Donor Capacities - Not all Surgeons are Equal

[blackislback]

Definetely dr. Zarev's donor extraction pattern and few other doctors with similar style, is something what makes his work different than other doctors who use FUE, as their patients post-op is very clean, and about using such big amount of grafts is probably depend by donor area quality, and probably he choose such patients where can achieve such results, think there is no some "special" patents  , but mostly it's about what @BoldnotBald explained ... But time will say did dr. Zarev say true or not about "patent" ...

And think he will not be soon here on "recommended" list, as he doesn't have consultants as mots of clinics, this @HugoX  explained, and seems as HugoX wrote his patients mostly Bulgarian, and they will not post here probably, as he charges 4e per graft, and by 2x surgeries per week for Bulgarian standard he get profit, same as some doctor in Turkey performs 4x surgeries per week, but even it's like that, still strange work without consultant, no much info in public for international patients, as even top recommended doctors from Belgium, Spain, still have consultants, social networks that international patients easier find them, and available at forums too...

Interesting will be to hear where @HugoX got recommendation or found info about dr. Zarev ?

Doing all as 1-man show think can't lead to much success in future, else if he is only local oriented, as if you not get email reply in some normal time frame like 1-7 days, but need wait 1-2 months, rather will choose any other doctor with same or similar results, like Eugenix, Conior, or any other... And bytime it makes too much tired person who does all - email response, extraction-incision-implanting, consultations, etc. , strange view of doing business in this industry by Dr. Zarev...

[A Fue Good Men]

On 11/1/2021 at 2:50 AM, Gatsby said:

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.

Reading about hair transplants, doctors, tools etc through the years has given me some certain ideas about the industry. Zarev has stated that his punch he developed uses vacuum assistance.

This right here is a big issue at first glance….a few years ago dr. umar actually took dr. Devroye to court for copyright infringement on his device and won a huge lawsuit. Umar actually has a vacuum assisted punch as well in his product lineup.

 

Zarev demonstrated in his most recent surgical technique video what he does during the whole planning and procedure itself. He actually blurred out the entire hand held punch he was using. That to me speaks volumes.

 

I think it’s a combo of his thorough planning, skill (ability to use small punches and split grafts), tools, and patient selection. To your point his wide donor area selection also allows him a wider area to extract from.

[kirkland]

Dr. Zarev seems like a skilled surgeon who prefers to do most of the steps involved in the surgery so he can better control the outcome. The trade-off is that he spends less time marketing and costs are higher since he is involved so much in each surgery. He may have improved the engineering of some of the tools of the trade but no doubt, his results are reflected in the amount of personal involvement in his cases. If he's building a new clinic, then I imagine the demand for his services are behind it. But I think his skills, his involvement in each surgery and the individual donor characteristics are all significant factors in the results he gets.

As for @Zoomsterand being turned down by one HT doc for weak donor characteristics only to find success with Eugenix, many doctors set their own boundaries as to what they feel comfortable in taking on for surgery. If you don't think you can satisfy the expectations of a patient, then you may turn away the case. Another doctor may have more confidence that they can achieve a successful outcome (success being measured subjectively by both patient and doctor). I was turned away from two prominent HT doctors in Canada because I had SMP and they didn't feel comfortable with surgery unless the pigmentation was removed. Dr. Sethi has performed HT surgeries on patients with existing SMP with no problems. Surgeons set their own limits along with the limits already set for them. 

[mtb]

I hear you, Curious. I find it interesting that there are a handful of surgeons are able to get fantastic results on NW6 patients in just one or two passes with such high graft counts. Half of the clinics I contacted said it wasn't possible to achieve coverage and density at my current NW6 status. I think it plays to the subjectivity of all medical practice on some level. Before you have any procedure (even non-hair transplant) you're best to get second and third opinions. Eugenix, Zarev, Cole, Erdogan and a couple others said they'd be able to do it for me. Zarev said he wouldn't tell me for sure until we met in person. He said if he didn't think he could get a good result he wouldn't even do a procedure. I respect that. I don't think Dr. Zarev cares about marketing or office staff. He's booking out surgeries over a year from now so he knows demand is definitely there. To be honest I think any of us are probably going to have a really good chance of success whether we choose Eugenix, Zarev, Konior, Reddy, etc. I think it's great that those docs are bringing more potential to the hair transplant world. Cases that wouldn't be attempted a decade ago are now being done on the regular.

Big shout out to @Zoomster and @HugoX who were kind enough to share their journey and answer a few PMs I sent. Thanks for helping those that are farther behind in the journey.             

 

[HugoX]

16 hours ago, blackislback said:

Definetely dr. Zarev's donor extraction pattern and few other doctors with similar style, is something what makes his work different than other doctors who use FUE, as their patients post-op is very clean, and about using such big amount of grafts is probably depend by donor area quality, and probably he choose such patients where can achieve such results, think there is no some "special" patents  , but mostly it's about what @BoldnotBald explained ... But time will say did dr. Zarev say true or not about "patent" ...

And think he will not be soon here on "recommended" list, as he doesn't have consultants as mots of clinics, this @HugoX  explained, and seems as HugoX wrote his patients mostly Bulgarian, and they will not post here probably, as he charges 4e per graft, and by 2x surgeries per week for Bulgarian standard he get profit, same as some doctor in Turkey performs 4x surgeries per week, but even it's like that, still strange work without consultant, no much info in public for international patients, as even top recommended doctors from Belgium, Spain, still have consultants, social networks that international patients easier find them, and available at forums too...

Interesting will be to hear where @HugoX got recommendation or found info about dr. Zarev ?

Doing all as 1-man show think can't lead to much success in future, else if he is only local oriented, as if you not get email reply in some normal time frame like 1-7 days, but need wait 1-2 months, rather will choose any other doctor with same or similar results, like Eugenix, Conior, or any other... And bytime it makes too much tired person who does all - email response, extraction-incision-implanting, consultations, etc. , strange view of doing business in this industry by Dr. Zarev...

I found Dr Zarev in videos and another recommend list of top surgeons, after that started to try and find info about him and found his website that for me was one of the better ones in showing before and after pictures in terms of lightning, angles and the amount of pictures,and there were many YouTube clips and I saw that there is a consistency in all the results. Also that he was basically one of few that had and showed many Norwood 5 and 6 with great results. 

Comparing for instance to Dr Bisanga who also do excellent work, Dr Bisangas results for the most part are between 2000-3000 grafts on Norwood 1,2 and 3s and always for the most part on persons with great donor and existing remaining hair. 

This is also interesting I think, the discussion about different surgeons and their work, why do you we not see many totally bald, Norwood 6 patients results with great donor capacity from as an example Dr Bisanga? Doesn't people with great donors capacity and Norwood 6 go to Dr Bisanga? Is he only choosing Norwood 2/3 with great donor and great existing hair? 

How many surgeons can do 8000-9000 grafts over 2 days on a patient with great donor capacity? 

Another thin I don't understand is why there is so much focus on patent talk? Dr Zarev have developed a tool that suits his way of work for extraction, but hes not exactly going around and bragging about it or saying it's revolutionary online, on forums or his website, for now he is the the only one that works with this method and working well by the looks of it. I don't think Dr Zarev is focused on these things now as there is no need. 

I also think that because Dr Zarev isn't active in this or other forums or pumps out YouTube videos or interviews doesn't mean his not "successful", is that how you measure successful? 

(He's btw fully booked last time I was there until end of November 2022 (of course there will be cancellations in between)) 

For me I would rather see a surgeon that is consistent in his results and has high involvement with the patient before, during and after surgery and this Dr Zarev deliveres without a doubt. 

And its not Dr Zarevs fault that his patients doesn't go to forums and write about their experience. He even didn't know I was writing in forums until a couple of months after my first surgery when he was getting inquiries saying they saw my post on a forum. 

But he knows it's not that good that people who send inquires (specially non Bulgariens) have to wait a long time for a reply as the staff working now does not speak English and Dr Zarev who speaks English is busy with surgery and patients. 

But he hopes this will become better when opening the new clinic and hiring a patient coordinator that speaks English. 

[Curious25]

1 hour ago, HugoX said:

This is also interesting I think, the discussion about different surgeons and their work, why do you we not see many totally bald, Norwood 6 patients results with great donor capacity from as an example Dr Bisanga? Doesn't people with great donors capacity and Norwood 6 go to Dr Bisanga? Is he only choosing Norwood 2/3 with great donor and great existing hair? 

Well this was my point exactly - I find it very hard to believe Dr Zarev is just fortunate enough to encounter these types of patients. I don't understand why other recommended surgeons don't have examples of this type of restoration, unless;

a) they aren't able to execute the same level of restoration 
b) a higher volume of lower level restorative surgeries is more financially beneficial - so they choose to prioritise business first (which I'm not suggesting is wrong to do so, just don't publicly criticise other surgeons who are performing this type of surgery as not being a viable or safe method, because your clinic chooses to put profits first).  



 

[blackislback]

10 hours ago, HugoX said:

Another thin I don't understand is why there is so much focus on patent talk? Dr Zarev have developed a tool that suits his way of work for extraction, but hes not exactly going around and bragging about it or saying it's revolutionary online, on forums or his website, for now he is the the only one that works with this method and working well by the looks of it. I don't think Dr Zarev is focused on these things now as there is no need. 

I also think that because Dr Zarev isn't active in this or other forums or pumps out YouTube videos or interviews doesn't mean his not "successful", is that how you measure successful? 

(He's btw fully booked last time I was there until end of November 2022 (of course there will be cancellations in between)) 

For me I would rather see a surgeon that is consistent in his results and has high involvement with the patient before, during and after surgery and this Dr Zarev deliveres without a doubt. 

And its not Dr Zarevs fault that his patients doesn't go to forums and write about their experience. He even didn't know I was writing in forums until a couple of months after my first surgery when he was getting inquiries saying they saw my post on a forum. 

But he knows it's not that good that people who send inquires (specially non Bulgariens) have to wait a long time for a reply as the staff working now does not speak English and Dr Zarev who speaks English is busy with surgery and patients. 

But he hopes this will become better when opening the new clinic and hiring a patient coordinator that speaks English. 

I nowhere wrote that number of YT videos,  or activity at forums has any relation to some doctor's skills, and quality of work, just wrote that difficult to see him in recommended list if here no more guys like you, who posted their result  by dr, Zarev done HT, but it's hist way of doing business, that not much in public, and that oriented mostly to bulgarian market, and those guys not post at this forum or other...

And i appreciate hir work and result, i dont care about patents, techniques, etc.  , for me only important at thend amoun of patients with good results  to see, rest less important.

And sure, not well that not get email replies or answer to phone calls, but ok, can understand that, for now he is focused to BG market, and respect it... Just was strange for me, that 1 person handle all those amount of job, like consultations-surgery-post-op and 2 days huge job does like 7k grafts, seems he is in really good condition to be such focused on big sessions for 2 days, really respect for his work. But probably as you explained he performs 2x patients per week, and then rest for next week, and by price 4e for 2 patients, get same amount of profit like some other doctor in Turkey, with price 1.5-2e who does 4x surgeries per week with 3-3.5k grafts, so 2x 7k surgeries per week or 4x 4k surgeries per week, at the end same amount of work, its just how someone organize his time, he probably decided it's better for him, 2x such patients,and 4 days work with 2 patients, then 4x days other doctor 4x patients 4k grafts...

But as OP says, it's strange still how get  this amount of grafts and donor area still fine, and those his info that 60% of donor area can use, there is probably some reason about it, his tools, or whatever, which he doesnt  like discover still, but one is true, his results are well.

And about other EU clinics, yes, it's true, most of doctors even those top recommended , Belgium , Spain, are with cases 1.5k to 3.5k, didn't see there much cases nw6, 5-6-7k grafts, else Eugenix, and few other clinics out of EU, so probably there is their policy choose patients easier cases, good donor area, less grafts need, nw2-3-4, and then relaxed work on it, then choose nw5-6-7 patients as dr. Zarev does, and need more work and concentration, and these nw2-3-4 can handle more patients = more profit, and it's legit, and clinic can do what wants, moral or not, about profit or not about profit, not important anymore, as this is for most of them only business, and rare are clinics who not care about profit and to be patient on 1st place, those are just standard stories every clinic "patient is at no1 at us" , reality is not always like that, but usual profit is no1 , patient is no2 ...  

[johnto]

16 hours ago, Curious25 said:

Well this was my point exactly - I find it very hard to believe Dr Zarev is just fortunate enough to encounter these types of patients. I don't understand why other recommended surgeons don't have examples of this type of restoration, unless;

a) they aren't able to execute the same level of restoration 
b) a higher volume of lower level restorative surgeries is more financially beneficial - so they choose to prioritise business first (which I'm not suggesting is wrong to do so, just don't publicly criticise other surgeons who are performing this type of surgery as not being a viable or safe method, because your clinic chooses to put profits first).  

 

I feel the thing is that a clinic can easily restore a norwood 2-3 all day every day and give consistent results.  For norwood 6+ its probably hit or miss.  Everything has to be in the patients favour (donor, hair thickness, graft survival) that it is too risky to do surgery on them. 

Also I believe clinics dont want to spend the time/energy training necessary to restore norwood 6s if the results are not predictable.  Remember that for this 1 surgery that may look amazing, there may be 2 others that dont come out as good. 

In that case its the clinics reputation on the line.  Its easier to say no at the beginning and take the easy cases than to change someones life for the worse and try to repair it after.  Once you have to repair for free you end having both an unhappy patient and you lose money on the case as well.

Now surgeons are regular people as well.  Some are motivated by money and others are motivated by being world renowned.  Ie they wan to be the best in the field worldwide.  Zarev may be one who wants above all else to make sure every single patient that walks into his office comes out as "perfect" as possible. 

 

Edited November 9, 2021 by johnto