DrTBarghouthi

Hi guys, A group of individuals have thankfully helped in setting up a Verteporfin related website - www.verteporfin.org The purpose of that is to have a reference site for the updates but also to channel everyone interested in supporting the ongoing progress of future trials. You can also use the site to reach out to us via whatsapp or email to register your interest in being in future trials. I am seeking the assistance of colleagues in having trial clinics in the US and Europe to make it easier for travel and to hopefully run simultaneous trials, as there are few different variables to test. I hope to have definite news on that soon. Thank you again for all your support across all channels and I would ofcourse keep this updated too.

Hard to scientifically put a number. Nonetheless, I feel that test areas have somewhere in the region of 30% improvement on average. The important question to seek an answer for is that if we had some improvement in T areas, then how far more can we get if we make adjustments?

I used the 30g needles commonly used with prp or mesotherapy and at the same depth we use. I’m just considering injecting at a smaller interval and having a uniform depth across all injections.

No laser was used. It is used to activate it for eye disease use. I don’t think there is a need for repetitive injections. Just possibly adjusted and uniform depth and also trial of higher doses.

Unfortunately not yet as I had to cancel my Panama trip last minute for reasons beyond my control. I will arrange a meeting with him online. There are also other doctors willing and we should have an FUT strip done by one of them soon hopefully.

I’m sorry I thought I replied but not sure where it went. Yes I still have the volunteer ready - I just want to use an updated dose on him to make sure we get the best out of it. Such volunteers are hard to find and so I want to make the best of it. It will be soon though. I’m also waiting to make sure I have enough verteporfin supply for a full FUE.

Yes some sort of marking it is important I agree. Will aim to do so for the next trial.

Thanks a lot. Yes I am discussing with some doctors and hopefully we will have different trials going soon. Testing higher doses will also be soon. I just want to make sure the supply is there and improve the protocol further this time.

Other treatments are used frequently (such as PRP) and in many cases we hardly see any skin or density improvement similar to this.

Yes I’m glad you share some of my observations as well. I think future attempts and adjustments are definitely worth pursuing because even the slightest difference between control and test areas is worth questioning and exploring.

Hi guys. So for this update I started with a zoomed out photo to try and make a more generalized idea about what’s going on. On the zoomed images - which I will also share, you can still see some potential hair growth around punch sites or within them as compared to control areas. You can also appreciate the difference in the punch area skin texture in between some of the test and control sites. Nonetheless, what is more interesting is the overall look of test vs control areas in the zoomed out photos. I particularly think that 0.4 mg gave an overall better healing and potential regrowth than others. You can hopefully appreciate how the area to the right of the blue line i marked shows a generally better looking donor healing than the same 0.4 control area. Again I do appreciate that limitations of this early trial and photography and I do think that some areas within the test areas healed better due to the injection technique or drug delivery method. This is something we have to improve as mentioned before. I will take histology in December of various sites to histologically compare test and control areas. Please note that the top left corner of the T area just happens to be part of an older scar that he had too. Here I can just see that the T has possibly less defined scarring borders and islands where healing seems to be better. It is not uniform throughout the box but that might show that vert was not active throughout the entire area. Again punch sites in T show better looking skin texture even with no hair growth it seems.

Hi guys. Apologies for the delay. I met the patient and will update the photos today or tomorrow at the latest.

Yes correct.

It’s not 0.24’per graft but per cm2

Thank you. I took photos from the same distance as it it the only distance that enabled me to show the scarring with some detail and not too blurry. Any noticeable change in angle is mainly due to the fact that the areas are just curved along the donor area.

Hi guys. Here is the update after 119 days (17 weeks). I continue to see distinct hairs around or within punched areas in the test areas across all doses. I continue to see clearly scarred areas in the control group. It is hard for me to track every single hair that grew before, some are indistinguishable but I am tracking any that seem within a scar and look distinctly shorter or still newer relative to surrounding hairs. I do think the 0.4 and 0.32 doses are best. If we look st zoomed out pics of both we can appreciate a difference in healing and possibly the contribution of new hairs giving better coverage and appearance in the test areas. The 0.24 dose did not heal as well in my opinion- possibly due to either the dose or because of using tumescent within the actual areas. It may have suppressed the mechanism somehow. I will keep up with the follow ups and would hopefully do a biopsy at 6 months. I think I will now need to test new doses within 0.4 and above or increase the concentration. I also need to find a more uniform injecting technique to establish great uniformity in injections. I will also proceed with injections in the recipient area and a linear scar injection. These are all still in the pipeline.

Hi guys. Here are the updated photos. As you can see, there is scarring in both control and test areas. The test area is a bit more pigmented and I think that the scarring is slightly better. Maybe it needs more time or a dose adjustment. Nonetheless, the tiny hairs in the test areas across the 3 dosages is becoming more of an obvious feature in comparison to control areas.

Thanks for tagging. I don’t see anything of major concern. It mostly is some case of folliculitis as hairs maybe trying to break through skin. I would continue to use any topical medication that seems to be working. May I also suggest trying some warm towel pads twice a day over the areas affected. Keep us posted.

Thank you very much. The next follow up is in less than a week actually. I’m currently doing a follow up every 4 weeks with this patient, but this is only for the purposes of the study. Once we have a working protocol or we get implemented as part of surgery, then I think less frequent follow ups will be the standard.

I agree. However, off-label use is always better to be approached with caution, and not everyone would be happy to get injected with a drug that was not approved for that purpose. For example, minoxidil tablets have never been approved for hairloss- but the drug has been present in oral and topical preparation for longer than Verteporfin- yet only in recent years the uptake increased. Same applies for Finasteride in post menopausal females- a drug present for many years for male loss and enlarged prostate- and yet females are still hesitant in taking a “hormone” reducing medication that is off-label.

Dear community, This is a 25 year old gentleman who had an FUE procedure done in September 2021. He is a NW 6 pattern with a family history of the same. His donor area is good with some fine to moderate hair calibre. We did around 2914 grafts for both the frontal and midscalp zones to add definition and density. His crown is thinning but still good enough to blend in well with the rest of the scalp. He is currently on compounded finasteride and minoxidil for maintenance. Photos were taken at around 10 months from surgery. Surgical details: FUE 0.9 mm punch 1's: 800 2's:1442 3's 563 4's 109 hair/graft: 2.0 Sites made using 0.9 mm and 1.3 mm Sapphire blades. Surgical photos: (Latest is 10months from surgery ) Before Planning: Immediately after: 10 months after: Comparisons:

Absolutely. It is not yet at this stage. Only if we reach a consistently good guideline.

I haven’t yet but hopefully once we see promising results/ or adjust the protocol and dosage etc we can have a better working model. We don’t want this turning into another PRP like treatment where no definite guidelines exist if you know what I mean.

It wouldn’t be long. If it’s proving to be beneficial in either wound appearance and/or some degree of hair improvement or regrowth, then I don’t see any reason not to offer it as part of the procedure. It would be similar to practices that add PRP or use specific post op dressings etc. It will be something that we just incorporate into the procedure for those who want- despite it being off-label.

Absolutely. There are many ways to test Verteporfin given the basic mechanism of how it works and all these suggestions are valid. However, our limitations are currently finding volunteers, booking slots for them and potentially having a supply of Verteporfin as it is not always easy to supply etc.