alopeciaphobia

10 hours ago, Jonathan said:

So now the question would be how many hairs does this patient have on average in a 4mm site. If 10 then the regrowth rate would be 100% if 15 then 50% regrowth right? Or am I missing something?

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!

1 hour ago, DrTBarghouthi said:

Hi guys,

Hope you’re all well. I took two biopsies today for our patient. I took them from one Test area and one Control area. Ideally I wanted to take from all sites but unfortunately these 4mm punch biopsies would need a stitch in each and felt a comparison between one control and one Test area could give us some indication for the time being about the scarring itself and the type of hair around the scarred area or within it. Will keep you posted once I get the pathology report back.

I’m looking at the 18th of March as a possible date for the second trial. I’m looking at either an FUE or at the possibility of injecting into the recipient area. 

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.

9 minutes ago, Square1 said:

Is there an overview somewhere of how and when the next experiments will take place? Will the patient that was involved in the first trial be monitored? If the treatment site still looks more dense than the control site, we might have an indication that the new hairs don't vanish after a couple of weeks / months.

@MrFox and @DrTBarghouthi stated that an update will be posted soon.

Also, this:

On 2/14/2023 at 5:59 AM, DrTBarghouthi said:

I will be scheduling a biopsy of our patient and testing a full FUE case using adjusted doses that we worked out. Still some interest from some colleagues especially for FUT- so hopefully more on that soon.

On 3/2/2023 at 9:12 AM, takuma said:

That's interesting, the possibility of not needing to do a hair transplant just injecting verteporfin after wounding bald areas of the scalp or thinning areas. That could come in handy for thin sides and thin back of head also.. Wounding the area and applying verteporfin if that were to grow back new hair that would be the endgame for baldness as we know it.

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.

1 hour ago, Rafael Manelli said:

This will be groundbreaking if it works. Not only for growing hair but also for repairing scar tissue 

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.

14 hours ago, takuma said:

Hi guys, I'm new here, i have a question do you guys think if verteporfin grows hair back, that we will be able to have 8k+ grafts per session for HT to get a Norwood 7 to a Norwood 0? Because the donor hair should all grow back and then you have another transplant and in 2-4 sessions you should be able to have full coverage even on a slick bald head. Especially if you have low donor hair count/ weak donor.

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?

8 hours ago, Arcturus9 said:

It saddens me that this is the most promising hair transplantation related treatment in decades (even if all it ends up doing is reduce scarring) and the site couldn't collectively muster 15kto help incentivize it along. This really has the potential to be a game changer in the hair loss world. Even if Longaker & Stanford get there eventually I'm sure Dr. Bharghouthi's experiments could serve to raise awareness among other surgeons and act as a starting point for future YAP inhibitors as adjunctive medications to hair transplants. As a small token of appreciation to the online hair loss community for saving my hair I think I will fill the remaining 14.7k Dr. Bharghouthi is asking for. 

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.

2 hours ago, DrTBarghouthi said:

Hi guys. I apologize for being out of the loop for the last while, but I had to cut down on my clinical duties temporarily and thankfully I’m back at it this month full time. I will be scheduling a biopsy of our patient and testing a full FUE case using adjusted doses that we worked out. Still some interest from some colleagues especially for FUT- so hopefully more on that soon. We are still dedicated to this research and in fact we have some interest from various funding entities that may be willing to further advance this and other projects. Will keep you updated. 

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!

2 hours ago, Melvin- Moderator said:

Yes, he was aware, he was going to talk with him, but he didn’t get a chance too. 

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.

2 hours ago, MrFox said:

Again I would ask why do you need to transplant the hair? Just injure the balding area and use Verteporfin in the same way you would in the donor zone. If it grows hair in the donor zone it will grow hair in the balding zone. There is NO evidence the drug differentiates between balding and non-balding regions. I think there is an assumption that there needs to be existing non-miniaturized follicles beforehand, but there is no evidence for this. It is already strongly recommended that people who receive a transplant stay on finasteride/dutasteride, so I really don't see why we are adding an unnecessary step, unless the patient is unable to use the medication for whatever reason. No offense to any surgeon on here, but even they would concede that they are not able to reproduce 100% what is found naturally. They are limited with what they have to work with. With transplantation, you would still be using grafts that are larger than normally found in the hairline, as well as problems with color, density, etc. Perhaps if there is still some scarring left over then this would not be ideal approach, but yet again we have only tried one test on one patient. I would be shocked if we nailed the absolute best results possible on the first test. It could be feasible that treatments would consist of some sort of injury device (i.e. modified micro-needling) along with the application of Verteporfin. That would mean much less time in the chair and recovery period for the patient. 

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.

On 1/21/2023 at 9:51 PM, MrFox said:

I just reject the notion that this is the way the industry should be moving forward because clinics want to continue transplanting hair. It would be an extra step that is not needed for most patients.

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.

2 hours ago, mr_peanutbutter said:

but for people who dont feel comfortable taking finasteride/dutasteride you would still need to transplant the dht resistant foliceles from the side and back of the head

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

On 11/22/2022 at 8:32 PM, Kistyle said:

See below for studies and results regarding FAK. It seems to be a similar mechanism as verteporfin. The results show a great number of regeneration. 

Would a trial with FAK be possible as well? 

 

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?

19 minutes ago, DrTBarghouthi said:

I just want to use an updated dose on him to make sure we get the best out of it.

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

12 hours ago, Carlos0 said:

Hey guys, hope everyone is well 

So, I’ve been doing a bit of more research and I found more details about the case of the person I mentioned before: 

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He mentions, “The incision line has disappered.The doctor excised all the hyperthropic scar. The scar started to heal drastically around end of day 60.”

I’ve been trying to keep skeptical about it. But, I am not sure how I could find this “somehow fake” since the man keeps updating with proof. I don’t know, but just like someone mentioned here, it doesn’t seem very far off. 

 

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.

1 hour ago, Fox243 said:

This is an amazing update. @Melvin- ModeratorI was wondering if any hair transplant surgeons had shown interest in collaborating with Dr. Barghouthi. I'm not sure how many surgeons know about this, but if we could somehow reach out to multiple surgeons to come up with their own version of a protocol and test many things (i.e. on a linear scar, in the recipient area, with different methods of injections/dosage/concentration), we could take the onus off Dr. Barghouthi; I think we could get a definitive result about the best way to use verteporfin and make it mainstream in clinics. This is a doc I've written up (along with some wonderful edits from community members) as an intro to vert: https://docs.google.com/document/d/1s3JkF9woMIebkXbpE_UxrjBfNy9i7AuBclDqn9HGrAo/edit.

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.

10 minutes ago, DrTBarghouthi said:

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!