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Home arrow Hairtransplant in detail arrow The strip- method
The Strip Method

The Strip Method: A detailed description

The cutting out of long strips of scalp through the use of a scalpel  and its being consequently cut into individual grafts is still practiced up to these days in the most institutes have advantages. But this method can also cause some problems and complications. For example, conspicuous scars, pain in the scar area, temporary numbness, destruction of a great number of healthy hair follicles and many more.

At first, you will see a short tabulatory overview about the properties of the strip method. Following the table is a detailed explanation about each given point.



up to 25 cm long or even longer, up to 10 mm wide, straight above the back of the head, mostly approximately 1 mm till 10 mm thick - sometimes calling the attention of others all at once


Extraction: Operation, healing process, post-operation complications:
- injury to nerves and bigger blood       vessels

- numbness, pain in scar area

- duration of wound healing

- wound infections 



several months

very seldom


Active sports
(for example, bodybuilding) - time needed after HT:

wait for around 3 months


destruction of healthy hair follicles:

quite a lot


control of the quantity of grafts to be extracted:

possible (to a certain point)


grafts that can be extracted afterwards:



use of surplus grafts:

possible (to a certain point)


control over the kind of grafts to be extracted:

no (eventually, minigrafts, micrografts)


possiblity of patient to control the number of grafts extracted:



use of body grafts in case donor hair from the scalp region is deficient:



HT's for the correction and reconstruction of other body regions
(for example, hairless scars, eyebrows, beard hair, pubic hair, etc:)    



transplantation of hair on the scars resulting from the strip method:



flexibility of graft extraction

locally limited


maximum quantity of all transplantable grafts from the donor region:

most lesser than in FUE 


results after many consecutive hair transplants in the donor region

the hair line of the nape is moved upwards as a result of the so-called lifting effect


time interval between future repetitions of hair transplants

cpproximately 12 months or immediately right after (with a resulting scar)


Time involved:

moderate; (a lot of the work is performed by the medical technical assistants)


Amount of work involved / maximum number of transplantable grafts per working day:

several thousands are possible



most cheaper than FUE


necessity of a previous shave of donor area:

yes/ no


after the operation:
- swelling of short duration

- temporary fall out of most transplanted grafts

- rest period of transplanted grafts

-final result is reached after

- grafts which take roots


yes, within 5 days

5 weeksapproximately 2- 6 months

approximately beginning on the 8th month

mostly over 90 %

1. Scar problem
With the use of a scalpel, a long elliptical or spindle formed strip of skin and subcutaneous tissue is cut out straight across the back of the head running from one ear to the other. The big and deep tissue defect arising from this is then stitched together layer by layer. What results is a 25 cm-long scar (seldomly even longer), which runs diagonally above the back of the head usually in the form of a so- called "smiley mouth“

At best, what is to be seen is a scar measuring 1 to 2 mm thin. However, in practice we encounter a much wider strip of scarred tissue. There are two reasons for this: tensions and individual characteristics of the healing process of the body.

Since a skin-subcutaneous tissue is taken out, both ends of the stitched parts of the back of the head is subjected to tension. To counter this force, the scar tissue widens ("back stretch effect“). This stretching may take place immediately after the operation, during the healing process or 6 months after the operation. This means that what was originally only a thin strip of scar may become wider in dimension after lapse of several months. Dimensions of up to 5 mm on the sides and of up to 1 cm in the middle are not seldom.
The individual healing process of the body differs from patient to patient and cannot be influenced at all. Even when blood laboratory results are optimal and when body composition is at its best, scars may spontaneously and unexpectedly widen in dimension during the healing process: (a) hypertrophic scar is usually observed when it develops above the skin level; (b) atrophic scar, when it is sunken in comparison with the level of the adjoining skin; (c) scar contraction, when it becomes hard; and in rare cases (d) keloid, when the scar tissue grows into healthy tissue.

Scars heal variedly well in different parts of the body. A patient's wound in the belly having perfectly healed in an earlier operation gives us no guarantee at all that this condition will hold true in the case of a scar in the back of the head after a strip hair transplant.
If you are interested in the strip- scar problem, take a look at: (there are some bloody pictures there, though).

No doctor practicing the strip method can give you a contractual guarantee that the resulting scar will be a thin one. 

The doctor performing the strip hair transplant has only a limited influence on the development of scars. He must cut out the strip from an appropriate elastic region within the donor region and must pay attention to the dimension and geometrical form of the strip (it should not be too big nor too wide, in order to avoid too much tension) and must consequently make a stabile and fine suture of the stripes.

Even a fine suture can only guarantee for a narrow and thin scar to a certain extent. We must take into consideration that the surgical threads remain in the wounds only for a certain period of time. The healing process takes a much longer period though. From this time on, the doctor and the sutures do not have any influence anymore on the skin tensions and the individual healing process of the body.

In the case of this patient, many strip hair transplants have been performed in the past. To be seen are many long and wide scars at the back of the head. Now repair work was done with the use of the FUE method: Each tiny reddish point to be seen on his scalp represents the spot of extraction of a follicular unit. In this example, the photo was taken immediately after the extraction took place.  In view of the small bleeding that ensues after the extraction of each follicular unit, the extraction sites seem to look much bigger than its usual dimension.


How the daily life is affected by strip scars:

  • Short haircuts.
    Depending on the width of the scar, having short haircuts between 1 and 5 cm are no longer possible, especially when one wishes that the scar should not get exposed at all. In these situations, it is necessary to have such scars covered by the hair immediately adjoining it. The patient must determine the length of his hair during his visits to the barber shop. This also means, that other kinds of hairstyle are limited.
  • Visiting hairdressers, swimming, etc.:
    Lots of patients wish some discretion when it comes to this matter, that they do not even want others to know about their HT. Depending on how the patient deals with the subject, visiting hairdressers, swimming or the mere stroke of their hair by their partner may already mean a great psychic problem. They feel always in danger of being discovered. They also feel obliged to answer curious.
  • Psychological effects:
    On account of the above-mentioned problems, many patients cannot accept their condition and feel uncomfortably "branded" as such.
  • Correction of scars:
    Correction of scars, which is done through cutting out of the scar tissues and renewed stitching of the wounds, does not give any guarantee that the dimension of the scar tissue becomes smaller. The force of tension exerted on the skin and the healing process of each body, which, by the way, is difficult enough to influence, are the determining factors. There are three possible outcomes: (a) the scar may become smaller in width, (b) it may remain in almost the same width as before or (c) may grow even much wider than before. On these grounds, it pays to have a scar correction done when it is indeed very big in proportions, that the patient does "not having anything more to lose".


2. Extraction: Operation, healing process, post-operative complications
The strip method is a real surgical operation, wherein a scalpel is used. The skin and the subcutaneous tissues are cut open and are then carefully closed again. In this process, blood vessels and nerves may get damaged if no extra precaution is taken. Since both cuts are made straight across the back of the head, a long area of skin and subcutaneous tissues is split wide open. Many patients complain about numbness in the adjoining area after a strip hair transplant. This numbness may disappear again after a few months. Paraesthesia and wound pains may develop, which may be either of temporary or permanent nature.
Another possible and very common complication is the increase in the dimension of these scars.
Wound infections after the operation are very seldom. Prophylactic antibiotics can minimize additionally this rare complication.


3. Active Sports (for example, body building)
Due to the big wounded area, the patient should avoid engaging in active sports activities - like body building, etc - for around three months after the operation.


4. Destruction of healthy hair follicles
Lots of healthy hair follicles of the donor area are destroyed when the scalpel is laid to follow and cut the line indicated on the scalp.
Because of the high density of hair follicles, it is almost impossible to "avoid" cutting directly through hair follicles situated on the line. If for example a 25-cm long elliptical strip of scalp is to be cut out, then the entire length of the cut made by the scalpel (which is equivalent to the circumference of the wound) is about 50 cm. It is obvious, that lots of hair follicles located directly on the line indicated for cutting will be destroyed by the scalpel.  

Likewise, the stitch using normal surgical material or metal clips also destroy those follicles immediately located in the area where the stitch is performed. Another risk factor is the ensuing division of the strips of skin into separate grafts (today mostly with the help of a microscope). When this division is performed without much needed care, lots of hair follicles are expected to be destroyed, too.


5. Control over the number of grafts to be extracted
Up to this day, many institutes still offering the strip method determine hair density in the donor area through a special measuring device. The needed area of elliptical strip is then computed basing on the results of these measurements and on the needed number of grafts. This procedure is, however, for various reasons, reliable only up to a certain point.


6. Taking of grafts at a latter period
Comprehensively, the strip hair transplant technique does not allow to quickly cut an additional small strip of scalp at a latter time, should the number of grafts earlier taken prove to be too few. Practically, much bigger strip of scalp is then cut out than is usually necessary, so as to have enough stuff just in case more of it is needed later.


7. Handling of extra grafts
In the case of extra grafts, there is only the option of implanting them on the planned receptor area as long as space and aesthetic considerations allow this.


8. Control over the kind of grafts to be extracted
The kind and composition of follicle groups contained in a strip of skin and subcutaneous tissue should be considered definite and whose property cannot be influenced by outer force at all. It is up to the hair transplant institute to decide, whether the cut-out strip of skin and subcutaneous tissue be divided afterwards into FU's(follicular units) or in the less natural-looking minigrafts or micrografts.

9. Possibility of the patient to control the number of extracted grafts
The patient does not know, how many grafts have been exactly extracted nor how many of them will be implanted into the receptor area. At this point, we know by now that the first step involved in the strip method is the cutting out of a stripe of skin and subcutaneous tissue, which are then cut into single grafts.
If the patient wants to know the exact number of grafts of the strip and how many of these grafts were taken out from the strip and then inserted into his bald areas, the patient must observe the handling and splitting of the strip, which is nearly impossible for him without a microscope.


10. Use of body grafts in case of deficiency in normal donor hair  
Should there be not enough donor hair from the donor area at the back of the head, it is absolutely not possible to use body grafts. This would mean having several long scars on the area of the body, where grafts have been taken. Since the hair density of the body is much lesser than that on the scalp, this would automatically mean cutting out more skin from the body just to reach the number of body grafts needed. This risk and the aesthetic disadvantages it pose do not correspond at all to the advantages we would like to achieve.

11. Strip HT's for correction and reconstruction of other regions of the body (for example, hairless scars, eyebrows, beard, pubic hair, etc)
On account of the strip technique it is not suitable, because only scalp grafts can be used. However, scalp grafts have different properties than hairs on the above mentioned sites. An unnatural look would result.  Additionally permanently cutting of such transplanted scalp hair would be necessary (e.g. transplanted scalp hair in the eyebrow). Grafts of the mentioned areas certainly can not be used with strip surgery because of the resulting scars in eye catching areas and because there are naturally to few hairs in these regions. These regions cannot be taken as donor regions in strip surgery.


12. Renewed transplantation on scars resulting from the strip method
This is not recommendable, for one would receive another scar. In this case, a problem would be solved only to create another one at a different place.


13. Flexibility: site of graft extraction
The choice of the area within the donor region from where the strip can be cut out is limited by the following facts:

  • the needed elasticity of the scalp must be present;
  • from the anatomical point of view, the area must be safe for deep cuts;
  • cosmetically, the scar must be located on such a spot, which can be completely covered by the remaining hair closest to it;
  • understandably enough, in case of performing a new strip hair transplant  one is bound to take new strips closest to the first scar resulting from a previous strip hair transplant  so as to avoid having more and much longer scars in the donor area.

14. Maximum total number of transplantable grafts from the donor area
The number of transplantable grafts is limited on account of the local nature of the place where the strips are cut out and the many skin tensions following the many previous transplants. This does not allow any number of strip hair transplants in the future. Furthermore, body grafts cannot be taken out with strip surgery.


15. Effect on the donor area after several HTs following each other
Because of the lifting effect that accompanies each new strip HT, the hairline on the nape is shifted upwards every time a new one is performed. It is true that the hairy region nearly retains its natural thickness (but sometimes this area becomes partly thin especially in the regions close to the scars).


16. Time intervals between future repetition of HTs
If the new strip contains the scar of the preceding strip hair transplant  (this is usually done, so that the patient does not receive many scars in the donor area unnecessarily), the waiting period between two operations should be around 12 months - depending on how large the former strip operation was. The reason behind this is the fact that the skin which has been subjected to tension must have regained back in the meantime its elasticity again.

If one would consider having more scars, then a new strip could be cut out immediately in other areas of the scalp.


17. Amount of work involved 
A strip hair transplant surgery requires less work than an FUE. Therefore, institutes offering the strip method can treat several patients at the same time in one day.


18. Time involved / Number of transplantable grafts per working day
Performing a hair transplant using the strip method requires not many time. Up to several thousand grafts can be transplanted in a day.


19. Costs
For a hair transplant, using the strip method, one pays less than in the case of FUE. Lately, however, the prices for FUE have significantly gone down that the differences are not that much as it used to be.


20. Necessity of shaving the donor area before the operation
The area of the strip of scalp that is to be taken out, needs to be shaven beforehand. After the strip has been taken out, the wounds are then closed in such a manner that the patient shows no short-haired areas of the scalp.


21. After the operation
After the operation, we observe the following before ever reaching the end result:
(a) Swelling of short duration,
(b) transient fall out of transplanted grafts,
(c) re- appearance of the transplanted grafts after a rest period of approximately 3-6 months,
(d) fit for the society
At this particular point, there is no difference between FUE and Strip-HT. The difference between them lies in the kind of graft extraction. Please refer to: How to deal with your hair after the transplant procedure: important tips/ Result