Hair replacement surgery, a 40-year-old procedure, is now at a stage where its history can be re-examined, present procedures enumerated, and its future evaluated. The provocative observation that donor site, composite grafts, or occipital hair follicles, when transferred to the frontal area of the scalp, not only survive and grow but continue in a growth pattern throughout the patient's life has spurred a major subspecialty of cosmetic surgery. The innovations, refinements, and new techniques that emerged during the ensuing 40 years truly have made Norman Orentreich's original experiment a definitive subspecialty. This article reviews some of the prior advances during this time, where they stand now, and state-of-the-art techniques.