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THE TECHNIQUE

Hair Restoration as Fine Work, Not Volume

For more than twenty years, Dr. Scott Alexander has built Biltmore Surgical Hair Restoration around a single principle: one patient a day, every step by hand, every result designed to look like it was always there.
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OUR APPROACH

One Case a Day

Most hair restoration practices run several procedures simultaneously, rotating the surgeon between rooms as each case reaches a stage the team can manage alone. Dr. Alexander does one case per day and stays with that patient from the first incision to the last graft — a span that begins at 7:30 in the morning and runs until the case is done, typically late afternoon.
Nothing is handed off at the moment it matters most. About half of his patients travel from outside Arizona to see him because of it.
Before a single follicle is harvested during a FUE procedure, Dr. Alexander makes all the recipient sites first. This means he knows the exact graft count he needs before extraction begins. The patient is ready to receive each graft the moment it leaves the donor area.

OUR TECHNIQUE

The Blade Is the Technique

Dr. Alexander has used custom-cut blades since he began hair restoration in 2003, a method he adopted from one of the surgeons who pioneered it. Most practices use generic blades. The differences matter.
Shape.The blades are chisel-cut — flat across the base, matching the actual geometry of a hair follicle. The base of a follicle is straight across, not pointed. A pinpoint blade has to go deeper to achieve the required width at the follicle’s base. Greater depth means disruption to the surrounding tissue. A chisel-cut blade reaches the correct width at the exact depth required — and no deeper.
Sizing. Each blade is cut to match both the width and the length of the follicle it will receive. The incision is only as wide as the follicle and only as deep as the follicle. No more. This custom-cut blade placement method is sometimes referred to as the lateral-slit technique. It allows Dr. Alexander to pack grafts at high density. For some patients, that density can mean their goals are achievable in a single session rather than multiple procedures, depending on donor characteristics and the area to be covered.
When a graft fits its recipient site precisely, it locks into position. It cannot shift or float as the wound closes. The angle Dr. Alexander sets into the blade is the angle the hair grows. It does not drift during healing.
With generic, oversized blades, the graft floats in the channel. As the incision heals, it pulls the graft in whatever direction the tissue happens to close. The result is off-axis hair — the signature look of a procedure done for speed rather than precision.
Smaller, precisely sized incisions also allow Dr. Alexander to place recipient sites closer together and to work between existing hairs without disturbing them. Working between existing hairs without disturbing them in this way is also designed to help reduce shock loss to those hairs during placement.

QUALITY CONTROL

Every Graft, Inspected

Every graft harvested during a FUE procedure is reviewed under a microscope before it is placed. If there is excess tissue on a follicular unit, it is trimmed. Biltmore does not place compromised grafts.
Most practices extract and place without an inspection step in between. At Biltmore, trained technicians assist with donor-area extraction under Dr. Alexander’s direct supervision, and Dr. Alexander personally creates every recipient site, inspects every graft, and places every graft himself.

CANDIDACY

Two Approaches, One Decision Framework

Dr. Alexander performs both follicular unit excision (FUE) and follicular unit transplantation (the strip method, or FUT). He recommends one based on what each case actually requires — not on what the practice finds easier to perform.
FUE is appropriate for smaller sessions — generally cases requiring under approximately 2,000 grafts. Individual follicle extraction, no linear scar, well-suited for patients who prefer to wear their hair short.
The strip method is often the better choice at larger graft counts. At scale, one well-placed linear closure results in less net scarring than multiple individual extraction sites spread across the donor area. For patients who will need two or more procedures over time, strip first is the strategic choice: two strip procedures can share a single closure site, and the remaining donor area stays intact for future work.
If a patient comes in expecting FUE and the case calls for strip, Dr. Alexander explains why. They understand, because the reasoning is straightforward. The recommendation comes from the case, not from convenience.

THE ARTIST'S EYE

Hairline as Design

Dr. Alexander studied art and design before medicine. That background shapes every hairline he builds.
When he began in hair restoration, the standard approach placed every hairline as a half circle — the shape depicted in the textbook, copied from surgeon to surgeon. He rejected it. He studied photographs of male models, learning how natural hairlines actually work: the proportions, the way they taper at the temples, how they frame the face over a lifetime.
Many patients retain traces of their original hairline — fine, wispy hairs running where the hairline used to be. Dr. Alexander designs from that remnant, building the new hairline in the same plane and at the angles where the original one stood. A hairline designed this way grows in as part of the face — not as something added to it.
A standard hairline requires approximately 600 single-hair follicular units, all placed individually along the front edge to produce a soft, graduated transition. That number is often achieved partly through graft-splitting during the procedure to produce enough single-hair units for the natural front edge.

PHILOSOPHY

What This Practice Is For

Dr. Alexander has one statement on how he thinks about his practice:

“I want to be the person you come to first, so you don’t need to be fixed.”
He works with patients who have intact donor areas and clear goals. He does not pursue a repair practice. He pursues a first-time practice — done correctly, done once.

A Consultation Is an Evaluation

An initial consultation covers two things: your goals and your donor area. It ends with a clear recommendation — including whether now is the right time. If the timing is not right, Dr. Alexander will say so, and he will give you a plan for the interval.

Consultations are complimentary for patients 25 and over. For patients under 25, the consultation fee is $100.

Virtual consultations are available for patients traveling from out of state.
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