Articles Tagged with: donor hair
Strip Harvestiing

Strip vs. FUE Donor Hair Harvesting

Donor Hair HarvestiingUnderstandably, most hair transplant surgery patients will evaluate the success of their procedure based on the appearance of the once-thinning or balding area of their scalp. After all, bringing back healthy, growing hair is what the process is all about. But what goes into the transplant area must come out from another part of your scalp. Harvesting donor hair is as critical a part of hair restoration surgery as the actual transplanting of the follicles. How those follicles are harvested – and how the donor area looks after harvesting – will have a big impact on how a patient will feel about their appearance after the transplant is completed.

Transplant surgeons typically harvest donor hair from the back and sides of the head where male pattern baldness does not impact hair growth. Since this hair is healthy permanently growing, it makes it perfect for transplantation as it will continue to grow in its new location.

The biggest concern with donor hair harvesting is whether there will be a visible, linear scar left behind after the hair is removed. This is of particular importance for those who wear short hairstyles. 

There are two primary methods which hair transplant surgeons can use to harvest donor hair: strip harvesting and Follicular Unit Extraction (FUE). At the Hair Transplant Institute of Miami, we favor the latter technique, primarily because of its precision and ability to remove donor hair with significantly less visible scarring than with strip harvesting.

Strip Harvesting

Until the more recent development of the FUE technique, strip harvesting was the most widely used way to extract donor hair. This process involves taking thousands of follicles all at once from the donor area on a “strip” of the scalp. That strip is removed and the doctor then stitches the incision closed, leaving behind a scar that will vary in length depending on how many follicles are needed for the transplant. In addition to scarring, strip harvesting also may involve a longer recovery time than FUE harvesting.

That said, the process does have some positive aspects, particularly the ability to harvest large numbers of follicles in a short period of time.  

Follicular Unit Excision

The advantages of FUE over strip harvesting arise from the precision with which surgeons can remove follicles from the scalp. By removing follicles individually, scarring is minimized as is any damage to remaining hair in the donor area.

At the Hair Transplant Institute of Miami, we perform follicular unit extractions using a technique called the ARTAS® Robotic Procedure which provides unmatched results in transplantation while also dramatically minimizing any visible or structural damage to the donor area.

Using the ARTAS system, our doctors digitally scan areas of the scalp, identifying hair in its natural groupings. Selected follicular units are then precisely removed from the donor area with an image-guided 0.8-1-millimeter circular tool in a scattered pattern, leaving most donor area hair in place so that it retains its original natural appearance.

Because scars are tiny and dot-like in appearance, the donor area on patients who undergo a hair transplant using the ARTAS system should look unscathed and give patients the option to wear shorter hairstyles post-operation.

Schedule an Appointment for a Hair Loss Evaluation Today

If you are concerned about hair loss and are ready to do something about it, we invite you to schedule a hair loss evaluation at the Hair Transplant Institute of Miami. Drs. Nusbaum and Rose are internationally acclaimed hair restoration surgeons with more than 40 years combined experience

To receive a personalized consultation and treatment plan, contact us online or call our office directly at 305-925-0222.

Beyond Hair Plugs

Hearing the phrase hair plugs is enough to send a chill down your spine. Mention hair plugs in casual conversation, and there is an almost universal impulse to recoil. Unsightly and painfully obvious, hair plugs are perceived by many as a desperate and unsuccessful attempt to reclaim the confidence and youthful allure of “normal” hair.

Today, we can do better than hair plugs. Much better.

Hair plugs are uncommon today, given the rapid evolution of hair loss treatment that has occurred over the past few decades. The “pluggy” hair transplant procedures of the past are long gone. Today, they have been replaced by more advanced procedures that leave virtually no sign that a hair transplant has been performed.

Beyond Hair Plugs

Below are several pictures of real patients who have recently elected to have a hair transplant procedure performed by Dr. Nusbaum and Dr. Rose at our hair loss clinic. Together, they illustrate just how far we’ve come since the hair plugs of the ‘80s.

When asked, an overwhelming 85% of Americans cannot identify patients who have had a hair transplant procedure (i).

What Has Replaced Hair Plugs?

Today, there are two fundamental approaches to hair transplant surgery that have replaced hair plugs. The first is strip donor micrografting, and the second is follicular unit extraction (FUE). Both are known to deliver exceptional results.

Strip Donor Procedure

The strip donor procedure is an evolved form of hair transplant surgery. Following initial consultation, the hair transplant surgeon discusses the procedure with the patient, showing him or her how their hair will be surgically restored. Following consultation, the strip donor procedure is performed in 3 basic steps.

First, a linear strip of follicular units is removed from an area of the patient’s scalp designated as the donor area. Next, that linear strip, or micrograft, is separated into tiny clusters of follicular units and prepped for transplant. Finally, each follicular unit is transplanted to the recipient area in a way that restores the scalp with natural density, thickness, and undulation.

Follicular Unit Extraction

Follicular Unit Extraction is a highly refined method of hair transplant that is performed in a similar fashion as strip donor procedures, with 1 major difference. Rather than extracting a linear strip of donor hair, surgeons use a punch instrument to remove clusters of donor follicles individually. Following extraction, these donor follicles are prepped for transplant and implanted to restore the donor area.

New: Robotic FUE

In the past decade, few things have made a more positive and transcendent impact on the medical community as robotic technologies. In the field of hair restoration, robots and advanced high resolution imaging now help surgeons to perform FUE procedures with even greater accuracy, precision, and reproducibility.

Hair transplant robotics technologies, like the ARTAS by Restoration Robotics™, enable surgeons to extract a greater number of donor follicles, without the downside of physical or mental fatigue. Following extraction, surgeons manually transplant the donor follicles just as they would in a typical FUE procedure.

Learn more about robotic FUE with the ARTAS in Miami.

Am I a Candidate for Hair Transplant?

To learn more about hair transplant procedures, visit this page on surgical hair restoration techniques. To learn if you are a candidate for strip donor or FUE procedures, contact the Hair Transplant Institute of Miami online or call 305-925-0222.


(i) “2010 Hair Transplant Challenge Survey.” International Society for Hair Restoration Surgery. Accessed 17 June 2013.

New Approach to FUE May Reduce Scalp Trauma by Over 21%

A new study co-authored by the Hair Transplant Institute’s lead surgeon, Dr. Paul Rose, reveals a new approach to follicular unit extraction (FUE) that may reduce scalp trauma by more than 21%. The new technique promises several key benefits for men and women seeking surgical hair restoration, including:

  • Accelerated healing process
  • Reduced appearance of post operative scars
  • Minimizing of any potential blood loss

Understanding Scalp Trauma

Although considered to be a minimally invasive procedure, FUE inevitably causes some degree of damage to the scalp. Postoperative scars are much less visible compared to the long, linear scar left by traditional strip donor procedures. Nevertheless, FUE leaves tiny circular dots that are a reddish color. Moreover, these scars tend to vary in size.

How Extraction Affects Scar Size, Shape

In the study co-authored by Dr. Rose, surgeons demonstrate that skin injury is significantly impacted by outgrowth angle, or the angle at which the donor hair grows away from the scalp. To safely remove a follicular unit, the extraction tool (punch) must be aligned with the general direction in which the hair grows. Thus, the angle at which the punch instrument enters the skin changes with the outgrowth angle of each follicular unit.

If the donor hair happens to grow perpendicular to the skin, the punch approaches the scalp at a 90-degree angle to extract the follicular unit. This is the best case scenario; a perpendicular approach means less friction, reduced trauma, and a less noticeable circular scar.

Outgrowth angles are rarely 90 degrees, however. And when punch instruments extract follicular units with an acute outgrowth angle (less than 90 degrees), a more shallow approach is taken that creates more friction, skin damage, and a larger elliptical scar.

The Solution: Better Angles, Less Trauma.

In the study, surgeons note that saline injections provide two important benefits during FUE hair transplant: Firmer skin, and more predictable outgrowth angles. Under these conditions, surgeons calculate that a punch instrument can be up to 56.25% larger while reducing skin injury by 21.98% (i).

“…it should be emphasized that by injecting normal saline, the skin is stretched,” the team writes. “So once normal saline has drained away, the skin returns to normal […] This important fact results in accelerating the healing process, decreasing the degree of scarring, and minimizing any possible blood loss.”

While follow up studies are needed, the use of saline injections during FUE hair transplant procedures promises to enhance patient experience and overall results.


(i) Zontos G, Rose P, Nikiforidis G. A mathematical proof of how the outgrowth angle of hair follicles influences the injury of donor area in FUE harvesting.