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: 

2 hours ago, Gatsby said:

I think at this very early stage (as promising as it is) it would be a mistake to use verteporfin. Just the incredibly high expectations alone on the drug as this stage could be cause for regret. All the best.

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

7 hours ago, Giddy said:

You dont happend to be in touch with any clinic in EU that could use verteporfin or do surgery yourself with verteporfin in EU? If not im happy to travel to Jordan in the future too! And I am grateful for your efforts.

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. 

8 hours ago, Damen1986 said:

@DrTBarghouthi If Verteporfin proves successful for at least improved wound healing, on what time scale do you think you could realistically offer this as an adjunct treatment for hair transplants at your clinic?

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. 

38 minutes ago, Ganderson said:

Thank you Dr! 
 

Extremely appreciative for all your communication.

* has the patient been shaving his head consistently since the procedure was completed? 
 

* could you tell us the schedule for upcoming updates? Would it be possible to include a picture a little further away from his scalp, (assuming his hair is shaved), so that we could perceive what the results look like from a distance in addition to seeing the close up pictures? May be a helpful comparison to see typical FUE scarring (several months out) with the naked eye in addition to the pictures utilizing your equipment 

 

* any additional patients or volunteers?

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. 

2 hours ago, Ganderson said:

Sorry doctor, just to clarify your answer here - you said “the studies on animals shower better skin regeneration” - do you mean better than without vertoporfin? Or better than human results? 

Better than controls (no verteporfin)

11 hours ago, DIEGO MAURICIO DEL CASTILL said:

Good afternoon doctor, it's a shame to insist on the question, but the truth is that you are the one conducting the study, my question is if verteporfin does not leave scars by applying it to a wound according to the studies you are conducting? Thank you.

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. 

2 hours ago, Melvin- Moderator said:

Wouldn’t telogen hairs be visible under a microscope if extracted? 

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.!

3 hours ago, alopeciaphobia said:

@DrTBarghouthi What size and type of punch was used for the extractions?

If the donor hair does end up regrowing to any extent, I think that for future experiments these would be a good parameters to know, and perhaps try out different ones. Perhaps a differently sized punch taking more or less skin out around the follicle, may affect the rate of donor regeneration?

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. 

On 8/10/2022 at 4:31 PM, alopeciaphobia said:

Incredible that this is finally being tested!

Although, my main concern is if the control and test areas in the donor region are not too close together? Wouldn't the capillary beds in the scalp potentially spread around the verteporfin that is injected into the T-area further around into the C-areas?

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. 

11 hours ago, 5BetaReductase said:

Awesome. What density do you implant at the hairline?

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.