The more radical type of extensive scalp grafting, utilizing large pedicle grafts, is a major plastic surgical procedure with limited appeal and dubious cosmetic benefits. The implantation of nylon filaments simulating hairs with hooks, "arrowheads," knots, or loops into the scalp results in a marked foreign body reaction and fibrosis, as the nylon "hairs," whether or not they are inserted through the bald follicles, end up outside the follicles deep in the dermis or in the subcutaneous fat, communicating with the surface via sinus tracts. At best it is a temporary expedient.
The Orentreich technique of multiple punch scalp autografts for male pattern baldness, which I modified in a few minor details, is a definitive and, at times, dramatically effective means of permanently redistributing the scalp hair in such a way as to improve cosmetically, in varying degrees, this gene-determined, normal-for-the-individual pattern of scalp hair growth. And despite our better understanding of the nature of male pattern baldness, this does not lessen the fact that by virtue of the particular pattern and distribution of hair growth and loss, shape of the head, color of the hair and various other factors, this condition is still a source of great distress to many men. Even their accepting the fact that male pattern baldness is not a disease but a hereditary growth pattern leaves many men unreconciled to the obvious (for them at least) esthetic problems involved. The Orentreich technique is an excellent example of utilizing a knowledge of nature's laws in order to circumvent certain inherent limitations, just as a knowledge of the laws of gravity and motion and the principles of aerodynamics allows man to be no longer earth-bound, even though that is his natural state.
The results of my own experience with multiple punch scalp grafting for male pattern baldness corroborate completely those of Orentreich, to whom full credit is due for developing a highly effective dermatologic cosmetic surgical procedure based on a simple, incisively clear and irrefutable clinical experiment.
AYRES S. Conservative Surgical Management of Male Pattern BaldnessAn Evaluation of Current Techniques. Arch Dermatol. 1964;90(5):492–499. doi:10.1001/archderm.1964.01600050040009