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:
Extraction by 4 mm punch:
The final result by using the punch-method
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.