The strip method – the most common method for hair transplants – comes along with scarring

The FUT hair transplantation or also called strip method and strip technology, is the most common method for hair transplants in Germany. Approximately 90% of the hair transplants in Germany are currently performed by using this method. A skin flap of at least 10 to 20 cm will be cut by using a scalpel from the back of the head in order to gain the donor hair. The resultant gap of the skin will be sutured or tacked. The corresponding gap of the skin results from the necessary number of hair follicles and the thickness of hair of the area of the donor hair. The more transplants of the own hair are needed for the hair transplantation, the bigger is the size of the skin flap.

The single steps of the strip method during the surgery

  • In order to gain the donor hair, a skin flap gets cut from the back of the head by means of a scalpel.
  • Most of the time, the cutting length runs from one ear to the other and has a length of up to 20 cm. The width of the laceration depends on the thickness of hair within the area for the donor hair and the needed number of transplants.
  • The resultant gap of the skin will be sutured or rather tacked after the extraction.
  • The skin flap will be cutted into several pieces by a technical assistant who uses a sharp-edged blade into single donor hair units.
  • The manually cutted units normally have different sizes.
  • The recipient area gets prepared through tiny recipient holes.
  • The donor hair / transplants get inserted into the recipient holes.

Disadvantages of hair transplants by using the strip method

  • The healing of the injured tissue comes along with scarring.
  • The injured tissue is traumatized by it and consequently remains hairless.
  • A widening of the scar occurs between three and six months after the surgery, which results from an excessive skin tension of the head through a permanent influence of the muscular tractive forces in the neck and back muscles. The so called Back Stretch Effect occurs.
  • The width of the scar-enlargement is determined by:

    • the width of the extracted skin flap
    • ◦the skin characteristics of the patient
    • suturing techniques
    • the physical stress, due to sports activities or heavy physical labour of the patient. ◦ A minimum 6 months break of physical strain has to be kept.

Thinning of the hair due to a trauma after the application of the strip method

  • Due to the surgical trauma after a transplantation by using the strip method / FUT, an irreversible loss of hair around the scar can occur.
  • This leads to a thinning of the hair through the loss of healthy hair at the back of the head. This hinders future hair transplantations.
  • Hiding the scar with the help of own hair is also very difficult.
  • Trauma-associated, irreversible loss of healthy hair due to the FUT / strip method around scars or rather sutures - irreversible Shock Loss

Further complications

  1. Transection of large cutaneous nerves with a possible permanent numbness in the area of the scar.
  2. Medium to severe pain after the hair transplantation
  3. It is rarely possible that skin death in the area around the wound, due to compression of the skin supporting arteries by dint of a strong suture.
  4. Visible scar after a advanced loss of hair. This is why this method shouldn't be performed for a hair transplantation for young patients who suffer from an advanced loss of hair.

Scarring stamp technique – the second leading method for hair transplants in Germany

About 5 to 8% of the hair transplantations in Germany get performed by surgeons who use stamp techniques (also called “punch technique“). In order to gain the donor hair, the stamp technique uses a hypodermic needle with a diameter of 

4 mm, which also results – just like the above mentioned FUT hair transplantation – in visible scars. The extracted cores with hair will subsequently be cutted into smaller groups of hair for the hair transplantation.


Left image: Surgical method stamp technique: Extraction of at least 4 mm cores from the skin by stamping / punching at the back of the head

Images in the middle and on the right: Circular scarring after a hair transplantation by using the stamp technique and a 4 mm punch

Disadvantages of the stamp technique

  1. 4 mm stamp technique is not allowed to be used for young patients with an advanced hair loss, due to its scarring. The scars might become visible and only a low rate of growth is given.
  2. An irreversible loss of hair, caused by a trauma, around and underneath the scar as well as a destruction of numerous healthy roots of the hair, medium severe pains after the surgery.