Donor Capacities - Not all Surgeons are Equal

[Curious25]

I have been inspired to start this after reviewing @HugoX 's recent 2 transplants with Dr Zarev. Without having concrete stats on his pre surgery donor density - I'm going to go out on a limb here and still use this as an example as to why not all top tier surgeons are equal. 

has explained on numerous occasions how Dr Zarev's ability to extract upwards of 10,000 FUE grafts from patients, is purely down to his patients having excellent pre donor density, therefore having a higher selection to play with from the get go. Whilst this indeed logically makes sense, I find it very hard to believe that Eugenix and Dr Zarev are the two most fortunate surgeons in the world to be blessed with these types of patients on a regular basis - because these types of candidates aren't unicorns, and I very rarely see any other top surgeons we talk about on these boards, performing 2 or 3 step surgeries on patients extracting the same level of grafts via FUE.

I propose that, just how some surgeons have reputations of having the capability of making lesser number of grafts go a longer way in the recipient area, such as Dr Reddy, Dr Konior etc. - I believe surgeons such as Dr Sethi and Dr Zarev, have the ability to execute advanced level extraction patterns in the donor areas, that they are in fact able to further deplete patients donor regions more so than their fellow peers, and leave it looking aesthetically no different. 

I'd be keen to hear peoples thoughts. 

[Gatsby]

I have to disagree. Dr Zarev extracts from the donor region 'all over the place' and is still yet to publish his 'technique.' Dr Sethi uses the art of beard grafts to be able to achieve a higher donor supply. I've personally spoken with Dr Pradeep about this as Dr Pradeep attended the conference on Dr Zarev which was MC'd by Dr Cole. Dr Pradeep told me he was refused any information about the techniques used and even Dr Cole was refused any information about Dr Zarev's 'technique' also which Dr Zarev claimed was waiting a patent (which still to this day Dr Zarev claims he is waiting on??). The number of Norwood 6/7 patients that Dr Sethi has published is legion. The number by Dr Zarev is few by comparison. Please don't get me wrong. I am in no way putting down Dr Zarev who is a young, talented surgeon. However at the end of the day it pays to keep you ear close to the source and not to the scandal. Dr Cole no longer has an interest in promoting Dr Zarev since this conference. It's in many ways similar to Dr Ray Woods with FUE many years ago.

[Fue3361]

Absolutely true I’d say.

[Melvin- Admin]

There’s no magic to this, it’s really simple supply and demand, if you have the supply to meet the demand you can harvest a lot of grafts. I’m more impressed with what can be done with a poor supply like @RR1 story. That said, I’m not taking away from this surgeon, but to say he’s a cut above the rest, isn’t true at all in my opinion. 

[Curious25]

I’m not saying he’s a cut above the rest per say - and gatsby, I used dr Pradeep as an example of a dr who does seem to get more grafts than others.

Supply and demand is obviously the limitation with every surgery - but how can you tell me that my proposal is wrong, when Zoomster goes to one recommended surgeon on here and is turned away for having a weak donor, yet a few years later, he’s shaping up to be a very well covered NW 1 after over 8000 grafts were extracted from that very same donor by a different doctor? 
 

Hugo’s donor was a fully established classic NW6 pattern, so it was impossible for Dr Zarev to have extracted from with outside that. 
 

I get the eagerness to remain politically correct, and I’m not insinuating these surgeons are better than the others, perhaps it would be nicer to say the other surgeons are more conservative?
But I don’t understand why it’s acceptable to openly acknowledge doctors such as Konior and Reddy are able to restore recipient areas often using less than market average numbers of grafts, however you aren’t able to highlight some doctors being able to do the same in reverse, with patients donor areas. 

Edited November 1, 2021 by Curious25

[asterix0]

@Curious25 The main issue is the general opacity of the industry. 

So much of what is considered good/bad is entirely subjective, how many clinics post highly combed over poorly lit photo as proof of a good result.

Why can we not get actual yield numbers, have the patients come in 12 months after if they can and agree to a detailed microscopic yield analysis? 

Of course you can do the math and see for yourself, when a top surgeon can do with 2000 grafts versus what another may need 4000 to do, some may say well if the patient got what they wanted with the 4000 and the price was right then no harm no foul? Everyone is happy right?

As long as we get heavily combed over after photos and no real numbers it will continue to just be a he said/she said industry for most people.

[Curious25]

11 minutes ago, asterix0 said:

@Curious25 The main issue is the general opacity of the industry. 

So much of what is considered good/bad is entirely subjective, how many clinics post highly combed over poorly lit photo as proof of a good result.

Why can we not get actual yield numbers, have the patients come in 12 months after if they can and agree to a detailed microscopic yield analysis? 

Of course you can do the math and see for yourself, when a top surgeon can do with 2000 grafts versus what another may need 4000 to do, some may say well if the patient got what they wanted with the 4000 and the price was right then no harm no foul? Everyone is happy right?

As long as we get heavily combed over after photos and no real numbers it will continue to just be a he said/she said industry for most people.

So what does that mean your views are on this topic?

[asterix0]

Just now, Curious25 said:

So what does that mean your views are on this topic?

I believe that there are a select few number of elite surgeons worldwide that are best if you want the most optimal result, such as the ones you mentioned, but not everyone obviously can either afford them, or is willing to wait long enough to book them.

I have my opinion who is the best in the world, who is the top 10, but it doesn't really matter too much I think for most people any of those can get you a fantastic result. 

 

[asterix0]

There are two questions that I think are most important for starting how to evaluate one's hair transplant journey.

1) What is my final pattern?

2) How good is my donor?

If (1) is a 6 or a 7, then (2) becomes even more important. I believe patients who will eventually be Norwood 6 or 7 should naturally do the most research, and be most selective with who they choose. 

[Zoomster]

I think with Hugo he got dealt a bad hand with his level baldness and young age yet at the same time he got dealt an Ace hand with regard to his donor characteristics...it looked delicious pre first HT ..any surgeons dream canvass. ..thick,dense ,slight wave/kink ..perfect in otherwords 👌🏼

Great result ..even better one pending .

[SLA]

All good points...Dr. Zarev undoubtedly produces excellent results for sure, however, all the examples I have seen from him are those with outstanding donors.

I am most intrigued by surgeons that can do more with less.

Perhaps Dr. Zarev has that ability, but I have yet to see it.

 

[Zoomster]

37 minutes ago, SLA said:

All good points...Dr. Zarev undoubtedly produces excellent results for sure, however, all the examples I have seen from him are those with outstanding donors.

I am most intrigued by surgeons that can do more with less.

Perhaps Dr. Zarev has that ability, but I have yet to see it.

 

I think I sense what you’re thinking ..

” I wonder what Dr Sethi could produce with Hugo’s donor ?🤔”...

🥇

[HugoX]

As I was tagged and only active patient of Dr Zarev at this forum I can say a couple of things. 

The amount of results that Dr Zarev have published is nothing compared to his portfolio on his hard drive/cloud storage. Each and one of them as amazing as the ones published and different Norwood scales, not just Norwood 5/6/7s with excellent donors.

Someone commented that Dr zarev extracts "all over the place", how is he's extraction pattern all over the place but not Zoomsters as an example from Dr pradeep, if you compare he's and mines post op after second transplant, how is not Zoomsters all over the place? What am I missing?

(Couldn't find exact angles) 

And obviously Dr Zarev wouldn't extract the same way if I went to him when I was around 23 years old, still a lot of hair left but crown and hairline/temples thinned out. 

And his "technique" that also was mentioned I am guessing is about his vacuum assisted extraction method, I have asked about this, obviously he would not tell me exactly all the details about this which is understandable, from my understanding the machine is his own developed and there is no other kind like the one he has, I belive it was based on another similar vaccum assisted machine but he has changed and developed so much that there is no other like it and he is the only one today that is capable of handling this machine, in other surgeons hand without proper training would not work well from what I understood. 

 

I have been basically totalt bald, Norwood 6 since I was 30 years old, from that time to January this year I have looked the same, and I will turn 40 in a month, my safe zone is obviously different than someone who is still Norwood 2/3/4 and younger or around my age. 10 years from now if I had done nothing I would 95% have the same donor as I had before any surgery (as long as I am healthy). 

Dr Zarev have taken in calculation that I will loose a bit more on sides and back (from the top) and that is why he has saved around 1500 grafts for the future. 

And let's not even mentioned my beard that would easily give 4-5k grafts but we haven't even touched that subject. 

I have asked Dr Zarev why he isn't publishing more results on his Web site or social media, simple answer is time, Monday to Friday basically 09 clock to 23/00 in surgery and consultations and he is also busy overseeing the new clinic that's being built.

As Dr Zarev does most(all) of his work himself, even the little things that other surgeons just don't do it simply leaves him no time to be active on social media or interact on forums which is a shame as there is alot of curiosity about him. 

I will end with saying that Dr Zarev does his work mathematically, hi calculates and measures to see what is achievable. Age, current and future hair loss are all within his calculations.

[BoldnotBald]

On 11/1/2021 at 4:14 PM, Curious25 said:

I get the eagerness to remain politically correct, and I’m not insinuating these surgeons are better than the others, perhaps it would be nicer to say the other surgeons are more conservative?

 

you are 100% correct.

[BoldnotBald]

On 11/1/2021 at 8:48 PM, HugoX said:

And his "technique" that also was mentioned I am guessing is about his vacuum assisted extraction method, I have asked about this, obviously he would not tell me exactly all the details about this which is understandable, from my understanding the machine is his own developed and there is no other kind like the one he has, I belive it was based on another similar vaccum assisted machine but he has changed and developed so much that there is no other like it and he is the only one today that is capable of handling this machine, in other surgeons hand without proper training would not work well from what I understood.

i am not sure whether dr zarev is being honest about his magical, modified vacuum assited extraction method:

as far as i know dr zarev uses the neograft / medicamat / punch hair system and which uses suction to get the punched grafts out of the skin. this system simply helps to avoid the need for those assisting nurses during the extraction process. so, it´s also quite money saving method.

all in all my understanding is that dr zarev´s magical "modification" is simply using his implanters for the insertion process instead of neografts´own implantation system.

 

[johnto]

I was hoping that someone would start a thread about Zarev.     I feel these "God" surgeons who treat high norwoods with amazing results usually are every meticulous about every step of the process.  when I look at the way grafts are implanted and how the steps to the process are planned Zarev and surgeons like Couto feel like their process and results look similar.

One of the things I have noticed is when they remove grafts from the donor zone they seem to spread the extraction sites equally around instead of removing them from a more localized area so if the donor gets thinner it does so equally so it is not as noticeable instead of creating a "halo effect" in the donor.

The second thing I notice is when they implant the grafts it looks so minimally invasive.  Almost no bleeding or trauma.  I guess this would be from the implanter pen they use and by being so meticulous with their pre-surgery consultations and quality control that they achieve the best results.

Finally for Couto and Zarev their patient pool is almost always European dark slightly wavy hair which helps make less grafts go a longer way.  

 

I mean look at the implantation from Zarev and Couto.  Its so clean and minimally invasive.  I assume they both use an implanter pen and not lateral slit technique which when I see this technique used always seems more bloody to me.

Edited November 6, 2021 by johnto

[johnto]

If you compare Couto and Zarev to Dr. Diep for example you can see the post-op difference.  I assume Dr. Diep uses lateral slits and then they implant the FUE grafts with forceps? (ps. Im not bashing Diep I actually really love his results I think he produces world class results.  I am just comparing technique thats all).

Edited November 6, 2021 by johnto

[BoldnotBald]

yep:

using sharp implanters instead of blunt ones won´t create a bloody recipient site.

also, extracting grafts from the entire donor area - as opposed to just the back - crucially contributes to this homogeneous look.

[BoldnotBald]

On 11/1/2021 at 10:50 AM, Gatsby said:

Dr Pradeep told me he was refused any information about the techniques used and even Dr Cole was refused any information about Dr Zarev's 'technique' also which Dr Zarev claimed was waiting a patent (which still to this day Dr Zarev claims he is waiting on??).

i would be VERY surprised if dr zarev ever received a patent. because there simply is nothing that can be patented about his "technique":

like dr pradeep / sethi he simply extracts from almost the entire donor area. period!

[BoldnotBald]

@Gatsby i would be VERY surprised if dr zarev ever received a patent. because there simply is nothing that can be patented about his "technique":

like dr pradeep / sethi he simply extracts from almost the entire donor area. period!

[Gatsby]

7 minutes ago, BoldnotBald said:

@Gatsby i would be VERY surprised if dr zarev ever received a patent. because there simply is nothing that can be patented about his "technique":

like dr pradeep / sethi he simply extracts from almost the entire donor area. period!

And their in lies my entire point. When Dr Zarev stated to Dr Cole, Dr Sethi, et al, that he cannot release his ‘technique’ as it was (and apparently to this day still is) pending a patent then you can begin to understand my point. There is nothing new or evolutionary about the basics of FUE. A Sapphire blade is still just a blade. Or where I come from ‘That’s not a knife? This is a knife!’ 

[Curious25]

That patients post op recipient from the Dr Zarev video is immaculate . . I saw it watching that very video a while back and was extremely impressed. 

Dr Konior is another another who has extremely clean looking patients post op. 

It pays to be meticulous. 

[SLA]

I just don't understand how Dr. Zarev claims to be able to extract 60% of the donor without signs of depletion, where other surgeons might say not to extract more than 40%.

[johnto]

24 minutes ago, SLA said:

I just don't understand how Dr. Zarev claims to be able to extract 60% of the donor without signs of depletion, where other surgeons might say not to extract more than 40%.

I think this depends on the patient.  He has said on his Instagram that it depends on donor capacity, hair thickness etc.  Not everyone can have these types of results.  Also I think he has said that you can extract 60% of donor area without "visible signs of depletion".  Ie. the donor becomes thinner but I believe because it becomes a bit thinner in  a homogeneous way its not perceptible.  Whereas if you extract in a more defined zone then if it thins you can tell (ie. halo effect).

I assume this would depend on type of hair.  Thick black slightly wavy hair Is better than thin blonde hair.  If you look at his giga sessions all patients seem to have similar type and quality of hair

Edited November 7, 2021 by johnto

[Curious25]

1 hour ago, SLA said:

I just don't understand how Dr. Zarev claims to be able to extract 60% of the donor without signs of depletion, where other surgeons might say not to extract more than 40%.

I’m guessing the extraction pattern he adopts. 
 

And yes, hair characteristics will obviously largely determine just how viable this will be. 
 

Regardless - I maintain some dr’s have better donor management skills and extraction patterns than others, because we have numerous patients on here who are walking examples of this. 
 

Until Dr Zarev is ‘recommended’ on here, if he ever is, the general consensus on his work will remain sceptical and cynical.