Dr. Zarev’s FUE Gigasessions

Dr. Tsvetalin Zarev FUE Gigasession Hair Transplant
Dr. Zarev’s 12,620 graft FUE Gigasession hair transplant patient. Before and after photo.

In general, I avoid writing an entire blog post on any individual hair transplant surgeon. I make rare exceptions to this rule when a surgeon is doing something groundbreaking, or garnering a lot of online attention.

My main reason for limiting these types of posts is due to the fact that even the most gifted hair transplant surgeons will have some bad results and unsatisfied patients. I never want to encourage a reader to go to someone specific for a hair transplant just based on one blog post. You have to always do your own extensive research (both online and offline) before making a choice.

Moreover, some surgeons are mostly interested in publicity and marketing. I could be unwillingly helping them by overestimating their abilities in a post. By corollary, I could also be judging someone too harshly or even entirely ignoring them unjustifiably. I have never had a hair transplant, so such posts are never first-person accounts.

In any event, I can no longer ignore Dr. Tsvetelin Zarev from Bulgaria (his first name is also spelled as “Tsvetalin” on the web). I communicated with him several times during the past year (see his responses further below in this post). I was still not too keen in writing about him without getting more feedback from other surgeons.

However, during the past month, a number of readers have inquired about his gigasession (or giga session) hair transplant procedure. This is likely due to this 2-month old Reddit post followed by this large recent HLT thread. So I have decided to finally write about Dr. Zarev.

I am also writing this post in order to warn readers about the dangers of falling for marketing terms such as FUE megasessions, FUE gigasessions and even “super gigasessions”. Please read the bottom of this post carefully.

Dr. Tsvetalin Zarev

I first heard about Dr. Zarev and his crazy up to 14,000 graft follicular unit extraction (FUE) gigasession hair transplants in 2019. At the time, the highly experienced Dr. John Cole praised Dr. Zarev profusely at the 8th Annual FUE Europe Conference. See Dr. Zarev’s presentation from that conference here (video also embedded below).

He has apparently developed a new extraction technique via which he can extract 60 percent of hair from the donor area, without leaving any obvious signs of damage or barren gaps. Note that for some androgenetic alopecia (male pattern baldness) sufferers, even the “permanent” donor region can thin significantly in old age. So look at your family history of baldness progression before choosing to undergo any large procedure that you might regret later.

10,000 Grafts More Common

Later on, while browsing through Dr. Zarev’s Instagram, it became clear that most of his patients seem to get closer to 10,000 grafts (spread across two or three procedures). Same when it comes to Dr. Zarev’s Facebook page. I saw a few cases of patients getting 10,000-12,500 grafts across two procedures. The 14,000 graft cases are likely extremely rare.

This is a relief, as it shows that Dr. Zarev is not just performing “super gigasession” hair transplants willy nilly just to break world records. There was a time when even 4,000 graft FUE procedures were considered to be too large, but it seems like this is no longer the case?

Note that an average graft has 2-3 hair follicles. And there are around 90,000-150,000 hair follicles on an average human head.

While I enjoyed the above presentation by Dr. Zarev, I did not pay too much heed to Dr. Cole’s praise. For one, I have not heard of too many other ISHRS member surgeons singing Dr. Zarev’s praise as yet. Moreover, Dr. Cole has over the years praised many people and procedures. Including exosomes and a Turkish hair transplant surgeon just this year.

Dr. Tsvetelin Zarev
Dr. Tsvetelin Zarev.

Dr Zarev seems extremely young to me based on the earlier mentioned 2019 video. However, it turns out that he has already been performing hair transplants for 10 years! Here is a local Bulgarian video from 2014 that covers Dr. Zarev.

His IAHRS profile mentions that he uses both manual and motorized FUE techniques, and applies a vacuum assisted technique for hair transplantation.

Dr. Zarev’s FUE price is 4 Euros per graft. See my hair transplant cost table for comparisons. I am surprised that there are no Google reviews of Dr. Zarev’s clinic as yet. Or perhaps in the US I am not being shown the Bulgarian version of Google reviews?

Dr. Zarev’s Email Response

I e-mailed Dr. earlier this year, and it took him a month to reply. I then e-mailed him again in May, and he replied again in July. Normally, one would get annoyed at this kind of cat and mouse waiting game. However, I was pleased to see that he is not in any way desperate or even keen for my covering him on this blog. Some hair transplant surgeons and/or their representatives have in the past bugged me incessantly to write about them and their latest groundbreaking technique.

These were my questions for Dr. Zarev:

1) If there is still controversy about FUE megasessions (and dense packing), how did you mange to go one step above into FUE gigasessions without attracting controversy? What percent of follicles can get damaged during gigasession dense packing?

2) How many grafts would you define as being in a) A typical average hair transplant. b) A megasession. c) A gigasession.

3) Are other surgeons such as Dr. Cole who praised you now offering this same procedure?

4) Can you also do strip/FUT gigasessions?

This was his response after 1.5 months:

1) I created FUE technology (My Note: I think he means his version of existing FUE), which in most cases allows me to extract up to 60% of the donor areas without causing unaesthetic dilution. The density of implantation in the recipient areas is a very important value, which is calculated individually for each patient, according to many parameters – diameter of the follicular units, number of follicles in the follicular units, length of the follicular units, elasticity of the sclera in the recipient areas, thickness , the dermis and subdermis, the specifics of the anatomy of the blood supply of the recipient areas, the location of the recipient areas and many others. Gigasessions do not necessarily mean a high density of transplants. When needed, I usually do it in two surgeries every 10 months.

2) Not categorized operations of small, medium and large. I transplant as much as necessary to achieve a natural visual density. I have had operations under 100 grafts, as well as over 14,000.

3) At this stage I have not shared this technology with anyone as I am still in development.

4) The type of operation I perform makes the application of FUT completely meaningless. (My Note: See my post on FUE versus FUT hair transplants).


Dr. Zarev sent me the following update after reading this post:

“I have never sought out loud popularity through the operations I perform classified as FUE Super Giga Sessions. Such operations are only part of my practice. I would also like to clarify that the self-serving, ill-considered and unjustified pursuit of operations with such a volume can be extremely dangerous and harm patients irreversibly. For the past few months, I have received daily inquiries from patients wishing for such an operation. For most of them, even from the low-quality photos they send, it is clear that they do not have enough resources in donor areas for an operation of this size.

The planning of operations with such a volume can be done only through personal consultation and precise and in-depth analysis of the donor and recipient areas. It is also extremely important to predict future losses, in cases where the baldness process is still in progress. I hope that the results I am showing do not give rise to vain hopes in many patients from which unscrupulous practices will take advantage of. Such scenarios can only lead to a lot of frustration. The operations I have performed in excess of 10,000 grafts are a result of in-depth preliminary analysis, meticulous execution and of course extraction technology, outside the general standards.

At the upcoming GHLS 2020 virtual conference, I will show a detailed video of one of my two-day operations. The video shows all stages of a patient’s first operation, in which the surgical plan includes the transplantation of a total of 11,500 grafts. And I want to clarify that in my practice, nurses do not have direct contact with the patient during the operation. I always perform personally all manipulations on the scalp, both in the process of extraction and in the process of implantation.”

Megasession versus Gigasession Marketing

If you Google search for “FUE gigasession” or “FUE giga session”, you will find an increasing number of surgeons claiming to offer such procedures. It has become a marketing gimmick. Some patients are even led to believe that a 10,000 plus graft procedure can be performed in one sitting with no risk. This is really dangerous. Make sure to read my posts on hair transplant gone wrong and on the dangers of getting a hair transplant abroad.

Two common problems with large giga session or even mega session type hair transplant procedures are:

  1. The donor region becomes see through and very thin and strange looking. Some call this look “moth eaten”.
  2. The surgeon overpromises and overcounts grafts. There are no shortages of cases where hair transplant patients receive fewer grafts than what they paid for. All the more reason to go to ethical and respected surgeons, even if significantly more expensive.

Dr. Alan Feller has in the past discussed the difficulties in even performing quality 2,500 or 4,000 graft mega sessions. Dr. Zarev seems to regularly be performing 6,000 graft procedures in one sitting. I assume it is much cheaper to hire technicians in Bulgaria versus in the US (Edit: seems like the doctor does all the “direct contact” work himself). But this many grafts is still crazy. Hopefully, Dr. Zarev can in the future share more information about his new vacuum assisted graft extraction technique.

On Reddit, Dr. William Rassman offered the following important warning on super giga session type procedures:

Gigasession hair transplant warning
Gigasession hair transplant warning from Dr. Rassman on Reddit.

How often do you get a Haircut?

Since the beginning of 2020, how often have you been getting a haircut? For most people, I assume this number declined in comparison to 2019.

Nancy Pelosi Hair Salon
White House press conference taken over by Nancy Pelosi’s illegal hair salon visit.

In much of the US, hair salons, beauty parlors and barbershops were forced to close for around 4 months this year.

Even after re-opening, they still require people to wear masks continuously while getting a haircut. And most salons limit occupancy levels and take your temperature before accepting you.

Myself and Nancy Pelosi are Superior Beings

I cannot go for more than 4-5 weeks without getting a haircut. I explain why in the original version of this 2015 post further below.

Ever since the Coronavirus pandemic started in 2020, I have tried to prolong this time frame. However, I could never go beyond 2 months. Besides looking disheveled, the itching and dandruff seem to get worse the longer I wait between haircuts.

Ultimately, I got 2 illegal haircuts in 2020. Without wearing a mask or getting my temperature taken. And by going to an illegally open barbershop operated by a wonderful woman. She only accepted one client at at time. As far as I could tell, the local police supported this small business owner by never fining or arresting her. Other barbers in my state rebelled too. Do I feel entitled and think that these nonsensical anti-barbershop visitation laws do not apply to me? Yes.

Mitt Romney Haircut.
Mitt Romney Getting a Haircut at Home.

This week, Speaker of the House Nancy Pelosi (the most powerful women in the US) joined me in acting entitled and superior while breaking the law. Or, more likely, she always exercised her superiority complex. I was just late to the party.

In Mrs. Pelosi’s hometown of San Francisco, getting a hair blowout and wash treatment at indoor salons or spas is still currently illegal. Yet Mrs. Pelosi was caught red handed (see videos below) breaking the law. While Californians are forced to get outdoor haircuts and hair treatments, Madam Speaker got preferential and illegal indoor treatment. And she removed her mask when she was not supposed to.

All while she has lectured and threatened people this whole year about wearing masks and following government rules. Based on her actions, 80-year old high Covid-19 risk Nancy Pelosi likely does not really believe in these sham recommendations. Just like myself.

However, unlike Mrs. Pelosi (and Dr. Anthony Fauci and Governor Cuomo), I do not scare people into following rules that I do not believe in myself. I may have a superiority complex, but I doubt that I will ever have a hypocritical complex. Blog readers should correct me if they ever smell any hypocrisy in my opinions.

Erica Kious owns the eSalon where the Speaker of the House got her hair treatment. Some interesting comments on Erica’s Yelp.

July 15, 2015

How often do you get a Haircut?

There was a time when my hair was always perfect. Lengthy, silky, symmetrical growth, no dandruff, no itching, no curliness above the ears, and absolutely no thinning areas. I could go months without a haircut and still look well groomed. Moreover, I rarely ever shampooed my hair, and often washed it just once or twice a week (with only water).

Over the years, as male hormones and genetics have taken over, I now have to get a haircut every 4-5 weeks in order to prevent whats left from getting out of hand. Moreover, I now have to wash my hair every single day, and am forced to use Nizoral shampoo once a week to control the itching and inflammation.

It seems like whenever I try to delay my haircut beyond 5 weeks after my prior one, I get more frequent itching and overall bad hair quality and texture. I even start pulling out my own hair after 5 weeks of keeping it uncut.

Scott Walker’s Haircut Obsession

I started to think about all the above after:

  1. Seeing my alcoholic hirsute friend get a haircut after 6 months this week! What is it with so many alcoholics and great hair?
  2. Reading the below entertaining and well researched Twitter feed from Christopher Ingraham. The leading current 2016 Republican presidential candidate is Wisconsin governor Scott Walker. He is obsessed with getting haircuts. He has mentioned the word “haircut” 19 times (!) on his Twitter feed, including 5 times in 2011:
How often do you get a haircut?
How often do you get your hair cut?

Based on the spacing of those Tweets, it seems like Mr. Walker got a haircut every 2.5 months in 2011. Unless he forgot to mention a few more such instances. I am surprised that Mr. Walker waited so long between haircuts, since he is balding significantly per his latest photos.

Balding men usually need to get more frequent haircuts. Perhaps Mr. Walker was not balding as severely in 2011 as he is today? Even funnier, Mr. Walker had one of the wackiest explanations ever when asked to discuss his balding last year:

Governor Scott Walker recently mentioned his bald spot and attributed it to bumping his head on a kitchen cabinet.

Politicians and their Hair

This election season is shaping up to be the most comedic ones ever, with a lot of focus on hair. Both Scott Walker and Donald Trump are now among the leading candidates for the Republican nomination.

Hopefully we will soon find out how often Mr. Trump gets a haircut or how often he gets his toupee replaced if that is really not his hair. I am, however, beginning to believe his claims that it really is his own hair. Edit: See my newer posts on Donald Trump’s hair.

Other leading candidates Marco Rubio and Mike Huckabee have also been asked about their receding hairlines and bald spots. All of this marks a great improvement from past discussions about Norwood 1 Democrat John Edwards and his $400 haircuts.

Unfortunately, we are still a long way from getting a Norwood 7 elected into the White House. Perhaps once a women is elected as President, they will finally focus on electing a bald male? Or, even better, a man with an obvious combover? Correction: Dwight Eisenhower was severely balding when elected in 1953 (h/t reader “Longbow).

Hair loss cure news blog. Hair cloning and multiplication for baldness. The latest news in hair regeneration treatments for androgenetic alopecia.