hairs entered a 4-month dormant cycle (telogen), after which they began continued growth for as long as donor site hair grew. Scalp areas that contain hairs genetically programmed for permanence (ie, sides and lower back of head) were (and still are) donor areas.

From the 1950s through the next 25 years, plug-graft transplantation was, with few exceptions, the most common hair transplant procedure performed. Smaller grafts, created by halving or even quartering the formerly standard 4-mm plug grafts, did not become popular until the early 1980s. Over the past 15 years, hair transplantation developments have followed this evolution toward smaller grafts in an effort to mimic the way hair grows naturally on the scalp.

Until the past several years, with the popularization and further development of follicular unit grafting, state-of-the-art hair transplantation involved the transplanting of some combination of minigrafts and micrografts. These 2 terms are open to definition, but typically a micrograft contains 1-2 hairs, while a minigraft contains 3-6 hairs. Combining these different-sized grafts (placing the micrografts along the hairline and the minigrafts further behind) provides the surgeon with a tool that potentially makes a hair transplant impossible to detect. Artistry, individualization of the specific procedure to the patient, and other variations in technique are of critical importance. Today, using the state-of-the-art procedure of follicular unit grafting and guided by sound aesthetic judgment, surgeons can achieve virtually undetectable hair restoration.