During a follicular unit transplant (FUT), a linear strip of hair bearing tissue is extracted from the donor region located on the back or side of the patient’s scalp. This strip is then dissected into thousands of tiny follicular units of hair using stereo-microscopic dissection. This dissection method allows naturally occurring follicular units to be separated under the microscope without damage, ensuring their survival.

This method is also known as FUT, linear or strip harvesting. Academically, the American Board of Hair Restoration Surgery (ABHRS), of which Dr. Lam was the president in 2021, recommends a more accurate term, linear strip excision (LSE), but unfortunately the general population remains unaware of this terminology. Accordingly, the procedure will be referred to as FUT, or strip FUT. The FUT method has been used to successfully transplant hairs for over 50 years and to this day, thousands of patients enjoy great results obtained from FUT procedure. However, when performed incorrectly, this method may leave a patient with unsightly scar, which explains the bad reputation strip donor harvesting endured in the last several years. Dr. Lam uses a combination of advanced techniques and technologies that allow for almost undetectable donor scars in most individuals.

With proper technique and attention to details, visible scarring is typically a thing of the past. An advanced wound closing (suturing) technique called trichophytic closure is used to minimize donor scars.

“Dr. Lam’s first volume of his hair transplant book series discusses his methodology in depth from beginning to end, focusing mainly only the strip procedure, whereas the new Volume 4 discusses FUE techniques.”

As seen in the illustration taken from Dr. Lam’s textbook, Hair Transplant 360, Volume 1 (2nd Edition), the small removal of the bottom edge of skin will allow the hairs to grow through the incision to make in many cases the incision virtually undetectable.

This illustration taken from Dr. Lam’s textbook on hair transplant shows how a trichophytic closure can help make a donor incision virtually undetectable by allowing hairs to grow through the scar.

This photo shows how donor strip harvesting can result in an almost invisible incision when done by experienced hands. Of course, there can be a slight widening but typically this is invisible with hair worn at a normal length.

Although the trichophytic closure is an important dimension to favorable donor healing, there is so much more. It begins with preparing the donor tissue in order to achieve minimal disturbance to the hair structures and maximum hair yield. It includes regenerative medicine treatment called platelet-rich plasma (PRP) that promotes healing and minimizes scarring. Finally, during the recovery period, a nutrient-rich growth factor is applied to the scalp containing liposomal ATP to optimize graft growth and survival.

Follicular unit extraction (more accurately follicular unit excision) (FUE) and FUT are both viable techniques for hair harvesting, and Dr. Lam is skilled at performing both procedures for you. Each method has its advantages and disadvantages, and Dr. Lam is skilled in all donor harvesting methods of hair transplantation so that he can tailor the best option for you. When compared to the FUE method, the main advantage of the strip method is that it can typically move substantially more hair without significantly thinning the “safe donor area (SDA).” The SDA refers to the area where hairs are not genetically programmed for hair loss and that will survive long term after a transplant. The FU-strip, or strip FUT, procedure offers an unparalleled number of hairs that can be moved in a single session while carefully preserving the donor hair. When someone has significant hair loss, especially from front to back, and does not wear his hair short, the FU-strip megasession may be ideal. After a consultation with Dr. Lam and his staff, you will have a better understanding of which procedure would be better suited for you.

The FU-strip procedure offers an unparalleled number of hairs that can be moved in a single session while carefully preserving the donor hair. When someone has significant hair loss, especially from front to back, and does not wear his hair short, the FU-strip megasession may be ideal. After a consultation with Dr. Lam and his staff, you will have a better understanding of which procedure would be better suited for you.

Dr. Lam believes that without the aid of meticulous graft dissection from a very experienced team, there is no way to perform this procedure in a reasonable timeframe with quality grafts. Dr. Lam’s team is very seasoned with over 20 plus years of experience so that such a large procedure can be performed in a day’s time. There are many factors that contribute to an overall good result and after a consultation with Dr. Lam and discussing with you the merits and suitability of each method, he will help you select the best technique for you.

Key Points

Who is the Ideal Candidate for Strip FUT?
Ideally, men who are uninterested in wearing their hair very short or who already have very long hair and do not want to shave their hair can be ideal candidates since with Strip FUT there is no shaving of the donor area. As mentioned, men with advanced baldness like a Norwood 6-7 are definitely better candidates with FUT over FUE because they do not have enough usable, safe grafts for FUE. Finally, in Dr. Lam’s opinion, almost all women benefit from FUT over FUE for many reasons including not needing to shave the head, the fact that they never wear their hair shorter, and also FUT does not reduce overall density, that is volume, in the back of the scalp.
What do you need to know to schedule a Strip FUT?
You should first have a consultation with Dr. Lam either by phone if you live far away or in person if you live close enough that would be feasible. If you are having a phone consultation, then high-resolution photographs from all standard angles, which Dr. Lam’s staff will explain to you, sent in in advance will help guide Dr. Lam’s judgment and advice in lieu of an initial in-person consultation. When you have decided to proceed with the transplant, if you are over 45 years of age or have a medical condition that needs to be evaluated, Dr. Lam’s team may recommend a medical clearance to make sure that you are safe to proceed. Schedule your procedure and plan on one week for recovery during which time can usually cover the small scabs with a hat after which time you may rub the remaining scabs away so that usually you are back to normal, that is, undetectable, after a week’s time in most cases. In rare cases, you may have unwanted swelling around your eyes for a few days up to a week but this is very uncommon today, as compared to about 10 years ago when it was much more common in Dr. Lam’s practice.

If you are not already on any hair-loss management therapy and you have miniaturized hairs, you may be recommended to start one or several treatments (such as finasteride [Propecia], minoxidil [Rogaine], Folliflo among other therapies) in preparation for the procedure. Depending on your unique situation, you may be asked to be on a hair-loss management treatment for anywhere between 4 to 6 weeks in order to strengthen your hair and minimize postoperative, temporary hair shock loss. Dr. Lam will guide you on these treatments whether they are necessary and as to the duration you should be on them prior to your surgery.

If you are from out of town, you will be required to arrive the day before the procedure and will be allowed to travel the day after, staying in town for a total of two nights. However, if you are not in town at three weeks after the procedure, you will need a professional to remove your sutures (stitches). Dr. Lam has many colleagues across the United States and the world who may be able to help remove your sutures.
What to expect after your FUT procedure with Dr. Lam
You may have visible scabs around transplanted hairs and swelling of your forehead and around the eyes that may last approximately a week.

You can wear a hat immediately after the procedure in most cases, and you can wash your hair 24 hours after and resume most physical activities 48 hours after. However, Dr. Lam recommends no exercise for a week, and to gradually return to exercise with two exceptions. He does not like swimming for 6 weeks if at all possible, and no direct contact sports for 2 to 3 months following the procedure. You can travel the next day. If you like to travel to another city, that is fine. However, do not engage in aggressive activity like hiking, and if you go to the beach, keep your head out of the water and keep your head protected from the sun with a hat.

You can wear hairstyling products 2 days after and color your hair 15 days after the procedure. Your stiches should be removed three weeks post-procedure, and we will help you schedule your appointment.

You may experience postoperative shock loss that may arise 4 to 6 weeks post-procedure. Don’t be alarmed since this is a temporary shedding representing weak hairs being pushed into dormant phase, which should regrow around the same time as transplanted hairs. Use of Folliflo around the time of the procedure can minimize but not eliminate this risk.

Transplanted hair should start growing in many cases at 5 to 6 months post-procedure, and continue improving in growth up to 12 months post-procedure or longer.

FAQs

I am very concerned about the scar. How does Dr. Lam minimize the appearance of the scar?

This is a very common concern, especially with the negative Internet hype that is promoting the FUE procedures as the only way to avoid a scar. First, FUE is not scarless. You will have tiny dots that prevent you from shaving your head. Second, FUT scars can heal tremendously well. Dr. Lam performs a very careful harvesting method, the details of which he has published in his textbook, Hair Transplant 360, Volume 1 (2nd Edition) along with his latest textbook, Hair Transplant 101. The care of the harvesting begins with minimal transection (injury) to the hair follicles during harvesting. Second, it is important to lessen any injury to the nerve and blood supply around the hair follicle, which Dr. Lam entirely avoids by using generous tumescent fluid that keeps the follicles very far away from the underlying nerve/blood supply. Third, it is important to reduce wound tension prior to closure. Fourth, Dr. Lam uses a trichophytic closure in which a millimeter of epidermal skin is removed off of the bottom edge of the incision to allow the top of the hair to grow through the scar, making the incision very hard to see in most cases. Fifth, Dr. Lam closes the incision with tightly spaced suture loops placed at a correct depth and left in for three weeks, which all contribute to fine, undetectable scars in most cases. All of these techniques allow Dr. Lam to achieve very difficult to see scars in the majority of cases. This is why Dr. Lam has filmed and published so many comb-through videos of his scars to show how difficult to detect they are with the naked eye even in high-definition, close-up, comb-through evaluations.
I have heard some of my friends have more discomfort with the strip method and also have pain and numbness that linger after this procedure in the donor area. Should I be concerned about this?

There is always a risk of prolonged numbness or discomfort but Dr. Lam has never experienced this outcome because of the care with which he performs his procedures. These poor outcomes are related to bad surgical technique. That being said, he does have patients who have mild to moderate discomfort in the donor area. However, he has invented a technique that almost entirely eliminates pain on the first day after surgery using dilute Botox, a technique that he is in the process of patenting. Also, of note, since the procedure is done while you are sedated, you will not feel any pain or discomfort during the entire surgery.
What if I want to shave my head after an FUT procedure?

You will be unable to shave your head following an FUT procedure because you will most likely see a fine line in the area of harvest. However, as mentioned, you will not be able to shave your head after FUE either because you will have fine white dots in the donor area. FUE does permit you to wear your hair shorter than FUT without a visible scar, but patients who have favorable hair density and good exit hair angles (something that Dr. Lam can counsel you on during your meeting with him) can oftentimes have relatively short haircuts without any visibility of the incision at all.
What are some of the after-care instructions I should be aware of following an FUT procedure?

The general after-care instructions listed on Dr. Lam’s website applies to both FUE and FUT techniques. However, following an FUT procedure, it is important not to have direct physical impact with high-velocity blows, for example, being hit in the head very hard, for 2 to 3 months. You can resume normal workouts after the first week but listen to your body so that you do not overtax yourself or fall down through exhaustion and thereby hurt your head. Also, it is advisable to avoid submersion in dirty water (no swimming in pools or lakes or immersing head under bathtub water but showering is ok) for at least a month (preferably 6 weeks). The reason is that water can cause infection in the scalp. Also, be careful when you are in the gym not to lean your head against any commonly used surfaces for the first 1 to 2 months to minimize exposure to the bacteria and germs that are in these public and sweaty environments.

FUE vs. FUT

Abbreviation	FUE	FUT
Procedure	Follicular Unit Excision (formerly known as Follicular Unit Extraction)	Follicular Unit Transplant (also known as Strip FUT)
Harvesting method	Small round punches	Linear Incision (Strip)
Ideal candidate	Men	Men and Women
Cost	Slightly more expensive	Slight less expensive

Surgery	Hair trimmed “high & tight” Sedation: oral and i.v. Bandage: none Needs ride home	Hairstyle is not affected, but do not cut hair super short before surgery Sedation: oral and i.v Bandage: none Needs ride home

Recovery	Can wear hat & wash hair in 24 hrs Discomfort minimal Exercise resumed in a week Contact sports in a month Rare chance of swelling Small scabs in recipient area, 5- 7 days Stitches: no Donor scabs visible for 5-7 days	Can wear hat & wash hair in 24 hrs Discomfort minimal Exercise resumed in a week Contact sports in 2-3 months Rare chance of swelling Small scabs in recipient area, 5-7 days Stitches: yes, removed after 15 days Donor stiches hidden in hair immediately after procedure

Donor availability	Scalp and beard hairs available for transplant	Scalp hair only available for transplant