I am often asked by prospective patients which harvesting procedure is preferable for hair transplantation. Follicular unit extraction or the strip harvest procedure? My answer is that it depends on the individual. If a person needs the option to cut his hair down to a number 1 or a number 2 buzz cut then follicular unit extraction is the needed procedure so as to avoid a visible linear scar. If the person is comfortable leaving their hair at a number 3 or preferably number 4 cut or longer,  then the strip harvest procedure is absolutely an option. Typical linear scars from strip harvest procedures should measure between 1 and 3 mm in width and the length is determined by the amount of hair follicles needed to be harvested. This is in contrast to tiny white dots that are left in the donor region after the follicles are harvested in follicular unit extraction. Neither procedure is scarless. There is no such thing as a scarless hair transplant procedure. In fact, the scarring from follicular unit extraction in the donor region is greater when measured in surface area then the scarring from the strip harvest procedure. The difference is that in the strip harvest procedure the scarring is concentrated in a linear scar which is more noticeable when the hair is very short as opposed to the diffuse pinpoint scarring which is the result of follicular unit extraction. Some patients who have been overharvested in follicular unit extraction still do not have the option to cut their hair very short as the confluence of many pinpoint scars can start to show as “moth eaten” scalp with a short haircut. Also, it is usually not advisable to cut the hair down to a number zero haircut after follicular unit extraction hair transplants as you will probably see the tiny white dots left from the extraction of the follicles. To be clear, when follicles are removed from the donor area in follicular unit extraction one by one, they do not grow back in the donor area. They are taken out and moved to another area where they then begin to grow.
In follicular unit extraction every third or every fourth hair follicle is randomly extracted so as not to create bald patches in the donor area. Because of this it is important to draw the hair follicles from the entire safe donor area. This means that the entire donor area is affected in the first hair transplant procedure. This is in contrast to the strip harvest procedure where only about a 1 to 1 1/2 cm wide area is extracted by a length that is determined by the amount of hair follicles needed to harvest, typically leaving behind a 1 to 3 mm linear scar with untouched robust donor area above and below the strip scar. When the patient returns for a second procedure the physician should harvest the second strip from the same area removing the original strip scar so as to leave the patient with only one strip scar even after multiple hair transplant procedures. If for some reason the strip scar widens and the physician is not able to extract the old scar, there is still untouched donor zone above and below the original strip scar allowing the physician to either take a new strip in a new area or begin follicular unit extraction in the surrounding areas around the original strip scar. What this means is that the ultimate donor zone in a patient will probably be contain more follicles if the patient begins with the strip harvest procedure versus follicular unit extraction. This also means that patients who are predicted to experience severe hair loss should strongly consider leaving their hair a little bit longer and undergoing the strip harvest procedure to begin with, in order to maximize the number of donor hair follicles from their permanent donor zone.
When harvesting follicles in follicular unit extraction, the patient must shave their head down to a number zero cut in order to extract the follicles, versus the strip harvest procedure which allows the patient to leave their hair longer and use the existing hair to cover up the strip scar.
In follicular unit extraction the physician can choose the larger follicular units i.e. the two, three, and four haired follicular units, while in the strip harvest procedure you only get what’s in the strip which may typically ends up being 2/3 one hair and two haired follicles. What this means is that the hair count can possibly be slightly higher in follicular unit extraction.
Follicular unit extraction can be much more variable than the strip harvest procedure because a high degree of skill and efficiency required to extract the follicles intact. This is in contrast to the strip harvest procedure which involves less handling of the hair follicles. Because of this we often see more variable rates of growth in the hands of inexperienced practitioners practicing follicular unit extraction. It is imperative that the prospective patient see multiple results of the physician you are considering with the follicular unit extraction procedure as well as the strip harvest procedure.
In summary there is no right or wrong when comparing follicular unit extraction and the strip harvest a procedure. Both are excellent procedures and both can provide excellent results in the hands of an experienced hair transplant surgeon. What’s most important is that the patient chooses the procedure that suits them the best both in the short term and the long run.
All the best,
Marc Dauer, M.D.