The quick answer is that both FUE and FUT leave scars, although with proper technique and appropriate hair length, those scars may be very difficult to see.
This is a topic that is often misunderstood. Because FUE is sometimes advertised as a “scarless” hair transplant, some patients believe that FUE does not produce any scarring. This is simply not the case. Any time the skin is cut or punched, the healing process results in some degree of scar formation. The important difference between FUE and FUT is not whether a scar is created, but rather the type, size, distribution, and potential visibility of the resulting scars.
With FUT (Follicular Unit Transplantation), a strip of donor tissue is removed and the donor area is surgically closed, resulting in a linear scar. With excellent healing and meticulous surgical closure, an FUT scar can sometimes be extremely fine—even difficult to find when specifically looking for it by carefully combing through the hair. In some patients, the linear scar itself may be approximately 1 mm in width or less. In others, it may widen to several millimeters. Less commonly, particularly in patients predisposed to abnormal scar formation, hypertrophic or keloid-type scarring may occur.
Dr. Armani uses an extremely fine, meticulous suturing technique for FUT donor-area closure. Depending on the length of the incision, the suture may cross the skin approximately 70 to 100 times, creating a closely spaced closure that can resemble the precision of a sewing machine. This portion of the procedure alone may take approximately 20 minutes. By comparison, some FUT closures are performed using staples or more widely spaced sutures, which can often be completed in only a few minutes. Dr. Armani believes that taking additional time and using a highly precise closure technique is an important part of achieving the finest and least noticeable FUT scar possible. However, even with meticulous closure, the final scar also depends significantly on each patient’s individual healing characteristics.
With FUE (Follicular Unit Extraction), individual follicular units are removed using small punches. Rather than creating one linear scar, FUE produces many small, round scars distributed throughout the donor area. The diameter of the punch required varies depending on the patient’s individual follicular anatomy and other technical considerations, but punches commonly used for FUE may range approximately from 0.7 mm to 1.25 mm. The resulting healed scars are not necessarily identical in size to the punch itself and can vary considerably among patients.
For FUE, Dr. Armani selects the smallest appropriate punch for each patient based on the size and characteristics of the patient’s follicular units. The goal is to use a punch large enough to safely harvest the follicle without unnecessary trauma or transection, while avoiding a larger punch than is needed. Using the finest appropriate punch helps minimize the size of the wounds created during extraction and, after healing, helps produce the smallest and least noticeable circular scars possible.
Neither technique necessarily allows every patient to shave the donor area completely without evidence that a procedure was performed. Both FUT and FUE scars may require some surrounding hair length for optimal concealment. The shorter a patient intends to wear the hair in the donor area, the more important the type and potential visibility of the scar become.
With FUE, the appearance of the donor area also depends on how many grafts are removed, how closely the extractions are placed, and how evenly they are distributed. Excessive or poorly distributed harvesting can produce a visibly thinned or “moth-eaten” donor area even when the individual FUE scars are very small.
The quality and visibility of scars from either procedure depend on a combination of surgical technique and the patient’s individual biology, genetics, and healing characteristics. With FUE, important factors include punch size, extraction technique, the number of grafts harvested, and their distribution throughout the donor area. With FUT, closure technique and wound tension are particularly important. Some people naturally form finer and less noticeable scars, while others are more prone to widened, hypertrophic, or keloid scars. A patient’s personal and family history of abnormal scarring can therefore be important when evaluating which harvesting method may be most appropriate.
Ultimately, neither FUE nor FUT should be described as truly “scarless.” The goal of an expertly performed hair transplant is not to eliminate scarring—which is biologically impossible—but to select the appropriate harvesting method and use meticulous technique to make the resulting scars as small and cosmetically inconspicuous as reasonably possible.
