Follicular Unit Transplant (FUT)

Follicular unit extraction (FUE) has become today’s hair restoration standard, but it isn’t the only option available to men and women seeking a way to address their thinning hair and hair loss. If you’re considering treatment, you may have heard of other options available to you, including follicular unit transplant (FUT), which we perform in Palo Alto and San Jose for San Francisco Bay Area patients. You understandably want to choose the best when it comes to your unique hair transplant. Hair experts Dr. David M. Lieberman and Dr. Sachin S. Parikh know this, which is why they stay up to date on the latest, cutting-edge research and developments, while also drawing on a long history of successful techniques and progress.

Many cases of hair loss can be handled by moving healthy, bald-resistant follicles from an area where they grow in abundance to the areas where they are needed to hide an increasingly visible scalp. For this reason, it’s a good idea to focus on the two main procedures used by doctors today: the highly advanced FUE method and its predecessor, strip excision FUT.

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FUT: A Bit of Hair History

Before comparing strip-excision FUT and FUE, let’s explore the recent history of hair transplant possibilities.

Just a couple of decades ago, the go-to procedure for hair transplant patients was known as mini-micrografting, more commonly referred to as “hair plugs.” While this method effectively allowed a doctor to move healthy hair from the patient’s donor site to the recipient site, the grafts were large chunks that often created an appearance of tufts made up of a dozen or more hairs, each sprouting from dimples in the skin.

FUT represented a huge step forward beyond plugs, in that it allowed doctors to take a much closer look at the scalp in question and work with decidedly smaller groupings of hairs, known as follicular units. FUT also allowed the doctor to maximize hair graft survival because it keeps the parts of the hair vital to its growth intact.

The FUT graft collection method further sets it apart from the hair transplant options that came before. It involves the doctor taking a long, thin strip of scalp from the back or side of the head, where hair is most resistant to baldness. The grafts, made up of follicular units with one to four hairs each, are separated and then surgically placed onto bare scalp in configurations to mimic natural growth.

FUT remained the most advanced hair transplant method until the development of follicular unit extraction, which improved the harvesting process by changing the donor site from a single strip to individual follicular units spread across the area. Because the follicles are being removed one at a time, removing an entire strip of scalp is not necessary with this technique, and therefore the linear scar can be avoided.

Comparing FUT and FUE

  • Collection

As noted above and elsewhere on this site, the follicular unit collection process is what sets the most advanced hair transplant techniques apart from the rest. FUT requires the surgical removal of an entire strip of hair-bearing skin, typically with a scalpel. FUT allows for the collection and transplantation of a large number of units at the same time, up to 5,000 in optimal conditions, which is typically more than is done in a single follicular unit extraction session

FUE involves taking individual units for grafts, one at a time. This extraction can be done manually, or with a device known as NeoGraft®, which is an automated system that improves speed and precision. The transplantation process can involve up to 3,000 grafts.

Also note that the strip-removal method preserves a good deal of tissue, so many follicular units remain surrounded by protective tissue, which is good for viability. Units individually removed from the scalp have less of the protection offered by surrounding fat and other tissue, but the focused cylindrical punches used for extraction slide each follicle out without transecting it, keeping the follicles intact and healthy. When using the best available techniques, graft survival is high during both FUT and FUE cases. NeoGraft® allows our center to maximize follicle survival during extraction and hair transplantation, and therefore produce robust hair restoration results without having to cut out a section of the patient’s scalp.

  • Extraction Scarring

Strip excision FUT requires stitches and leaves a long, thin scar on the back or side of the head where the follicle-filled tissue was removed in a straight line. Advances in medical technology have improved this aspect of FUT over the years, minimizing the visible line.

Today’s FUT recipients will generally find that they have a scar that’s thinner and less obtrusive than the surgery created for patients in previous years, though they will have a scar. Patients who choose FUT often wear their hair in such a way as to cover the line.

Since the more recent and advanced extraction method removes individual grafts, there’s no linear scar. Each excision will leave a tiny puncture mark. These circular marks are very small and will be distributed around the donor site with no discernible pattern to catch the eye. Even short hair will likely be enough to cover these marks if they are present. Unlike FUT, extraction requires no stitches, so there are no suture-related complications.

  • Recovery

Due to the nature of the hair transplant healing process, which can be impacted by the tightness of the scalp and other factors, recovery after an FUT procedure can be painful or include decreased sensation in the area that underwent surgery. Strip excision (FUT) stitches require the same care and attention as would stiches from any surgical procedure. Since FUE involves no incisions or stitches, the healing time is much shorter than the alternative. Our patients describe less discomfort after FUE compared to the traditional strip method

  • Cost

Strip excision FUT is generally a less expensive option than follicular unit extraction, especially since the amount of work that can be done in one FUT session may require two comparable follicular unit extraction sessions. Overall cost, no matter which procedure is chosen, depends on each individual patient’s unique degree and pattern of hair loss, as well as the desired final outcome.

Why Two Surgeons Are Better Than One

“We use each other as a sounding board in every procedure which creates a confidence level that every step is the best possible decision for the patient.”

More to Know: Beyond FUT and Follicular Unit Extraction in the Bay Area

Before making the decision about FUT versus FUE or any other hair transplant method, it’s imperative to determine the cause and degree of hair loss. Transplantations work well to cover areas thinned and made bare by male or female pattern baldness, but you may ultimately find that your particular condition can be remedied by a medication or change in diet. Your hair loss may even be temporary due to some sort of trauma or stress, so there would be no need to intervene surgically.

The team at L&P Aesthetics Center for Hair Restoration will work to determine the root cause of your hair loss and create a plan that will deliver the best results tailored to you, whether that’s non-surgical, FUT, or follicular unit extraction using FUE.