MrFox

I believe he is assisting another surgeon in an FUT case.

Well, it seems like one of them is with the YouTube channel The Hair Chemist, it seems like he is going to track his experience with it.

I agree the FDA is woefully inept, but fixing the entire drug approval process is way more of a challenge than just continuing to work with Verteporfin. We should consider ourselves lucky that the drug was already approved. Perhaps if we continue to get great results from using Verteporfin than it will be possible to push other drugs through the approval process. Also other countries are much faster with approvals, so perhaps we will see the drugs approved there in the recent future.

Correct me if I'm wrong but in the studies I have seen with FAK inhibitors, it was only a partial thickness wound. It may be that a deeper wound causes a better regenerative response in combination with the drugs. My understanding is that the FAK inhibitor drugs are not approved by the FDA yet and therefore that is why Verteporfin was used. I think that was exactly why it was chosen by the Stanford Team; they were looking for drugs already in use. As we know getting a new drug passed by the FDA can take up to 20 years, so definitely would be a hinderance to immediately researching on human patients.

Some confusion here, I'm saying some type of micro needling device could be used. I think it would have to be something developed to cause more injury than a typical home device. I agree the home testing is not a good test to base any sort of scientific judgment on. I agree the wounds would have to be large/deep enough that without the use of verteporfin would cause scarring. This is basically what Dr. B said he is willing to try. Essentially creating a series of cuts in the skin, in the balding area, that would normally lead to scarring and then using Verteporfin to prevent the scarring and put the skin in a regenerative healing trajectory. I just think practically speaking, it might be easier for clinics in the future to have some sort of assisted wounding device, if that protocol is found to work. You could imagine a scenario where the patient would come in, get numbed, have verteporfin injected, and then have for lack of a better term "micro needling" device used in the balding area. It would be faster for the patient, and it would also allow for a consistent wound depth, circumference of wound, and dispersion.

Bald areas still have hair follicles, they are just miniaturized. Why are they miniaturized? Prolonged exposure to DHT and your hair follicles having a genetic sensitivity to DHT. If the area is wounded to the point that it would normally scar but Verteporfin is used to set it on a new healing pathway. One in which "NEW" hair follicles hair being created. So why would the new hair follicle already be miniaturized?

Perhaps we could invite him and create a thread on here for him? It just might be helpful to ask him some direct questions. I'm really curious to see his point of view, coming from someone who has had both FUE and FUT procedures before. I wonder if there will be a noticeable difference in recovery from the patient's point of view in regard to tension and nerve sensations in the healed area.

That would be an interesting trial, definitely give us more insight. I think when it comes to facial hair it would be able to grow back non-vellus hair in the beard region if you already had beard hair before. That is to say I don't think it would work to grow beard hair for someone that does not have a beard, instead it would grow back vellus hair. This is because hormones/genetics are dictating which hairs become vellus and non-vellus.

I wouldn't be to quick to jump that conclusion. We still have to test it in that manner.

My suspicion is that the threshold with a micro needling device would cause scarring. That is to say it would take micro needling at depth or gauge of needle that would normally cause scarring. It may still be possible to use a micro needling device with the use of Verteporfin to cause hair regrowth. Thats why I think the test Dr. B talked about with injuring the balding area with small incisions and using Verteporfin is a good idea. Essentially, we are replicating micro needling at much slower pace.

I've never heard of the technician doing the incisions with H&W and unless it is verifiable source than I wouldn't take any heed from that. Yes, they use a technician for extractions, but that is pretty standard, and it definitely doesn't mean the quality is any less.

NVM the biopsy that confirms the results from and independent lab! Surgeons don't want to take the initial risk, now that we have some solid results, I would be shocked if more don't come on board. Remember even techniques like FUE took a long time to be fully adopted by all the clinics.

It's all about having options. Personally, I'd prefer the first option and take the medication.

Understood, perhaps he would be willing to try on the biopsy he takes from the control area on the next study. I don't think that would affect the results and since we are already removing scar tissue, all that would be needed is to inject a small dose of verteporfin to the wound.

Great video! @Melvin- Moderator Why not punch out the existing scars from a previous FUE procedure then inject verteporfin? As long as all of the existing scar tissue was removed, using a larger punch, it should behave the same as a virgin skin that is wounded. Again, Longaker has stated several times saying that he thinks this approach would work. I don't see why this would be any different than removing a previous FUT scar, as was discussed. Definitely hope this is something that is tried after the next trial.

It's all about choices. If the idea of taking any drugs does not seem like a cure, then it probably is not the solution for you. I don't think anyone believes the follicles in the balding area would not be susceptible to miniaturization. Luckily, we have drugs that prevent or significantly slowdown that process, including oral and topical solutions. There is strong evidence that wounding induces follicle neogenesis on any part of the scalp, not just the DHT resistant area. Which makes the most sense, it would be extremely strange if the follicles only grew back on the back of your head and nowhere else on your body. The research does not support this, especially seeing that the drug is being used for scarring all over the body. The follicles that would most likely grow back in the balding area would not be miniaturized, as we know that process is relatively slow, and the drugs prevent that miniaturization by not allowing the DHT to bind to follicle. Yes, if you stopped the drugs, it is highly likely those follicles would miniaturize. This is the big disadvantage to that approach; however, I believe it has advantages as well. I believe the procedure would be less invasive. I think it would be less time intensive on a hair clinic staff, meaning it would take less time and therefore potentially less money for the consumer. I think it works for patients for balding areas that normally could not be treated by hair transplantation, for example retrograde alopecia. Finally, I think the results would be more likely to look natural, as you are allowing the body to replicate your own natural hair growth patterns, hair follicle distribution, color, etc. Again, it's all about having choices, and I don't think trying to limit research in one way or another is helpful way to approach this. We don't know how this drug fully works yet and we need to continue testing to find out its optimal usage.

I think it’s important to remember this is a first test. It’s undoubtedly better than the control, if we can continue to improve upon these results than it still may end up being a real “cure”. As it stands now I still think any hair transplant patient would take the test area over the control. Is it perfect yet? No, but it’s a hell of a lot better than what’s available to patients now.

Is this still in the works?

I've been wondering if there is any way to test for other things in the next biopsy whenever that happens? Obviously the most important thing initially to find out was follicle amount as well as fibrosis. It would be great if we could see about blood vessels, nerves, adipose tissue, and sweat glands as well, perhaps even pigmentation. I would be surprised if we did not see an improvement all of those appendages as well. The research from Dr. Plikus indicated that hair follicles generate new blood vessels as well as fat cells. I've also read that nerve endings need blood supply in order to proliferate so it may be that there is some regeneration as well. If the new follicles are attached to an erecti pili muscle, then undoubtedly there is some nerve connection that would allow for the follicle to be stimulated.

There has not been any update since last month, as far as I know he was about to place the order for Verteporfin last time he updated the group! I have tagged him recently in the discord group asking him his thoughts on the biopsy results from the original trial, so hopefully we will hear from him soon.

Hey let’s move the discussion over here, so we keep this open for updates frond Dr. B!

Well we now know that scarring is a late stage evolutionary adaptation. Dr. Longaker and others research has indicated this. So it may be that the skin has an inherent ability to regenerate but is being overridden by the scarring adaptation. If it is following your own genetic blueprint, it would stand to argue that the skin would regenerate hair in the areas that have hair and perhaps not in the areas that do not have hair. Verteporfin is overriding the scarring signaling. Ultimately it will take testing on those areas to know for sure.

Wasn’t there talk about using a computer imaging machine to map and the follicles? That seems like the most accurate way to tell.

Wasn’t there talk about using a computer imaging machine to map and the follicles? That seems like the most accurate way to tell.

That’s sort of right. I think absolutely you would be able to use it on existing scars, but there are not dormant follicles under the scar tissues. The follicle has been completely removed during the original transplant. You would need to remove the scar tissue completely and administer Verteporfin. So for FUE scars that would require a larger punch than the scar. In theory the skin regenerates a by product of which is hair follicles.