Dr Zarev Vacuum Assisted Tecnique For Graft Extraction

[coolio]

What do you think is the smallest punch size possible that will remove the minimal amount of surrounding tissue of the FU needed for survival? What is the current smallest punch size used by a hair transplant surgeon in anybody's experience?

Smallest workable size? It depends on the grafts and the patient.

A single-hair graft on a patient with thin hairs? Some docs might go down to 0.6 mm.
A four-hair graft on a guy with thick hairs? 1.0 mm might be justified.

If you cut too close to the graft and you don't nail it perfectly then you're just transecting grafts. Some transplants that used large punch sizes have produced pretty good thick hair in the recipient area. It's the donor area that suffers from big punches.

 

[Sanchez1234]

His hairlines look good. Ive seen so many fake hairlines like the one below on the left. What are the best hairline fue doctors?

 

[werefckd]

Thanks. I agree, this guy appears to be getting more bang-for-the-donor than anyone else in the business. At least that I have seen.

I've thought for years that FUE (and for that matter, FUT) docs are probably losing a higher percentage of grafts than anyone is admitting to.

As for raiding outside the safe zone, I'm cautiously on board with that - assuming that the "endangered" grafts are not reimplanted in a pattern that would cause unnatural results when they fade. Very important caveat.

Large sessions always scare me. More grafts at once = more grafts lost if that Doctor didn't do a great job. And if more grafts are dense-packed together at once, there is more danger of reduced survival rate. Or even skin necrosis.

Particularly with shiny bald skin. I would NEVER want to get a ton of grafts dense-packed into a shiny bald area in a single session. It's just not worth the risks. Shiny bald skin is different from hair-bearing skin. It takes time for the skin to revert to hair-bearing condition. Don't flood it with too much density at once. Nature never designed your skin to cope with anything like that.

One more thing that is rarely talked about - hair cycling. If you transplant your whole head in one big session, all those hairs will get their cycles synchronized. Several years later you may be in for a sudden "bad hair season" when a lot of them cycle over again at the same time. It may take a few cycles (like 10+ years) for them to get out of lockstep with each other. It's one more reason why I would rather get a lot of grafts done in 2-3 separate sessions.

I believe what you mentioned are some of the reasons why doctors like Konior don't do more than 2k-3k grafts for a single procedure. Look at that case, he implanted 6k grafts in FOUR sessions with many months between them, from 2017 to 2019.

Raymond J Konior, MD| Chicago Hair Institute | Evolution of a 6710 Graft Multi-Stage Repair

This 50 year old man presented with a history of multiple failed hair restoration procedures. At a young age he underwent several large-graft plug sessions and a midline scalp reduction. He reported that the majority of the plugs failed to grow and what did grow left him with unnatural patches of...

bit.ly

Not for the impatient, but the safest way to go

 

[werefckd]

More about the yield part.

Say you had 100 grafts transplanted but 10 of them ended up not growing: you lost 10/100 or 10% of the transplanted grafts. Is it right to say you had a 90% yield?

What if you originally had 110 grafts extracted, but 10 were transected so you only could implant 100?

Also, what if during the extraction, 10 neighbouring grafts on the donor were damaged and died?

In that case, the total grafts really taken from your donor was 120, so the real denominator when calculating yield is 120 not 100. 90/120 = 75%.

So a 90% yield could very well be really a 75% yield (or even less) depending on how you count.

If there is a doctor that gets you a 70% true yield and another one 95% then the second doctor can give you 35% more hair with the same donor used. Thats a huge difference and more than enough to make or break the end result of a restoration.

 

[coolio]

Yeah, that's why I think the transplant world is too focused on counting grafts. They need to pay more attention to the net total end result. 1000 grafts from one Doctor might give you the same hair as 700 grafts from another.


Also, with FUE, they usually start by cherry picking the grafts with more hairs-per-graft (in pursuit of density). That's great for the first couple thousand. But there is a limited supply of grafts with several hairs.

Look at these high-graft patients who had multiple sessions of 2-3k at a time - the first session always looks like the most hair gained. The third session might look like half as much gain as the first. As your lifetime total FUE graft count goes up, the returns are diminishing.

Seeing patients with 10k grafts is encouraging. But those are numbers. Prices paid. The results rarely look like quite that much.

IMO, if you don't think you could be happy with about 5-6k grafts (lifetime) then getting transplants may not be wise. You cannot expect your 10k to really look like 10k. You cannot even expect your results to look above-average for any number.

 

[werefckd]

He answered my email. Said that looking at my pictures, I have enough donor to achieve full visual density. I'm Norwood 5 right now...

Please share the pictures with us, good Brasilero!

 

[coolio]

I believe what you mentioned are some of the reasons why doctors like Konior don't do more than 2k-3k grafts for a single procedure. Look at that case, he implanted 6k grafts in FOUR sessions with many months between them, from 2017 to 2019.

https://bit.ly/2GNm4xo

Not for the impatient, but the safest way to go

God, what a life-changing repair for that patient.

 

[werefckd]

God, what a life-changing repair for that patient.

Dr. Konior is among the best, if not the best hair transplant doctor

 

[nahte42]

^God that's a good result but must be hell to go through surgeries like that over a multi-year period. I could never.

 

[coolio]

Once you have worn a bad transplant on your head for a while, you'll be ready to go through any amount of surgeries to fix it.

 

[werefckd]

^God that's a good result but must be hell to go through surgeries like that over a multi-year period. I could never.

The patient already had failed hair transplants with other surgeons. Dr. Konior's reasons for the "slow" approach:

-

This restoration was performed over one and a half years, not two and a half years. There was a one year interval after its completion which is when the final photos were obtained for presentation here. There is no reason any ethical surgeon would force a fast-track restoration.

First, the patient had been operated on by several physicians with nothing positive to show in terms of graft survival. An experienced surgeon would first question whether the patient had some intrinsic healing predisposition that compromised graft survival. Committing to a one-shot restoration would have proved disastrous should his limited supply have been fully depleted with a resultant low yield as had been experience in his prior procedures.

Second, he had a highly compromised donor site with extensive scarring and lower quality residual follicular-units. Attempting the one-shot approach would have risked an over-harvest of the scalp’s donor area with the potential for unacceptable visual thinning and detectable scars.

Finally, a staged approach allows the surgeon to strategically build zones of coverage and density gradients based on the perspective of seeing what a prior procedure was able to accomplish. Understand that we are using a relatively small number of hairs to hide a vast expanse of scalp. It is the strategic integration of hair using density gradients, graft insertion angles and prioritization of placement zones that makes a little look like a lot.

-
Dr. Konior = GOAT

 

[werefckd]

hair transplant doctors watching Dr. Zarev's presentation of his 12k grafts perfect restoration be like: "fuuuuuuck"

 

[werefckd]

So I was browsing Dr. Zarev's website and YT channel, trying to find a chink in his armor (because his results looks like magic/too good to be true), and I may have found it.

This dude's donor area kinda of looks depleted here. I mean, it looks good considering almost 13K grafts were extracted, and everything is very uniform and there are no scars, so it doesn't look bad, but clearly the density is not there anymore:

But the thing is, once the hair grew a little longer, the donor looked reasonably denser again:

To the point that the donor almost looked like how it was before all the extractions:

I think one explanation for that is that the patient has very think hairs and once they got longer they helped improving the visual density of the donor area. So hair caliber would be another important variable in order to achieve such espetacular end result (on top of the technique and talent of Dr. Zarev).

 

[nahte42]

@werefckd Great find. Link? Did Zarev take donor hair from the back and sides?

This is something that I want to look more into for sure because of my situation being a Norwood 6-7 who is desperate to have the hair on the back and sides of my head relocated to the top. People keep telling me it can't be done; I'm too far gone; there aren't enough grafts and the top would look terrible. But I'm not giving up. My hair isn't that dark, either, which means, according to the facts of hair to skin contrast, I wouldn't need as much hair relocated as someone with a high hair/skin contrast to receive a decent visual look.

This guy still looks great. If I saw him in public I wouldn't notice anything off at all. I would gladly accept thin hair and even scarring on the sides and back of my head in exchange for restoring hair on top. I'm honestly shocked at how many cases Zarev seems to have where there is no visible depletion of donor area at all. I'm totally fine with visual depletion in donor area. It's so much more important to have hair on top.

 

[werefckd]

@werefckd Great find. Link? Did Zarev take donor hair from the back and sides?

This is something that I want to look more into for sure because of my situation being a Norwood 6-7 who is desperate to have the hair on the back and sides of my head relocated to the top. People keep telling me it can't be done; I'm too far gone; there aren't enough grafts and the top would look terrible. But I'm not giving up. My hair isn't that dark, either, which means, according to the facts of hair to skin contrast, I wouldn't need as much hair relocated as someone with a high hair/skin contrast to receive a decent visual look.

This guy still looks great. If I saw him in public I wouldn't notice anything off at all. I would gladly accept thin hair and even scarring on the sides and back of my head in exchange for restoring hair on top. I'm honestly shocked at how many cases Zarev seems to have where there is no visible depletion of donor area at all. I'm totally fine with visual depletion in donor area. It's so much more important to have hair on top.

There you go:

There are many hair transplant doctors that can give a Norwood 6-7 very good, life transforming, results man. If you feel that way you should definitely consider that route.

 

[coolio]

Look at this photo.

Look at the coverage in that guy's donor area. Now try to imagine that skin in a different context. Imagine it's the transplanted recipient area on somebody's front/top or crown.

We would identify it as thin coverage immediately. We would know right off the bat that the short buzz is downplaying how sparse the coverage really is.

I'm not commenting on the ultimate aesthetics of that patient. Maybe you want it. But IMO that donor area is unacceptably thinned. Even "safe" donor areas gradually get thinner in older age, too. That patient's donor area is barely acceptable now but it may look noticeably worse in another 20 years. In 30-40 years it definitely will.


IMO the problem with most Norwood#6-7 transplants is that they get too ambitious on the crown coverage. The results can look SO MUCH more natural if the patient is willing to accept a visible thinning spot on the crown. The point is to recreate an earlier stage in the balding process, not try to cover a huge Norwood#6-7 shiny area with even density across the whole thing.

It's the same principle as the hairline. A fully-dense Norwood#2-3 frontal area looks a lot more natural than a Norwood#1 with inadequate density.


To oversimplify it - We have enough donor hair to fully restore the front/top, or fully restore the crown. Not both at once. If you want major restoration work in both places then you have to compromise in both places.

 

[whatintheworld]

There you go:

There are many hair transplant doctors that can give a Norwood 6-7 very good, life transforming, results man. If you feel that way you should definitely consider that route.

I'm not sure about many, but there are a select few that can give acceptable results. Norwood 6/7, especially with average donor, is very, very tricky.

The best I have seen are Zarev, Konior, Lorenzo, and the Eugenix clinic in India.

 

[whatintheworld]

Look at this photo.

View attachment 151394

Look at the coverage in that guy's donor area. Now try to imagine that skin in a different context. Imagine it's the transplanted recipient area on somebody's front/top or crown.

We would identify it as thin coverage immediately. We would know right off the bat that the short buzz is downplaying how sparse the coverage really is.

I'm not commenting on the ultimate aesthetics of that patient. Maybe you want it. But IMO that donor area is unacceptably thinned. Even "safe" donor areas gradually get thinner in older age, too. That patient's donor area is barely acceptable now but it may look noticeably worse in another 20 years. In 30-40 years it definitely will.


IMO the problem with most Norwood#6-7 transplants is that they get too ambitious on the crown coverage. The results can look SO MUCH more natural if the patient is willing to accept a visible thinning spot on the crown. The point is to recreate an earlier stage in the balding process, not try to cover a huge Norwood#6-7 shiny area with even density across the whole thing.

It's the same principle as the hairline. A fully-dense Norwood#2-3 frontal area looks a lot more natural than a Norwood#1 with inadequate density.

That donor, for the coverage obtained on top, is a good trade off if you ask me.

Now, if you wonder what will the donor look like in 30/40 years? Probably worse, but dude, having hair in your 30's and 40's vs. 60's and 70's is a big difference.

 

[nahte42]

I wonder how this guy's back and sides look at a longer length? Surely better I'd think. The most significant downside to this amount of donor area depletion is that you might not be able to buzz it down to zero length because of visible scarring (?) Not sure. His head seems to have visible red areas. Maybe they go away over time though.

 

[Selb]

Look at this photo.

View attachment 151394

Look at the coverage in that guy's donor area. Now try to imagine that skin in a different context. Imagine it's the transplanted recipient area on somebody's front/top or crown.

We would identify it as thin coverage immediately. We would know right off the bat that the short buzz is downplaying how sparse the coverage really is.

I'm not commenting on the ultimate aesthetics of that patient. Maybe you want it. But IMO that donor area is unacceptably thinned. Even "safe" donor areas gradually get thinner in older age, too. That patient's donor area is barely acceptable now but it may look noticeably worse in another 20 years. In 30-40 years it definitely will.


IMO the problem with most Norwood#6-7 transplants is that they get too ambitious on the crown coverage. The results can look SO MUCH more natural if the patient is willing to accept a visible thinning spot on the crown. The point is to recreate an earlier stage in the balding process, not try to cover a huge Norwood#6-7 shiny area with even density across the whole thing.

It's the same principle as the hairline. A fully-dense Norwood#2-3 frontal area looks a lot more natural than a Norwood#1 with inadequate density.


To oversimplify it - We have enough donor hair to fully restore the front/top, or fully restore the crown. Not both at once. If you want major restoration work in both places then you have to compromise in both places.

I disagree, a thinning crown is worse than thinning donor areas. You can enhance the donor areas with smp if you want to and nowadays people cut the sides and back shorter.