Dr Zarev Vacuum Assisted Tecnique For Graft Extraction

[coolio]

It's an opinion. A judgment call for oneself.

I will say this:

In the last 30 years we've seen styles go longer, shorter, buzzes, beards, clean shaven, stubble, and back to beards. IMO it's never wise to voluntarily screw up any part of your head. That's what you are doing if you make a decision to over-harvest the donor area.

In the 1980s men HAD to have hair. If you were a balding man with a corporate job then you couldn't buzz down. Your only options were rugs, combovers, or rocking the George Costanza look. It caused a lot of guys to get bad transplants. By the 1990s-2000s some of them were really wishing they didn't have the bad hair transplant work. Buzzing down had become acceptable and they had good head shapes for it. But the bad hair transplant work ruled it out.

It's striking how quickly these things can change. And many times, the next trend is the very farthest thing from the last one. It's wise to try to keep your options open. Natural hair loss isn't ideal but it will always been less objectionable than looking unnatural.

 

[werefckd]

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 don't think that would be a bad density even for the recipient area. It doesn't look ultra dense, but I don't think it looks depleted or bad. Remember the photo is very upclose with flash and the hair is very short. In the other pics where the hair is a little longer his donor almost looks untouched.

Compare it with the post op picture of Zoomster, who got 5,400 (less than half of the Zarev patient) scalp grafts extracted by Eugenix. His donor area looks way more depleted.

 

[coolio]

The Zarev case isn't terrible but it's more depleted than I would be comfortable with.

As we age, guys with higher NWs level usually have worse "donor thinning" even in the supposedly safe areas.


That last pic of the 5400 FUE grafts looks worse than the Zarev pics. IMO that is beyond the range of differing opinions. They definitely went too far on him.

 

[werefckd]

The Zarev case isn't terrible but it's more depleted than I would be comfortable with.

As we age, guys with higher NWs level usually have worse "donor thinning" even in the supposedly safe areas.


That last pic of the 5400 FUE grafts looks worse than the Zarev pics. IMO that is beyond the range of differing opinions. They definitely went too far on him.

Fair enough.

What's your opinion on the donor in the final pictures? Doesn't it seem like it improved? I don't know if it's just a longer hair illusion, maybe after the operation some of the not extracted hairs in the donor ends up suffering and recovering down the road.

 

[werefckd]

By the way, Zoomsters donor area ended up looking acceptable I think

 

[Selb]

Wow they harvested so much from the donor regions and still got amazing coverage when grown out. I can see now why 8k+ grafts are possible without completely annihilating the donor areas. Imagine double zoomster’s thickness on the scalp.

Honestly, that’s pretty much the cure if you’re in hurry and don’t want to wait on finasteride and min gains and you’re older than 25

 

[nahte42]

I don't think that would be a bad density even for the recipient area. It doesn't look ultra dense, but I don't think it looks depleted or bad. Remember the photo is very upclose with flash and the hair is very short. In the other pics where the hair is a little longer his donor almost looks untouched.

Compare it with the post op picture of Zoomster, who got 5,400 (less than half of the Zarev patient) scalp grafts extracted by Eugenix. His donor area looks way more depleted.

View attachment 151403

In my opinion still better than having a horrific looking horseshoe ring. But that's just my feeling. Lighter hair color would decrease the visual appearance of depleted donor area too.

 

[coolio]

These donor areas do look better when they're grown out.

But IMO it's just not a good risk to tear that far into the donor area.

Younger guys always think there is nothing worse than the appearance of balding. Until they get a bad transplant. Then they discover there really are worse outcomes - looking sick, scarred, or unnatural. The older you get, the less embarrassing it is to have some male-pattern hair loss. But the embarrassment of looking sick, scarred, or unnatural? That never gets any less painful. And the more your donor area thins, the worse the problems get.

It's just a general limitation of hair transplants. Long term thinning is always a factor. It's only a question of how severe. If you get transplanted to the ragged edge when you are 20s/30s, it may not take another 40 years before it becomes a problem. It might only take 15-20 years before there's a noticeable visual worsening. That's not as far away as it might seem.

Cost-to-benefit ratio. Is it really worth the risks to squeeze that last 10-20% of the grafts out of your donor area? This process never comes with guarantees. It's hard to even predict exactly what your results from any given session will look like. If you've got 6-7000 grafts and the results are good, is it really so important to grab another 1500?

 

[BurningCoals]

I feel like it might be better to settle for like a NW2.5, maybe even 3, hairline instead of a NW1-1.5, especially if you have aggressive balding genes that will leave you with a thinned donor. Better safe than sorry.

Although, in case of a nuked donor that has been harvested and thinned from balding, wouldn't it be possible to get SMP to cover the scarring and create an illusion of more hair, and keep the sides buzzed? I mean SMP looks fake af on slick bald areas, but I think it should look fine if blended with real hairs.

 

[whatintheworld]

I think some of the people here haven't researched transplants enough to see what over harvested donor looks like.

With significantly less grafts, many surgeons will have your donor looking much worse than the pictures in this thread.

 

[nahte42]

It seems to depend on how long you'd intend to wear your hair in the future in terms of the tradeoff between crown coverage vs overall density. If you want to grow it out more maybe settling for a higher hairline and/or leaving the crown a little bald would be ok because you can more easily cover those areas with longer hair. But if you want to be able to buzz your hair shorter and not look stupid, I think I'd rather the hair be spread out well even if the density is poor. My uncle has diffuse thinned as he has aged but buzzes his hair and even though it's not very dense anymore, the lack of density is consistent throughout and so it looks totally fine.

 

[coolio]

I feel like it might be better to settle for like a NW2.5, maybe even 3, hairline instead of a NW1-1.5, especially if you have aggressive balding genes that will leave you with a thinned donor. Better safe than sorry.

Absolutely. The patients who are really safe to get a Norwood#1 hairline transplanted are in the minority. Those men do exist in the world, but most of them don't ever get severe/young enough hair loss to be looking into hair transplants. Unfortunately, the more desperately you want transplants, the worse of a candidate you probably are for it.

Although, in case of a nuked donor that has been harvested and thinned from balding, wouldn't it be possible to get SMP to cover the scarring and create an illusion of more hair, and keep the sides buzzed? I mean SMP looks fake af on slick bald areas, but I think it should look fine if blended with real hairs.

It goes back to the issue of looking unnatural. Between natural balding + modern life (styling, etc), people are used to seeing men with balding areas that look less than 100% dense & natural.

But if your donor area looks anything less than 100% thick then it looks 'off' to other people. Like you are sick or scarred or wearing fake hair or something. Nature normally doesn't affect the donor area at all, not on healthy men.

People are very good at sensing when something about your face or hair looks 'wrong' even when they cannot explain what it is.

I think some of the people here haven't researched transplants enough to see what over harvested donor looks like.

With significantly less grafts, many surgeons will have your donor looking much worse than the pictures in this thread.

Oh, I know they can get a lot worse.

But that doesn't mean these cases aren't heavily harvested.

IMO looking at all these showoff cases on the net, it leads to a false sense of donor capacity in general. In real life tons of guys get their first 3000 FUE done and come away surprised/shaken about how much it impacted their donor area. Transplants simply cannot create more hair than you started with. Those hairs all came from somewhere.

 

[BurningCoals]

Absolutely. The patients who are really safe to get a Norwood#1 hairline transplanted are in the minority. Those men do exist in the world, but most of them don't ever get severe/young enough hair loss to be looking into hair transplants. Unfortunately, the more desperately you want transplants, the worse of a candidate you probably are for it.



It goes back to the issue of looking unnatural. Between natural balding + modern life (styling, etc), people are used to seeing men with balding areas that look less than 100% dense & natural.

But if your donor area looks anything less than 100% thick then it looks 'off' to other people. Like you are sick or scarred or wearing fake hair or something. Nature normally doesn't affect the donor area at all, not on healthy men.

People are very good at sensing when something about your face or hair looks 'wrong' even when they cannot explain what it is.



Oh, I know they can get a lot worse.

But that doesn't mean these cases aren't heavily harvested.

IMO looking at all these showoff cases on the net, it leads to a false sense of donor capacity in general. In real life tons of guys get their first 3000 FUE done and come away surprised/shaken about how much it impacted their donor area. Transplants simply cannot create more hair than you started with. Those hairs all came from somewhere.

Yeah guess that's true. Although I am interested in the overharvesting + SMP route, haven't found all that much about that, if there even are people whom have done that.

My hair loss currently isn't bad enough to warrant an hair transplant (I'm too young and have no money regardless lol) but if I were to get one in the future when the hair loss significantly progresses, I want to have it kinda look like I am naturally losing hair. Would have greatly preferred a thick NW1 but that's obviously not viable. I have NW7 genetics so I need to be careful.

Man, I wish hair cloning was available and affordable. Then we could just let ourselves go bald, get an hair transplant or two (if the first one wasn't good enough) and then we would never have to think about this stupid baldness sh*t ever again.

 

[nahte42]

Yeah guess that's true. Although I am interested in the overharvesting + SMP route, haven't found all that much about that, if there even are people whom have done that.

My hair loss currently isn't bad enough to warrant an hair transplant (I'm too young and have no money regardless lol) but if I were to get one in the future when the hair loss significantly progresses, I want to have it kinda look like I am naturally losing hair. Would have greatly preferred a thick NW1 but that's obviously not viable. I have NW7 genetics so I need to be careful.

Man, I wish hair cloning was available and affordable. Then we could just let ourselves go bald, get an hair transplant or two (if the first one wasn't good enough) and then we would never have to think about this stupid baldness sh*t ever again.

How old are you and what's your situation? I'm 24 and already a norwood 6 but with a still barely intact original hairline (diffuse hair loss into the horseshoe pattern). I'm set on doing what it takes to have the majority of my hair relocated to the top. I don't get the huge concern with how the donor area would look. Obviously we're removing hair from there so we should expect it to look thinner. That should be the norm. We can always shave the back and sides anyway like today's hairstyles, as long as there's no major scarring, and Zarev seems to be able to do that to a good degree.

Just imagine. You could have pictures taken from the front of you and feel great about yourself knowing you have hair on top that attractively frames your face properly.

Also are there medical loans to help pay for a transplant? I've heard there are but haven't looked into them.

 

[BurningCoals]

How old are you and what's your situation? I'm 24 and already a norwood 6 but with a still barely intact original hairline (diffuse hair loss into the horseshoe pattern). I'm set on doing what it takes to have the majority of my hair relocated to the top. I don't get the huge concern with how the donor area would look. Obviously we're removing hair from there so we should expect it to look thinner. That should be the norm. We can always shave the back and sides anyway like today's hairstyles, as long as there's no major scarring, and Zarev seems to be able to do that to a good degree.

Just imagine. You could have pictures taken from the front of you and feel great about yourself knowing you have hair on top that attractively frames your face properly.

Also are there medical loans to help pay for a transplant? I've heard there are but haven't looked into them.

I'm 19 (started balding at 15-16 rip) and around a NW2.5 (although I think many would consider me a NW3, but my temples don't stretch as far back as a NW3 does on the original Norwood chart) with some thinning, mostly at the forelock (which pisses me tf off since that's the worst place to be balding at imo, the forelock is the most important for framing your face if you ask me). Been on minoxidil for about a year, and it has actually done a really good job at maintaining my hair, but I know it won't last forever so I will have to look into getting on finasteride soon. If I don't respond to that or I get brutal sides then idk what to do...

Exactly, I'm interested in the whole permanent undercut look + SMP to cover up scarring and creating the appearance of having more hair, if that's actually possible/viable. I've been trying to ask around, but I mostly get the same stuff about butchered Turkish hair transplants and that stuff.

No idea about medical loans to pay for transplants, though I wouldn't think so because it is an "cosmetic issue" and that stuff.

 

[coolio]

Exactly, I'm interested in the whole permanent undercut look + SMP to cover up scarring and creating the appearance of having more hair, if that's actually possible/viable. I've been trying to ask around, but I mostly get the same stuff about butchered Turkish hair transplants and that stuff.

The style of having the top really long and the sides/back buzzed down really short . . . . it won't STAY in style forever.

In 1985 guys were wearing mullets. Some had full beards. Barely 10 years later the beards were gone and the mullets were downright lame.

It's just not wise to permanently hitch yourself to one style. Not when the style is a prominent one that deviates far from neutral.

 

[BurningCoals]

The style of having the top really long and the sides/back buzzed down really short . . . . it won't STAY in style forever.

In 1985 guys were wearing mullets. Some had full beards. Barely 10 years later the beards were gone and the mullets were downright lame.

It's just not wise to permanently hitch yourself to one style. Not when the style is a prominent one that deviates far from neutral.

I suppose, but it is still better than being bald. I mean, the shaved head might not be in style either in the future. Not too long ago it was associated with neo-nazis and stuff (and it still is to some extent).

But it isn't an ideal solution, I agree there. Better to have intact-looking hair at the sides and back, and with a conservative hairline, and maybe a slightly thin crown, rather than annihilating the donor zone. I'm just interested in whether the above is actually possible.

 

[nahte42]

I'm 19 (started balding at 15-16 rip) and around a NW2.5 (although I think many would consider me a NW3, but my temples don't stretch as far back as a NW3 does on the original Norwood chart) with some thinning, mostly at the forelock (which pisses me tf off since that's the worst place to be balding at imo, the forelock is the most important for framing your face if you ask me). Been on minoxidil for about a year, and it has actually done a really good job at maintaining my hair, but I know it won't last forever so I will have to look into getting on finasteride soon. If I don't respond to that or I get brutal sides then idk what to do...

Exactly, I'm interested in the whole permanent undercut look + SMP to cover up scarring and creating the appearance of having more hair, if that's actually possible/viable. I've been trying to ask around, but I mostly get the same stuff about butchered Turkish hair transplants and that stuff.

No idea about medical loans to pay for transplants, though I wouldn't think so because it is an "cosmetic issue" and that stuff.

Yeah you are in a particularly difficult situation right now because you're so young and your hair loss is ongoing; it hasn't stopped yet and like you said you'd likely need finasteride for life to stop future loss and that's if you could even tolerate any side effects. I would not have a transplant at your age because it would be too unrealistic to try to relocate hair while trying to anticipate what areas of your remaining hair you'd lose in the years to come.

Not to make you feel down but I personally feel like I might have a better option right now because I'm literally completely bald on top already. I mean, I have hair all across the scalp, you can feel it, and ironically a brush of the hand across the top and the back/sides feels the SAME (which is weird because clearly the density and thickness is vastly different). But it's so sparse and thin and light on top that it's not even visible unless I let it grow out to a cm or more. The hairline recession and crown loss have already met and merged for me. Which may be good because I don't want to go on finasteride ever. Since I am already completely bald, I may be able to have something done and not take finasteride. At least I hope so.

Also, yes, I looked into it...it is possible to use personal or medical loans to finance hair transplants.

The style of having the top really long and the sides/back buzzed down really short . . . . it won't STAY in style forever.
In 1985 guys were wearing mullets. Some had full beards. Barely 10 years later the beards were gone and the mullets were downright lame.

It's just not wise to permanently hitch yourself to one style. Not when the style is a prominent one that deviates far from neutral.

You're right it may not stay "in style" forever but I still repeat that I strongly believe having hair on top and no hair on the sides and back is still a far superior look than being bald with the ring around the head, and this will always remain true. You look at the former and that's not a bald guy. The latter is a bald guy. And bald guys are inferior and always will be.

 

[nahte42]

So I've scheduled a consultation with Dr. Shaver at Dr. Bernstein's office in NYC in a few weeks. I don't really expect to have any procedure done there as of now, but I have never had a consultation with a hair loss/transplant expert. I only talked about my hair loss with my local dermatologist, so I've been wanting to talk with an expert to examine my case.

As a Norwood 6-7 at 24 I accept that I am basically completely bald on top, and I also accept that I refuse to accept leaving my head as it is now. Reason? It looks terrible, no matter what length I have it at or even if I shave it. I have the horseshoe ring (even with shaving) and I'm determined to get rid of it because it's repulsive.

I currently use Minoxidil, Nizoral shampoo and occasionally dermaroll and am willing to continue doing that.

I'm going to ask them a number of specific questions about my situation including:
> How many hair grafts do I have remaining around the sides and back (the ring area)?
> What percentage of those grafts could be relocated to across the top of the scalp?
> Will show her Dr. Zarev's work and see what she thinks of it

As I see it, I might have the following options to fix my situation so I can stop hating how I look:
1. Find someone willing to move the majority of my hair on the sides and back to the top (FUE) + SMP on the sides and back if necessary to increase visual density of donor area
2. Use of body hair if necessary, but very unsure about this
3. Laser hair removal for the sides and back so that the horseshoe ring is gone

Because we need to unanimously admit, this:

is always far superior to this:

 

[kiwi666]

It seems to depend on how long you'd intend to wear your hair in the future in terms of the tradeoff between crown coverage vs overall density. If you want to grow it out more maybe settling for a higher hairline and/or leaving the crown a little bald would be ok because you can more easily cover those areas with longer hair. But if you want to be able to buzz your hair shorter and not look stupid, I think I'd rather the hair be spread out well even if the density is poor. My uncle has diffuse thinned as he has aged but buzzes his hair and even though it's not very dense anymore, the lack of density is consistent throughout and so it looks totally fine.

Glad you posted this. This is exactly what I’ve been thinking about doing.

I’ve recently caught myself looking at men with balding crowns and thinking... better than bald all over. Certainly something I’m trying to reconcile anyway.