Facial plastic surgery in Salt Lake City, Utah
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ConsultationsHair transplantation is a surgical procedure that moves follicular units — naturally occurring groupings of one to four hairs — from a donor area, typically the occipital and parietal scalp, to areas of thinning or loss. Two techniques are used: follicular unit extraction (FUE), which removes grafts individually, and follicular unit transplantation (FUT), which harvests a strip of donor tissue. Both are permanent. The transplanted follicles retain their genetic resistance to hair loss after placement. Dr. James Manning performs the procedure in Salt Lake City, Utah.
Recipient sites — the small incisions that determine where each graft will be placed and at what angle — are made by hand by Dr. Manning, one site at a time. This is the most technically demanding part of the procedure and the step most directly responsible for the direction, density, and hairline design of the final result.
Once the sites are created, grafts are placed into each one. FUE grafts are harvested individually from the donor area using a small punch. FUT grafts are harvested as a strip, dissected into individual follicular units, and placed in the same fashion. Both approaches produce permanent results when graft survival is maintained through careful handling.
Good candidates for hair transplant have a stable pattern of loss, sufficient donor density, and realistic expectations about what surgery can and cannot address. A thorough donor assessment at consultation determines graft availability and sets the scope of what’s possible.
Women are candidates when donor density is high enough and scarring alopecia has been ruled out. Patients interested in eyebrow, beard, or facial hair restoration are also candidates — both techniques apply in these areas.
Progressive loss that is not yet stable is managed medically before or alongside surgery. Vitamin deficiencies and thyroid dysfunction — often overlooked contributors — are identified and addressed prior to transplantation.
FUE (follicular unit extraction) removes grafts one at a time and leaves no linear scar, making it a good fit for patients who wear their hair short and want to keep that option. Recovery in the donor area is faster, and it is currently the more widely used technique in hair restoration.
FUT (follicular unit transplantation) removes a strip of donor tissue, which allows for a larger number of grafts in a single session — particularly useful for patients with significant recession extending deep into the donor area. It is also the technique of choice for revision cases, female pattern loss, and eyebrow or facial hair restoration where maximizing graft yield matters. FUT can be performed through a prior scar, consolidating rather than adding new donor disruption. About 15–20% of Dr. Manning’s hair transplant cases are FUT.
| FUE | FUT | |
|---|---|---|
| How grafts are harvested | Removed one at a time with a small punch; no linear scar. | Removed as a strip of donor tissue, then dissected into individual units. |
| Best suited to | Patients who wear their hair short and want to keep that option. | Larger graft counts, revision cases, female pattern loss, and eyebrow or facial hair restoration. |
| Donor recovery | Faster healing in the donor area. | Can be performed through a prior scar, consolidating rather than adding new donor disruption. |
| The result | Permanent when graft survival is maintained; currently the more widely used technique. | Permanent when graft survival is maintained; used in about 15–20% of Dr. Manning’s cases. |
Unnatural-looking hair transplants share a few predictable causes — and they are largely preventable:
Dr. Manning trained under a technician with 30 years of experience in hair restoration — spending a full year focused on the procedure before performing it independently. He performs a significant portion of each transplant himself, including recipient site creation by hand, one site at a time. Many surgeons delegate this work entirely.
Dr. Manning performs two to three hair transplants per week. It is one of his primary areas of focus — not an ancillary offering.
FUE Transplant focused on the frontal scalp and vertex - 2 years post-op
01 / 04
1–2 wks
Donor heals
The donor area heals within one to two weeks. Recipient-site scabs shed over the first seven to ten days.
2–6 wks
Expected shedding
Transplanted hair typically sheds. This is expected and does not indicate graft failure.
3–4 mos
Growth starts
New growth begins and continues to thicken and mature over the following months.
6–8 mos
Meaningful result
Most patients see a meaningful result at this stage, with density still improving.
1 yr
Final result
The final result is visible at one year, with hair growing and behaving like native hair.
Nonsurgical treatments pair well with transplantation as ongoing maintenance. Finasteride, dutasteride, spironolactone, and bioidentical hormone replacement therapy address the hormonal drivers of loss. Minoxidil supports follicular health. Correction of underlying vitamin deficiencies and thyroid dysfunction — often overlooked contributors to hair loss — is addressed prior to or alongside surgery.
For patients seeking a more comprehensive change in facial framing, hair transplant pairs well with hairline lowering surgery — also called forehead reduction.
Dr. James Manning is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology–Head and Neck Surgery. He specializes exclusively in the face.
Dr. Manning trained under a technician with 30 years of experience in hair restoration — spending a full year focused on the procedure before performing it independently. He performs a significant portion of each transplant himself, including recipient site creation by hand, one site at a time. Many surgeons delegate this work entirely.
Dr. Manning performs two to three hair transplants per week. It is one of his primary areas of focus — not an ancillary offering.
Medically reviewed by Dr. James Manning, MD · July 2026
FUE removes individual follicular units one at a time, leaving no linear scar — it's well-suited for patients who wear their hair short. FUT removes a strip of donor tissue, allows for larger graft counts in a single session, and is typically used in patients with more extensive recession or those undergoing revision work. Both techniques are permanent when the grafts survive.
Graft counts depend on the degree of loss, the density of the donor area, and the goals of the patient. A consultation and donor assessment are required to give a meaningful estimate. Under-quoting graft counts and over-harvesting the donor area are the most common mistakes in hair transplant surgery — both leave patients with inadequate coverage and a depleted donor supply.
Yes — this is expected. Transplanted hair typically sheds between two and six weeks after surgery, a phenomenon called telogen effluvium. The follicles remain intact; they are simply cycling into a rest phase. New growth begins at three to four months. A localized telogen effluvium can also affect native hair in the surrounding area, which typically resolves on its own. (Loh SH, Lew BL, Sim WY. Ann Dermatol. 2018 Apr;30(2):214-217. PMID 29606820)
Grafts taken from the donor area are genetically resistant to the hormonal changes that cause androgenetic alopecia. Once established, they retain that resistance and grow for life.
Native hair that has not been transplanted may continue to thin over time. This is why nonsurgical management — DHT-blocking medications and minoxidil — remains important after surgery. (DHT, or dihydrotestosterone, is the hormone primarily responsible for androgenetic hair loss.) Protecting the native hair around and behind the transplanted zone preserves the overall result and may reduce the need for additional sessions.
For patients with progressive loss, a second session may be appropriate in the future — either to address new areas of recession or to increase density in a prior zone. But the grafts placed are there to stay.
The procedure is performed under local anesthesia. Most patients describe discomfort only during the initial injection; the extraction and implantation are well tolerated. Post-procedure soreness in the donor area typically resolves within a few days.
Good candidates have stable donor density, realistic expectations, and a pattern of loss that is largely stable — or are managing progression with medication. Women are candidates when donor density is sufficient and scarring alopecia has been ruled out. Patients interested in eyebrow, beard, or facial hair restoration are also candidates.
Yes — and it typically is. Hair transplantation does not require general anesthesia. The procedure is performed under local anesthesia in the office setting.
Nonsurgical management — finasteride, dutasteride, minoxidil, and spironolactone where appropriate — is an important part of the overall plan. These medications protect native hair that surgery cannot address. Vitamin deficiencies and thyroid function are evaluated prior to surgery, as both can affect hair loss and healing.
If you are considering a hair transplant and want to understand what’s possible for your specific anatomy, we’d love to see you in consultation.
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