BlueSkyDay

Zarev webpage basically states he achieves far better patient outcomes due to the next generation vacuum assisted extraction that extracts pure grafts and does not extract unnecessary tissue leaving more Follicular units available for utilisation . He is effectively saying virtually every surgeon who used motorised punches and manual punches is undermining your potential results by damaging the donor region. I met Dr Reddy who warned me about the risk of damage and scarring to the donor region if surgery is not meticulously and slowly performed. He further warned of the risks of damage if the surgeon leaves the motorised punch in continuous mode . Trivellini says the motorised or manual punches gamble with your donor region - suction is needed to pull the grafts straight so the punch can cut them cleanly and be removed intact. Otherwise they risk being transected. Effectively the surgeon that is supposed to be remedying your hairloss problem is casing 20% to 30% loss to your donor area. You are paying the surgeon to make your hairloss even worse. There are surgeons using the Trivellini system. Dr Rassman, one of the founders endorses it. There is a list of surgeons on the Trivellini webpage - so they may be an alternative to dr Zarev. Obviously Dr Zarev’s results are highly influenced by his training, meticulous approach and planning, and experience My opinion is only consider a qualified surgeon that uses vacuum assisted FUE. I’m going with Zarev even at 9 euros per graft . His portfolio , videos , endorsements and recognition at conferences show he is the pioneer and world expert currently

Just a short note to say thank you to @mr_peanutbutter @mtb for the Zarev posts I have now registered with Dr Zarev and await their appointment response . The consultation fee is 900 euros and the eventual surgery will be at 9 euro per graft.

I had a look at FUEgenix but could not determine what extraction and implantation techniques are used. Does Dr Munib use vacuum assisted FUE? who are the European surgeons using vacuum assisted (apart from Zarev)

@hairman22 given how well this thread has developed I sent a message to Dr Zarev yesterday asking for an appointment the response from Dr Zarev today was pasted above. I added the heading “THE MARKET HAS SPOKEN “ as a response to all the lovely posters on here who need double blind studies as proof of Dr Zarev claims , Dr Trevillini’s evidence. I wonder how many on this forum work for hair mills I suggest the proof is in the bookings for the next 3 years, i think it’s safe to say the market of hairloss suffers think he is the top man for restoring your hair. i will try to get an appointment in 2028! I wish I was in some way affiliated so that I could jump the queue!

THE MARKET HAS SPOKEN Hello! Due to overwhelming demand for consultations and our fully booked schedule until 2027, we now offer only off-schedule consultations. The off-schedule consultations are at the price of 900 euro. In case you want to book an off-schedule consultation, the price of the surgery will be 9 euro per graft. We will put you with highest priority on our cancellations list. In case there is an opening we will contact you accordingly. The consultation will be performed in person (we do not offer online consultation). You will be requested to pay the consultation fee only if we manage to find you an appropriate time slot for you. If you are an eligible candidate your surgery will be performed around two years after the consultation. All communication during the consultation and surgery will be in English. Please let us know if you would like to book an off-schedule appointment. Best regards, ZAREV | Clinic

My Response is related to your comment below However, to say it's all down to the method he uses for extracting punched grafts is a massive stretch, IMHO

To me this means there are only a few exceptional surgeons and Dr Zarev is probably ranked no 1. I believe his criticisms of motorised FUE (non vacuum assisted) plays a major role in donor area preservation and greatly assists his ability to extract high graft numbers. The evidence of Dr Zarev, Dr Trevillini, Dr Rassman show that vacuum assisted FUE is now the best practice extraction technique. By way of definition of results : I think this includes the following: Natural looking results, adequate density, donor region preservation for future use, lack of scarring, lack of damage / trauma, lack of over-harvesting, minimal recovery period , safety that will determine who the best surgeons are.

Earlier I said "The Gold Standard today is Vacuum Assisted FUE (AVA / Neograft / Trevillini) performed by an IAHRS surgeon, with all the memberships, qualifications and results to back up."

Trivellini System Overview It is particularly important that suction is used along with the Trivellini follicular extraction device to accomplish our goal for the following reasons: The suction helps to achieve a better extraction of the follicle by elevating it just a little bit so that the handpiece has a clearer path for easier removal. As the punch cuts through tissue, the suction motion pulls the follicle inside the lumen of the punch. This minimizes the need to advance the punch as much as the traditional devices. The follicle is not fully straight in the skin before the extraction. The suction and traction it provides on the follicular unit can straighten the follicle and minimize the risk of transection. That is why Trivellini System has lower transection rates and produces grafts of a higher quality. Suction can also get rid of any oozing blood and clean the surface of the skin for better visibility while extracting grafts. The above shows that motorised FUE suffers from Higher Transection rates.

@Berba11 The assumption that non compliant surgeons be canned from IAHRS is your assumption, and is flawed. The IAHRS as a professional body should be promoting best practice and encouraging its members to adopt Best Practices. That is what my professional body does, I do not see why surgeons should be exempt from adopting best practices. The quotations from Dr Zarev's and Trevelli's are evidence for my argument. Its there to assist members of this forum -its not for you. I think its clear from Zarev and Trevellini that Best Practice is now Vacuum Assisted FUE. These techniques include AVA FUE, Neograft FUE and Trevellini FUE. Given that you have a consultation with Zarev you accept his credentials and results. Zarev's results speak volumes. Ultimately patients have to choose a surgeon they believe in. I accept Zarev's assertions about the damage caused by Motorised and Manual FUE, which are corroborated by Trevellini. The post surgery photos back up both Zarev and Trevellini - the photos say it all. The case for vacuum assisted FUE is corroborated by the photos - its obvious man I also had a consultation with Dr Reddy who highlighted the risks of motorised FUE, particularly leaving the motor in a continuous mode to increase the speed whereby causing higher transection rates and increasing scarring. IAHRS should be ensuring their members follow best practice - that's what professionals do It is notable that Dr Rassman, one of the Founding fathers of FUE endorses the Trevellini Vacuum Assisted FUE system. In effect he agrees that it is state of the Art FUE technique. Dr. William Rassman concludes that Trivellini System allows it to be an ideal replacement for many other types of hair restoration systems that have been used in the past. Trivellini Tech has been very active in the field of hair restoration with many novel ideas in the last few years. I am sure they will continue to push the field of hair restoration forward their out-of-the-box thinking. Dr. Jae Pak and I endorse the Trivellini System for all FUE users who want to enjoy speed and agility in managing the FUE process.

@Berba11 Definitely not ludicrous - Zarev and Trevellini are in agreement that Vacuum assisted FUE avoids 20% to 30% damage to donor area. This is obviously significant, and why they advocate moving on to Vacuum assisted FUE techniques. Dr Zarev website states: "Dr. Zarev has used all the FUE method techniques (manual and motorized) and in the last 9 years has been actively developing and applying the latest hair transplant technique - AVA FUE (Automatic Vacuum-Assisted Follicular Unit Extraction)" "Vacuum-assisted extraction guarantees the high quality of micrografts, because it reduces to a minimum the risk of damage to them when the punch enters the scalp and then separates the graft from the scalp. The lack of mechanical trauma to the grafts with AVA FUE technique, and the precision of the process, significantly increases the percentage of surviving micrografts: our results are in the range of 95% - 98%. AVA FUE technique considerably shortens the first stage (extraction of donor material) and makes it possible to harvest a greater number of micrografts while causing the patient less discomfort" On Manual FUE technique Dr Zarev states: "Manual insertion of the punch, and extraction using tweezers, are the two critical moments as regards the vitality of the grafts, since the considerable mechanical trauma involved in these operations may damage the donor material" "This technique has two shortcomings, which influence the effectiveness of the procedure (the percentage of grafts that take root and the number of grafts transplanted at a single stage): Risk of damaging the donor material during extraction (it decreases the percentage of surviving grafts – the loss may attain from 20% to 30%) Insufficient speed of the procedure (it limits the number of grafts – in a period of 4 to 6 hours, only 1200 to 1500 grafts may be extracted) " On Motorised FUE technique Dr Zarev states: "Extraction trauma remains the same as in the case of manual technique, as the number of damaged grafts is likewise between 20% and 30 % " Dr Trevellini states "We know that the angle of the hair changes as it emerges from the scalp because we are able to see it; it is tangible. However, what is beneath the epidermis is usually a puzzle for the FUE surgeon. In the three-dimensionality of a follicular unit, each hair usually has a different path from the bulb until its departure from the skin. The surgeon can only estimate this, since it is not visible. Axial movement applied to the punch by the surgeon’s hand during insertion undergoes changes of direction in its path as it penetrates the skin. This causes constant modification of the resulting force vectors in the dynamics of follicle extraction. Since the punch movement is unpredictable, its path and its geometrical shape are very irregular. Nevertheless, the surgeon’s hand movement is much better than the linear motion of the punch performed by a robotic arm. Given these realities, the advance of a punch blindly into the scalp almost becomes a game of chance in which there can only be a loser, the patient" Conclusion In effect you are calling Zarev and Trevellini "ludicrous" - that is obviously ludicrous given their credentials, and given that all patients cannot afford putting 20% to 30% of the extracted grafts at risk of damage. So I stand by my earlier comment, why would any sane person sign up & risk destroying 20% to 30% of their grafts by choosing surgeons that perform motorised (not vacuum assisted) FUE. The IAHRS should be insisting that their members adopt Best Practice Vacuum Assisted FUE so that the patients best interest are protected. It is absolutely outrageous that a professional body is failing to do this. Zarev and Trevellini have highlighted the old practices that the majority of surgeons are using : Motorised FUE (not vacuum assisted) and Manual FUE. I accept their warning and choose to follow their advice: insist on the latest Best Practice technique - Vacuum Assisted FUE.

I want to thank the poster of this topic. It caused me to do further research on FUE techniques. I read Dr Zarev's web-page covering the 3 FUE techniques : (1) The Latest AVA FUE (2) Previous : Motorised FUE (not vacuum assisted) (3) Original Manual FUE. Dr Zarev makes it clear that there is only 1 winner : Vacuum assisted FUE. He believes the other 2 technqiues are not in the Patients best Interests because the damage to the donor area and grafts is unacceptably high. He states 20% to 30% of grafts are damaged. Unnecessary tissue is extracted causing additional / avoidable scarring, more trauma, longer recovery. It is absolutely outrageous that the IAHRS allows its members to continue using the old FUE techniques. As a result of this thread and the research it led me to do, I have cancelled my surgery for 2 April. The Gold Standard today is Vacuum Assisted FUE (AVA / Neograft / Trevillini) performed by an IAHRS surgeon, with all the memberships, qualifications and results to back up. These Vacuum assisted FUE devices have (1) improved graft quality, (2) reduced transections, and (3) make it easier to remove the grafts without trauma If the surgeon does not post after surgery photos of the donor area then be suspicious. I noticed this problem with the surgeon I was dealing with. Be very careful out there - Its an absolute minefield out there!

I recommend reading "An Innovation in Suction Assisted FUE" by Roberto Trevillini. Best Practice today is Suction or Vacuum assisted FUE. The use of micro-engine punches is old technique. Patients are gambling with their remaining hair follicles if they Do not go the Suction Assisted FUE route. As Roberto says: “We know that the angle of the hair changes as it emerges from the scalp because we are able to see it; it is tangible. However, what is beneath the epidermis is usually a puzzle for the FUE surgeon. In the three-dimensionality of a follicular unit, each hair usually has a different path from the bulb until its departure from the skin. The surgeon can only estimate this, since it is not visible. Axial movement applied to the punch by the surgeon’s hand during insertion undergoes changes of direction in its path as it penetrates the skin. This causes constant modification of the resulting force vectors in the dynamics of follicle extraction. Since the punch movement is unpredictable, its path and its geometrical shape are very irregular. Nevertheless, the surgeon’s hand movement is much better than the linear motion of the punch performed by a robotic arm. Given these realities, the advance of a punch blindly into the scalp almost becomes a game of chance in which there can only be a loser, the patient. We have developed a new device and technique for FUE that 1) improves the margin of safety in the extraction of the follicular unit, 2) provides better control of the punch movements into the scalp, and 3) facilitates safe removal of the follicular unit.”

Dr Zarev uses AVA FUE. This appears to be very similar to NEOGRAFT FUE. NeoGraft® is a minimally-invasive follicular unit extraction (FUE) hair replacement method that safely harvests individual hair follicles and transplants them to areas affected by hair loss. This innovative hair transplant technology is the most advanced method on the market today. NeoGraft leaves behind no scars, includes a mere 48 hour recovery rate, and has a 92-98% success rate. my takeaway is that patients should avoid motorised and manual FUE- the surgeon or technician is playing a game of chance with you limited donor area. I will demand higher standards from my surgeon ensure your surgeon uses vacuum assisted FUE to avoid handling the grafts with forceps (traditional FUE uses forceps to pull out the grafts - this is another opportunity for the surgeon to damage your limited grafts)

Dr Robert Trevillini developed a vacuum assisted FUE device as well - Trevillini system ( similar to NEOGRAFT system). The traditional FUE method means the surgeon plays a game of chance with the patients donor area and the patient pays the surgeon to damage the donor area. Below is a quote from Dr Trevillini: We know that the angle of the hair changes as it emerges from the scalp because we are able to see it; it is tangible. However, what is beneath the epidermis is usually a puzzle for the FUE surgeon. In the three-dimensionality of a follicular unit, each hair usually has a different path from the bulb until its departure from the skin. The surgeon can only estimate this, since it is not visible. Axial movement applied to the punch by the surgeon’s hand during insertion undergoes changes of direction in its path as it penetrates the skin. This causes constant modification of the resulting force vectors in the dynamics of follicle extraction. Since the punch movement is unpredictable, its path and its geometrical shape are very irregular. Nevertheless, the surgeon’s hand movement is much better than the linear motion of the punch performed by a robotic arm. Given these realities, the advance of a punch blindly into the scalp almost becomes a game of chance in which there can only be a loser, the patient. We have developed a new device and technique for FUE that 1) improves the margin of safety in the extraction of the follicular unit, 2) provides better control of the punch movements into the scalp, and 3) facilitates safe removal of the follicular unit.