Patients interested in undergoing a FUT strip hair transplant (follicular unit transplant) have many questions including how it is performed, how long is the recovery time and are there advantages or disadvantages of having this more traditional method of hair transplant as opposed to FUE. Below are some of the most frequently asked questions concerning FUT:
How does FUT work?
Follicular unit transplantation, or strip FUT, is performed to transplant follicular units into balding areas of the scalp. FUT differs from FUE in that a strip of scalp skin is removed from the posterior scalp also known as the permanent zone. The size of the horizontal linear strip varies based on the number of grafts needed.
In the case where only 1000 grafts are needed, the width and length will be small. However, in a mega session where 3000 plus grafts are required, the maximum width and length might be reached depending on the density of hair within the permanent zone strip. Due to issues of scalp laxity and wound closure, a maximum width of 18 mm can be safely removed in most patients.
Once the strip is removed, the wound is closed in two layers with dissolvable internal sutures followed by external staples or sutures. The strip is then processed and meticulously cut into natural groupings consisting of follicular units of 1 to 4 hairs. This preservation of the natural grouping maintains their anatomical structure and allows for a realistic post-transplant look.
Who are ideal FUT candidates?
Patients who do not plan to wear their hair in a short style are ideal candidates for FUT as the inevitable linear scar in the posterior aspect of the scalp will be camouflaged/hidden by longer stands of your own native hair.
How many grafts are needed?
The number of grafts needed depends on the area of scalp to be covered as well as the desired hair density. The approximate number of grafts will be determined at the initial consultation appointment.
How long do FUT results last?
The results from an FUT transplant procedure should last a lifetime as FUT uses your own hair from the permanent zone. There may be some natural thinning of the donor permanent zone as you get older but, since this is your own transplanted hair, it will likely be susceptible to this same process. Hormonal changes impact hair that is prone to balding but this should not affect the transplanted hair.
How long does strip FUT surgery take?
Depending upon the number of grafts needed, the procedure time could span 6 to 10 hours. Both FUT and FUE are an individual hair transplant process so the total surgical time can vary.
What is the recovery time after FUT?
The linear scar where the donor hair was removed can vary in length depending on the number of grafts required and the density of hair within the strip. The length of time needed to heal your surgical wound varies from individual to individual. On average, your surgical wound will close by 7 to 10 days. Typically, staples are used for closure and they will be removed in our office at, or around, 10 days. As for the recipient site, there will be tiny crusts associated with the new hair grafts that may be visible for up to a week. The appearance of the recipient site is the same as what is seen after an FUE procedure.
We encourage patients to wash their hair twice a day for the first 4 days to lightly remove the crusts. Afterwards, shampoo as you normally would. If the crusts persist after the first 5 days, allow the shampoo foam to sit on the recipient site for up to 15 minutes to help facilitate removal of the scabs.
By the 4th day, patients are out and about but are told to be careful regarding hyperflexing or bending their neck as the surgical wound has not completely healed. They also should avoid exercises that increase the tension around the donor wound for a month. In terms of the long range recovery period, please view the timeline of what to expect after a FUT – strip transplant.
Do FUT results look natural?
Overall, the final results of transplanted hair should look natural in appearance to the point that others will not be able to discern if a transplant was performed. See results on our before and after gallery page.
How much does FUT cost?
The cost of an FUT procedure varies among patients. Before determining the final cost of surgery, a complete examination of your scalp and hair will be performed by a hair restoration surgeon. The price of surgery depends on the number of grafts needed and the desired density to achieve your goal. When comparing the price of FUT verses FUE, the total cost for FUT might be slightly less. Visit our hair transplant cost page to learn more about the cost of the procedures.
What are the advantages and disadvantages of FUT?
The main advantages of FUT include:
- Larger number of follicular units can be transplanted during one session as opposed to FUE
- Less cost to the patient
The main disadvantages of FUT include:
- Horizontal scar on the donor posterior scalp
- Slightly longer recovery time
- Increased chance of donor wound complications
- Greater pain and discomfort after hair transplant
Read more about FUE vs Strip Hair Transplant to learn about the advantages and disadvantages of the procedures.
Is FUT painful?
Just prior to the start of surgery, patients are given a sedative which is followed by lidocaine/bupivacaine local injections periodically throughout the day. In general, there is minimal to no pain during the actual procedure. Patients may experience some pain and discomfort after the procedure. Although the pain is more intense after a strip FUT procedure, the symptoms are self-limiting and should resolve within several days. We will provide pain medication after the procedure to cover any residual pain.
What are the risks and complications of FUT?
There are a few complications associated with strip FUT including:
FUT differs from FUE in that there may be a greater risk of numbness, hypertrophic scarring or widening of the scar. The number one issue that patients may report is a tightening of the scalp in the back of the head. The tightening can be alleviated if patients perform a scalp exercise 10 times a day for a month prior to surgery.
One other risk common to both FUT and FUE hair transplants is “shock loss”. This loss of hair after surgery can be reduced if patients use finasteride for 6 months after surgery. A more in-depth look at possible complications can be found on our hair transplant complications page.
Will new hair grow right away?
Once the new grafts are transplanted, the recipient site will actually resemble hair stubble. The transplanted hairs will slowly grow for a period of a month before entering the resting or telogen phase during which the hair will fall out. Within the next 2 months, the transplanted hair shafts will once again regrow new hair as they enter their growth or anagen phase.
When will the final results be visible?
The new hair will start to appear as fine, thin hair once it enters the growth phase 2 or 3 months after the hair transplant. Over the course of the next several months, the hair will become thicker and longer. After 10 to 12 months, coarse hair will be noticeable and the final results can be expected after 8 to12 months.
What else to know about after FUT?
We supply our patients with a “post-op goody bag” containing all of the necessary items needed for a smooth post-transplant recovery. The bag includes the following items:
- Special shampoo to wash newly transplanted hair
- Sponge/brush used for twice daily hair washing
- Neck pillow to help better position your head at night and minimize damage to your newly transplanted hair
- Medications including pain relievers, sleep aid, and a med to minimize swelling after the procedure
- Disposable sheets to help keep your pillow tidy after hair transplant
- Hat to shield your head from the elements when you leave our office
- Post-op documents including a post-procedure hair care guide, hair wash instructions and a list of your upcoming follow up appointments
- What happens the day after my surgery?
Patients are asked to return to our office the day after their surgery for their first hair wash. During this visit, we perform and instruct patients on the proper hair wash technique and answer any questions about post-procedure care. After the hair wash, the donor and recipient sites are examined by the physician and any thick crusts are removed.
Patients should sleep at a 45-degree angle to reduce the incidence of swelling as well as use a neck pillow while sleeping to prevent any rubbing or movement of the grafts. Special attention must be paid to the posterior scalp surgical scar to avoid excess crust/scab buildup. Avoid bending or any hyperflexion of the neck while the wound is healing so that it does not dehisce (reopen).
After the 4th day, patients can resume their normal daily activities but should avoid strenuous work or exercise for at least 7 days. Patients need to avoid direct sunlight on the scalp for 6 months. Use protective outerwear such as a hat and/or apply SPF 30 sunblock to avoid sunburn on the scalp. If staples are used for donor wound closure, they will be removed in the office around day 10.
Is FUT the right choice for me?
The final decision to have FUT or FUE depends on your hair restoration goals. If you are interested in restoring your hairline or covering a large balding area on the top and crown in only one session, an FUT hair transplant is something to consider. FUT is an excellent choice for providing a large number of grafts to cover bigger areas of the scalp in only one session.
The residual scar is the other important factor to consider. If you do not plan to ever cut your hair short in the posterior donor area, a linear strip scar will always be covered with your own natural hair. In order to make an informed decision about having a hair transplant, we have compiled a guide outlining the key features of FUE vs. FUT procedures.
Is there a need for follow-up or revision FUT?
Patients can progress to a higher Norwood class of hair loss as they get older. In these cases, some people might undergo a second hair transplant in order to cover a new or enlarging area of balding. The hairs that were previously transplanted will not be lost as they were removed from the permanent zone and transplanted into the area of balding. They are considered permanent hair but they are just in a different location. The chances of needing to undergo a revision, however small, may occur if the proper hair washing technique is not followed or excessive manipulation of the scalp occurs within the first 4 days/nights while sleeping.
If I had a strip procedure in the past, do I have to proceed with FUT for my next hair transplant?
When considering a second hair transplant after a previous FUT strip procedure, you have the choice of proceeding with either FUE or FUT. If you had a strip FUT in the past, you already have a scar in your donor area which means you cannot take advantage of scar-free FUE procedures. Your next FUT should not give you a double scar and it should be done through the same area of the scar that you already have. Some patients consider FUE after a previous FUT simply to minimize the pain and discomfort after a traditional strip procedure.
Can I fix my FUT donor scar in the future?
Although we cannot eliminate the scar from a FUT procedure, there are many ways to improve the visibility of the scar. The FUT scar could be repaired through simple scar revision, FUT transplantation into the scar or by other cosmetic procedures such as camouflaging the scar through Scalp Micro Pigmentation (SMP).