The punch-method was established and first described by Dr. Okuda in 1939.

By using 4-mm-sized cylinders some selected parts of the scalp on the donor site have been removed before the device was applied on the balding area to remove equal-sized parts of the scalp and relocate the hairy tissue.

The results of this method have shown heavily bundled grafts on the recipient area appearing as unnatural as a brush. While using big punch-devices for the extraction process numerous visible scars have occurred on the donor site.

See an example of a 4 mm punch:


(Source: www.newhair.com)

Extraction by 4 mm punch:

Punch Extraction
Extraction by 4 mm punch

(Source: www.newhair.com)

The final result by using the punch-method

(Source: www.newhair.com)
Result punch
This method was developed later.

While the extraction method remained unchanged the restoration method had undergone some progress. After extracting little hairy parts of the scalp the harvested skin was dissected into mini-/micro-grafts with medium sized tissues of 4-8 follicular units and small-sized tissues of 1-4 follicular units.

Nowadays this method is rarely used since there are still clinics performing this old-fashioned method as may be seen in Germany.