Why did it take so long for reasonable hair transplants to develop?

I’ve been reading about the history of hair transplants recently and I’m baffled by how in the 1950s, 60s, 70s, 80s and at least early 90s getting those awful plug procedures were the norm. I’ve also read that in Japan they started experimenting with hair transplant techniques in the 1930s and 40s, and one pioneer even mentioned that the grafts need to be small so they look natural. Did really nobody else figure this out for 50+ years and they thought walking around looking like having the hair of a doll was the best and most natural thing you could do?

That is the question I asked when I entered the business in 1991. I had observed the old technique in preparation for opening my own practice from 1990-1992. So, after watching the terrible deforming procedures that were the standard of care back then, I started on my first case to perform follicular unit transplantation in large quantities in a single session. The surgery was complex, and my first case was 700 grafts.  Then I increased the next one to 900 grafts, then 1200 grafts, and well into my first 12 months, I could perform up to 2000 grafts per surgery. The size of my team increased significantly, with more doctors and a lot of surgical technicians whom we trained.  By the second year, I got up to 3000 grafts and published the progression in the Hair Transplant Forum so doctors worldwide would understand the possibilities. Those old procedures produced many freaky-looking men, so I developed repair techniques that became the new standard of repair care in 1992.

In addition to publishing, I presented patients at meetings, starting in 1993 when I brought 3 patients to a meeting to demonstrate the results of this technique.  In 1994, I brought 23 patients to the ISHRS meeting in Las Vegas, where hundreds of doctors were in the audience. My presentation required a long break after, as the patients were viewed firsthand, outside of the conference room. That set a new standard until 2002 when I pioneered the FUE procedure after a 6-year development process. I brought one patient to the conference to show off the results, as well.  Everything I did, I published in top medical journals. Young men who understood what I had done started demanding it from their doctors, who eventually either quit practicing (because it was a long, complicated, and tedious procedure) or adapted. I still practice that art form today, with the FUE I pioneered in 2002.