Objective To improve survival rate of hair follicle after hair-bearing scalp minigrafting and to investigate the role of microsurgery in this procedure. Methods From 1990 to 2003, 156 cases suffered from male pattern baldness (MPB) and cicatrical baldness (CB) received hair-bearing scalp minigrafting. Moreover microsurgical technique was applied to this procedure. Among of them, the largest alopecia zone was about 12.5 cm ?15 cm. Results Survival rate of transplanted hair follicles was 95% (MPB) and 89% (CB) respectively. Baldness never occured in the former alopecia zone. Survival rate of transplanted hair follicles in CB was significantly higher than that of the former reports. There were 2 cases with abnormal figure of hair margin and 4 cases with unsatisfactory hair direction in hair grafted zone. Hematoma occurred in 2 patients who had no negative effects on hair follicle after hematoma were cleaned. The other cases all obtained satisfactory postoperative appearance. Conclusions Hair-bearing scalp minigrafting, combined with microsurgery technique, can improve survival rate of hair follicle after hair transplantation. Preoperative design, choice of indication and anesthesia, etc. are very important, too.