This method requires excision of an ellipse of skin with hair from the back of the head. Usually the ellipse is approximately 8–12 cms in length and 4–6cm at its widest part. This ellipse is given to a skilled technician who, under the microscope, trys to cut between the hairs to divide the whole ellipse into workable strips. The strips are then given to two or more technicians to divide under a low power microscope into grafts of 1, 2, 3 or more hair follicular units. The follicular unit is so named because upon observation of a shaved scalp, the hair emerges from the skin in groups of one or more, When these grafts are inserted, no skin is removed and each unit is inserted into slits or tunnels.

Proponents of this method have been very vocal. Strong statements have been made suggesting superiority, however these are unproven.


Mini and micrografting is done by harvesting thin strips of skin from the scalp. This is done by the physician. The strips are given to a technician who divides them into grafts of 1, 2, 3 or more hairs, similar to follicular units. The division is done by placing the thin strips on a translucent stage with back lighting, resulting in hair follicles being well outlined and follicular units identified before cutting. A lighted magnified loupe is also utilized by the technician for strip enhancement. All this ensures the best division of the strip.


At the latest 8th Annual International Society of Hair Restoration Surgery in Hawaii, a paper was presented by Dr. Walter Unger (a pioneer, acknowledged and respected, world renowned transplant surgeon) comparing strip grafting and follicular grafting. He harvested the strips of hair. After the hair follicules were counted, his technician divided the strips into grafts. The grafts were 1, 2, 3, or more hairs. Total amount of grafts and hair follicles were added and the grafts were then implanted. After they had grown on the patient, the hair follicles were again counted.

Dr. Seager (an expert hair transplant doctor who does only Follicular units) harvested an ellipse and his best technician divided the ellipse into strips, then into follicular grafts. These were implanted and growth of hair was counted later.

There were no significant differences, in the failure of hair to grow or in death of hair follicles between the two procedures.

That fact, had been noted by other hair transplant physicians in their practices. Some had tried the follicular method and then reverted back to strips, or a mixture of strips divided into follicular grafts, because they felt there was no advantage. However, until this study there was no objective evidence supporting what had been found in practise.

Surgeons doing follicular grafts had claimed that they achieved many more grafts from the same surface area than did surgeons doing strip grafting. Dr. Unger’s work proved that not only was there no increase in amount of grafts from an ellipse of the same surface area but that there was also no increased damage to the hair follicles. In fact it was shown that in Dr. Unger’s care, there was a slight increase in the number of hair follicles. However, it was not a statistically significant increase.

Another paper by Dr. Brechner and supported by Dr. Unger showed 2mm grafts (minigrafts) had a survival rate of 100%. This is superior to follicular units or standard grafts.

Dr. Seager also agreed that there were pitfalls in doing follicular grafting. Dr. Unger and physicians who have done hair transplants for many years, understand that a good technician is what is essential.

In the follicular unit method, it is the technician (who may also be a doctor) who divides the ellipse into strips, then further divides it into smaller follicular grafts.

In the strip method, the doctor is the technician who harvests rhe strip and the technician then divides the strips into grafts.

How the grafts are handled, especially the 1-2 hair units, is much more important than how they are derived. We know that drying them out is the worst killer of grafts. Also we know that squeezing them at the wrong areas prevents proper growth.


Controversies will always be with us. We must discern between unproven zeal and scientific study; marketing ploys and fact. Methods used in such an important procedure as hair transplantation must be proven and duplicateable.
“There are many roads to Rome” and it is best that you select the surgeon with whom you are most comfortable. Research the years of experience they have so you are convinced that they know what they are doing. Do not go with the newest, assuming it is the best. Use your instincts, who are you most comfortable with?


There is now a 5 year report of patients who initially were on a Propecia study and continued on with the medication. Conclusions were that the sooner the patient started the medication, the more effective it was in preventing permanent hair loss. There is also a stabilization effect on hair loss. Discontinuation of the medication resulted in re-establishment of the degree of hair loss prior to the therapy. Propecia is only successful in preventing further hair loss in 83% of patients.

Dr. R. Knudsen (Australia) reports that if there are sexual side effects, or fear of sexual side effects, patient may take 1 pill every second or third day. He felt the results were identical to daily dosing. Dr. Liao believes that patients with no side effects should stay on the daily dosage. More studies on reduced dosage are needed to make sure that it will have the same success for prevention of hair loss.

Another side effect is that of breast pain or gynecomastia, and it is not dose related. This side effect is rare and cessation of Propecia will resolve this.

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