Hair Transplant Methods for creating the recipient sites and inserting the grafts

Andreas Krämer Hair4life



Hair loss sufferer, consultant since 2004, co-author of the book “Hair Transplantation Guidebook” by Alliance4Hair, founder of Propatient with lawyer Chr. Bomke, co-founder of the HTTC training center for doctors. Known from SWR, SAT 1, ZDF, Spiegel and many others. About Us

In hair transplantation, there are different ways of forming the receiving openings for the new hairs (grafts) and inserting the grafts:

  • Driling the recipient sites and insertion of grafts with tweezers
  • Openings of the recipient sites by laser insertion of grafts by tweezers
  • Needle openings and insertion of grafts by tweezers
  • Slit openings, (sagital or lateral slits), by means of scalpels, or special blades and insertion of grafts by tweezers

Stick and Place Method/Technique

  • Formation of a recipient opening with direct insertion of a graft, conventional stick and place technique
  • Formation of the recipient opening and simultaneous insertion of the grafts with Choi Implanter (Implanter Pen)

Lasers and drills are very rarely found today. With lasers, it was found that there is a risk of damaging tissue in such a way that the hair roots cannot grow properly.

The two most common instruments today are needles and small scalpels or specially cut blades. The scalpels/blades are used to create either sagital (from top to bottom) or lateral (side) slits.

There are major differences in the sizes of the instruments and therefore also major differences in how many grafts/FU’s can be placed per square centimetre. The finer the instruments, the more grafts/FU’s per square centimetre can be placed, but the finer the instruments and the smaller the receiving opening, the higher the risk of damaging the grafts. More about this in the chapter “Hair Transplant Dense Packing”.

Needle openings

Good hair surgeons who work with needles today usually use sizes from 25 gauge (0.5 mm) to 20 gauge (0.9 mm), i.e. less than 1 mm.

In the picture below you can see very well the difference between the different needle sizes

With a special device you can measure the different sizes very precisely

When measuring, one notices that the sizes given are always the inner diameter. For example, a 25 gauge needle corresponds to an inner diameter of 0.5 mm and an outer diameter of 0.518 mm

Slit openings by means of “cutting edge” – custom size blades technique

In order to achieve a good density per square cm in the recipient area during a hair transplant, leading hair surgeons today – who work with the slitting technique – use a special cutting device. With this device – also called “cutting edge” – the blades with which the slit openings are later formed can be cut very precisely down to the smallest sizes.

Even blades of 0.7 mm in length can be prepared with it. There is hardly any width.

When we check the size of the previously cut blade, we find that the “cutting edge” works very accurately.

Here is a cut blade of 1 mm in length:

Here we see how the blade is held in a special jig. So now the slit openings can be formed.

Stick&Place technique

In conventional hair transplantation, the hair surgeon usually forms all the recipient sites in one or more steps and then he or experienced assistants insert the grafts.

However, in the stick-and-place technique, the hair surgeon transplants the graft immediately after the recipient site is created. The recipient site is formed using a needle, scalpel or blade and then the graft is directly inserted, another receiving opening is formed, another graft is inserted and so the process is repeated until all the grafts that have already been removed and appropriately stored have been inserted.

Watch the following video to see an example of stick and place at the HLC – Hairlineclinic in Turkey/Ankara:

Stick&Place technique with Choi Implanter (Implanter Pen)/DHI technique

Choi Implanter/Pen (DHI Technique) – Picture courtesy of

The stick and place technique with Choi Implanter, which is also often called DHI technique (read also DHI hair transplantation method (Choi Implanter): Andreas Krämer’s experience report), is an auxiliary device/pen with which a recipient site is formed, but at the same time the graft is inserted. The pen must first be loaded with a graft, then the recipient opening is formed by means of the pen/Choi Implanter and then the loaded graft is inserted into the recipient opening at the push of a button.

Hair transplantation with Stick & Place and Choi Implanter (DHI technique) also carries risks: Beware of cheap clinics where the hairline design/formation of the recipient opening and insertion of the grafts is left entirely to the assistants

Just as the formation of the hairline by a doctor and the insertion of the grafts with tweezers by assistants can be risky if you are inexperienced and lack the necessary know-how, the use of an implanter is of no use if the implanter is loaded by an inexperienced person and the graft is damaged, or if the implanter is inserted incorrectly due to insufficient know-how and experience, e.g. by an inexperienced doctor or by inexperienced assistants.

In the 1980s and 1990s, the stick-and-place technique with the implanter had a bad reputation, because in strip hair transplantations performed at that time, the doctor often only removed the strip, but the formation of the recipient openings (and thus also the hairline design!) and insertion of the grafts was left exclusively to the assistants with the Choi implanter, which ultimately led to bad results again and again due to incorrect handling and/or inexperience (poor growth, unnatural hairline, incorrect hair growth direction, etc.).

Therefore, even today – especially with cheap clinics (hair factories) that like to advertise with the Choi-Implanter/DHI technique and other terms – it is important to make sure that the complete process of forming the recipient openings and inserting the grafts is not carried out exclusively by assistants (read also “Risks through cheap hair transplantation discounters in Turkey”, or the chapter “Legal help after poorly performed hair transplantation”).

The best technique for forming the recipient sites and inserting the grafts

As with all other techniques, there are also different opinions, arguments and procedures among different hair surgeons when it comes to forming the recipient sites, inserting the grafts and whether to stick and place etc.

Many renowned and experienced hair surgeons still form the recipient sites with needles or with fine cut blades and then the grafts are inserted with tweezers by well-trained and experienced assistants or the hair surgeon himself and certainly these hair surgeons argue for exactly this procedure.

Some of them make as many receiving openings as grafts are available and only then insert the grafts, others proceed in stages, some only use stick and place for fine-tuning, others, however, basically use the traditional stick and place technique and others prefer the use of a Choi implanter.

Each approach has its arguments. For example, some renowned hair surgeons who do not use the stick-and-place technique are of the opinion that the hair growth direction and angle of the neighbouring native hairs follow better and that the overall hairline design is better (one has a better overview) if many hundreds and thousands of receptions are formed in one process, while others favour the stick-and-place technique for fine-tuning hairlines. Some hair surgeons see the advantage of Stick & Place in the fact that the grafts are immediately inserted into the recipient opening and are thus directly perfused, others, however, see an overall advantage in terms of time (shorter operation time) if hundreds or even thousands of recipient openings are formed in one breath and then the grafts are inserted in a complete procedure.

Important for a good hair transplant result are above all experience and know-how

As already mentioned here on Hairforlife, there are several ways/procedures that lead to a good hair transplant result, but above all it is always the necessary experience, sufficient know-how and also the talent of the doctor that are mainly responsible for consistently good results!