What is the difference between FUT vs. FUE—pros and cons for coarse (African-American) hair.

I'm trying to decide which procedure to choose for my traction alopecia on my temples and sides. What are the pros and cons of either procedures on African-American, tightly curled, coarse type hair?

Doctor Answers 7

Difference between FUT and FUE, pros and cons for African-American hair

Dear evie_lina,

Thanks for your question.  FUT, or Follicular Unit Transplant, refers to a linear strip procedure, where a strip of scalp is removed surgically, and the wound that results from the removal is closed with stitches.  This will leave a permanent scar on the back and possibly sides of your scalp.  This can be done on most any person with a good donor area.  Many men, particularly those who like to keep very short hair, don't want a permanent scar on the back of their head, and will opt for an FUE procedure.

And FUE procedure, or Follicular Unit Extraction, refers to a procedure where a device is used to remove a single follicle at a time for transplantation.  There are no scalpels used, no stitches used, and no linear scar is left behind in the donor area.  While this may seem like the obvious choice, the singular advantage of an FUE procedure is that no linear scarring is left behind.  With coarse, curly hair, it can be problematic to safely remove follicles from your donor area without damaging them.  This is because just like your hair is curly on the outside of your scalp, it is also curly on the inside of your scalp.  The punches used on every FUE device are straight.  It is sometimes possible to perform FUE on an African American person.  A test procedure is indicated to see if you'll be a candidate for this type of procedure.

So the short answer is that with FUT a linear scar is left behind in the donor area, and with FUE the hair is trimmed down and the follicles are removed one at a time.  At our clinic we're proud to be the first in Georgia to offer the ARTAS robotic hair restoration surgery system, but there are many devices.

If you're a female, the logic in trying to perform an FUE starts to break down.  Typically with traction alopecia a fairly large amount of hair will need to be transplanted.  If using the FUE method, you'll be required to shave all of your hair on your scalp down to about 1/32nd of an inch (essentially shaved).  Women tend not to like this look, for obvious reasons.  With a dedicated, experienced, and fully-trained board-certified surgeon, you can expect minimal scarring in the donor area with an FUT, allowing you to wear a pony tail or pull your hair up without worry that the scar will show through.  Clearly, a consultation with a dedicated hair restoration surgery clinic is indicated.

Atlanta Hair Restoration Surgeon
5.0 out of 5 stars 153 reviews

FUT vs FUE in African Americans

First of all, not every African American is a candidate for FUE, so we perform a FOX test in our office to determine if an FUE can be done successfully in such people. Generally the FOX test comes out negative and therefore we recommend a strip surgery for such people. If the FOX test is positive, then an FUE is an option. Large punches used to get around the tight curly character of the hair produces a pluggy look, something that is not acceptable today. Many people with Traction Alopecia may need a lot of hair to move, and this is usually more cost-effective with Strip surgery and will produce the highest quality grafts/.

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 27 reviews

FUT is better choice then FUE

It is but obvious that FUE is not a good option in curly hair -as punches are straight transections are expected. ,specially in females as very can't trim hair.
Vortex require lots of grafts so again FUT is preferred. 
Trichophytic closure technique can give almost invisible scar.
go to an expert FUT surgeon .

Suneet Soni, MBBS, MS, MCh
India Plastic Surgeon
5.0 out of 5 stars 24 reviews

FUE of curly hair

FUE does not always work on curly African American hair.  You need to see a doctor for an exam and possibly a limited FUE test (we call it FOX Test).  This is because curly hairs have a higher rate of transection.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 100 reviews


Basically, in Follicular Unit Transplantation (FUT), the hair for relocation is obtained by surgically excising a strip of hair bearing skin from the donor region of the scalp. The skin edges of this wound are then sutured closed. Follicular Unit Extraction (FUE) is a revival of the old punch technique obtaining donor hair with a small circular cutting instrument. These punches are used to harvest follicular units one at a time from the donor area. Each harvest or extraction creates a small circular scar. The difference is with the strip you get a continuous linear scar, whereas with punches you get discontinuous, round circular scars. You get a better Yield with FUT technique because one can see the follicles when excising the strip whereas in FUE it's a blind extraction from the skin. Due to the blind extraction, there may be damage to the hair follicle and also collateral damage to the surrounding hairs. Therefore, it is likely that when hair is transplanted to the recipient area in case of FUE technique some of the hairs be damaged and therefore either not growin or grow thinner. Also if the hair is curly the likelihood of getting collateral damage is higher. These pros and cons should be discussed in detail before making a decision as to which harvesting technique is best for the patient before the procedure.

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.8 out of 5 stars 27 reviews

Hair transplant

Good question.  Follicular unit extraction  can be more challenging with African American hair if the hair is very curly.  We often use a slightly larger "punch" for this type of hair.  Larger punches can potentially mean a scar, so we would want to know if a history of keloid formation exists.  Your best bet is to go to someone who has experience with this type of hair and procedure. I would avoid a strip method (often used with FUT) because it will likely yield a large scar running across the back of your head which could be visible even with moderate length hair.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 46 reviews

What is the difference between FUT vs. FUE—pros and cons for coarse (African-American) hair.

Differences between “Organic Hair Transplantation” and classical hair transplantation :

A chemical mixture is used in the classical hair transplantation method in order to increase the volume of the scalp. This process helps surgeon to work comfortably however it was observed that these chemicals also harm the scalp tissue. This result in decreased viability of new transplanted hair grafts.

However a mixture containing adipose derived stem cells is injected to the scalp in the “Organic Hair Transplantation” for the same purposes. Injection of this mixture result in rejuvenation of the scalp without causing any harm. Surgeon can also work more comfortably after the injection of the mixture since the volume of the scalp is increased


Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.9 out of 5 stars 90 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.