FUT surgery follows a six-phase process: consultation and marking, local anesthesia, strip removal, graft dissection, recipient site creation, and graft placement. The entire procedure takes 4 to 8 hours and harvests up to 4,000 grafts from a single donor strip.
This guide walks through each phase so you know exactly what happens from the moment you arrive at the clinic to the final suture.
Phase 1: Consultation and Hairline Design
Your surgeon begins by marking the donor strip area and designing the recipient hairline. This planning phase takes 20 to 45 minutes and sets the foundation for the entire procedure.
Donor Strip Marking
The surgeon identifies a strip of scalp in the safe donor zone, the area between the ears at the back of the head. This region is genetically resistant to DHT, which is why transplanted hair remains permanent. The strip is typically 1 to 1.5cm wide and 15 to 25cm long, depending on how many grafts you need and your scalp laxity.
Scalp laxity matters significantly for FUT. The surgeon pinches the donor area to assess how easily the skin moves. Good laxity means a wider strip can be taken with a clean closure. Tight scalps may limit strip width and total graft yield.
Recipient Area Design
Using a surgical marker, the surgeon draws your new hairline. This accounts for your Norwood stage, facial proportions, age, and expected future hair loss. You review and approve the design before any cutting begins.
Phase 2: Anesthesia and Preparation
Once the surgical plan is confirmed, the clinical team prepares you for the procedure.
Local Anesthesia Administration
The surgeon injects local anesthetic into both the donor strip area and the recipient zone. Most clinics use lidocaine with epinephrine. The initial needle stick is the most uncomfortable part of the entire day. Some clinics use vibration devices or nerve blocks to reduce injection discomfort.
Full numbness sets in within 5 to 10 minutes. You remain awake and alert throughout the procedure. Mild oral sedation is available at most clinics if you prefer to be more relaxed.
Donor Area Trimming
The hair around the donor strip is trimmed short (not shaved) so the surgeon can see the follicle angles clearly. The surrounding hair remains long enough to cover the donor scar once healed.
Phase 3: Strip Removal
This is the defining step of FUT. The surgeon removes a thin strip of scalp containing thousands of follicular units.
The Incision
Using a scalpel, the surgeon makes two parallel incisions along the marked donor area. The incisions follow the angle of the hair follicles to avoid transecting (cutting through) grafts. The entire strip removal takes 10 to 20 minutes.
Donor Closure
Immediately after the strip is removed, the surgeon closes the wound using sutures or staples. A trichophytic closure technique angles one edge of the incision so hair grows through the scar line, making it less visible over time. Sutures or staples are removed at day 7 to 10 during a follow-up visit.
The closed donor area produces a single linear scar that is easily hidden by hair at 1cm or longer.
Phase 4: Graft Dissection
The removed strip goes to a team of surgical technicians working under high-powered stereomicroscopes.
Slivering and Separation
The strip is first divided into thin slivers, then each sliver is carefully dissected into individual follicular units. Each unit contains 1 to 4 hairs. This phase is labor-intensive and takes 1 to 3 hours depending on graft count.
| Graft Count | Typical Dissection Time | Team Size |
|---|---|---|
| 1,000 | 45 to 60 minutes | 2-3 technicians |
| 2,000 | 1.5 to 2 hours | 3-4 technicians |
| 3,000 | 2 to 2.5 hours | 4-5 technicians |
| 4,000 | 2.5 to 3 hours | 5-6 technicians |
Graft Storage
Dissected grafts are stored in a chilled holding solution (typically Hypothermosol or saline) to maintain viability. Time outside the body is critical. Grafts kept under proper conditions maintain 90-95% survival rates.
Phase 5: Recipient Site Creation
While dissection continues, the surgeon creates tiny incisions in the recipient area where each graft will be placed.
Incision Technique
The surgeon uses fine blades or needles (0.6 to 1.0mm) to make thousands of small slits. Each incision is angled and oriented to match natural hair growth patterns. The density, angle, and direction of these sites determine how natural the final result looks.
Single-hair grafts go along the very front of the hairline for a soft, natural edge. Multi-hair grafts (2-4 hairs) are placed behind the hairline for density.
Site Density
A skilled surgeon places 35 to 50 grafts per square centimeter in the recipient area. Higher density requires more precision but produces thicker-looking results.
Phase 6: Graft Placement
The final and longest phase involves inserting each dissected graft into its recipient site.
Insertion Process
Technicians use fine-tipped forceps to place each graft into the pre-made incisions. The graft must sit at the correct depth: too shallow and it may fall out; too deep and it can form cysts or grow at an unnatural angle.
This phase runs concurrently with dissection. As grafts are prepared, they are placed. For a 3,000-graft session, placement typically takes 2 to 3 hours.
Final Inspection
The surgeon reviews all placed grafts, checking for proper angle, depth, and distribution. The recipient area is gently cleaned. No bandage is typically applied to the recipient zone, though the donor area is wrapped with a light dressing.
After the Procedure
You receive detailed aftercare instructions covering sleeping position, medication schedule, and washing protocol. Most patients leave the clinic 30 to 60 minutes after the last graft is placed. You should not drive yourself home.
The first 48 hours are the most critical for graft survival. Avoid touching the recipient area, sleep elevated at 45 degrees, and follow your surgeon's medication schedule exactly.
For a detailed comparison of FUT versus other methods, see our FUE vs FUT comparison.
FAQ
How long does FUT surgery take?
FUT surgery typically takes 4 to 8 hours depending on the number of grafts. A 2,000-graft session runs about 4-5 hours, while a maximum 4,000-graft session can take 7-8 hours. Most of the time is spent on graft dissection and placement, not the strip removal itself.
Is FUT surgery painful?
FUT surgery is performed under local anesthesia, so you should not feel pain during the procedure. You may feel pressure and tugging during strip removal. Post-operative discomfort at the donor site is typically managed with prescribed pain medication for 3-5 days.
Are you awake during FUT surgery?
Yes, you are awake during FUT surgery. The procedure uses local anesthesia to numb the donor and recipient areas. Some clinics offer mild sedation to help you relax, but general anesthesia is not required. Most patients watch movies or listen to music during the session.
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