Written by Dr. Griffin
Hair transplant surgery offers men and women a permanent and natural-looking solution to pattern baldness. In the early days of hair transplants, the results did not always appear natural and left many transplant patients feeling dissatisfied with the outcome. This changed in the 1990s when surgeons began to understand the importance of the follicular unit to hair transplant surgery. Today, modern hair transplant surgery involves the extraction and transplantation of distinct follicular units. While the transplantation technique is the same, there are two main methods used to extract the follicular units, known as strip harvesting and Follicular Unit Extraction (FUE).
Follicular Unit Harvesting Techniques
When doctors talk about “follicular units” they are referring to the entire hair follicle structure. This includes the visible hair above the surface as well as the glands, blood vessels, nerves and tissue hidden beneath the skin. The entire follicular unit must be preserved during extraction in order for hair to re-grow best in its new location. Strip harvesting and FUE both allow for the preservation of the follicular units during extraction.
Follicular units contain between one and four strands of hair. In the early days of hair transplant surgery, doctors transplanted plugs of up to 25 hairs at a time, which led to the unnatural “barbie doll” look associated with the early days of hair transplant. Today, skilled surgeons strive to place follicular units of one to four hairs in a careful pattern to mimic natural hair growth.
Real Patient Before & After Photos
To obtain the follicular units, the surgeon first removes a horizontal strip of hair from the back or sides of the patient’s scalp. The incision is meticulously sutured to minimize scarring. Then the surgeon and his or her team carefully dissect the follicular units and prepare them for transplantation.
Follicular Unit Extraction
When using the FUE method, the surgeon creates tiny holes around follicular units on the sides or back of the patient’s head and then carefully lifts the follicular units out of the scalp. These follicular units are then transplanted in the recipient area. To learn more about this technique, please visit our Follicular Unit Extraction page.
Benefits of strip harvesting
Strip harvesting is the original and oldest technique used in follicular unit hair transplants. As such, many surgeons are highly skilled at using this approach and are able to produce excellent results time and time again. Benefits of strip harvesting include:
- A natural result
- A quick healing time following surgery
- Minimal scarring in the recipient and donor areas
- In comparison to FUE, surgeons are able to harvest follicular units more quickly, typically allowing for a shorter procedure.
- In comparison to FUE, the donor area does not need to be shaved short for harvesting of follicular units. Only a small strip of hair is cut short, which is then covered by surrounding hair after suturing.
Real Patient Before & After Photos
Risks of strip harvesting
Strip harvesting is a reliable procedure that has been used safely for decades and is associated with very few risks; however, when compared to FUE, there is one main disadvantage to this approach:
Strip harvesting results in a horizontal scar at the donor site. Most skilled surgeons are able to suture the skin in a way that the scar is barely visible, concealed by longer hair. The scar is more likely to be seen in patients who like to wear their hair shaven or closely cropped, so it is recommended and understood that one must wear their hair at least ½ inch long to conceal the scar.
Ideal candidates for strip harvesting
Ideal candidates for hair transplants are those that display male or female pattern baldness, are in good overall health, and have realistic expectations for their surgery. Patients with longer hair are better candidates for strip harvesting than those with short hair or shaven heads. Patients who have very loose or very tight scalp skin may be better suited to undergo FUE to obtain the hair follicles. Women may prefer strip harvesting because there is no need to shave the entire donor area short for harvesting as in FUE.
The recovery period following strip harvesting is relatively short. Patients are able to resume normal activities within 24 hours, but should refrain from strenuous activities and exercise for seven days. Some scabbing at the recipient site is expected, so many patients prefer to remain home from work for three or four days until the scabbing has disappeared. Some patients report tenderness in the extraction areas as the skin heals and the sutures disappear. While the pain is not severe, many patients find the recovery after strip harvesting to be slightly less comfortable than FUE.
Regardless of the extraction method used, when performed correctly the results of all modern hair transplant surgery are permanent and natural looking. After the procedure, the transplanted hairs will fall out, but they will re-grow within three to four months. The full effects of the hair transplant are typically seen within 12 to 18 months.