tripleg

Check the interview that @Melvin- Moderator did with @DrTBarghouthi. I'm so glad things are moving forward! Thank you both so much.

You're missing medical supervision. This is a bad from a personal standpoint in the off chance that something goes wrong a doctor would be able to take care of you. It's a also bad a from a public standpoint - in case something goes wrong and it becomes public, the reputation of this approach will be unfairly tarnished by someone performing the experiment without medical supervision. Also the scalp is not the same as the leg. You really want the procedure to be an FUE extraction just like in a hair transplant. Don't do it yourself. Get a doctor to do it. DrTBarghouthi has already begun doing this properly. Others will joing him in due time.

Your optimism is contagious

"You may saaaaay i'm a dreamer but i'm not the only one" 😁 Wouldn't the regenerated hair still be susceptible to DHT necessitating Finasteride?

Hassan/Wong are exactly the kind of doctors I had in mind. They were FUT masters, but experimented early on with FUE to the point where now they consider it better than FUT. These are the type of pioneering docs who move the field forward. So far I'm only aware of DrTBarghouthi taking an interest in trying out Vertoporfin.

10-15 years? Vertoporfin is here NOW! And if it works, it works NOW!

We don't know. It might be 0% or it might be 100%. We'll know more as different doctors begin to experiment.

Recently Stanford filed patents on using Verteporfin for wound healing and hair follicle neogenesis: "Methods of promoting healing of a wound in a dermal location of a subject are provided. Aspects of the methods may include administering an effective amount of a YAP inhibitor composition to the wound to modulate mechanical activation of Engrailed-1 lineage-negative fibroblasts (ENFs) in the wound to promote ENFmediated healing of the wound. Also provided are methods of preventing scarring during healing of a wound in a subject and methods of promoting hair growth on a subject. Aspects of the methods may include forming a wound in a dermal location of a subject and administering an effective amount of a YAP inhibitor composition to the wound to modulate mechanical activation of Engrailed-1 lineage-negative fibroblasts (ENFs) in the wound to promote ENF-mediated healing of the wound. Also provided are kits including an amount of a YAP inhibitor composition and a tissue disrupting device." https://patentscope.wipo.int/search/en/detail.jsf?docId=WO2021021607 It seems they see some promise.

Absolutely DO NOT do this without your doctor's agreement and supervision! Yes, the wounds would likely need to be fresh. In the procedure on mice Verteporfin was injected around the edges of the wound immediately after creating the wound. Repeated injections on day 4, 8 and 12 didn't improve outcomes and had detrimental effects. Again, if you're considering doing this without your doctor - please don't!

First of all - this should be discussed with your doctor and only done with his/her agreement and supervision. Second - nobody is making any claims that this is guaranteed to work. It might very well fail. All that we're saying is that there is preliminary research that this works in mice/pigs and it *might* work in humans. Luckily the drug in question is already FDA approved and has an excellent safety profile, so any patient/doctor can use it today if they choose. It's basically a low risk/high reward situation. This thread is a discussion about having a conversation with your doctor, if this is something you'd like to try.

Thank you very much Melvin for asking Dr. Bisanga about verteporfin. It’s at the 45:50 mark in this interview: https://www.instagram.com/p/CXoq33GP9Ca/ Here is what was said: Dr. Bisanga: “I heard about it, I didn’t really dive into it because we just had a big global hair loss summit where even people in research were not really talking about it. There are some things that have been done on mice and they are kind of promising, but the problem is [on mice it takes 20 days to get full growth]… then you have to translate what is in the mice to humans - that is why we’re still talking about hair multiplication even today - is because that transition from the lab rat to human is not always that easy because we’re not rats, we don’t have the same physiology. That’s why I say: There is a lot of hype, there are things probably in the pipeline, but we need to make sure, to let researchers finish the process, to do all the steps… To do trials in humans, but we’re not there yet.” Melvin: “I’ll be honest, I don’t think unlimited donor is gonna happen in our lifetime.” Dr. Bisanga: “Nothing is unlimited. Our heart is not unlimited - it has a certain number of heartbeats. Our brain cells… We need to get away in the hair industry from thinking that we’re going to give people their hair back completely. People need to be realistic.” *** First let me say that I hate hype and sort of cringed when I typed the words “unlimited donor” in the title of this thread, but I wanted to draw attention to this possibility. I think many of us here are aware of the various promising treatments that never materialized (not to mention all the scams). I myself am borderline cynical when I hear about the next great thing in hair loss. I think any veteran of the hair loss industry is wise to have that as their default stance. So I fully appreciate Dr. Bisanga’s reasoning. Dr. Bisanga’s answer was sort of what I expected. First he said he’d heard of it, but didn’t look at it in detail. But this is exactly what we are asking the doctors to do: take a closer look, please! So what is Dr. Bisanga waiting for? He’s waiting for researchers to complete their studies. This can take another 5-10 years or it may never happen due to lack of funding, lack of interest, better opportunities and any number of reasons really. We could sit on an effective treatment for years waiting for trials. Digression: If you’ve studied the history of science you may be aware that progress doesn’t alway go from research to practice. It goes the other way around too. Sometimes enterprising practitioners start experimenting and getting some initial success and later scientists come along and help improve the process. The steam engine, for example was not invented by scientists, it was invented by engineers and the science was worked out afterwards. Believe it or not, we still don’t fully understand how bicycles work! (https://youtu.be/9cNmUNHSBac?t=573)! *** Back to verteporfin though. Should doctors really be trying it out an unproven treatment? Normally no, but verteporfin is an FDA approved medication with 20 years of use by ophthalmologists and an excellent safety profile. Any hair transplant surgeon can discuss it with their ophthalmologist colleagues, like @DrTBarghouthi has done (Thank you!). The key point is that this seems a low-risk high-reward type situation. Any doctor can legally and ethically use this drug off-label with his/her patients. We already use both dutasteride and oral minoxidil off-label, which is what we're proposing with verteporfin My own view is that there is a 5% chance that all or most of donor hair will be restored and a 20-25% chance that there will be partial restoration of donor reserves, say 50% - so if you extract 2000 grafts you may get 1000 grafts back. Even if verteporfin only reduces or eliminates scarring in the donor area - it would be a win! It may also prove useful in reducing scarring in the recipient area. We may never find out unless we ask the doctors to take a closer look. *** @Melvin- Moderator- Thanks again for taking this up! I hope you will continue to bring up this subject with the doctors that you speak with. May I ask you to frame the question a little differently? We probably shouldn’t be asking the doctors what they think about it today because almost none of them have taken a detailed look at it, so they’re likely to give an answer similar to what Dr. Bisanga said - a wise answer all things considered. Instead we should be asking them to take their time to study verteporfin closer and get back to us with their thoughts or concerns about trying it out with patients. Instead of asking: “What do you think about verteporfin?”, we should say something like: “We think verteporfin is worth trying today because it’s low-risk, high-reward. It’s FDA approved and has an excellent safety profile. We know there are no human trials. We know it’s a long shot and it may not work, but some of us feel it’s worth trying. Would you consider taking a closer look at it and get back to us with your thoughts or concerns?” We’re trying to get them to take a closer look at it, not to wait for research, which may never be completed or even started. The communication challenge I see is how do we get doctors to take a closer look at this without coming off as naive and uninformed. We should make it clear to the doctors that we are informed about the current state of the research (no human studies), but we feel because the drug is FDA approved with a great safety profile, it’s worth trying despite the lack of human trials to date. Perhaps it doesn’t even make sense to put them on the spot and ask them on live streams, but rather ask them offline to take a closer look so that it can be discussed once they have done a deep dive. This thread is a great starting point for a deep dive: https://www.hairrestorationnetwork.com/topic/60076-fda-approved-drug-verteporfin-found-to-fully-regenerate-skin-including-hair-follicles/

Still hoping to hear from @DrTBarghouthi too.

Thanks for acting on this! I figure the docs will probably want some time to study the literature in depth, but would be great to hear from them as soon as possible! They may already be very much aware of this for all we know.

Imagine if we could have unlimited donor hair reserves! That would be a revolutionary development. There is a drug called veteporfin that may make this possible. Veteporfin is still experimental for treating wounds in humans, but it is already FDA approved to treat an eye disease. It's been around for ~20 years and it has an excellent safety profile. Veteporfin was found to regenerate skin scarlessly with all the dermal appendages, including hair follicles (!) in mice and pigs. Even though pig skin is very similar to human skin, it is unknown whether it will regenerate terminal scalp hair in human hair transplant patients. Clinical trials in humans are in the works, but waiting may take years and the trials may never be completed. Since veteporfin is already FDA approved and known to be safe, any doctor can legally and ethically attempt experimental use of this drug off-label with his/her patients with low risk and high potential reward. All that is required is agreement from the doctor and the patient. I propose that patients willing to try this approach advocate for themselves and discuss it with their hair transplant surgeon. Better yet, if you’re really keen to try this, you may consider speaking to several doctors and find one willing to try this. If doctors hear patients asking about this in consultation they are more likely to pay attention and look into it. (pic from this paper: https://www.science.org/doi/10.1126/science.aba2374) The exact protocol would need to be developed by the doctor, but here’s a sketch of what it may look like. The doctor would do a small number of FUE extractions (say 10-20) in a small area, inject vertiporfen around the edges of the extraction wounds and see what happens. First signs of hair growth in donor area may appear as early as 30 days after the procedure, and by 90 days the extraction sites may look indistinguishable from normal skin (with hair!). If successful, the procedure may be repeated with greater number of extractions. Infection control may need more attention, but that's something your doctor should be thinking about. @Melvin- Moderator It would be great if you could start asking all the HT docs what they think about this when you talk to them. If this approach proves to be successful, any doctors who were pioneers will definitely gain in reputation. I'll quote @toagi "Most researchers don't care about hair loss, so we could sit on a working cure for years waiting for trials to be conducted to test it." This is why I think it's reasonable to at least start bringing this up with doctors. They tend to be conservative by nature, so it's not likely that they will bring this potentially revolutionary enhancement to the patients. Instead I think it's more likely that we as patients will have to initiate the discussion with the doctors. Of course, It's possible that it won't work, but it would suck if we didn't even try it. If you think I'm way off-base with this one please let me know. I'd like to hear your arguments against it. Here is an excellent thread by @toagi for more reference. It contains all the scientific details: Here is video on Veteporfin from Kevin Mann: https://www.youtube.com/watch?v=ePlIWf7y3lg

My money is on Dimitar Berbatov.

Bump. Would be curious to hear opinions about the two docs. It seems they're both top docs. But is one better for a certain type patient than another? Or just any differences in approach?

I am currently living in Moscow, Russia where I'm originally from. I split my time between NYC and Moscow, but HTs are more expensive in the U.S. and the surgeons in Europe are just as good IMO, especially for FUE. And here is a pic of the back of my head. This is 6 days of growth after shaving to zero.

Thanks! And thanks for the help you've given on this an other threads.

I am on finasteride for two months, waiting to see how I respond. I may add topical minoxidil after I've been in on fin for a year, but I worry I will not stick to the routing of applying daily. I'd rather not "get my hair hooked on minoxidil" right now. If I get some sides from fin (highly unlikely) or if I continue to lose hair despite fin, I will postpone surgery and likely not do it all unless I can find a way to stabilize (with something like dutasteride or minoxidil). But statistically speaking I will most likely at least stabilize on fin with no side effects and be able to move forward with surgery.

I haven't had any in person assessments yet, but planning on it. I've had an online assessment by Dr. Muresanu of Hattingen. He had me point a USB microscope at different points on my donor. Based on this he said my donor was okay, but nothing spectacular (paraphrasing). No mathematical calculations were done. Same for hair calibre - exact calibre unknown, but on the thinner side, though not super thin. So basically a lot of grafts required. I also attempted a self-assesment following the instructions you supplied to me in another thread: https://baldingblog.com/how-to-quantify-your-donor-area-hair-supply/ It seemed my donor was slightly below average, but I wasn't always sure if FUs were singles/doubles/triples and I was erring on the lower side. It was tedious to try counting/classifying all the FUs and making sure I don't miss any. I may attempt this process again more carefully. In mean time I'm hoping to receive at least some benefit from finasteride. Perhaps it can strengthen my donor a bit. I did see a couple of miniaturized hairs in donor as well under the microscope.

I'm early in the process of researching clinics. I'm targeting Europe for my HT. Currently on my radar: Hattingen - more so if I end up going the FUT route, but currently leaning FUE. FUE with them would probably be more expensive and while I feel they're a top clinic, I get the sense that there are other European clinics are just as good at FUE. Next on the list are the Belgians in alphabetical order: Bisanga, Devroyem, Feriduni, Lupanzula Also on the list: Bruno Ferreira That's my shortlist at the moment. I've also considered Dr Zarev from Bulgaria. But he seems to be a FUE megasession specialist. I know there are also great options in Spain and in the U.K. and other places in Europe. I plan to travel to Europe and visit the as many clinics as I can in person to get an assessment and meet the docs. For me it's very important to meet the doc beforehand. In the mean time I'm waiting to see how I respond to finasteride, which I've only been on for two months so far. For me, I don't think HT surgery makes sense unless I can stay on finasteride for life.

Hello, I haven't yet had any hair transplants and I started finasteride 2 months ago. My donor is okay, but nothing spectacular and my hair is on the thinner side, but not super-thin. Currently I shave my head very close. It seems I'll need 5000-6000 grafts to get good coverage (see pics below). I am currently leaning toward FUE. I don't think I want to attempt an FUE megasession of 5000 grafts, nor am I sure any surgeon would attempt it in my case. In cases like mine it seems common to cover the frontal 1/3 of the scalp in the first surgery and the rest of the scalp in the second surgery. If I were to do that I think I would not be inclined to grow my hair out until the result of the second surgery would begin to show. This is because the first surgery would still leave my mid-scalp and crown bare and I'm not too keen on trying to comb over that area. I know some people do it successfully, but for some reason it doesn't feel right. I'm open to have my mind changed on this, but I don't know... Walking around with a hair line would be nice, but considering the mid-scalp and crown are still bare, I would feel less exposed and more secure with short hair. Like if a girl were to run her hand through my hair the whole situation would become immediately apparent with a comb-over. Most likely after the first surgery, I would be shaving my head to 3mm-6mm or whatever the minimum length required to cover the scarring from FUE. (It seems FUE scars take some time to "mature" meaning they're not as noticeable at first, which means I may be able to get away with shorter hair in the early months after surgery #1). So here is my question: Would it be possible to take say 2500 grafts in the first surgery and spread them out more or less evenly throughout the scalp instead of concentrating all the grafts in the frontal 1/3? I believe this would offer a better intermediate aesthetic result while I'm keeping my hair short until surgery #2 is completed. Would the resulting density be too thin to make any noticeable improvement even with short hair? Would it somehow complicate surgery #2 because the surgeon will need to insert new grafts in between previously transplanted grafts (Could the scarring in recipient area make it more difficult or less likely to succeed?) Alternatively, if the grafts from surgery #1 are concentrated in the frontal 1/3 and I cut my hair short, maybe it would still look better than spreading the grafts all over the scalp. What do you think?

The redness on the back of my scalp was diagnosed as Nevus Simplex (a type of capillary malformation). It's not a really a problem with respect to HT or otherwise. No biopsy was required. The dermatologist also confirmed my alopecia as androgenic alopecia, not scarring alopecia or anything else. She examined my scalp with a dermascope (she didn't have a trichoscope).

Does a scalp biopsy damage hair follicles? Especially miniaturized hairs?

Hey guys, I'm in the early stages of researching HTs. In one of my online consults I was asked about redness on the back of my scalp (I shave my head close to zero). I think the redness is just because I have sensitive skin and the back of my skull is often in contact with a pillow, but I'm not sure. I am going to see a dermatologist/trichologist to diagnose it. What other things should I get checked out for to ensure that my scalp is ready for an HT? What conditions are particularly bad in terms of leading to failed HTs that I should be on the lookout for? Any other questions I should the doctor? (Note: this doctor is not an HT surgeon, just a dermatologist/trichologist). Thanks.