The “Stick and Place” Technique in FUE Surgery: A High-Precision Approach to Graft Placement
Hair restoration has evolved significantly over the years, with one of the most advanced and widely used methods being FUE Surgery or Follicular Unit Extraction (FUE). This technique is typically broken down into three key stages:
- Extraction of donor follicles from the donor area
- Sorting the follicles by the number of hairs they contain
- Placement of the follicular grafts into the recipient area
In this article, we'll focus on the third and most intricate step: placing the grafts in the recipient area, with particular attention to the "stick and place" technique in FUE Surgery - widely regarded as the most precise and highest-quality method for FUE graft insertion.
Different Techniques for Placing Grafts in FUE Hair Transplantation
There’s more than one way to place follicular units during an FUE hair transplant. The method chosen often depends on the clinic’s skill level, technological resources, and desired outcomes. Below are the primary graft placement techniques used across the industry:
1. Pre-Made Incisions with Forceps Insertion by Multiple Assistants
In this method, recipient sites are created in advance, followed by multiple assistants inserting grafts using forceps. While this approach can increase efficiency and allow more grafts to be placed in less time, it has significant limitations.
Since all incisions must accommodate the largest graft size, smaller grafts end up being placed into unnecessarily large incisions. For example, if a patient has:
- 10% single-hair grafts
- 70% double-hair grafts
- 20% triple-hair grafts
...and needs 2,000 grafts, then 2,000 incisions will need to be created to fit the largest grafts. This results in overly large incisions for the majority of grafts.
Moreover, since these pre-made incisions begin closing as soon as they are created, surgeons often compensate by making them even larger. Typical blade sizes for this technique range from 1.1 mm to 1.4 mm, or 18G to 20G needles, leading to:
- Increased vascular disruption
- Higher risk of scarring
- Greater damage to any existing native hair
- Elevated chance of complications such as tissue necrosis
The only major advantage of this technique is speed and the ability to delegate tasks to a team of assistants.
2. Sharp Implanters / Direct Hair Implantation (DHI)
This technique involves using sharp, pen-like implanters to place grafts directly into the scalp without making pre-incisions. Marketed as “Direct Hair Implantation” (DHI), it’s often portrayed as a modern and advanced method.
However, the incisions created by these implanters are typically circular and equivalent in size to those made by 18G to 20G needles (e.g., 18G = 1.2 mm, 19G = 1.0 mm, 20G = 0.9 mm). These circular openings are often larger than linear blade incisions of the same diameter, leading once again to:
- More scarring
- More trauma to the scalp
- More damage to preexisting native hair
While DHI offers the benefit of speed and potentially less trauma to the follicle bulb during placement, its precision and long-term cosmetic outcomes often fall short of more refined methods.
3. Stick and Place Technique – The Gold Standard
The “stick and place” technique in FUE Surgery is a high-precision method in which each follicular unit is inserted immediately after the recipient site is created. This approach allows for customized incision sizing based on the actual graft:
- 0.6–0.7 mm blades for single-hair grafts
- 0.8–0.9 mm blades for double-hair grafts
- 1.0 mm blades for triple-hair grafts
By tailoring each incision to fit the specific graft, we minimize:
- Scarring
- Vascular disruption
- Trauma to existing hair follicles
This technique is rarely used in high-volume, technician-run clinics due to the expertise and time commitment required. At BKS Hair Restoration, every incision and graft placement is performed by a skilled physician, not delegated to assistants.
Why Stick and Place Is Worth the Time
Although time-consuming, the stick and place method offers:
- Unmatched precision
- Superior cosmetic results
- Minimized trauma to the scalp
- Optimal graft survival and natural hair growth
Just like any high-quality craft, excellent outcomes require time, skill, and attention to detail. If your goal is the most natural-looking and long-lasting hair restoration, stick and place is the gold standard technique in modern FUE surgery.
Precision graft placement using the stick and place technique at BKS Hair Restoration - minimizing scarring and maximizing natural results. Photo shown here is before the hair transplant and immediately after grafts were placed using the stick and place technique.
FAQs about The “Stick and Place” Technique in FUE Surgery
What is the “stick and place” technique in FUE hair transplant?
The stick and place method in FUE Surgery involves creating each recipient site individually and placing the graft immediately after. This allows for custom incision sizes, resulting in better graft fit, less trauma, and a more natural-looking result.
Is stick and place better than DHI or implanters?
Yes. While DHI and sharp implanters are faster, they create larger circular incisions that increase the risk of scarring and vascular disruption. Stick and place allows for smaller, customized incisions with less trauma and superior outcomes.
Why don’t all clinics use the stick and place method?
Stick and place is time-intensive and requires a high level of surgical skill. Most high-volume or technician-led clinics opt for faster, less precise methods to increase efficiency and reduce cost.
Does stick and place reduce the risk of complications?
Yes. By using the smallest possible incision and placing grafts immediately, this method reduces vascular trauma, scarring, and damage to existing native hair, which lowers the risk of complications such as necrosis.
Who performs the graft placement at BKS Hair Restoration?
At BKS Hair Restoration in Haddonfield, NJ, all graft placements using the stick and place technique are performed exclusively by Dr. Bhumik Shah, ensuring the highest level of precision and artistry
Get Started Today
BKS Hair Restoration is conveniently located in Haddonfield, NJ and has helped patients in New Jersey, Philadelphia, PA, Delaware, and New York, NY. Contact us to schedule your one-on-one consultation with Dr. Shah today and start your journey toward restoring your confidence and your hair!
