what kind of special device is dr.zarev using and why dont other surgeons try to copy him

[BlueSkyDay]

@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.

Edited March 24 by BlueSkyDay
Grammar

[Berba11]

3 hours ago, BlueSkyDay said:

In effect you are calling Zarev and Trevellini "ludicrous"

Thanks for requoting the same stuff you've quoted multiple times already over and over again. I didn't realise how much fun it would be to re-read it for the 5th time over!

Let's get to the fatal flaw in what you're saying.. This statistic of patients destroying "20% to 30% of their grafts by choosing surgeons that perform motorised (not vacuum assisted) FUE" comes only as a claim from one single source: Dr Zarev. This is not, to my knowledge, in the published literature. Dr Zarev has not (again, to my knowledge), published any paper that validates this claim. It may be true, but as it stands you're simply taking it on faith and not peer-reviewed science. On that basis, you want every single IAHRS surgeon to be binned from the organisation if they continue to use methods that are tried, tested and effective? It simply doesn't follow.

Nor have you actually addressed the key point I raised:

Quote

Is a technique like the one Zarev deploys better than the others? Maybe. That doesn't mean the other techniques are suddenly bad. Some of the best results we've ever seen pass through these forums are from motorized FUE extractions, and have left perfectly good donor areas at the same time.

Zarev and Trevellini are not themselves calling for every surgeon who does not share their methods to be canned from hair restoration organisations. I'm sure they'd agree that this would be a ludicrous suggestion.

3 hours ago, BlueSkyDay said:

I accept their warning and choose to follow their advice: insist on the latest Best Practice technique - Vacuum Assisted FUE.

And that's totally fine - you do you. Dr Zarev's donor extractions are legendary for good reason (I even have a consultation with the man himself in October next year) and what he's doing clearly works very excellently. But the implication of what you're saying is that there's no merit to manual and motorized extraction. 1000's and 1000's of happy patients - including complicated repair patients and higher NW patients - are, unfortunately, a rather stark refutation of your position.

Of course, if your argument had simply been that major hair restoration organisations should be at the forefront of innovation & development in the field then I would agree with you. Improved donor extractions, verteporfin and other developments shouldn't really be left to trailblazing individuals. Equally, Zarev isn't training other surgeons, and exactly what he's doing and how remains somewhat of a mystery. Until he opens his doors to other surgeons then progress in this area will be slower than it otherwise could be.

[BlueSkyDay]

@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.

Edited March 24 by BlueSkyDay

[BlueSkyDay]

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.

Edited March 24 by BlueSkyDay

[BackFromTheBrink]

I don't think 70-75 percent survival rate is accurate for traditional FUE. I'd say it was closer to 90% for accomplished surgeons.

Zarev is brilliant at planning surgery. His attention to detail in examining and mapping the donor area is second to none.

Combined with a highly efficient extraction technique he gets great results.

However, to say it's all down to the method he uses for extracting punched grafts is a massive stretch, IMHO.

 

[BlueSkyDay]

29 minutes ago, BackFromTheBrink said:

I don't think 70-75 percent survival rate is accurate for traditional FUE. I'd say it was closer to 90% for accomplished surgeons.

Zarev is brilliant at planning surgery. His attention to detail in examining and mapping the donor area is second to none.

Combined with a highly efficient extraction technique he gets great results.

However, to say it's all down to the method he uses for extracting punched grafts is a massive stretch, IMHO.

 

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."

[BlueSkyDay]

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.

Edited March 24 by BlueSkyDay

[BackFromTheBrink]

2 hours ago, BlueSkyDay said:

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."

That's interesting, but I can't see how it relates to my comment.

[JoeD]

2 hours ago, BlueSkyDay said:

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.

I think some better understanding of “levels of evidence” is in order here.  Perhaps what you/they say is true…. But anecdotes and case reports prove nothing.  When you show me some published randomized controlled (ideally double blinded) studies that stood up to peer review…. Only then can you make such a statement. 

Edited March 24 by JoeD

[Berba11]

10 hours ago, BackFromTheBrink said:

That's interesting, but I can't see how it relates to my comment.

Welcome to the club 😅

[BlueSkyDay]

13 hours ago, BackFromTheBrink said:

That's interesting, but I can't see how it relates to my comment.

 

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

 

[mr_peanutbutter]

anyways..clearly dr.zarev and fuegenix doing something better then the rest of the other doctors right now

if you have the money id go to either of these two

 

i just hope other surgeons will catch up at one point, maybe break into zarevs office or bribe @DrMunibAhmad assistant to make secret videofootages of his procedure, idk

Edited March 25 by mr_peanutbutter

[BackFromTheBrink]

1 hour ago, BlueSkyDay said:

 

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

 

Then let me ask a question which cannot be misinterpreted. Given the same skill of surgeon, what % of grafts will survive on average with;

1) motorised punch and the suction technique you are advocating as ‘state of the art’. 

2) traditional FUE where grafts are handled by motorised/manually punching them and extraction with forceps?

I’ve no idea how you think the method of handling grafts will influence the naturalness of the result, but I’m sure you can enlighten us….

 

Edited March 25 by BackFromTheBrink

[BlueSkyDay]

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

[hairman22]

23 minutes ago, BlueSkyDay said:

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

makes sense he would have too many patients now at 5euro per graft

where did u see that?

I do think he will have a surgeon trained in at some time hopefully

[JoeD]

32 minutes ago, BlueSkyDay said:

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

And there it is….. moderators, don’t posters have to disclose their clinic affiliation from the start?

[mr_peanutbutter]

4 hours ago, JoeD said:

And there it is….. moderators, don’t posters have to disclose their clinic affiliation from the start?

he is quoting the website lol, as if zarev would need any form of advertisement at that point…

[mr_peanutbutter]

@mtb @anxious6 @HugoX

since you were patient, can you say more to the device dr.zarev was using?

[mtb]

I don't really know. He talked about it a little when I was there but I don't remember much of what he said. I didn't really snoop around the surgical suite either. I thought if he wants to keep it secret I shouldn't pry. What I cared most about was the outcome. 

[BlueSkyDay]

@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!

 

Edited March 25 by BlueSkyDay

[Berba11]

51 minutes ago, BlueSkyDay said:

I suggest the proof is in the bookings for the next 3 years

His results are part of the wait time. The other factor - likely much bigger factor - is that he does pretty much everything by himself and is often doing huge surgeries. Plus his consultations are 2-3 hours long and you must have an in-person with him. Naturally that means his waiting times will be much longer.

Adopting your logic here, how would you explain Dr Feriduni's two & half year waiting time for an in-person consultation? He has a bigger team helping him do surgeries, and is doing smaller surgeries than Zarev. His consultations are about 1 hour. So surely his wait time is more strictly attributed to his results rather than due to the other factors that apply more so to Dr Zarev, right? Has the market not spoken here, too?

[general-etwan]

On 2/29/2024 at 10:34 PM, mr_peanutbutter said:

seee…why are no other doctors trying to get this?

 

i feel like much doctors got way too comfortable and dont try to to search way of improvementa really…whether thats verteporfin or a new device

"Improvement" has to be profitable or at least not overly stressful on profits. Naturally, most doctors/clinics have no reason to push for more and better when they are increasing their profits satisfactorily as is. Let the one or two pioneers in the world do the risk-taking and wait for the technology to become easily accessible and mainstream. But not much incentive to do so right now when most people get good results from standard FUE transplants. A big of the success of the Zarev cases is that he does his surgeries by hand from start to finish, and is extremely selective in his hand-picked patients.

[Fox243]

27 minutes ago, general-etwan said:

"Improvement" has to be profitable or at least not overly stressful on profits. Naturally, most doctors/clinics have no reason to push for more and better when they are increasing their profits satisfactorily as is. Let the one or two pioneers in the world do the risk-taking and wait for the technology to become easily accessible and mainstream. But not much incentive to do so right now when most people get good results from standard FUE transplants. A big of the success of the Zarev cases is that he does his surgeries by hand from start to finish, and is extremely selective in his hand-picked patients.

Why do you think he is extremely selective in his hand-picked patients? 1) He's shown several cases of NW7s with poor donors, 2) People that have visited that I've talked to have looked at many of Zarev's private cases, all of which are good. I think Zarev just treats each patient with so much care that 99% of outcomes are great while for a normal "top" clinic, it may be closer to 90%.

[mr_peanutbutter]

3 hours ago, general-etwan said:

"Improvement" has to be profitable or at least not overly stressful on profits. Naturally, most doctors/clinics have no reason to push for more and better when they are increasing their profits satisfactorily as is. Let the one or two pioneers in the world do the risk-taking and wait for the technology to become easily accessible and mainstream. But not much incentive to do so right now when most people get good results from standard FUE transplants. A big of the success of the Zarev cases is that he does his surgeries by hand from start to finish, and is extremely selective in his hand-picked patients.

how are these patients selective?  of these patients would get rejected for not being a suitable candidate by many other clinics or get told to manage their expectations to a degree that half of their head would remain bald.

 

first people said, the results of zarev are fake

then they said, oh he only picks selected patients with thick coarse black bulgarian hair.

 

the truth is way simpler. he is just better then the other clinics at this points and i think that his device plays a big part in that. 

 

for the rest i agree with you though. hopefully him now able to charging 9 eur per graft  will motivate some other doctors to catch up.

 

 

https://www.instagram.com/p/C0E25hNqOPf/?hl=de&img_index=2

 

https://www.instagram.com/p/CzgSB_VK2M7/?hl=de&img_index=4

 

https://www.instagram.com/p/B0-3IjlHsUJ/?hl=de&img_index=4

 

https://www.instagram.com/p/BuHzHMsgj7q/?hl=de&img_index=4

 

 

Edited March 26 by mr_peanutbutter

[BlueSkyDay]

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)