alopeciaphobia

We can calculate how many follicles we'd expect. The surface area of a 4mm diameter circle is: 4 * pi = 12.5mm². Thats 0.125 cm². A cm² of healthy scalp has about 85 follicular units with 2.3 hairs per unit on average. So if taken from a healthy scalp, a 4mm biopsy would be expected to have 85*0.125 = 11 follicular units or 85*2.3*0.125 = 25 hairs. But that doesn't add up. In the sample with 5 hairs, it's very unlikely that the Dr removed 20 out of the expected 25 hairs. Of course, the donor area can also thin (slightly), the biopsy may have transected a bunch of hairs, or the pathologist may have counted follicular units rather than hairs... Or maybe my math is off?

Folks, Dr. Barghouthi said the biopsies were 4mm punches. To put that into perspective, for FUE, the most common punch size is 0.8-0.9mm. So it's very much expected to have mutiple hairs left over after FUE in that biopsy.

Does anyone know if there are still supply chain issues with verteporfin? With these results, I'd imagine it's only a matter of time until (cosmetic) surgeons are going to want a steady supply of this stuff. Imagine using verteporfin for Fleur-De-Lis abdominoplasty, that would be HUGE.

It's truly amazing that a blinded pathologist was able to determine such a difference in fibrosis. Also the hair count difference is very interesting. Hopefully we can create more awareness around this case such that this can be repeated with a larger sample size. If a larger amount of biopsies shows similar differences in fibrosis and hair count, things could be published in a major journal... To be more realistic, hopefully you'll be able to gather some interesting results this year and present them at a conference!

That is incredible news! Thanks again, Dr., for single-handedly spearheading the development of this potentially revolutionary technique. I can only sympathize with the difficult decision of whether to try a full FUE + donor verteporfin or a recipient verteporfin experiment first. Both have the ability to become revolutionary. Hopefully, time and funding will soon permit to try out both. Out of curiosity, how would you imagine the methodology for a recipient side injection experiment? Thanks again! Wishing you the best.

@MrFox and @DrTBarghouthi stated that an update will be posted soon. Also, this:

That's why it's so exciting! Especially because there are multiple very promising applications that have the potential to be breakthroughs. Whether wounding + verteporfin can regrow hair directly in the balding area, or if verteporfin can (repeatedly) regrow extracted donor hairs. Even if only one of those methods ends up working, it would mean we finally have a way of increasing the total number of terminal hairs on the scalp, something which traditional hair transplants can't do. And if none of the above works, reducing scarring is still awesome.

So true, surgery with less scarring could be amazing and relieve people from aesthetic issues hurting their confidence and self image, in a similar vein to fixing hair loss.

No, because you're risking necrosis, poor survival rates, and donor degradation by traumatizing the scalp that much. That being said, it's not even a given that in the long run, a transplant would be the best and only option. Say a future experiment would show that injuring the balding area, followed by injecting verteporfin into it (without transporting any grafts), would trigger some regrowth.. who knows how many procedures you would need, with how much time in between. This is why we need more research.

It actually took me quite some time to find the donation page. Maybe we should ask Melvin to add the verteporfin.org link to the first post of the topic?

That is incredible. I don't even know what to type, because I can't find words that do it justice... This will have a huge impact on the trials. That is a mind-blowingly generous donation. You're amazing.

So happy to hear you're back at it Dr. Barghouthi! We you for your courageous and pioneering approach, and we hope you and your family are well. Very glad to hear this promising treatment isn't bring forgotten about, but instead getting more traction in the medical/research community. I for one am very excited about the full FUE patient with updated methodology! Are you planning on performing any standardized quantitative measurement of hair density in the donor area? Thanks again, Dr. Barghouthi!

Thanks for trying to move this forward, Melvin. After the initial excitement, I had been feeling a bit let down by the sudden halt in the progress of the pilot study. It's great to know there are others willing to experiment.

I totally agree that verteporfin+wounding should be experimented with in balding areas. It might very well work, but it's still purely theoretical at this point whereas we have a tiny bit of proof from this case study that it will work to some extent with hair transplants. Lets not understate how promising that is, especially now Dr. Barghouthi is on hiatus we have to excite and include other surgeons to keep it moving forward.

I strongly disagree. Donor availability is often the only limiting factor in hair transplants, and any method to get significantly more use out of it would be a breakthrough. Even for guys that arent NW5+, donor regrowth would allow them to either have more grafts left over to offset future hair loss or to do their transplant at higher density. Imagine being able to have 4000 usable grafts left over after surgery instead of 2000. Or being able to go up to 70 FUs/cm2 instead of 45. Both of those are huge. Even for a NW3. And then we're not even talking about scarring. People often want a fade haircut nowadays and less scarring could make that look so much better. Verteporfin, if it really works, would be a breakthrough for the industry and its patients. Whether they are a NW3 or a NW7. If it becomes available and affordable, anyone not opting to conserve their precious limited resource of donor grafts, would be a fool.

They're less sensitive to DHT, not necessarily DHT resistant. Even the hair in the horseshoe zone can eventually thin out.

Definitely a very exciting potential treatment, that I hope will see more research over the coming decade. However, it doesn’t hold the same short term potential as verteporfin does, due to it not being a preexisting, FDA approved, and off-patent substance.

@DrTBarghouthi If you don't mind me asking another question, what injection method did you use in this experiment, and how would you imagine improving it in a future one?

That's awesome. Any idea of what that dosage is going to be, compared to the pilot study?

Super happy to see the update Dr. Bargouthi. It makes me happy to hear you mention several different ways in which the pilot experiment lacked, as this means that the potential for verteporfin may be even better than what we're currently seeing. I for one, am extremely excited for a trial with a higher and more consistently applied dosage. Hopefully you'll be able to operate soon on the patient that was supposed to get a full FUE with verteporfin with you. Here I put the 0.4mg images, unaltered (only cropped) side by side. As far as I can see the difference is obvious. Less (bare) punch scars visible, while the ones that are visible seem to match the color of the scalp far better.

Some more examples of widely used off label treatments that many of us are very familiar with: * Dutasteride (any ROA) for hair loss * Oral minoxidil for hair loss * Topical minoxidil in any location other than the crown

So this was not just verteporfin being injected into the damaged skin, the scarred skin was excised first and then injected with verteporfin? In case of future experiments on using verteporfin on balded areas, this makes me wonder whether simply injecting verteporfin is the right approach, or whether the miniaturized follicle first need to be punched out prior to injection with verteporfin.

Amazing writeup and also I think it's a fantastic idea to leverage this forum's close relations with practitioners worldwide to find more surgeons willing to experiment on a wide variety of parameters and hypotheses related to verteporfin. I hope @Melvin- Moderator can make something work. One challenge I can foresee would be sourcing the verteporfin. Apparently there have been some major supply chain issues around the drug. I heard from another user that there initially was a discord group attempting to source it. Perhaps that could be a valuable connection in setting up more experiments.

Thank you so much for including these shots! They give a much better big picture of the regrowth and scarring. Was the top left photo taken from a different angle than the others? Itooks like it shows significantly better hair coverage, but it may be due to how the shot was taken. Also very excited about the dosage increases and recipient area injections!

I think we can all agree Hairliciously should've credited Dr. Bargouthi or this thread. But why spend more attention on these Youtubers than needed? Let's instead use this thread to talk about the exciting promising experiment that is FUE + verteporfin!