Zarev's presentation at the Global Hair Loss Summit 2020

[werefckd]

9k+ FUE restorations are very rare. The only other well know doctor I know that does restorations that size via FUE is Dr. Lorenzo.

You can check the YT channels of the hair transplant doctors, forums like the hair restoration network and recuperar el pelo where they have tons of patient reviews. Anything above 6k scalp grafts via FUE is very rare to find, less than 1% for sure. Above 9K FUE it's practically non existent.

 

[werefckd]

I don't know if its a "stamp of quality" if someone does it all by hand?

We know the longer time the follicles are outside the scalp, the lower the chance is for follicle survival.

Shouldn't it be more relevant to know if they can do it fast with good survival rate and coverage?

If something is done by hand, we know that the quality will be lower and lower over time and repetition, here it is a great advantage that machines can cover the repetitious work, and maybe do the "detailing" by hand.

But okay i'm not in for transplantations. My experience with doctors isn't the greatest I have to admit, and no one can make a guarantee how you will be scaring, and with a massive invasive procedure like hair transplants I know for my self its a no go, and the obvious that you still need to be on medication afterwards.

There are many variables, and even the doctors opinions can conflict between themselves (more often than not they are self serving). That's why I believe results speak louder than words.

And even with Zarev doing both extractions and implantations himself, he still is very fast (otherwise he wouldn't be able to cram 4.5K grafts sessions into a single day), that's another thing that is weird and seemed to be impossible.

Regarding your opinion about hair transplants, I used to think exactly the same, but started to change my mind during this year after seeing spectacular, truly life changing results consistently posted by patients in the forums. May I ask what Norwood are you?

 

[werefckd]

6 minutes of the guy babling about dates and girls, very little about his procedure.

How many grafts did he had?
Was it FUT or FUE?
Who performed it?

I checked it. It was FUT not FUE, as I suspected.

It's much easier to do giga sessions with FUT compared to FUE. But then you end up with those huge scars in the back of your head.

 

[MeDK]

There are many variables, and even the doctors opinions can conflict between themselves (more often than not they are self serving). That's why I believe results speak louder than words.

And even with Zarev doing both extractions and implantations himself, he still is very fast (otherwise he wouldn't be able to cram 4.5K grafts sessions into a single day), that's another thing that is weird and seemed to be impossible.

Regarding your opinion about hair transplants, I used to think exactly the same, but started to change my mind during this year after seeing spectacular, truly life changing results consistently posted by patients in the forums. May I ask what Norwood are you?

I would same I'm a 5-6 on the Norwood scale. But i still wouldn't do a hair transplant. I can't justify to pay for an procedure like that, and then still be on medication.

Then i would rather be with no medication and save the money. To me the hairloss isn't something that destroys my self confidence like many others.

That is why I am okay with the way for actually better treatments instead of those invasive non-reversible treatments. Okay you can argue about moving those hairs back. But reality is that almost no one have their hair moved back.

Too me regenerative treatments are the only treatments relevant to me, I have a hard time finding the downsides, besides the risk of tumors of course.

 

[werefckd]

I would same I'm a 5-6 on the Norwood scale. But i still wouldn't do a hair transplant. I can't justify to pay for an procedure like that, and then still be on medication.

Then i would rather be with no medication and save the money. To me the hairloss isn't something that destroys my self confidence like many others.

That is why I am okay with the way for actually better treatments instead of those invasive non-reversible treatments. Okay you can argue about moving those hairs back. But reality is that almost no one have their hair moved back.

Too me regenerative treatments are the only treatments relevant to me, I have a hard time finding the downsides, besides the risk of tumors of course.

Well the downside of the regenerative treatments is that they don't exist, lol. I just grew tired of browse those forums year in and year out and nothing changes. All speculation and hopes and in the and nothing happens.

The only thing that can give us a full head of hair again are hair transplants. And it's going to continue to be like that for many years.

 

[MeDK]

Well the downside of the regenerative treatments is that they don't exist, lol. I just grew tired of browse those forums year in and year out and nothing changes. All speculation and hopes and in the and nothing happens.

The only thing that can give us a full head of hair again are hair transplants. And it's going to continue to be like that for many years.

Regenerative treatments does exist, I don't know why you state they don't exist, replicel is an good example to name a relevant one. Doing trials in humans. So its not fiction, its out there. And sure its going to take some time, but so does getting your hair growing after a hair transplant.

Hair transplants can't give a head full of hair. You move around some hair, you don't gain more hair. Hair transplant would be relevant, if they didn't require life long medication afterwards. But since they do, they aren't relevant to me.

 

[werefckd]

He had FUT and FUE done. The user Mustang on this forum had about a dozen different transplants. He probably had over 10k grafts done altogether.

Probably did the bulk with FUT and used FUE for touch up sessions as this is the current standard.

Regarding Mustang, he had 9k+ grafts extracted with 10 small FUE sessions spread over 14 years. Probably used various different doctors. And his donor got destroyed. Almost impossible to extract 9K+ grafts via FUE and keep your donor looking acceptable. Only two docs I know to achieve that is Zarev and Lorenzo. Other respectable docs don't won't even try it.

 

[the smoking baby]

The extraction method he uses is different for sure.

At least the punch size is smaller. I don't think in terms of implantations there is any difference between him and another doctor. But he has found a way to extract more grafts and he is using a different tool to extract the grafts, which causes less trauma. Just look at the post-op pictures of his patients, the scars are way smaller. And even after extracting large amounts of grafts, the donor zone still looks alright.


Reminds me of a doctor that tried to do a similar thing a few years ago by developing a tool named "pilofocus". it never came to light. There was a very annoying dude named Artista in another forum that kept pushing this new tool and promising wonderful things, lol, but just like everything else, it never worked out in the end.

That was Dr. Wesley, in NYC. He was attempting to refine FUE by a method called piloscopy, which uses an extractor underneath the skin of the scalp to remove the follicle from below, thereby avoiding the punctuate scarring that is the result of standard FUE. I know that he spent time developing both the tools and technique but the third "t' - time - was the limiting factor. You can't remove FU's faster from below as you can from above so an equivalent surgery using piloscopy would be significantly more expensive than regular FUE since it would take longer to remove the same amount

Innovation, even with FUE, is still progressing. We have promising treatments on the horizon but innovations in hair transplant surgery will still keep it the best option for restoring hair for the foreseeable future.

 

[the smoking baby]

One innovation in FUE may be the use of AI to optimize the largest number of donor extractions possible without leaving a visibly depleted area. AI could assist the surgeon to select the FU's in the most optimal pattern possible.

 

[werefckd]

Respectable docs don't go outside the safe zone

The extraction patten that Zarev uses is very similar to what the other hair transplant doctors use. The claim that he goes outside of the so called safe zone is a myth not backed up by evidence. Would love to be proven wrong tho.

 

[werefckd]

One innovation in FUE may be the use of AI to optimize the largest number of donor extractions possible without leaving a visibly depleted area. AI could assist the surgeon to select the FU's in the most optimal pattern possible.

By this pic it looks like Zarev can achieve that with restorations up to almost 13k grafts. What do you think?

 

[the smoking baby]

I think it's possible that Dr. Zarev just has a good eye, a steady hand and decent stamina. Those three things combined could account for much of his current reputation. He can extract high numbers without the extractions 'bumping' into one another. That ability is not a consistent feature across the hair transplant surgeon spectrum. He may have a good sense of the direction of the punch relative to the graft which keeps his transection rate low and (as he himself has said), he can do really long surgical hours - 9, 10, 11 hours in a single surgery. Absent whatever innovations he has made in surgical tools, it just seems that he's a very good surgeon.

 

[whatintheworld]

The safe zone is not the same for every patient.

This is why microscopic evaluation and careful mapping of the donor area is important before the procedure, which is what this doctor does.

To say he "goes outside the safe zone" may mean, if you were to have the exact same extraction pattern of a different patient, it would be outside your particular safe zone. Each patient is different, and for some, more aggressive approaches can be taken, for others more conservative.

These results show what is possible with patients who have higher donor regions and capacities. This does not mean that everyone can obtain these results. But it seems you can at least be assured that whatever number of grafts you have available, your yield % will be very good, and your transection rate very low. This is all we can ask for as patients and is very encouraging to see.

 

[whatintheworld]

Respectable docs don't go outside the safe zone

When you say "the safe zone", do you imply that everyone has the same safe zone?

That is just untrue. There is the same middle region that we can call the "universal" safe zone, which is probably what Dr. Rassman refers to, and is where the FUT strips are, in theory at least, taken from.

But with microscopic analysis, you can see that, unless you are headed to Norwood 7 with DUPA, there is more donor region available than this particular region.

 

[werefckd]

No, I mostly agree with him:

Dr. Zarev is an amazing surgeon. Some men have only 12000 Follicular units in their donor area so if you take them all out, you would be bald in the back and side of the head. Clearly, those men who received 12000 grafts (Follicular units = grafts) transplanted may have had very high donor hair densities (like 18,000 Follicular units in the permanent zone) and I have done surgery on such men with remarkable results.

William Rassman, M.D.

Later on, In another post he said Zarev went out of safe zone in the patients he showcased in that now famous presentation in Manchester back in 2019. In that part I disagree, the patients already were NW6 and had lost all the "unsafe" hairs anyways. Again, the area he used for extractions was very similar to what other surgeons use, so that's not what makes him different from other doctors.

Safe zones are not universal. It varies a little bit from patient to patient. You could say doctors should always consider that a patient will become a full NW7 no matter what when establishing their safe zones but you can't call a doctor no respectable if he differs slightly from that as most people don't progress to NW7.

 

[werefckd]

I think you are confused. In one post you imply that he is not respectable, in the other you say he is one of the doctors being considered by you. That doesn't make sense.

The point of of this discussion, at least for me, is not to claim that he has magical powers or that he is the best ever, I just want to elicit information and investigate things. I think he is a talented doctor and I'm considering having an hair transplant with him but I would like to research more before pulling the trigger as there are a few other docs that I consider top notch too.

 

[whatintheworld]

No, it's not untrue. Everyone who is balding is subject to potentially having every hair in the norwood 7 region miniaturize. The norwood 7 region is the same on everyone, and any hair taken from that region could miniaturize. On some patients it might not, but there is no way to know. You can guess, which Zarev does. Personally, I like the approach as long as the patient understands the risks, but a lot of doctors would call that unethical.

No, actually you are wrong.

Not everyone is "potentially" destined to their Norwood 7 region miniaturizing. Can you predict it 100%? No.

With your logic, no one should have a transplant, because even the Norwood 7 ring can miniaturize and diffuse. There is a non-zero probability it can happen to anyone.

 

[whatintheworld]

It's generally considered to be bad practice to go outside the safe zone. I happen to like that he does it, but I'm not blind to the ethical considerations. It's considered a disreputable method by other surgeons. Sorry, but that's just reality.



You said I'm wrong, and then you said I'm right. Are you even listening to yourself. I'm out of this thread because all you guys are doing is arguing semantics. It's boring and unproductive. Have fun

No, I didn't say you're right. Let me say it more clearly so you can understand.

You're wrong.

Bye.

 

[werefckd]

Found this in another forum:

A patient from De Freitas, one of the top docs in the world right now. His extraction area for that patient is much more aggressive than any case I saw from Zarev.

 

[werefckd]

Talking about De Freitas, look how ridiculous there results are. The guy got aesthetically cured, period.