Dr Zarev 11,941 grafts. 1st procedure 8,321, 2nd procedure 3,620

[TakeAction]

On 12/19/2023 at 7:33 PM, Stewie said:

its not rocket science, the results are great, what he Is doing is no different from anyone else in terms of technique, but what is different is his and a few other docs approach to this SAFE area your only suppose to take from, I went aggressively bald very early like many on the forum and dont see a problem going right up to the borders, but many docs just won't do it, and thats the difference, nothing mind boggling, just he sees and trust the process himself

Agreed, I've found many doctors reluctant to take more hair from the donor even in high norwood cases. It makes no sense, the hair in my donor is of no use to me. I need as much of it as possible on the top of my head. It's a very conservative approach from doctors but if it's necessary to take hair from a larger possible area and the patient understand there is a possibility that the grafts may not last as long as "safer" grafts I don't see the problem.

Also, patients who respond well to meds should not have to worry about this too much anyway. It's really unlikely if someone is on dutasteride that a significant amount of hair in their donor area even outside the traditional ultra conservative safe zone will thin. Or at least the total degree of miniaturization will be low and not a major issue long term.

Also Zarev will extract 60% of the donor and in some cases even more. This makes a huge difference and is important for advanced patterns.

Edited January 5 by TakeAction

[Silent123]

On 12/28/2023 at 3:16 AM, mtb said:

2 months post second procedure. 11 months from first procedure. No real changes. After my first procedure 2 months was the worst of the ugly duckling phase. Can now feel and see a few tiny new hairs. It’s onward and upward from here. 

I think most would be happy with that haha! Looking forward to the final result. Keep us posted 

[mtb]

On 1/5/2024 at 11:14 AM, TakeAction said:

Agreed, I've found many doctors reluctant to take more hair from the donor even in high norwood cases. It makes no sense, the hair in my donor is of no use to me. I need as much of it as possible on the top of my head. It's a very conservative approach from doctors but if it's necessary to take hair from a larger possible area and the patient understand there is a possibility that the grafts may not last as long as "safer" grafts I don't see the problem.

Also, patients who respond well to meds should not have to worry about this too much anyway. It's really unlikely if someone is on dutasteride that a significant amount of hair in their donor area even outside the traditional ultra conservative safe zone will thin. Or at least the total degree of miniaturization will be low and not a major issue long term.

Also Zarev will extract 60% of the donor and in some cases even more. This makes a huge difference and is important for advanced patterns.

@TakeAction I mostly agree. If the patient wants it the doctor ought to be open to it. It's okay if the doctor isn't because it's also their preference and there will be other doctors that are willing to do it. Dr Zarev's punch size and extraction technique allows him to take up to 60% of the donor which I don't believe other docs are doing just yet. But maybe I'm wrong, I stopped researching 1.5 years ago since I made the Zarev decision.

On 1/5/2024 at 10:24 PM, Silent123 said:

I think most would be happy with that haha! Looking forward to the final result. Keep us posted 

@Silent123 Thanks. Yes, I'm quite happy with it. The only issue at this point is harsh downlighting. Once the second procedure hairs come through that issue will be greatly reduced. 

[TakeAction]

This is from one of Zarev's presentations. He uses two thirds of the area of the head as the donor. Traditionally I believe the "donor" is what Zarev refers to as the occipital area (high and middle) which is ~140 cm^2 or 1/4 of the surface area of the scalp that contains hair.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371726/

This academic paper on the donor area says that about 75% of hair can be lost and only 25% is considered permanent donor hair:

Quote

Of the total 50,000 follicular units on the scalp, 75%, that is, 37,500 are on the frontal region and vertex and hence are at risk of being lost. The permanent donor area has 25%, that is, 12,500 units. As we need 50% to appear normal, this means that a maximum of 6,250 follicular units are available for transplantation. So, in a worst-case scenario, we would have 12.5% (6,250) follicles available to cover 75% (37,500) area, achieving a density of one-sixth (18%) of normal.[4]

It's a massive discrepancy. The traditional donor has less than half the total grafts as Zarev's expanded donor area. This paper claims that 375 cm^2 could be lost which is an unrealistic or even impossible scenario, like Norwood 9. This patient in the presentation was NW6 and had 220 cm of area to cover. @mtb I believe your surface area to cover was similar?

I don't doubt that Zarev has some improved techniques that allow him to also extract more. But a big part of what he does is simply expand the donor. Why are other doctors not doing this?

 

Edited January 8 by TakeAction

[omarca]

Maybe because hair loss is progresive? some doctors are more conservative and looking for further loss in future some of those transplanted hairs may fall because where not from the safe zone ?

[TakeAction]

1 minute ago, omarca said:

Maybe because hair loss is progresive? some doctors are more conservative and looking for further loss in future some of those transplanted hairs may fall because where not from the safe zone ?

Right, but my point is for higher norwoods, like a norwood 6 who has not progressed further or is on meds and responds well, it becomes necessary to be a little less conservative in order to get enough grafts for a good result. 

[GeneralNorwood]

38 minutes ago, TakeAction said:

I don't doubt that Zarev has some improved techniques that allow him to also extract more. But a big part of what he does is simply expand the donor. Why are other doctors not doing this?

 

1. Other doctors plan procedure in 5 minutes, Zarev makes long consultation with specific measurements which lasts 2 hours. It's not like he recklessly expands the donor area. He looks at every areas and estimates grafts/cm2 in this areas and other details of the hair, then he decides how much he can extract from every area. It sounds simple, but it takes a lot of time.

100 patients equals 200 hours for the consultations and within this times random clinic can perfrom ~ 25 procedures. 

 

2. Expanding from traditional safe zone is what i call "New School of HT". There are more doctors that take this new approach. First examples that come to my mind are dr. Pittella or dr. Ferreira. 

Edited January 9 by GeneralNorwood

[Stewie]

4 minutes ago, GeneralNorwood said:

1. Other doctors plan procedure in 5 minutes, Zarev makes long consultation with specific measurements which lasts 2 hours. It's not like he recklessly expands the donor area. He looks at every areas and estimates grafts/cm2 in this areas and other details of the hair, then he decides how much he can extract from every area. It sounds simple, but it takes a lot of time.

100 patients equals 200 hours for the consultations and within this times random clinic can perfrom ~ 25 procedures. 

 

2. Expanding from traditional safe zone is what i call "New School of HT". There are more doctors that take this new approach. First examples that come to my mind are dr. Pittella or dr. Ferreira. 

Can't agree more

[TakeAction]

20 minutes ago, GeneralNorwood said:

1. Other doctors plan procedure in 5 minutes, Zarev makes long consultation with specific measurements which lasts 2 hours. It's not like he recklessly expands the donor area. He looks at every areas and estimates grafts/cm2 in this areas and other details of the hair, then he decides how much he can extract from every area. It sounds simple, but it takes a lot of time.

100 patients equals 200 hours for the consultations and within this times random clinic can perfrom ~ 25 procedures. 

 

2. Expanding from traditional safe zone is what i call "New School of HT". There are more doctors that take this new approach. First examples that come to my mind are dr. Pittella or dr. Ferreira. 

Yeah I definitely oversimplified when I said he "simply" expands the donor area.

At the end of the day doing a bit of extra detailed planning for this kind of procedure should be standard. I'd definitely be willing to pay a premium for it.

If I recall correctly a lot of doctors don't like to go over 40-50% extraction of the donor. In the patient from the presentation, he had a total of 5600 + 4900 + 2700 = 13,200 FU outside the main occipital region. If we even conservatively took just 15 percent of those expanded zone grafts, that's an extra 2000 grafts, which can make all the difference.

By taking a full 40 percent, that's an extra 5000 grafts.

Edited January 9 by TakeAction

[Melvin- Admin]

The case in the thumbnail is over 10 years old.

I believe the traditional “universal safe zone” is a fallacy. Safe zones need to be viewed individually. Some patients don’t progress past Norwood 5, others to 7. The safe zone in both patients will be different. I have never agreed with the generic FUT safe zone is the best. The donor should be harvested from all available areas IMO.

[MC117]

Melvin and GeneralNorwood nailed it. I'm a bit tired of repeating the same stuff via dms or other forums/discords/tg/IRL.

The power of Dr.Zarev resides in his specific assessment of each cases as we are all very different, giant consultations (taking hundreds of pictures of the donor and clicking on every single hair with his machine linked to his software),his size punch, his scars retractability capability, his hair diameter choice and placement, hair orientation, very professional follow up, no med obligation, percentage of regrowth which is always above 95%, very proportionate extractions and incisions, his fast recoveries, way smaller scars, no harsh redness and it goes away quickly, his artistic eye for hairlines, hard working profile, fast regrowth, blood supply management in the recipient zone, High definition pictures posted of his patients even years later up to 10 as of now, body hair master, experimenting with extracting tools for years...

You got it, this doctor is a whole and no, no one comes that close to him. He set a new standard in this industry and I hope more physicians take that path. He'll train some brave physicians in the future too. Been waiting for someone of this caliber for years now.

Edited January 11 by MC117

[Kacan]

Could you please share the regime that Zarev recommended for you?

prp? Vitamins? Finasteride? Minoxodil?

[mtb]

On 1/10/2024 at 7:03 PM, MC117 said:

Melvin and GeneralNorwood nailed it. I'm a bit tired of repeating the same stuff via dms or other forums/discords/tg/IRL.

The power of Dr.Zarev resides in his specific assessment of each cases as we are all very different, giant consultations (taking hundreds of pictures of the donor and clicking on every single hair with his machine linked to his software),his size punch, his scars retractability capability, his hair diameter choice and placement, hair orientation, very professional follow up, no med obligation, percentage of regrowth which is always above 95%, very proportionate extractions and incisions, his fast recoveries, way smaller scars, no harsh redness and it goes away quickly, his artistic eye for hairlines, hard working profile, fast regrowth, blood supply management in the recipient zone, High definition pictures posted of his patients even years later up to 10 as of now, body hair master, experimenting with extracting tools for years...

You got it, this doctor is a whole and no, no one comes that close to him. He set a new standard in this industry and I hope more physicians take that path. He'll train some brave physicians in the future too. Been waiting for someone of this caliber for years now.

Yeah, @MC117 you're right. It's more complicated than "there's nothing special. He just goes outside the safe zone". He is waaaay beyond that as you mentioned. If it was that easy everyone doc would be doing it.

 

@Kacan Dr. Zarev gives patients 5% minox with .1 mg topical treatment. He says taking oral fin is up to the patient but he doesn't advise them taking it. He does prp during the session but doesn't recommend it in the months after the procedure. He did have a high caliber multi-vitamin supplement for me the first procedure to be used daily but didn't mention it after the second procedure. At the first procedure he recommended using ketoconazole shampoo a couple times a week starting a month after the surgery and ongoing. I never started it because I forgot. Also for 10 days after the procedure you're on various meds that I don't remember the names of (some were in Bulgarian). Pretty standard post surgery meds you'd see after any other type of surgery. 

[Wally West]

On 1/20/2024 at 4:13 AM, Kacan said:

 

Could you please share the regime that Zarev recommended for you?

prp? Vitamins? Finasteride? Minoxodil?

@Kacan For me, he recommended pretty much the same;
- Topical Finasteride (As I had sides to oral)
- Minoxidil 5%
- Ketoconazole shampoo
- Anacaps Reactiv vitamins
@mtb Are these the multivitamins he gave to you?

That said, I've now had to stop topical Finasteride because of side effects, and he was surprised that I had sides. I'm trying topical Dutasteride now, but not sure if he recommends it or not.

[Fox243]

26 minutes ago, Wally West said:

@Kacan For me, he recommended pretty much the same;
- Topical Finasteride (As I had sides to oral)
- Minoxidil 5%
- Ketoconazole shampoo
- Anacaps Reactiv vitamins
@mtb Are these the multivitamins he gave to you?

That said, I've now had to stop topical Finasteride because of side effects, and he was surprised that I had sides. I'm trying topical Dutasteride now, but not sure if he recommends it or not.

I heard finasteride was optional though, especially since you're a NW6

[GeneralNorwood]

19 hours ago, Wally West said:

@Kacan For me, he recommended pretty much the same;
- Topical Finasteride (As I had sides to oral)
- Minoxidil 5%
- Ketoconazole shampoo
- Anacaps Reactiv vitamins
@mtb Are these the multivitamins he gave to you?

That said, I've now had to stop topical Finasteride because of side effects, and he was surprised that I had sides. I'm trying topical Dutasteride now, but not sure if he recommends it or not.

Hey, can you start your topic with your HT journey?

We need more independent reviews of Zarev in this forum 😉

[asterix0]

21 hours ago, Wally West said:

@Kacan For me, he recommended pretty much the same;
- Topical Finasteride (As I had sides to oral)
- Minoxidil 5%
- Ketoconazole shampoo
- Anacaps Reactiv vitamins
@mtb Are these the multivitamins he gave to you?

That said, I've now had to stop topical Finasteride because of side effects, and he was surprised that I had sides. I'm trying topical Dutasteride now, but not sure if he recommends it or not.

What side effects did you get from topical fin? Are you sure it wasn't placebo effect?

[OliverAtom]

On 12/16/2023 at 10:35 PM, mtb said:

Had my second hair cut today since my first procedure (not counting Dr Zarev shaving the sides for second procedure). Some before and afters. Also a few of where I came from albeit with different lighting.
 

At this point nearly all the grafts from the second procedure (Oct ‘23) have cycled and fallen out and will start sprouting randomly in the next couple weeks (at least that was my experience with first procedure in Jan ‘23). Still some donor shock loss which should take another two months two recover. 
 

 

Wow. This is just insane! 11000 grafts and you still have another 2500!!! 

Your final result will be incredible. Can not wait to see it already!

[mtb]

3 months since second procedure. 12 months since first procedure. Can see a little growth but it’s covered by my longer hair. Shock loss won’t resolve for another month or two. Mid scalp and crown set to start filling in. Some non-flash photos as well as flash

 

 

 

Edited January 25 by mtb

[Melvin- Admin]

 

1 hour ago, mtb said:

3 months since second procedure. 12 months since first procedure. Can see a little growth but it’s covered by my longer hair. Shock loss won’t resolve for another month or two. Mid scalp and crown set to start filling in. Some non-flash photos as well as flash

 

 

 

Wow simply amazing 🤩 

[hairman22]

this is going to look amazing at 6-9 months

[MC117]

15 hours ago, hairman22 said:

this is going to look amazing at 6-9 months

Totally agree !

[EricEdwards]

On 1/25/2024 at 11:12 PM, mtb said:

3 months since second procedure. 12 months since first procedure. Can see a little growth but it’s covered by my longer hair. Shock loss won’t resolve for another month or two. Mid scalp and crown set to start filling in. Some non-flash photos as well as flash

 

 

 

Excellent result. Cost involved?

[BaldReaper]

are the pictures taken in the clinic? can you post pictures taken by yourself?

[BackFromTheBrink]

53 minutes ago, EricEdwards said:

Excellent result. Cost involved?

Zarev was $4 per graft and has increased to $5 in the past 18 months or so.

You can pay more to get an off calendar surgery but I don't think that was the case here.