The Best Transplant Results I have ever seen, is this legit?

[asterix0]

Hi @Melvin-Moderator,

Would you be able to schedule a QA session with Dr. Zarev from Bulgaria? The results on his page are the best I have seen from any surgeon, anywhere. Here is a link for them:

https://www.hairtransplantation.bg/index.php/en/results

Apparently he uses a modified FUE technique called AVA which is based on vacuum assisted extraction, which is detailed here: https://www.hairtransplantation.bg/index.php/en/hair-transplant/transplant-methods/the-ava-fue-technique-we-apply

I am not affiliated with this clinic but merely a prospective patient who is highly impressed and intrigued by this Doctor, but there are not too many forum accounts at all about him. That's why I think a QA session where he describes his technique may be of great help to everyone. 

 

[Melvin- Admin]

I’ve never heard of this doctor, do you have patient reviews? There’s a lot of doctors who can look like superstars when they cherry-pick, but real reviews is what matters.

[asterix0]

I do not there is little information online, which is why I thought a QA session would be helpful.

I do know he is an IAHRS member.

He also presented at a conference about his FUE "giga-sessions":

https://www.youtube.com/watch?v=XASvPhbsRO4

 

 

[Melvin- Admin]

On 9/4/2020 at 9:18 AM, asterix0 said:

I do not there is little information online, which is why I thought a QA session would be helpful.

I do know he is an IAHRS member.

He also presented at a conference about his FUE "giga-sessions":

https://www.youtube.com/watch?v=XASvPhbsRO4

 

 

IAHRS is not an open or transparent organization, the only person who oversees that organization is Spencer Kobren, he doesn’t allow patients to complain about surgeons publicly. We’ve removed three surgeons in the last 4 years that he still recommends, and we’ve done so because of negative reviews posted on this forum.

That said, this surgeon may be great, I don’t know, but I think it’s important not to get caught up in hype. I’ll be on the look out for his results, hopefully his patients start to post reviews, and if I start to see actual patients with great results, I’ll definitely reach out.

 

 

[LonelyGraft]

4 hours ago, Melvin-Moderator said:

IAHRS is not an open or transparent organization, the only person who oversees that organization is Spencer Kobren, he doesn’t allow patients to complain about surgeons publicly. We’ve removed three surgeons in the last 4 years that he still recommends, and we’ve done so because of negative reviews posted on this forum.

That said, this surgeon may be great, I don’t know, but I think it’s important not to get caught up in hype. I’ll be on the look out for his results, hopefully his patients start to post reviews, and if I start to see actual patients with great results, I’ll definitely reach out.

 

 

Couldn’t have said it better myself. IAHRS is a Money grab for Spencer kobren. He lives in the most expensive area of LA and drives a brand new Range Rover. To top it off hes the president a hair transplant organization  but most members here know more about transplants than him. He’s never even had a hair transplant. 

[LonelyGraft]

4 hours ago, asterix0 said:

Hi @Melvin-Moderator,

Would you be able to schedule a QA session with Dr. Zarev from Bulgaria? The results on his page are the best I have seen from any surgeon, anywhere. Here is a link for them:

https://www.hairtransplantation.bg/index.php/en/results

Apparently he uses a modified FUE technique called AVA which is based on vacuum assisted extraction, which is detailed here: https://www.hairtransplantation.bg/index.php/en/hair-transplant/transplant-methods/the-ava-fue-technique-we-apply

I am not affiliated with this clinic but merely a prospective patient who is highly impressed and intrigued by this Doctor, but there are not too many forum accounts at all about him. That's why I think a QA session where he describes his technique may be of great help to everyone. 

 

Dr zarev created quite a stir when he presented these results at the last ishrs conference. However I think it’s all smoke and mirrors. There is no magic vacuum punch that will Let doctors  extract 10k+ grafts....dr umar already invented such a punch years ago  and there’s not much to show for it.

 

i highly doubt some random doctor from Bulgaria of all places will be pioneering the hair transplant industry. He’s likely just parading patients with very high donor densities and good hair characteristics 

[Melvin- Admin]

10 minutes ago, LonelyGraft said:

Couldn’t have said it better myself. IAHRS is a Money grab for Spencer kobren. He lives in the most expensive area of LA and drives a brand new Range Rover. To top it off hes the president a hair transplant organization  but most members here know more about transplants than him. He’s never even had a hair transplant. 

I have no problem with him making a good living, but there is a REAL problem when patients cannot share their dissatisfaction with doctors publicly, to build trust, there needs to be transparency.

[asterix0]

 

54 minutes ago, LonelyGraft said:

Dr zarev created quite a stir when he presented these results at the last ishrs conference. However I think it’s all smoke and mirrors. There is no magic vacuum punch that will Let doctors  extract 10k+ grafts....dr umar already invented such a punch years ago  and there’s not much to show for it.

 

i highly doubt some random doctor from Bulgaria of all places will be pioneering the hair transplant industry. He’s likely just parading patients with very high donor densities and good hair characteristics 

Do you see anything suspicious in his results page that would make you suspect otherwise? The pictures he included are all high resolution, with good lighting. 

I don't see anything exceptional about the patients donor characteristics, but maybe I'm missing something. 

[LonelyGraft]

36 minutes ago, asterix0 said:

 

Do you see anything suspicious in his results page that would make you suspect otherwise? The pictures he included are all high resolution, with good lighting. 

I don't see anything exceptional about the patients donor characteristics, but maybe I'm missing something. 

Hair transplants are simply a case of supply and demand. He’s showing patients with 12 and 13k Grafts With fue which is unheard of. There are rarely patients that have more than 10k grafts doing both fut+fue. There is no magic punch system that can get patients to those high graft numbers without being SEVERELY depleted. Your hair density and characteristics play a huge role in the available donor supply and results. Something just doesn’t add up. Second, there is no other explanation in either link on why he is able to reach those high graft numbers. 
 

secondly, vacuum pressure in no way can be good for fue grafts. The grafts already see lots of stresses from torsion and compression, adding another stress from the traction of vacuum pressure just can’t be good.

[asterix0]

3 hours ago, LonelyGraft said:

Hair transplants are simply a case of supply and demand. He’s showing patients with 12 and 13k Grafts With fue which is unheard of. There are rarely patients that have more than 10k grafts doing both fut+fue. There is no magic punch system that can get patients to those high graft numbers without being SEVERELY depleted. Your hair density and characteristics play a huge role in the available donor supply and results. Something just doesn’t add up. Second, there is no other explanation in either link on why he is able to reach those high graft numbers. 
 

secondly, vacuum pressure in no way can be good for fue grafts. The grafts already see lots of stresses from torsion and compression, adding another stress from the traction of vacuum pressure just can’t be good.

I think the whole point is that there appears to be a novelty in the mechanism that allows for this high graft extraction. But since little has been explained so far, that is why I made this thread, to hopefully obtain some more information about it.

His results page has very clear images and the donor and recipient areas look immaculate. I could not identify any camera tricks, combovers, or similar shenanigans. 

The argument of it being unheard of doesn't really make sense, since it is a new type of procedure. We should expect different results, but in this case they just appear to be extremely good. 

Again, I have no horse in this race I am just a prospective patient who is doing my research and due diligence. And these results are the best I have ever seen for high Norwoods. 

Edited September 5, 2020 by asterix0

[aaron1234]

4 hours ago, LonelyGraft said:

He’s showing patients with 12 and 13k Grafts With fue which is unheard of.

I took a look at his website and I'm stunned at how untouched the donor area appears on his NW7 patients who had 12k grafts.  This is simply impossible.  He must be incorporating body hair, but it's not clearly stated (many descriptions are in Bulgarian).

[LonelyGraft]

3 hours ago, aaron1234 said:

I took a look at his website and I'm stunned at how untouched the donor area appears on his NW7 patients who had 12k grafts.  This is simply impossible.  He must be incorporating body hair, but it's not clearly stated (many descriptions are in Bulgarian).

Something is off. Why can pioneers in the industry not get nearly this many grafts yet this random dude from Bulgaria That’s Been doing hts for 10 years or less have the magic bullet? I remember umar gained his reputation around 2007-2008 like this but his 15 minutes r fame r long gone.

[LonelyGraft]

3 hours ago, asterix0 said:

I think the whole point is that there appears to be a novelty in the mechanism that allows for this high graft extraction. But since little has been explained so far, that is why I made this thread, to hopefully obtain some more information about it.

His results page has very clear images and the donor and recipient areas look immaculate. I could not identify any camera tricks, combovers, or similar shenanigans. 

The argument of it being unheard of doesn't really make sense, since it is a new type of procedure. We should expect different results, but in this case they just appear to be extremely good. 

Again, I have no horse in this race I am just a prospective patient who is doing my research and due diligence. And these results are the best I have ever seen for high Norwoods. 

Again, it’s not about tools. You have a certain number of follicular units in your safe donor area. Depending on hair characteristics and density you can take 40-60% if those grafts on average without it looking too depleted. There’s absolutely no way he can do this for an average patient. I don’t care what the tool is or if he’s using a punch so small that he’s only taking skeletonized grafts.

 

if his tool was this amazing he would be selling that and making a killing, not doing hair transplants for a living. Umar tried selling his punch systems and i have heard of no surgeon that uses it yet many use the waw, Cole, and Harris systems.

[1978matt]

There's about 41 exceptional results, but what about the other 4959 surgeries he did in (I'm guessing) the last 10 years? The 41 are probably the top 1% of results.

You have to have great donor, excellent hair qualities, and maybe even be a fin responder to get these types of outcomes.  They do look really good but I would advise the average guy not to expect the same outcome as you could end up very disappointed. 

 

[Gatsby]

Yes I have become aware of Dr Zarev this year and the patient results that he has presented. It's quite incredible that he posts patients that have 11,000 plus graft moved (and more) yet the donor area appears the same regardless. Interesting.

[Curious25]

Some excellent points already made on here which basically summarise the situation you have. 

The ability to extract 12k + grafts via FUE, and not leave a depleted looking donor is predominantly down to good donor characteristics that are - high donor density, thick hair calibre, and high HGI (number of hairs per graft).

The variables a doctor can control are the extraction pattern, size of punch, and the size of the 'safe area' they deem fit to extract from. This is important - because if you're solely extracting based on the area that would be left in a NW7 patient, available grafts will be a lot less than the amount of grafts a doctor could utilise if they decided to extract from a NW5/6 pattern. I'm not saying that this isn't good practice, because advancing to a NW7 pattern is ultimately rare, and there are many who do just end up at NW5/6 - however for younger patients, it is sensible to remain within the NW7 region at first. 

His results on high NW's are outstanding, so I agree with you that he is definitely doing something right, but I think that the main contributing factor is the patients having exceptional donor qualities - and he's maybe slightly more aggressive in terms of depleting the donor than some of the more conservative doctors we are used to seeing. If your virgin donor density is 80 FUcm2 - some doctors would only be willing to extract 30-40FU's per cm2 - however perhaps Dr Zarev is willing to extract upto 50 FU's, therefore one of the methods he does differently with regards to achieving higher graft numbers. 

One of the reasons I really like FUE is because done right, it ends up creating a homogenous scalp. When my hair is grown out, my sides and back are still a lot more thick and bushy than on top, and they always have been - therefore for any physic students out there, think of it like areas of high pressure moving into areas of low pressure - ultimately when I'm done, I will hopefully have similar densities across every region of my scalp per cm2 - Due to the nature of which hair sits on your donor region, laying downwards, and the reflection of light tends to be quite favourable, IMO most could probably get away with only having 30FUcm2 without it looking depleted (given the extraction pattern has been evenly spread. 

Like others, I would love to see some real patient results, and threads - perhaps have a look on the international forums?

Having youtube superstar Dr's like himself and Couto recommended on here one day would be great, but we need a good collection of patient results for that to happen! 
 

Edited September 5, 2020 by Curious25

[Al - Moderator]

The good: He is getting some very impressive results while leaving the donor still looking good.

The bad: He is using the entire donor area without allowing for any future hair loss and he is going way out of the safe area which will cause a high percentage of these patients to lose a lot of transplanted grafts over the next few years without having any available donor hair to use to fill in anywhere. You can see he goes right up to the current bald area all the way around their heads and all the way down to the nape where retrograde thinning will occur in a lot of these man. Remember these are almost all NW 6 patients that were shown, so there is going to be a large number of them who start thinning in the donor area, have their bald area widen, and start losing from the nape upwards. You can't say it only happens to a small percentage of men because we are only looking at NW 6 men. We aren't looking at the general population where many of them won't progress to this level in the first place, so the chances of it happening on men who are already NW 6 go wayyy up.

 

 

[Curious25]

 

12 minutes ago, BeHappy said:

The good: He is getting some very impressive results while leaving the donor still looking good.

The bad: He is using the entire donor area without allowing for any future hair loss and he is going way out of the safe area which will cause a high percentage of these patients to lose a lot of transplanted grafts over the next few years without having any available donor hair to use to fill in anywhere. You can see he goes right up to the current bald area all the way around their heads and all the way down to the nape where retrograde thinning will occur in a lot of these man. Remember these are almost all NW 6 patients that were shown, so there is going to be a large number of them who start thinning in the donor area, have their bald area widen, and start losing from the nape upwards. You can't say it only happens to a small percentage of men because we are only looking at NW 6 men. We aren't looking at the general population where many of them won't progress to this level in the first place, so the chances of it happening on men who are already NW 6 go wayyy up.

 

 

I think age is a big factor with that - a NW 6 patient in their 40's or 50's is probably less likely to continue to bald much more than a NW 6 patient in their 20's. I'm also pretty sure I've read Doctors declaring the NW scale not being a scale of progression - merely an identification of pattern. 

[Al - Moderator]

13 minutes ago, Curious25 said:

ultimately when I'm done, I will hopefully have similar densities across every region of my scalp per cm2 - Due to the nature of which hair sits on your donor region, laying downwards, and the reflection of light tends to be quite favourable, IMO most could probably get away with only having 30FUcm2 without it looking depleted (given the extraction pattern has been evenly spread. 

 

This is a great point. Since this Dr is using the entire donor area the patients don't end up looking like they have a depleted donor area because you don't end up with a thinner section where grafts were taken surrounded by thicker areas where hair hasn't been extracted. Since it's all even everywhere you don't notice it because there's no contrasting area. I can see this in myself with my repair. Since my existing hair on my sides and back are already thin, it's taking less hair on top to blend in with it to make it look even all around. I'm not trying to get an extremely thick area to match the rest because the rest of it isn't thick either.

So how this Dr is using the donor is an interesting idea, but I really do think there will be a high number of failures in the long term results.

 

 

[asterix0]

I think there will only be failures if these patients actually progress to Norwood 7 and their sides/lateral humps drop.

They may be on finasteride to prevent this from happening, or like @Melvin-Moderator says, it is actually uncommon for men to progress all the way to norwood 7. Most that do bald likely bald to Norwood 5 / 6. 

It may be that they progress to Norwood 7, maybe not. But this is a chance that, if you were a Norwood 5 or 6, you would probably take considering how clean the donor area looks post extraction. Because even if this transplant "fails", it looks like you can still buzz/shave your head and look normal. 

It looks like his AVA technique allows for very clean extraction that minimizes donor scarring. He also seems to have quite the delicate touch in the extraction, as in the youtube video in the conference he gave with Dr. C and the other surgeons, he mentions the first part of his mega-session surgery lasted 11 hours! That seems like incredible stamina, considering there was another doctor here, who in a thread said after 500 FUE grafts he got tired and felt uncomfortable doing more...

[Curious25]

Just came across a JT video in which he showcased a Dr Zarev case.

The case was an outstanding NW6 transformation, similar to what you have probably seen online, and JT was as you would expect, very complimentary and in awe of the transition - he mentioned about the vacuum style tool he had invented to extract grafts, however didn't seem very well informed as to how and why it made a difference, he just concluded by saying he had a very unique and interesting approach to his surgeries, and then moved on. 

JT proclaims to have pretty strict criteria in place when it comes to his associations with the Dr's he recommended and showcases, (I'm not implying this is or isn't the case) so perhaps that will be an extra vote of confidence for people considering this doc.  

[1978matt]

15 hours ago, Curious25 said:

JT proclaims to have pretty strict criteria in place when it comes to his associations with the Dr's he recommended and showcases..  

$$$$

[Curious25]

13 hours ago, transplantedphil said:

JT also recommends Baubac - a HT doc who makes patients sign NDA's before surgery and recycles cherry picked clinic postings from years ago. Red flag if youve ever seen one. A forum member posted about their bad results a while back and Ive heard of others. Apparently JT had never met Baubac in person, (only had a phone call and saw his results), and yet was comfortable placing him on his own recommended list. So sadly I dont give any value to JT's "strict criteria". The fact that JT didnt seem too well informed about Zarev's FUE punch strongly suggests he hasnt really investigated him properly either. 

Id argue Zarev is still worth investigating (his results do exhibit artistry, untouched donors, and he is able to perform and achieve incredible mega sessions at a higher standard than 99% of most other clinics), but placing any value in JT's assessments generally is dangerous.

Agreed. I guess the point I was probably trying to make (admittedly failing to) was that despite him not being discussed or showcased on this forum, he has already got some sort of exposure in the western world, if he’s in some form of collaboration with JT. 

[Cristero]

On 9/5/2020 at 1:51 PM, BeHappy said:

The good: He is getting some very impressive results while leaving the donor still looking good.

The bad: He is using the entire donor area without allowing for any future hair loss and he is going way out of the safe area which will cause a high percentage of these patients to lose a lot of transplanted grafts over the next few years without having any available donor hair to use to fill in anywhere. You can see he goes right up to the current bald area all the way around their heads and all the way down to the nape where retrograde thinning will occur in a lot of these man. Remember these are almost all NW 6 patients that were shown, so there is going to be a large number of them who start thinning in the donor area, have their bald area widen, and start losing from the nape upwards. You can't say it only happens to a small percentage of men because we are only looking at NW 6 men. We aren't looking at the general population where many of them won't progress to this level in the first place, so the chances of it happening on men who are already NW 6 go wayyy up.

 

 

Those are the same areas where H&W are harvesting and a couple of us on this forum are trying to understand the reason for that, especially on patients that are not even in their 30s.

So it's not just Dr. Zarev doing that.

[Cristero]

Another thing that makes me think Dr. Zarev is legit is that got the endorsement from Dr. Rassman.

Dr. Rassman added on a comment to a thread on Reddit:

"To get 14000 grafts from the donor area without causing significant depletion and a see-through look, you would have to have a coarser hair with high density, a rare combination of metrics. I saw his presentation in Europe and the patients who had these high number of grafts has (1) very high donor densities and (2) he harvested outside of the permanent zone which means that some of these hairs are subject to apoptosis (death from genetics) something I do not do. There are some doctors who believe that since the Class 7 pattern is rare (about 7% of the population) most advanced balding men will end up as a Class 6 pattern. Under that assumption, harvesting the donor area of a Class 6 pattern of balding yields easily 60% more grafts. If the doctor is wrong, and these patients fall into that 7% group, then the 60% of the hairs that were transplanted will fall die and fall out. Being conservative, I don't go beyond the Class 7 donor area and that is why for advanced balding patients I generally recommend Strip (FUT) surgeries rather than FUE surgeries. By the way, I coined the term FUE and published it with the first paper ever on the subject which you can read here: https://newhair.com/wp-content/uploads/2018/11/mp-2002-fue.pdf

 

William Rassman, M.D.”

 

We can all agree that, even if the insane results are only 41 as it has been said, I never saw any clinic getting even closer to that. I'm just curious to see if there are patients reports online.