DrTBarghouthi

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.

Thanks. Yes we shave to the same length before each follow up. Will include zoomed out photos next follow up which is somewhere in mid September . I do have 2 patients lined up. I am hoping to be able to fit one of them in some of the upcoming weekends by next week or early September.

Better than controls (no verteporfin)

It is still difficult to say how better scarring will be with Verteporfin. The studies on animals showed better skin regeneration and currently on our trial patient, there is a difference in the rate of healing and differences in skin structure in the test punches.

Yes but I meant it could be a telogen hair that wasn’t extracted and then started growing at time of follow up.

Very promising we hope. I agree it is still early to make any conclusions. As for transections, the extracted grafts were checked for that to outrule it. Could still be a telogen hair ofcourse at time of extraction. In all cases, we keep following up and the coming weeks will hopefully give a better indication. I have another case lined up end of this month/ early September it is a full transplant though. I am looking at exact dosage to give in that case.

Thank you all for your kind words guys. I really hope that we will have something that can significantly improve the hair loss industry and scarring.!

We used 0.9 mm punches. The possibilities and variables can be numerous and would therefore have multiple studies that can come out: different dose, volumes, punch sizes, sites, injecting in recipient areas etc. We have to fine tune the next studies accordingly.

Considering we needed to test different doses I had to make the squares nearby but we left around 1 cm between the squares to minimize this cross coverage. Remember that volumes are tiny imo to overalp that much.

Hi Guys. These are the photos 56 days after. What I find interesting is the presence of fine hairs nearby or around T areas . Not sure what to make of it or whether telogen hairs, but I couldn’t find them around Controls but I did find then around or within “some” of the scars in T areas across three doses.

No need to apologize my friend. It is always understandable that waiting for results and what to expect is an anxiety provoking issue. Yes we should wait longer, your 5 months looked better than 4 and so on so we should wait. We will always be supportive of you.

Apologies for the delay in answering anyone- I’ll update any future photos with clearer labels of scars etc. This was anyway an unplanned 6 weeks follow up but the proposed follow up was at 8 weeks which is still next Saturday. Will keep you all posted here.

Hi guys. This is a 42 days follow up. I have kept the photos blinded in case you guys want to have a guess about dosage and which photo is a test or control area. It helps at times when we blind the results. I will share the exact dose and T vs C later.

Thank you for tagging and I fully understand the awkwardness of this situation @kid It may well be a case if telogen effluvium given the cyclical improvement/ deterioration that you experience. This means that the hair cycles at an irregular pace to normal and so growth and resting cycles are erratic. Can we start by checking some blood tests: CBC/ Vitamin D, Zinc, Magnesium and B12. Also Ferritin and iron levels and TSH levels? Scalp conditions can also cause this erratic cycling. It is not permanent loss, just incomplete growth during the growth or anagen phase. I would also consider a scalp biopsy at some point down the line to outrule any less common conditions. Ofcourse please feel free to contact me privately anytime to elaborate further. I’m happy to guide you further during this time or to carry any of these tests through us or through any colleagues nearer to you.

Thanks guys. I should have an update on Saturday. It will be a 45 days update.

Hi guys. Yes we now have one patient 30 days post treatment. There will be one in August or possibly two. I think we will be talking about this in the podcast.

Thank you. Your donor looks fairly acceptable, however, I would like to see full face photos (privately if more suitable) to assess what can be done to your hairline. In the photos it is hard to appreciate the distance of your current hairline and whether the repair will need extractions of multiples and staying at the same length or trying to go higher or lower. This needs a full face assessment.

Thank you for tagging. Please feel free to send some photos here or via the contact details below in the signature and we can hopefully assist you with that.

Thanks. The densities vary according to type of hair, average hairs/ graft and type of hair. Also depends on how much surface area needs coverage. Therefore, it is important to take all of this into consideration and to convey it to the patient. Nonetheless, we do aim to maintain 45-55 follicles per cm2. Sometimes we have to go a bit less and sometimes we can go up to 60. For this case, it was around 50-55 in the frontal zone.

Thank you all 🙏🏻🙏🏻

A lower dose of finasteride or 1 mg on alternate days usually helps many people both in terms of results or reducing potential side effects.