Hair Transplants: Follicular Unit Transplantation (FUT) Explained

What is FUT?

Hair transplant surgeryAlso known as ‘strip surgery’, FUT stands for Follicular Unit Transplantation and is a type of surgical hair transplant known for minimizing trauma to the scalp and producing natural-looking results.

In FUT operations, ‘follicular units’ made up of naturally occurring groups of one-to-four hairs, sebaceous (oil) glands, nerves, a small muscle, and occasionally fine vellus hairs, are transplanted. Preserving the unit as a whole in this way is thought to help hair growth once transplanted.

Modern Follicular Unit Transportation is considered an advance on older hair transplant techniques which used larger grafts, and often gave obvious and ‘pluggy’-looking results. Transplanting the smaller units used in FUT allows thousands of grafts to be transplanted in a single session, resulting in a more natural-looking effect for the patient. If done well, the new grafts should mimic normal hair growth patterns and be virtually undetectable.

How is FUT different from standard Follicular Unit Extraction (FUE)?

The difference between Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) revolves around the way in which the donor hair that is used for the transplant, is taken.

For FUT, hair from the back of the scalp is harvested in a single, thin strip. It is then trimmed into individual follicular units under microscopes, with each unit measuring around 1mm in width. Assuming there is an adequate supply of donor hair available from the patient, up to 3,000 grafts can be transplanted at one time, yielding 100 hairs per square centimetre. However, this method requires a longer healing time after surgery and leaves a large scar across the scalp, though this can be hidden by longer hair.

Alternatively, FUE uses a robotic ‘punch’ device to remove the follicular units directly from the back and sides of the scalp. This specialised punch allows hair to be removed directly from the skin without causing damage, so it is a non-invasive procedure. This means the scalp will heal faster and patients often show no visible signs of having had a hair transplant, just ten days after surgery.

The surgical procedure

James Nesbitt before and after his FUT hair transplant

Actor, James Nesbitt before and after his FUT hair transplant

Because each follicular unit is generally of a similar size, it makes them more straightforward for the surgeon to work with. This is particularly useful in the planning stages and helping to work out the precise number of grafts that can be carried out.

For a hair transplant to look as natural as possible, the implanted hairs must emerge from ‘normal’ skin. In order to cause the least amount of trauma to the skin on the patient’s head, excess tissues of non-hair bearing skin are first trimmed from around the small follicular units.

The surgeon then inserts them into tiny, needle-made incisions in the patient’s scalp, whereby any damage to the connective tissue and blood supply is minimised, and the units fit snugly. This also provides a degree of control over the direction in which the hair will grow.

By using this FUT technique, some of the cosmetic issues with old-fashioned hair transplant methods, such as dimpling and pigment changes in the skin, graft depression or elevation, and a shiny looking scalp, can be avoided. The combination of making tiny incisions along with transplanting small, specially trimmed follicular units, preserves the elasticity of the scalp whilst keeping the grafts firmly in place.

Additionally, whilst the healing process is longer for FUT patients than those who opt for FUE procedures, the snug fit of these units facilitates healing as it ensures the grafts receive enough oxygen from surrounding tissues.


Who is an ideal candidate for FUT?

Belgravia Male Pattern Hair Loss Client - Before and During Treatment

A Belgravia Male Pattern Hair Loss Patient Who Successfully Regrew His Hair Using Medically-Proven, Non-Invasive Hair Loss Treatments – Click the Image to See His ‘Hair Loss Success Story’

Our hair transplant partner, Dr. Bessam Farjo, says that: “Strip FUT is ideally suited to patients suffering from advanced hair loss, who require large amounts of restoration and high graft numbers”. 

Dr. Farjo always advises anyone considering this type of surgery first has a private consultation to ensure they fully understand the different types of hair transplants available and know which option is most likely to work for them.

According to the American Hair Loss Association, there are three main groups who make the best candidates for FUT hair replacement surgery.

These are:

  • Men who have been losing their hair due to male pattern baldness for more than five years, or whose condition is a Norwood Scale Class 3 or above
  • Men for whom medically-proven hair loss treatments may not work (this is usually due to the stage and pace of the hair loss when they first start treatment)
  • Men who have been balding for many years and whose hair loss has now stabilised
  • Men and women who have lost their hair due to trauma, burns or cosmetic procedures, such as facelifts

Surgeons are often reluctant to carry out FUT on men who are entirely bald. Strip surgery may not be possible for people using blood thinners including Plavix, Coumadin and Heparin. Also, anyone taking beta-blockers such as Inderal (Propranolol), may need to switch to a select beta-blocker medication before their FUT operation can take place. Your surgeon should run through all the medications and lifestyle changes that may be necessary ahead of any hair transplant operation, including temporarily stopping smoking and consuming alcohol.

Is FUT widely available?

Hair Transplant SurgeryMany hair transplant surgeons and specialist clinics now offer both FUE and FUT methods. A surgical hair transplant is a complex operation that should only ever be carried out by a skilled professional who specialises in this area.

You should research reputable surgeons and, ideally, meet with a few before choosing the one you trust and feel most comfortable with. The results you experience will be a direct reflection of the skill of the surgeon so it pays to take your time ensuring you get the right person for the job.

We refer patients who are interested in surgical hair restoration to our hair transplant partner, Dr. Bessam Farjo – mentioned above – who is a graduate of the Royal College of Surgeons in Ireland (RCSI), with an outstanding reputation as a hair loss surgeon, as well as being a highly respected professional within the hair loss industry.


The expert view

Belgravia trichologist, Leonora Doclis explains more about the process of Follicular Unit Transplantation:

FUT is the more commonly used method of transplant, whereby a strip of scalp in the back of the head is dissected. This strip is then divided into smaller units comprising one, two or three follicles, and then implanted into the thinning areas. The positioning of the units determines the aesthetic result of the hair transplant and the resulting hair growth should lean towards the natural direction of hair growth.”

Minoxidil DropperShe also counsels anyone considering a hair transplant to remember that surgery and hair loss treatments go hand-in-hand:

“Hair transplants are done to cover thin parts where the hair can no longer grow back through the use of pharmaceutical hair growth treatments. The transplanted hair grows naturally since it is not affected by DHT. However, the hair around the implants may still be susceptible to hereditary hair loss and can progressively thin. This is why, it is important that a comprehensive hair loss treatment programme is maintained after the procedure to sustain the hair around the implants.”

To see the types of results it is possible to achieve with effective non-surgical hair loss treatment programmes, view our extensive collection of photographic Hair Loss Success Stories, featuring ‘Before and During Treatment’ images and feedback from over 1,000 Belgravia patients.

Summary of the main advantages of FUT

  • Good for covering larger areas of baldness (a larger number of grafts can also help in combating any post-transplant shedding)
  • Quicker process with less trauma to the scalp
  • More natural looking results

Summary of the main disadvantages of FUT

  • Requires incisions into the scalp
  • A longer healing time is needed than with FUE
  • Will leave scarring across the scalp

Further information

If you would like to discuss your suitability for a hair loss treatment programme or hair transplant surgery, contact us to arrange your free consultation with one of our specialists. An examination will be carried out and you will be advised as to the best treatment options for your specific situation. To book an appointment at one of our Central London hair loss clinics, call 020 7730 6666 or send us a message. Alternatively, you can complete our Online Consultation Form if you are based outside London or the UK, and one of our advisors will contact you.