Dr Zarev Vacuum Assisted Tecnique For Graft Extraction

kiwi666

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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.
View attachment 151437View attachment 151438

View attachment 151439View attachment 151441

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:
View attachment 151443

is always far superior to this:
View attachment 151444

I don’t think your plan is terrible.

I wonder if you could distribute enough from the sides to the top so that you could shave it to a 1 guard and use SMP to make it appear fuller.
 

whatintheworld

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Hmm, your pattern looks more like Norwood 7 than Norwood 6, I think you will definitely have to add beard/ body hair grafts in order to get the coverage you are looking for.

It will be tough but I'm rooting for your success
 

nahte42

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I don’t think your plan is terrible.

I wonder if you could distribute enough from the sides to the top so that you could shave it to a 1 guard and use SMP to make it appear fuller.
That's my hope. It's not even that I need to have much hair at this point. It's the ring that bothers me so much. I need a fix to this so I can go out without hats and take on the world and not feel awful about the current look, because I'm so young. If I can decrease or get rid of that horseshoe contrast it's a win and I'll be much happier.
 

kiwi666

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That's my hope. It's not even that I need to have much hair at this point. It's the ring that bothers me so much. I need a fix to this so I can go out without hats and take on the world and not feel awful about the current look, because I'm so young. If I can decrease or get rid of that horseshoe contrast it's a win and I'll be much happier.
Just checking, you can’t razor it each day?
 

BurningCoals

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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.



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.
Yeah I'm not planning to get an hair transplant anytime soon. I don't care that much about having a perfect Norwood 0 hairline (though I'd prefer it to my current situation), it's more that I just want to avoid "the bald guy" label.

Yeah you have it "better" in a way since you will barely lose anymore hair, although the downside is because your loss is so advanced it is more difficult to get a transplant (though not impossible). Man, if male pattern baldness had to progress to advanced stages it could have at least stopped at like NW4-5 territory. Getting a transplant at that level wouldn't be that hard.
 

coolio

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Prince William vs the thick top & shaved sides - It's not an either/or decision. That's the point I'm trying to make.


Look at this FUE patient. This is before/after 3000 grafts into the crown. For many higher Norwoods that might be half the lifetime donor supply. That's the difference between your donor area looking nice and thick versus moth-eaten. Is the crown coverage improvement really that critical?

I know any kind of crown loss seems like a horrible curse in your 20s. But you won't always be in your 20s.

hs-post-op-3000-graft-FUE-in-a-50-year-old-male-FI.jpg


There is an old saying in the transplant industry that the crown is a 'black hole' for grafts. It just swallows grafts by the thousand and barely shows a difference. Your head is convex-shaped so the crown's surface area is bigger than it appears in pics. And the area is pointed up at the sky which makes the light harsher on it too. Getting thin/moderate coverage is realistic, but trying to make it look DENSE just sucks.

Setting aside the first centimeter of hairline, you could build an entire frontal third out of 3000 grafts. I mean starting with shiny bald skin and making it a decent Norwood#2.5 forelock. The payoff per-graft is SO MUCH BETTER on the front of your head than on the crown.

It's the diminishing returns principle. The early gains in your appearance (per graft) are much more worthwhile than the later gains. Trying to go from a Norwood#2.5 to a Norwood#1, and trying to go from thinning crown coverage to fully dense . . . . the donor area damage is getting worse while the cosmetic gains are getting smaller.
 
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Felipe302

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Yeah, I'm also not restoring my crown. I'm 32 right now and already got 2500 grafts in the hairline. It made a huge difference in my appearance, but I'm not satisfied yet.

During my consultation with Dr. Zarev, I will tell him that I want to reinforce hairline/mid-third of the scalp without placing any grafts on my crown. Only when I'm satisfied with the density of my hairline and middle third, if there is any donor area left, I will do something about the crown.

I understand that younger guys feel terrible about their crown area but... When you get to your 30's, it's really not that bad... I would rather have a bald crown than a shiny bald head. Beggers can't be choosers.
 

coolio

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It's not only the decision to attack the crown loss or not. It's also the way you go about it.

Look at the shiny crown on the far left. It will not look natural to put an even layer of grafts across the whole shiny area. It's just not the way hair loss normally occurs. Real hair loss starts with the middle of the crown and works outward from there. Like the middle pic.

severe-hair-loss-1.jpg


The edges of the crown and the vertex need MORE density than the middle of the crown or your whole head won't look right.

If that means you run out of donor grafts while the crown is still not covered as well as you like . . . . fine.

Being "the guy with the thinning hair" is a lot better than being "the guy with the bad hair plugs". If the front half of your head looks decent and frames your face well + the rear half of your head doesn't draw attention for looking unusual = you did well. That's the best we can do with 2020 technology.
 
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whatintheworld

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@nahte42 out of curiosity, did you try finasteride before when you noticed your hair thinning?

If not, how come? The safety profile for the drug is pretty good, millions of men take it without issues.
 

werefckd

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It's not only the decision to attack the crown loss or not. It's also the way you go about it.

Look at the shiny crown on the far left. It will not look natural to put an even layer of grafts across the whole shiny area. It's just not the way hair loss normally occurs. Real hair loss starts with the middle of the crown and works outward from there. Like the middle pic.

View attachment 151447

The edges of the crown and the vertex need MORE density than the middle of the crown or your whole head won't look right.

If that means you run out of donor grafts while the crown is still not covered as well as you like . . . . fine.

Being "the guy with the thinning hair" is a lot better than being "the guy with the bad hair plugs". If the front half of your head looks decent and frames your face well + the rear half of your head doesn't draw attention for looking unusual = you did well. That's the best we can do with 2020 technology.

Very good points Coolio. I would like to point out that if the bald stop of the back of the hair is a little less extreme and the person goes to a good doctor, it is possible to improve your situation while still looking like a natural balding pattern:

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Of course, it all depends on the quality of the donor you still have (and your body hair, this guy used 2007 FUE + 1888 BHT) and the skills of your doctor.
 

nahte42

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Just checking, you can’t razor it each day?
I *can* but it still looks horrible since my "ring" hair is so thick and dark and my skin pale. It will always show noticeably through the scalp. The first pic is a day or two after shaving and I also get tons of irritation. It's not worth the annoyance of shaving every day for something that still looks so bad.

I actually dyed the hair on the sides and back a blonde color for a Halloween costume and it actually looked SO much better, especially from a distance:
20201122_111023.jpg

So this tells me that if I can decrease the contrast between the remaining hair and my pale scalp it will look better.
@nahte42 out of curiosity, did you try finasteride before when you noticed your hair thinning?

If not, how come? The safety profile for the drug is pretty good, millions of men take it without issues.
I noticed my hair "thinning" around age 17 (about 2 years after it actually probably started). But I convinced myself it was simply maturing hair, and also by the time I got into reading about finasteride I was very scared of the possible side effects as a young guy, so I've never taken it, but my dermatologist told me at age 21 or so my loss is so aggressive it wouldn't help much now. I would've needed to get on it by like age 16 and I didn't know anything about it then.
 

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werefckd

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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.
View attachment 151437View attachment 151438

View attachment 151439View attachment 151441

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
Damn man, that's a very aggressive pattern male pattern baldness. I would be very careful of letting any hair transplant Doctor touching it as chances it won't look good and you won't be able to shave your head like that anymore. Bald is bad but as Coolio is point out, bald + butchered is much worse.

The only Doctor I would consider doing something with is Dr. Konior. You could try making a consultation with him and listen to what he is going to say. Maybe your scalp donor is very thick and you have good body hair and he can do something for you, I don't know, but I wouldn't get my hopes up.

I would also really try needling+minoxidil in the back of your head as you still have some hair there and it can improve the "horse shoe" appearance.
 

nahte42

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Damn man, that's a very aggressive pattern male pattern baldness. I would be very careful of letting any hair transplant Doctor touching it as chances it won't look good and you won't be able to shave your head like that anymore. Bald is bad but as Coolio is point out, bald + butchered is much worse.

The only Doctor I would consider doing something with is Dr. Konior. You could try making a consultation with him and listen to what he is going to say. Maybe your scalp donor is very thick and you have good body hair and he can do something for you, I don't know, but I wouldn't get my hopes up.

I would also really try needling+minoxidil in the back of your head as you still have some hair there and it can improve the "horse shoe" appearance.
Thanks for the advice.

But I still think I look better in the most recent pic I shared above ^. That was a look for a Halloween costume. I look better as an attractive zombie (2nd pic with blonde sides and wispy hair on top) than I do a repulsive zombie (first pics). Lol

I just have to do something here with the main goal of decreasing the contrast of the ring.
 

werefckd

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Thanks for the advice.

But I still think I look better in the most recent pic I shared above ^. That was a look for a Halloween costume. I look better as an attractive zombie (2nd pic with blonde sides and wispy hair on top) than I do a repulsive zombie (first pics). Lol

I just have to do something here with the main goal of decreasing the contrast of the ring.
I agree. And it's good that you still have your donor intact. Whatever you do, please don't ever go to a cheap or even average hair transplant clinic. Honestly you should talk with Dr. Konior.
 

BurningCoals

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@nahte42 I know this will sound very cliche, but have you tried growing a beard? I feel like the horseshoe looks less extreme with a beard, since it looks more like an extension of the beard (or is it the other way around lol).
 

nahte42

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@nahte42 I know this will sound very cliche, but have you tried growing a beard? I feel like the horseshoe looks less extreme with a beard, since it looks more like an extension of the beard (or is it the other way around lol).
Yes, I have but I don't like it getting too long. I always keep short facial hair though. I do grow it out to a decent length sometimes but prefer to keep it shorter.
 

coolio

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I noticed my hair "thinning" around age 17 (about 2 years after it actually probably started). But I convinced myself it was simply maturing hair, and also by the time I got into reading about finasteride I was very scared of the possible side effects as a young guy, so I've never taken it, but my dermatologist told me at age 21 or so my loss is so aggressive it wouldn't help much now. I would've needed to get on it by like age 16 and I didn't know anything about it then.

Finasteride at 16yo? No way. IMO even 18yo is uncomfortably early.

They can publish research saying it's harmless but that doesn't make it harmless. And, screwing with the sex hormones before adult development is finished? That is asking for much worse trouble than doing it after.

IMO a "safe" age for Finasteride would be at least 20yo. (Yes, I know that is way too late to save a lot of guys' hair. But the situation is what it is. We need better hair loss treatments.)
 

werefckd

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Compare the donor area of patient of Dr. Zarev after 12K grafts

1606071740200.png


Versus the donor area of a patient of another doctor after 9K grafts:

1606071800770.png


I'm not even going to discuss the fact that Zarev extracted 3K more grafts and the donor still looks more dense, because this result can be attributed to the original (higher) density of the patient.

But look how the second patient has these clear gaps over his donor while Dr. Zarev's patient donor area is very homogeneous and natural, even with 3K more extractions.

Goes to show how refined Dr Zarev's technique is.
 

coolio

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There is the factor of Dr. Zarev raiding outside the 'safe zone.' That may be worth a few thousand grafts depending on the patient.
 

werefckd

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By the way, that second dude has been "recharging" his donor area with BHT. The improvement is definitely there.

1606075560086.png
 
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