This chapter presents a brief review of the history of hair transplantation and the anatomy and physiology of hair follicular units. Also presented is a step-by-step description of the author’s preferred technique and pearls learned over the past 25 years to consistently accomplish natural and aesthetically pleasing results. This very labor-intensive procedure requires a team of skillful assistants to be able to do this well and comfortably. The author also describes the details of equipment and instrumentation needed, from surgical blades to the dissection microscopes, and more. The most frequent cases seen in practice include male pattern baldness, female pattern alopecia, and scarring alopecias secondary to previous surgeries (i.e., post rhytidectomy). The restoration of lost sideburns and a temporal hairline will demonstrate some of these examples.