alopeciaphobia

I wouldn't say either is totally botched, but MattDominance's does certainly look quite artificial, and Hairliciously just unwisely spent the vast majority of his donor grafts on getting a juvenile hairline and now has 2000 grafts left even though natively he's a NW2. At any rate, the more attention verteporfin gets the better. The more the information spreads, the bigger the chance that more surgeons are going to experiment with it. And that's a very very good thing.

Is a recording going to be available on youtube as well? EDIT: thanks for the Instagram link, Ganderson!

I agree with the many others before me that the most burning question is going to be how many of these regrowing FUs are seen as a percentage of the total amount of extracted FUs. Even if we see zoomed-in pictures that do show some post-extraction regrowth, we can't tell whether 5% or 95% of the FUs regrew. If during a future update, @DrTBarghouthi could shine some light on this, that would be amazing.

Very good point. In the hypothetical case that it will regrow most of the hairs nicely, imagine a NW7 patient who wants a dense head of hair and a youthful hairline, for whom money is no object. The patients dreams could come true, while the surgeon can make absolutely stupid amounts of money from just a single patient.

Thats also the part I'm very thrilled and excited about. Will those hairs stay semi-miniaturized looking, or will they gradually thicken up? Since the follicle (re)generates from scratch, perhaps it also starts off very thin, and then goes through some phases of gradual thickening, just like new hair growth on the scalp and body during childhood and adolescence. Only time will tell. Nevertheless, even if the grown back hairs stay thin, it would *still* be a massive improvement in cosmetic appearance of the donor zone. After all, it's the gaps between the FUs that tend to be very noticable, that would be covered up better.

Amazing! Is it me, or is that a triple FU growing back in the 0.24 pic? Also guys, who cares about tiny scars if the hair grows back and thus said tiny scars would be covered up by thick luscious locks?

That's amazing! If it really does end up being effective, unless European clinics quickly follow suit, I very well might book a trip to Jordan!

That is a really interesting thought. I only thought of verteporfin in the case of FUE, but it might also be worth it to do a FUT repair procedure where the original scar is cut out and sutured back up with verteporfin injected. Alternatively, a different, non-experimental option worth exploring is to get another small FUT from a surgeon who is highly experienced in doing trichophytic closures to improve the appearance of the scar.

I agree it would be extremely worthwhile to test extracting a few miniaturized follicles and inject the sites with verteporfin. Even if it's just say 10-20 FUs or so, just as a proof of concept. And if that would show any results, one could try a larger operation.

Amazing! The more case studies the better! Will said patient also have a control and test area?

Good point. To reduce the extent of that happening, best would be to be on finasteride for 10-12 months before the procedure so those hairs get stronger. Which is what I think a lot of doctors would recommend.

It all depends on how much donor you have, and that is nearly impossible to accurately tell through pictures. You'd need an in-person consultation for that. That being said, I think most doctors would recommend to create a conservative hairline and spend a good portion of the available donor hair in the frontal third, depicted below in blue. Then add just a low amount of density to the crown and fill in the mid scalp ever so slightly. Having a naturally diffusely thinned looking crown but moderately dense frontal third, with a gradual transition between those two, can be a good look, given the resources. It's still going to be advisable to use finasteride to ensure the used donor hair doesn't thin out further, and if you're lucky thicken up the existing partially miniaturized areas a little bit. After surgery you'll also likely have to wear the sides and back of the hair a bit longer to mask the extractions well. Another option is to do a combined FUE and FUT to extract the maximum possible amount of donor hairs, but again only in an in-person consultation can a doctor assess whether that's an option for you.

Honestly dude, it could be worse. Obviously the hairline is unnatural looking, but since you're 10 months out, you could get a second surgery with a higher quality surgeon. If you lower the hairline by a few millimeters more to mask the current hairline, and optionally add just a bit more density to the frontal third if donor allows, it would look very good.

Already a massive cosmetic improvement at month 6, looking forward to more updates!

This is a really interesting point. DHT is already high since the mid to late teenage years, but in most men it takes longer than that to see the first signs of hair loss. But I don't think there's any data that shows whether DHT just takes a very long time to damage the follicle, or whether follicles become more and more vulnerable to the destructive effects of DHT as part of aging. Though in any case, perhaps people can achieve maintenance with something like ~0.1mg of finasteride per day if a newly formed hair is never exposed to DHT in the first place, and there is no prior damage to undo. After all, we all know prevention generally requires less medication than regrowth.

What if the patient in question is on a 5AR inhibitor during that potential regeneration, and stays on it indefinitely afterwards? I agree that this idea can be considered a long shot, but it's still definitely worth testing imo. Even if it does eventually miniaturize again, that might take many years, and in case of 5AR inhibitor usage often more than a decade.

In case it turns out an FUE extracted follicle is able to regrow, I would assume its androgen sensitivity would follow the natural androgen sensitivity of that area of the scalp. I can't imagine there being any biological reason why it wouldn't, since it seems that some scalp regions are just genetically programmed to grow follicles that are more androgen sensitive than others. I think a more interesting question would be whether or not that hair can get a fresh start from a blank slate. In case a miniaturized hair in the frontal, midscalp or crown region can regrow after being extracted by FUE, maybe it can stay healthy despite still being androgen sensitive, if it's never damaged by excessive androgen receptor excitation after growing completely from scratch. After all, all of us have thousands of miniaturized follicles that wouldn't have been miniaturized (as much) if through 5AR inhibitor use, they never came into contact with excess androgens since their creation. If verteporfin-induced regrowth would allow us to reset the state of a follicle to that moment right after creation, maybe, just maybe, those hairs can get a second chance at enjoying a full lifetime of low DHT levels. Obviously this is pure speculation on top of speculation, resting on lots of big ifs that are still unclear. But it's extremely interesting and fun to think about what future experiments could look for IF things work .

Even if the donor would partially regenerate, and you would therefore technically create extra hairs, we don't know if that hair will grow back in a more and more miniaturized way after every extraction, and therefore would may not be infinitely repeatable. Though there are many exciting ideas to explore, e.g., perhaps if one extracts from one half of the donor area into another half of the donor area, and vice versa in a next surgery a year later, maybe that would effectively cultivating more donor hairs? Or perhaps, in patients who are already on a 5AR inhibitor, if one fully extracts miniaturized follicles in balded areas, then inject those sites with a certain dose of verteporfin, maybe more healthy hairs grow back from scratch due to being in a low-DHT environment from day 1? Or perhaps extracting empty scalp skin in between follicular units results in a similar probability of a new hair growing there compared to extracting scalp skin containing follicles, and we don't need to extract actual hairs at all? Lots of theories that are worth putting to the test.

I think that unless we're speaking of a few hundred grafts or less, it's almost always going to be worth paying the extra for. Even if you are a NW2 - NW3, having partial donor regeneration means you can achieve much higher recipient area densities, with much less risk not having enough donor hair left for a future operation. For example, even if only 1/3rd of the donor hair regenerates, this would mean that we could achieve 75 FUs/cm2 (almost native density) instead of 50 FUs/cm2 (normal reconstructed hairline density) in total, using the same amount of donor hair. And since many people get their surgery now in their late twenties or early thirties, preserving as much donor hair as possible is extremely important as they may recede further.

@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?

Wow, these preliminary results are looking more promising than anything else in the last decade or more! My goodness, just the reduction in scarring alone could be breakthrough worthy, but now we're potentially even seeing signs of early regrowth? Part of me doesn't want to get excited, since we've been hearing "the cure is just around the corner" for the last 10+ years, but boy is it difficult not to. I cannot believe we might just be among the first few people on this earth to witness what may be the beginnings of an incredible milestone in cosmetic surgery. Imagine what the inhibition of scarring could do for the plastic surgery industry also! And all we need to wait... I definitely will be on the edge of my seat waiting for new updates to come in! Thank you Dr. Barghouthi, and everyone who volunteered to help this project. You're doing god's work!

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?

What surprises me a bit about your case is that 2400 grafts were used on such a small recipient area. Do you know the size of the recipient area in cm2, and how many grafts per cm2 he used? Perhaps it's somewhere around 40cm * 60/cm2 = 2400?

Looks absolutely fantastic dude. Considering that native hair has has a whopping 80-90 FUs/cm2, I'm actually really impressed just how dense the transplanted area is compared to native areas. Especially with the "wet look" styling, which usually really emphasizes lower density, it still looks great. Any idea how large the recipient area was in cm2 or how many grafts/cm2 you had? Looks like it must be close to if not around 60.

This is extremely strong progress. Obvious from the huge amount of very short (but strong looking) hairs sprouting out everywhere. Congratulations. Once you are at the 12-18 month mark and most of the regrowth has settled in, I agree that a 2000-3000 graft transplant for the temples will look amazing with the right surgeon. Your suggested hairline looks spot on. Not too juvenile, and also not overly receded looking. Will look great for a 30 year old.