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Follicular Unit Transplantation (FUT) stands as a cornerstone in combating thinning hair or baldness. FUT, just like PRP Injection, stands as a viable solution for addressing various types of hair loss in both men and women, including those stemming from sports injuries, receding hairlines, alopecia areata, and androgenetic alopecia, offering effective healing process, minimal side effects and lasting results.

In FUT procedures, hair is meticulously extracted from the donor area in a single strip and then meticulously divided into grafts under a high-powered microscope. These grafts are strategically placed within tiny micro-incisions, meticulously designed to mimic natural hair growth patterns. While FUT originally encompassed any procedure yielding 1- to 3-hair grafts (follicular unit grafts), it now specifically denotes a hair transplantation method utilizing the strip harvesting technique to obtain these grafts. When we mention FUT in this segment, we are explicitly referring to follicular unit “strip” surgery.

For the past 25 years, FUT has stood as the gold standard of hair transplantation. It remains the most dependable technique for achieving naturalness and maximum density in the recipient area. Typically, the linear scar resulting from the strip incision is exceptionally fine and often inconspicuous, even when the hair is trimmed as short as 1 cm in length. Many patients opt for this method due to its extensive track record of consistently yielding a high number of grafts with exceptional survivability.

While both FUE and FUT can yield outstanding results, in some cases where patients require a higher number of grafts to address various types of hair loss including losing hair, female pattern baldness, male pattern baldness, receding hairlines, Platelet-Rich Plasma (PRP) treatment and a combination of both FUT and FUE techniques is employed to obtain more grafts than either technique can accomplish individually.


Meeting a patient’s expectations of both naturalness and density are the two most important goals in hair restoration surgery. The strip FUT procedure involves four main steps: donor harvesting, graft preparation, recipient site creation, and graft placement. Each step is an integral link in the chain that creates a successful hair transplant.

FUT image10-20a
1. Donor Harvesting
FUT image7-17
2. Graft Preparation
FUT image8-18
3. Recipient Site Creation
FUT image9-19
4. Grafts Placement


The initial phase of the procedure involves delicately removing the donor strip from the recipient site, ensuring minimal damage to the donor hairs and reducing scarring in the donor area post-suturing. The process begins with identifying the safe donor area, which comprises hair that is resistant to loss. Prior to strip removal, the hair at the site is carefully trimmed, a practice upheld at Shapiro Medical Group for several reasons:

  1. Maintains alignment with the hair’s natural angle during incision.
  2. Facilitates graft handling during placement.
  3. Provides a clearer preview of the transplant’s progress, aiding in fine-tuning for optimal results.

Choosing Safe Donor Area

Choosing safe donor area wet hair to reveal risk area
Wet Hair to Reveal Risk Area

Leave Donor Hair Long

leave donor hair long
Helps with Placing

Before extraction, the physician assesses donor area density using digital technology and specialized software, alongside evaluating scalp laxity to determine the safe amount of tissue to remove without causing tension or scarring. Patients are also instructed to perform scalp stretching exercises beforehand to maximize laxity. Additionally, we administer Vitrase medication to enhance scalp laxity and minimize scarring risk.

Check Donor Laxity

check donor laxity
1-2cm Depending on Laxity

Measure Donor Density

measure donor density 1cm circle
1cm Circle

Utilizing 5.0 power surgical loops magnifies the tissue removal area, enabling precise alignment with hair angles to prevent damage. Following strip removal, the donor site is meticulously sutured with a trichophytic closure technique, which promotes scar camouflage by allowing hair growth through the scar tissue.

donor strip removed follow angle of hair
DONOR STRIP REMOVED Follow angle of hair
donor sutured trichophytic
DONOR SUTURED Trichophytic
donor sutured incision hard to see
DONOR SUTURED Incision hard to see


Once the strip is removed, it is dissected down into individual 1- to 4-hair follicular unit grafts.

Donor Strip is Cut into “Thin Slivers” with a Microscope

donor strip is cut inot thin slivers with a microscope
FUT image20-32d

The first step in graft preparation is to sliver the donor tissue under a microscope into thin sections only 1 to 2 hairs wide. With the use of a high-powered microscope, the tissue can be converted into these thin slivers with almost no trauma or transection. Next, the slivers are cut down into the individual 1- to 4-hair follicular unit grafts and trimmed of as much excess tissue as safely possible. This trimming creates the smallest possible graft that enables the physician to use the smallest possible incision, resulting in less trauma and better graft survival. During this time, the grafts must remain hydrated and cooled. At SMG, we use a special holding solution called Hypothermasol that has antioxidants, buffers and nutrients to help maximize survival at cooler temperatures.


While the grafts are being prepared, the physician will create the recipient sites by first planning the best pattern and distribution of grafts. This plan is created by evaluating the patient’s donor supply, balding area and expectations. The physician then makes thousands of tiny incisions in a way that will ensure maximum survival of the grafts, minimal trauma to pre-existing hair, and the proper exit angle and direction of the grafts. At SMG, a number of tools are used to accomplish this goal:

  1. Custom-cut blades that can be matched perfectly to the size of the graft.
  2. Separation of the 1- to 4-hair grafts so they can be selectively distributed to create more specific density, gradients and natural patterns. The 1-hair grafts are placed in the front for naturalness, and the 3-hair grafts in the center for density.
  3. True Surgical Loop Magnification to find the space between existing hairs.
  4. Following the natural angle and direction of hair to mimic natural patterns.
  5. Both coronal (lateral) or sagittal incisions, depending on the characteristics of each patient.
  6. Incision densities ranging from 25 to 50+.
  7. Sessions ranging from as small as 500 (e.g. eyebrows) to as large as 4,500.
custom blades are matched to graft size
Custom blades are matched to Graft Size
incisions made in patter that mimics nature
Incisions made in pattern that mimics nature
follow normal angle and direction of hair
Follow normal angle and direction of hair
go in between existing hair to limit trauma
Go in between existing hair to limit trauma


Incorrect placement may result in trauma and reduced graft survival rates. Several methods aid in the placement process:

  • Utilization of true surgical magnification to enhance visibility of the recipient sites.
  • Use of fingertip cups to securely hold the grafts during placement, preventing dehydration.
  • Application of specialized forceps designed for precise graft placement.
  • Employing the technique of ‘gentle placement’ to ensure minimal trauma during graft insertion
grafts are placed gently
Grafts are Placed Gently
use magnification
Use Magnification



The primary advantage of strip FUT lies in its extensive 25-year history, consistently delivering superior density and coverage. Over a patient’s lifetime, strip FUT typically yields a larger number of grafts compared to exclusive FUE procedures. Additionally, FUT grafts often exhibit slightly better survival rates due to their fuller structure with more protective tissue. Nonetheless, advancements in FUE techniques, such as the Hybrid Blunt Punch and Oscillation System, have led to the production of grafts similar in size to those obtained through FUT.


In contrast to FUE, which extracts individual hair follicles, FUT involves excising a strip of skin from the back or side of the head and utilizing the contained hair follicles as grafts. Consequently, the main drawback of strip FUT is the potential for a wider linear scar and an extended healing period. While most FUT scars are minimal and inconspicuous, shorter hair lengths may result in increased visibility of the scar.

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