FUT hair transplant: how the strip method works, its scar and how it compares with FUE

What is FUT, or strip hair transplantation?

The abbreviation refers to follicular unit transplantation. Follicular units are the small groups in which hairs grow out of the skin, most often in ones, twos, threes or fours. You will also see the procedure called FUSS, for follicular unit strip surgery, or simply strip surgery.

The underlying idea is shared by every hair transplant. In the horseshoe of hair that runs round the nape and up above the ears, known to surgeons as the safe donor area, follicles remain unaffected by the androgenic factors that drive miniaturisation, and they keep that property once moved to the crown or hairline (Garg & Garg, 2021).

What sets FUT apart is the way the hair is harvested. An ellipse of hair-bearing skin is excised in one piece, the wound is closed with sutures or staples, and every unit inside the strip is then separated and used (Keene et al., 2024).

How an FUT procedure works, step by step

The operation is done under local anaesthetic. Once the donor area has been marked, the surgeon cuts a horizontal strip in the occipital region, following the angle of the follicles to avoid cutting through them, and lifts it away. The width of that strip, measured from top to bottom, sets both the number of grafts available and the width of the future scar.

Closing the wound calls for as much care as removing the strip. A suture pulled too tight increases tension on the wound edges, which encourages the scar to widen and, when the tension becomes excessive, can compromise the skin to the point of necrosis (Kerure & Patwardhan, 2018). A trichophytic closure improves the look of the line: on one edge of the wound or on both, the surgeon trims a shallow ledge 1 to 2 mm wide, thin enough to spare the follicles beneath, and the hairs kept in this way later grow up through the scar and make it harder to see (Nirmal et al., 2013).

Meanwhile, a team works on the harvested strip. It slices the band into thin sections, then isolates each follicular unit under magnification while trimming away excess tissue, which makes it possible to follow the axis of every follicle along its full length. The sorted grafts are kept chilled until they are implanted.

The surgeon then opens small incisions across the recipient area, setting the angle, direction and density according to the hairline or the zone to be covered, and the grafts are placed one by one. This final stage resembles that of a standard FUE, since only the way the follicles are collected differs.

The linear scar: what decides how wide it is?

A strip always leaves a horizontal scar at the back of the head. Covered by medium-length hair, it usually goes unnoticed; with a very short cut or a clipper, it shows. That is why Garg and Garg (2021) steer patients who want to keep their hair short towards FUE.

Its width depends first on the width of the strip that was taken. Nirmal et al. (2013) used a dermatoscope to measure the scar of 30 patients three months after surgery with strips 10 to 15 mm wide. Strips of 10 to 12 mm had left scars of 3 to 5 mm, strips of 13 to 15 mm scars of 5 to 10 mm, and patient satisfaction fell as the strips got wider. The best scores went to strips under 1.3 cm and to double trichophytic closures, performed on both edges of the wound.

The patient’s own skin also plays its part. A tight scalp with little laxity is more likely to produce a wide scar, as is a history of hypertrophic or keloid scarring, and Garg and Garg (2021) consider FUE preferable in both situations.

Some clinics advertise an FUT scar “under a millimetre” wide, whereas the finest scar measured in the series by Nirmal et al. was 3 mm at three months. The width you end up with depends on how wide the strip is, the laxity of your skin and the way you heal, all points worth clarifying before you decide. How both kinds of mark change over the months is tracked in our hair transplant scars article.

Recovery: what changes between strip surgery and FUE

After FUT, the back of the head carries a suture line that pulls during the first few days. Kerure and Patwardhan (2018) list a wide strip, wound tension, bleeding and large sessions under inadequate anaesthesia among the factors behind pain, which is generally controlled by careful technique and painkillers. The stitches or staples come out when the surgeon decides, but the scar takes weeks, sometimes months, to mature: according to the same authors, bending the neck again without following the advice given puts the scar under tension and can widen it.

Sensation in the area can change as well. An incision cut too deep can sever branches of the occipital nerves and leave hypoaesthesia, meaning reduced sensation to touch in the area those nerves supply; abnormal nerve healing can keep up a heightened sensitivity, or even give rise to a neuroma, a small nodule that is tender to the touch (Kerure & Patwardhan, 2018). These authors also list numbness and persistent pain among the possible complications of FUE, so the risk applies to both methods.

Other effects are specific to the donor area. Temporary shedding above and below the incision, known as donor effluvium, can appear and almost always recovers within three to four months (Kerure & Patwardhan, 2018). In the series by Nirmal et al. (2013), the most frequent complication was a folliculitis-like eruption in 16 of 30 patients, with few lesions that caused pain or itching in only three of them. Infections are rare after hair transplantation, below 1% according to Kerure and Patwardhan, but a very tight donor closure raises the risk.

Garg and Garg (2021) recommend FUE for people who cope poorly with pain or need to get back to work quickly. Whatever the technique, pain that builds over the following days, a wound that opens, a discharge of pus, spreading redness or a fever mean you should contact the team without delay.

FUT or FUE: what do comparative studies show?

Gupta, Love and Harris (2020) set the two methods side by side using the available literature. They conclude that FUE and FUT both produce high-quality grafts and are equally effective at doing so, and that the main difference lies in the type of scarring left on the donor area. They also describe groups of patients suited to one technique, the other or both, which rules out a single verdict for everyone.

A Brazilian team compared the grafts of patients operated on first with a strip and then with FUE during a second procedure, in the same clinic and with the same surgical team (Takata Pontes et al., 2024). Units harvested by FUE more often held three hairs or more, and the ratio of hairs to units was higher. The authors put this down to selection, since with FUE the surgeon picks the fullest units whereas a strip delivers whatever it contains; even so, they decline to name one method as superior, because the right indication depends on several factors.

FUE has its own constraints. It requires the donor area to be shaved, unless an unshaven variant is used, and it leads to more transected follicles in very curly hair, two cases in which Garg and Garg (2021) do not regard it as the preferred method. It marks the skin too, with small white macules at the extraction points: when the harvest is well performed, most cannot be made out by eye, but a very close crop can reveal them at short range, particularly on olive to dark skin (Kerure & Patwardhan, 2018).

The steps, duration and recovery of that procedure are laid out one by one in our FUE hair transplant guide. Whichever harvesting method is used, the grafts come from the same donor area and keep the same resistance to balding once implanted.

Donor area: which method uses your supply more sparingly?

The donor area is a finite supply, and the two methods draw on it in different ways. A strip removes an area of skin whose units are all transplanted, leaving a hairless scar line bordered by zones that have not been harvested. FUE spreads its extractions over a wider surface, leaving part of the units in place around each extraction point.

That spread has a ceiling. Kerure and Patwardhan (2018) advise against extracting more than one follicular unit in four within the safe zone, because overharvesting can thin the donor area for good, to the point of leaving permanent patchy loss. Keene et al. (2024) draw an argument for the strip from this: since FUE can only take a fraction of the units before thinning becomes visible, its cumulative lifetime yield remains limited in patients with advanced hair loss. These authors advocate combining both methods in the same patient, while acknowledging that experience with their own combined technique is still limited.

These considerations matter most if your hair loss is progressing. A first strip does not rule out a later procedure: when a new strip is impossible or declined, FUE can take over, unless the donor area is extensively scarred (Garg & Garg, 2021). How this supply is judged is set out in our piece on assessing the donor area, while a separate article on the second hair transplant explains when another session is justified.

Who might FUT still suit?

The choice of technique comes after the question of whether a transplant is appropriate at all. Garg and Garg (2021) point out that hair loss still evolving in a young patient calls for medical treatment first, that the cause of diffuse loss without a defined pattern should be treated before any surgery, and that a very bald patient expecting a full head of hair, with no donor supply available beyond the scalp, is not a candidate. Once the indication is confirmed, several criteria point towards one method or the other.

Your situation	Method to favour
Hair worn very short	FUE
Tight scalp	FUE
History of keloids	FUE
Need to return to work fast	FUE
Past FUT, no second strip	FUE takes over
Won’t shave donor area (women)	Strip or unshaven FUE
Very curly hair	Strip, to be discussed
Very extensive hair loss	Both combined, to be discussed

Garg and Garg (2021) underpin these pointers, apart from combining both methods for very extensive hair loss, which is the position of Keene et al. (2024). FUT therefore remains under discussion in three cases: a woman who does not want her donor area shaved, very curly hair whose unit-by-unit extraction transects too many follicles, and advanced hair loss where every unit counts over the long term. Our article on a Norwood 7 hair transplant shows how a limited supply is shared out once hair loss reaches that stage.

Between these extremes, some patients are suited to both techniques, as Gupta et al. (2020) underline. The choice then comes down to the haircut you intend to wear, the recovery you are willing to go through and what your donor area will still need to supply in ten or fifteen years.

Already had FUT: how can the scar be made less visible?

An old strip scar can be made less noticeable in two ways. The first is to implant grafts harvested by FUE into the scar itself; what makes grafting into scar tissue succeed is the subject of our page on hair transplant into scar tissue.

The second is scalp micropigmentation, which recreates the look of a closely clipped scalp with fine dots of pigment and blurs the line under a short cut; Body Expert offers it as a scar camouflage package that covers FUT scars. Choosing between the two depends on the width of the scar, the quality of the skin and the donor supply still available, which a review of your photos helps to establish.

FUE, Sapphire FUE or DHI: how the technique is chosen at Body Expert

Our partner clinic in Istanbul performs three techniques: classic FUE, Sapphire FUE, whose sapphire blades open the implantation channels, and DHI, which places the grafts with a Choi implanter pen. The choice between them depends on the stage of hair loss, the area to be covered, the hair type and the density sought; our DHI vs FUE comparison explains how they differ at the implantation stage.

If your profile matches one of the cases where strip surgery would be discussed, raise it as soon as your photos reach us: reviewing them tells us what our partner clinic can achieve with FUE or DHI in your case. The treatment plan you then receive sets out the recommended technique and the estimated number of grafts, alongside a free quote within 24 hours, with no obligation. The package places no limit on the number of grafts; your donor area is what decides how much can reasonably be harvested, now and in any second session.

While you are in Istanbul, a dedicated English-speaking patient coordinator looks after you throughout, your nights are booked in a 5-star hotel with breakfast, and VIP transfers cover every trip between the airport, the hotel and the clinic; flights remain outside the package. Our 12-month post-operative follow-up, carried out remotely, covers the healing of the donor area and then the whole regrowth phase. To follow the stay day by day, from arrival to departure, see our hair transplant in Istanbul offer.

Sources

Garg, A., & Garg, S. (2021). Overview of follicular extraction. Indian Journal of Plastic Surgery, 54(4), 456-462. https://doi.org/10.1055/s-0041-1739244

Gupta, A. K., Love, R. P., & Harris, J. A. (2020). Old friend or new ally: A comparison of follicular unit transplantation and follicular unit excision methods in hair transplantation. Dermatologic Surgery, 46(8), 1078-1083. https://doi.org/10.1097/DSS.0000000000002373

Keene, S. A., Susacasa, A., Miranda, P., & Radwanski, H. (2024). Follicular unit excision-linear ellipse donor harvesting technique: Combining standard follicular unit excision with follicular unit excision inside a linear strip (modified linear strip excision) to optimize graft yield. Facial Plastic Surgery, 40(2), 205-213. https://doi.org/10.1055/a-2198-2703

Kerure, A. S., & Patwardhan, N. (2018). Complications in hair transplantation. Journal of Cutaneous and Aesthetic Surgery, 11(4), 182-189. https://doi.org/10.4103/JCAS.JCAS_125_18

Nirmal, B., Somiah, S., & Sacchidanand, S. A. (2013). A study of donor area in follicular unit hair transplantation. Journal of Cutaneous and Aesthetic Surgery, 6(4), 210-213. https://doi.org/10.4103/0974-2077.123408

Takata Pontes, L., Ruston, A., & de Moraes, A. M. (2024). Strip harvesting follicular unit transplantation versus follicular unit excision: Comparing the number of hairs and the ratio of hairs to follicular unit. Dermatologic Surgery, 50(9), 851-854. https://doi.org/10.1097/DSS.0000000000004230