This year we want you to get the best advice about your hair loss and the best choice for hair restoration. In our blog posts from last year, we discussed FUE hair transplant surgery, Propecia and its effects, hair loss in women, and also we explained what the Holt Hair Restoration Center is and what we do. For 2013, we want you guys to start the year off right with a full head of hair.

Our main website lists frequently asked questions with in depth answers. We also explain why Holt Hair is the best possible hair restoration care anywhere. Follow us on Facebook and Twitter. We also offer free consultations. Contact us at 616-940-3640.


What is FUE or Follicular Unit Extraction?

FUE is an abbreviation for Follicular Unit Extraction; also known as the follicular isolation technique or “FIT”. It is an alternative hair transplant technique to what is presently the more conventional “strip harvesting” procedure.

It is important to note that the difference in these procedures pertains only to how the hair follicles are obtained from the donor area of the scalp. All other aspects of the transplant procedure, such as site preparation and implanting, are the same between the two methods.

Here is the difference related to obtaining the donor follicles:

With the more common strip harvesting technique, the donor hair is removed as a narrow strip of hair bearing skin, using a conventional surgical incision and removal (excision) of the hair bearing tissue. The donor area is then carefully closed by suturing; using relatively new closure techniques designed to minimize any visible scar and to even promote hair regrowth within the line of healing. The strip obtained is then further dissected under microscopes, to obtain the trimmed follicular units, which are the small groupings of hair follicles which will become the transplanted grafts. Because the entire follicle can be seen under the microscope, the graft trimming process is very controlled and precise as all excess tissue is removed from around the follicular unit groupings of hair follicles. One follicular unit is the same as one “graft”, and they will contain an average of about 2.5 hair follicles per follicular unit graft.

In an FUE procedure, no linear surgical incision is made. Instead, specialized instruments are used to individually extract each follicular unit one by one. These extractions essentially utilize a specialized “drill punch” technique for removing the follicles without damaging them. The punch tools are now motorized and utilize very small punch hole sizes, as the drill head imparts specialized and varied motions to accomplish each extraction with a minimal risk of transection or damage to the hair follicles. The drill punches used are generally no greater than about 1 mm in diameter. When FUE was first introduced, this was done with small, non-motorized biopsy punches. It was effective, but too many hair follicles were damaged by “transection”, as the follicular units cannot be fully visualized by this method as they are removed. Innovations in the motion and design of the punch ends has accomplished the goal of minimizing transections in this method where the follicular units cannot be visualized as they can when dissected from a strip of donor hair.

Gradually, these new and innovative instruments, combined with experience in various techniques accommodating different hair characteristics, has allowed FUE to be accomplished with a minimum transection rate, whereby the procedure has become slowly more acceptable and even preferred by some patients.

There are advantages and disadvantages to doing FUE, and it cannot be said in most cases that one approach is clearly superior in all aspects over the other. However, in most cases it can now be said that FUE is a viable option, if the advantages for a particular patient seem to outweigh any disadvantages. This may vary, depending upon your individual needs, priorities, and plans for future hair styling. For example FUE may be preferred in someone who foresees a desire to where their hair vary short in the back, where even a very fine linear scar may not be completely concealed.

In most cases, it comes down to a guided patient preference, combined with considerations for cost differences.

During your free consultation, we can help you sort out all the considerations, and determine if FUE is a good option for you. It is very fortunate that we have not only one, but two very excellent methods at our disposal to offer!

What are the advantages of having an FUE transplant?

With FUE, there is no incision line, and therefore the possibility of a visible linear scar is eliminated. This might be preferable for someone who wishes to wear their hair quite short, where the very small, circular extraction scars are spread between the existing hairs and blend in after healing, to be practically undetectable. This procedure also results in somewhat less immediate post-op donor area discomfort, and fewer restrictions during the relatively short healing period.

The procedure may also be of advantage to someone who has scars from the much older style transplant techniques, where donor hair can still be obtained, but where risking additional scar is a concern. It may even be a useful approach to obtaining follicles to revise problematic old scars by grafting them; a very effective method of old scar revision!

Again, with newer techniques, most scar issues have been eliminated, even in the strip harvesting method. Still, many candidates for hair transplantation simply do not like the idea of having surgery involving incisions. In some cases this concern is the primary barrier preventing them from having a hair transplant which might otherwise greatly benefit them! If this is the case, FUE just might be the passage way through that barrier, and back to having your hair once again!!

What are the disadvantages of having an FUE?

FUE is generally a more time consuming procedure, requiring specialized instruments and technical assistance, which adds to the cost of the procedure. There are also practical limits on how many grafts can be obtained in a single session. Although automation of the devices has slowly narrowed the gap between the maximum numbers of grafts that can be done in a single session, FUE procedures should generally be limited to no more than 1500-2000 grafts per session; whereas with strip harvesting, it may be possible to perform procedures of 3000 or more grafts in a single session if needed. There is however no prolonged waiting period required between sessions with FUE, if more grafts are required for coverage. They may even be performed on consecutive days!

Another minor disadvantage of FUE, is that more shaving is required in the donor area before the extraction can be performed. In strip harvesting, the only hair shaved is in the strip itself, which is to be removed. Surrounding hair then easily covers the suture line which remains undetectable. In FUE, hair must be shaved in the areas to be harvested by extractions, because the individual punch sites will be spread over a greater area since it is not coming from a concentrated strip of donor tissue. This could leave some shaved areas that may need concealment until the hair re-grows in the extraction field.

Contrary to some exaggerated marketing statements, FUE is not a “scar-less surgery”. However, the very small scars are spread out through a larger area, and tend to blend in. The risk of a visible linear scar being seen with shorter haircuts is diminished with FUE. The difference in scarring is of little practical importance in those who would ordinarily have at least a ¼ to ½ inch of hair length in the donor area, and with newer strip harvesting closure techniques, sometimes even these linear scars are very hard to find later. Therefore, FUE might be given preference over conventional strip harvesting for a client anticipating wearing the hair relatively short, who is worried about a faint, linear scar being visible or has general fears related to surgical incisions.

The final disadvantage to the FUE procedure relates to cost. Requiring specialized equipment, and greater time to harvest the donor hair, the price/graft is proportionally higher. If all other factors are neutral, the conventional strip harvesting approach is more economical for the same number of grafts.

FUE Equipment and Technical Aspects:

In reading about FUE, you will come about a good bit of “marketing” of various brand name devices for extracting follicles. These are very innovative and interesting units. However, let me say that almost all modern extracting technology incorporates the same basic essential extraction motions needed to accomplish clean extractions with a minimum amount of dissection. Robotic units such as ARTAS, and other high end “fixed” units such as NeoGraft, have features related more to the user’s comforts. A client who has a particular interest or desire in FUE, should shop beyond the brand names of the extraction units. It is not necessary to travel to a center that markets the exclusive use of a computerized robotic instrument, or a particular brand name of extracting unit. With many excellent FUE extraction devices now available, the quality of the transplant once again comes down to the experience and expertise of the surgeon and technicians performing all aspects of the procedure. This is always the most important consideration to weigh.

At Holt Hair Restoration, I utilize only the most experienced technical assistants in the hair restoration industry for doing the FUE case. Remember; the extraction method of obtaining the donor follicles is the only part of a hair transplant that is different than the much more common “strip harvesting” technique. All other aspects of the transplant, from hairline design, planning, recipient site making, implanting, and aesthetics, are the same.

As noted, FUE is a newer procedure where the technology to extract larger numbers of grafts in a single session is still growing. Since each follicle must be carefully extracted from the donor scalp one F.U. at a time, this is a more time and labor intensive procedure. It also requires the highly expensive extraction units to efficiently obtain high quality grafts. As a result, one could expect to pay over $6 / FUE graft, vs. about $4 / conventional FU graft at present pricing. In summary, FUE is a rapidly developing and acceptable method of obtaining donor hair in an otherwise conventional HT. It may be beneficial to those who are concerned about a scar being visible with their hair cut short, or as a concern simply from the general thought of having a surgical incision. It may also be useful in those patients where a more modest 1500-2000 FU graft HT is thought to be adequate as a completed first procedure, and perhaps the only procedure that might ever be needed. It might be particular beneficial to the client who can afford the slightly higher costs to achieve the special benefits. If FUE is not for you, however, keep in mind that modern day strip harvesting transplants obtain the same natural follicular units for transplant into the deficient scalp area, resulting in natural and undetectable restoration of your hairline and visibly thin areas. There is no better way to deal with hair loss than with a modern day hair replacement surgery from an experienced, board certified hair specialist, and a seasoned and highly experienced surgical team of technicians! Call me today at 616-940-3640 or use our Contact Form. Steven Paul Holt MD, A.B.H.R.S.


Propecia (Finasteride) is easily the most effective, convenient, and efficient manner of maintenance in hair loss prevention therapy. Some believe that Propecia is only necessary once you have noticed obvious hair loss, but what many don’t know is that Propecia can be effective at preventing future hair loss from early onset to even after hair transplant surgery. If hair loss runs in your family, don’t wait, contact us today.

Common Questions About Propecia:

I just have a little hair loss, should I use Propecia?

Yes, even with minimal hair loss Propecia has been shown to be effective in preventing further hair loss.

I just had hair transplant surgery, should I use Propecia?

Yes, even if you have already had hair restoration surgery you can either start or continue to use of Propecia to prevent further or new hair loss. Without the continual use of Propecia your hair is no longer protected from future hair loss.

Some people may think Finasteride (Propecia) is expensive discouraging many potential candidates from purchasing and using it. Soon, with the patent protection coming to an end, generic brands of Propecia will soon be available cutting the cost to as little as $2-3 per month.

Remember, Propecia (finasteride 1mg) is the only oral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of hair loss in men. And, Propecia has been approved by the FDA since December 1997.

Today, there are still a lot of misconceptions about Finasteride (Propecia), hair regrowth, and hair loss prevention because of false accusations. Please contact The Holt Hair Restoration Center today for the truth about Propecia. Schedule your free consultation today.

For more information go to our Hair Loss Issues page.


This is the first of multiple posts that will discuss the truth and misconceptions about Propecia (finasteride 1mg).

Recently the internet forums and other sources have been abuzz with talk about “permanent sexual side effects” associated with the use of Propecia (Finasteride).

Propecia (finasteride 1mg) is the only oral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of hair loss in men. And, Propecia has been approved by the FDA since December 1997.

The controversy began largely in the publication of an uncontrolled review of a number of men who reported sexual side effects associated with Propecia use, which persisted well after discontinuation of the drug. By “uncontrolled study”; that is to say that the paper was not a scientific study in the sense that it could have possibly determined causation.

Symptoms of libido change and/or ED (erectile dysfunction) are common in the general population of men NOT taking Finesteride as well. Therefore the matter of cause in these purely anecdotal reports, by no means establishes any kind of proof that Finasteride use can or does cause permanent sexual side effects in men who take it for hair loss. The very small incidence of these symptoms in the controlled studies, are consistent with my own prescribing experience in very large numbers of patients, and in almost all such cases, these rare events are evident in the first few weeks of use. They do not show up months or years after initiating the treatment.

Also consistent with prior studies and the general practice experience of physicians who most commonly prescribe Finasteride for hair loss, is the finding that such rare adverse reactions generally dissipate even if the patient remains on the drug, and in virtually all cases they disappear when the drug is discontinued.

Inevitably, however, in any large population of male subjects, some will develop the common problems of ED and loss of libido from a number of potential causes, regardless of whether they have ever taken Finasteride or not! Therefore, such a review of anecdotal cases is likely to be very misleading, and thereby lead to fear and unnecessary discontinuation of a very safe and highly effective treatment option for hair loss prevention and regrowth. With that said, I think the position statement by the ISHRS* represents very well, the professional opinion and experience of the physicians who most commonly prescribe this drug, and therefore those with the most practice experience with it. Read the full ISHRS Press Release.

*About the ISHRS: The International Society of Hair Restoration Surgery (ISHRS) is the largest organization of physicians worldwide who specialize in the treatment of hair loss. The ISHRS is a non-profit medical association of over 700 physicians specializing in alopecia and hair loss. The ISHRS provides continuing education to physicians specializing in hair transplant and restoration surgery and gives the public the latest information on medical hair restoration and non-surgical treatment for hair loss.


Yes, and it is far more common than realized. Hair loss doesn’t just occur in men. Hair loss can affect women as well. It doesn’t seem possible or likely to many people, but it actually affects 1 in 5 women; and even more beyond age 40.

There are significant differences between men and women, in both the possible causes and the management of hair loss. While hereditary/genetic influences are still the most common cause in both genders, women have a higher incidence of medical conditions that may be causing, or contributing to hair loss and/or thinning. It is very important to proper management, that the contributing factors be identified.

Many if not most women will be found to be excellent candidates for hair restoration surgery (hair transplantation). These would generally include cases of hereditary hair loss, hair loss from prior traction from tight beading and braids, and certain conditions caused by the use strong hair chemicals; such as relaxing agents. Other causes of hair loss may be best managed with non-surgical treatments, and some causes are reversible and may recover with little or no treatment at all. One example of this is the condition called Telogen Effluvium; or T.E. This is hair loss and thinning that occurs within several months of an identifiable event that puts stress on bodily systems; such as a major illness, high fever, child birth, or general surgery. Under these conditions, certain signaling process in the regulation of the hair growth cycle cause the hair follicles to enter a resting phase, during which the hair shaft will be shed before a new growth cycle begins. This will recover back to normal within about 6 to 9 months in the great majority of cases. Minoxidil use may help shorten the recovery process hair follicles to stop growing.

There are other types of hair loss (alopecia) that might preclude restoration surgery as the initial approach. These represent conditions best treated by non-surgical therapies. Alopecia Areata is a common condition that usually presents with one or more circular patches or “spots” where hair loss appears as a result of an immune system response that actually attacks hair follicles in localized areas, causing it to fall out. This type of hair loss can generally be diagnosed by examination alone; or with a simple scalp biopsy test if needed. It is often treated by a dermatologist with steroid medications placed directly into the affected areas. It also recovers in the great majority of cases, though it may become recurrent.

Perhaps the most difficult female hair loss conditions to diagnose and treat are those falling into the general category of “Inflammatory Scarring Alopecia”. This is a diverse group of conditions that include scalp diseases such as Lichen Planopilaris, Discoid Lupes, and Follicular Degenerative Disorder. They are often associated with inflammation and scaling of the scalp, patchy hair loss. Diagnosis with exam and scalp biopsy is important to determine the condition, and to guide treatment to control and hopefully reverse it. Long term, permanent hair loss that has resulted from one of these conditions, may become suitable for hair transplantation after all signs of inflammation have subsided.

Other, less common conditions, that may still be very suitable for the benefits of hair transplantation surgery include congenital conditions, prior scalp trauma; such as in burn injuries or surgical scars in the scalp and other hair- bearing areas, and focal, permanent hair loss from prior radiation therapy.

Regardless of the cause, hair loss is an especially sensitive issue and troublesome burden for a woman to have to suffer. There are special aspects to the approach to managing female hair loss as opposed to the more typical hair loss that men experience. Proper diagnosis and management of hair loss in women requires special training, experience, and a proper understanding of the differences by the hair loss specialist.

Fortunately, the great majority of women can find solutions for their hair loss problems, and most will also be found to be excellent candidates for the highly beneficial and life changing results that can be achieved by hair transplantation surgery.

The Holt Hair Restoration Center manages all types of hair loss issues in both men and women. We are experienced in all of the latest techniques and procedures for both controlling ongoing hair loss and restoring it.

Don’t let hair loss problems get you down. Call us for a free consultation today. We can determine the type of hair loss issue that you have, and formulate the best treatment plan for it. Don’t wait. Call today.


After nearly 10 years with a national firm, I decided that the very best service I can provide to my patients would be best done within the collective trust of one patient, and one doctor, along with my dedicated and expert staff of hair replacement experts.

I have no regrets in how I arrived here. Although I worked as an employed physician, with a high profile firm, I have been blessed to have earned the trust and respect of the many hundreds of patients whom I call friends. They know quite well that no “company” can take care of patients at this level of sensitivity and trust. That can only come through the establishment of a close personal relationship that has always been held on sacred ground since the ancient days of medicine; The Doctor-Patient Relationship. That relationship is just as it should be….between one doctor, and his trusting patient!

I am now in a position to make this trust as the very foundation of my practice.

I want to assure my new patients that I am a ‘real hair surgeon’ and expert in this specialty. Of the 1000 or so doctors in the USA that practice hair restoration at some level, fewer than 300 are Board Certified, and even fewer are fellowship trained in this specialty. I am happy to say that I am one of them.

Steven Paul Holt, MD, A.B.H.R.S.