MrFox

1 hour ago, alopeciaphobia said:

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?

The pathologist is most likely referring to follicular units rather than hairs. Otherwise the control would have had 80% of the follicles harvested, which did not happen. I think if that is the case, then 10 hair follicular units per the punch site would be practically speaking full regeneration. 1 follicular unit off could be down to multiple reasons, including personal genetics or randomness of your own hair growth density. What I noticed is how many grafts are in the catagen phase from the test area. I wonder if more time is going to yield better visual results? Doesn’t that mean that the hairs must be cycling? Any thoughts?

3 hours ago, DrTBarghouthi said:

Hi guys, 

I received the biopsy results for both test and control areas as follow. Please be aware that the pathologist had very little insight at what the test area and control areas are and that he only knew that it is an area of an extraction site. He has no insight about the trial whatsoever. I also randomly assigned which areas to take the biopsy from and was taken from the 0.32 mg injection and control sites. 

Test: Sections show follicular hyperkeratosis, focal follicular plugging, No Lichenoid perifollicular lymphoid infiltrate, No dyskeratosis of the follicular epithelium, No perifollicular concentric fibrosis and minimal dermal fibrosis. 10 Hair follicles are seen. Three in anagen, 5 in catagen and 2 in telogen phase. 

Control : Sections show follicular hyperkeratosis, focal follicular plugging, focal lichenoid perifollicular lymphoid cell infiltrate, No dyskeratosis of the follicular epithelium. Perifollicular concentric fibrosis in some hair follicles and focal dermal fibrosis. 5 hair follicles are seen, 1 in anagen, 2 in catagen and 2 in telogen phase. 

 

I do think this is clearly a positive analysis on a cellular level. Ofcourse we do have limitations in that we couldn't biopsy all areas but I think it is a good result after all especially the variation in dermal fibrosis and hair counts. 

 

I think that's pretty clear cut that the drug has had a substantial effect! Very exciting news! Are you still planning on setting up an interview with @Melvin- Moderator to discuss the results? It would also be great if you could talk about the upcoming trials as well!

Great news, It looks like Dr. Bloxham is planning on doing a mini FUT trial with Verteporfin starting in March. He just updated us all on the discord channel.

On 2/6/2023 at 8:06 PM, TorontoMan said:

 

I just did my first application of exactly 1 pump and I did it by pouring it onto a small plate first so that I can dab smaller amounts on my fingers and work it into different areas of my scalp. Right away I realize that one pump is definitely not enough of this cream to apply throughout the entire top of my scalp. @Melvin- Moderator wondering if you'll be in contact with Dr. Hasson or anyone from Xyon soon to ask if they have any suggestions for maximizing the application. I'm curious to know if putting into another vehicle would suffice, perhaps something like PG/ETH and give let it dilute and use an applicator with drops on the scalp to get it everywhere more evenly? My immediate thought is that might work against their vehicle which is the whole purpose of this product.

I would like to avoid having to use more of the product per application as 2% per application is pretty strong albeit a lower percentage of it going systemic. In any case would be interested to hear what they suggest, maybe some of the patients in the study used more than 1 application?

I've noticed this as well, it just seems like such a small amount to get in all the areas of your scalp. I have coarser hair in the areas that I'm trying to prevent from balding and it just feels like it gets caught on the follicles instead of on the scalp. I feel like you don't have enough to cover the entire scalp with the daily dose, sides, back, and top. 

1 hour ago, Marlo said:

Ugh, $1800 for 15 mg sounds prohibitively expensive for usage in hair transplants. Do we know how long Bausch & Lomb can keep the patent going?

From my understanding, it is not the patent that is the issue but rather that it has not been deemed profitable to create a new production line for Verteporfin. 

I don't think the price is really the issue, rather the availability of Verteporfin as well as the fact that it is being used off-label for a different intended use.  While I agree $1800 is expensive it's not so expensive as to prohibit testing. I would be surprised if people weren't willing to pay a few $1,000 more in order to have substantially less scaring in the donor zone. 

3 hours ago, mr_peanutbutter said:

hmm i was about purchase some sweet bausch & lomb stocks (there is also bausch health stocks) after i read your reply but then i read this

 

“VISUDYNE is a registered trademark of Cheplapharm Arzneimittel GmbH used under license. 
Bausch + Lomb, Focus on Access and RETISERT are trademarks of Bausch & Lomb Incorporated or its affiliates.
© 2023 Bausch & Lomb Incorporated or its affiliates. VID.0310.USA.21“

https://www.bauschretinarx.com/visudyne/ecp/about/

just for clarity: this mwans b&l have the license and rent it out to cheplapharm? or is the other way around

 

 

more concerning however is what you write about the limited supply. thats really concerning. so it could be very well noone else will use this for hairtransplants in 2023..

 

regarding the prices: how much ml do you think would be necessary to use? in average

 

 

I'm not really sure how they purchased it from third parties, I wasn't part of the group buy. The only brand name is owned by Bausch & Lomb, there isn't a generic producer of the drug as far as I am aware, hence the shortages. If you're buying the real thing you would have to buy the whole bottle i believe which is 15 mg and then it would depend on the amount of area being used and the concentration. The average scalp of a human is about 700 cm2 and the highest dose was .40 cm2. So unless I'm missing something you would need about 18 bottles for the whole head, but this is just what I was able to find. That isn't necessarily the price or amount that would be needed in the end. I imagine if a clinic is using it enough, they would be able to source it higher quanties for less price. 

6 hours ago, mr_peanutbutter said:

what company is offering this product? is there still an activ patent? i couldnt really find anything except that in germany its offered under the tradename "visudyne" from the company cheplapharm arzneimittel gmbh but i guess thats just a importer/distributer for the german market 

 

and do you know how expensive the medication is? 

 

thanks

 

 

It's sold under Bausch & Lomb and the sole manufacturing line in the world is in the U.S.A. They have upped production since the shortage began but they expect supplies to be limited until the end of 2023, with priority being given to ophthalmologist that use the drug for it's patented use with certain diseases affecting the eyes. I believe the 15 mg bottle goes for $1800. 

5 hours ago, mr_peanutbutter said:

is there a general shortage of verteporfin?

Yes, there is a global shortage as there is only one production line in one factory producing the brand name Verteporfin. 

1 hour ago, mr_peanutbutter said:

i hope there are other doctors testing though

Well Dr. Bloxham has stated that he is wanting to test, it seems like he is working towards testing it on a mini FUT incision. It might be sourcing that is a problem for many of the doctors, because of the shortage. 

50 minutes ago, Square1 said:

I genuinely feel I am missing why others aren't excited. If someone knows, please feel me in.

Idk, I think a lot of it might be that so many people have been burned before. There are always promising cures that come and go. That being said even what we have seen so far from the trial from Dr. B is substantially more progress than any other cure that has come along, so I am also at a loss as to why more surgeons have not shown interest in at least trying Vertporfin in the donor area. 

This tread is to discuss the topic of Verteporfin for hair regeneration and wound healing. Please post any ideas or questions here rather on the other tread in order to keep that tread open for updates by Dr. Barghouthi or other Dr's testing Verteporfin.

Dr. B was planning on wounding the DHT sensitive area on his next test so it's not irrelevant, but sure if we want to make another thread then that's fine with me. 

On 2/4/2023 at 7:06 AM, doxiloo said:

I think this thread has long diverged from its original point. I share your enthusiasm and theoretical questions guys, but this thread was originally launched to keep us updated with the experiment Dr Barghouthi is doing. And since  Dr Barghouthi is not available for the moment due to personal issues, I think the best thing we can do is to wait for future updates. We're going over and over through the same points which i'm sure brings anxiety to other members of this forum that occasionally check this thread for updates from Dr Barghouthi. We still don't even know if verteporfin even works in terms of regrowing hair in the donor area after being harvested and u guys are talking about wounding the dht sensitive area and other hypothetical ideas that's well beyond the current progress of the experiment. 

Again, I appreciate the enthusiasm and I am optimistic about this one, but I'm suggesting that maybe a separate thread should be created for this conversation and leave this thread exclusively for updates from Dr Barghouthi.

4 minutes ago, mr_peanutbutter said:

the hair would be sensitive to dht again

you dont know how often you could repeat this

 

Yeah neither do you, you're making an assumption that it can only be repeated so many times! Yes of course the hair is DHT sensitive again, hence the drugs which we know stop hair loss for the vast majority of people with male patterned baldness. 

4 hours ago, alopeciaphobia said:

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.

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. Not to mention that transplantation is not recommended for certain types of alopecia. For example retrograde alopecia is not typically treated through transplantation, but could possibly be treated through a protocol as described above. 

4 hours ago, mr_peanutbutter said:

i cant believe only 1-2 hairsurgeons are trying this out right now

Me too!

On 1/15/2023 at 8:21 AM, 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

I agree that this could be an option for those people who do not want to take the drug for whatever reason. 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 continue to see this idea pushed forward, almost as if people assume that verteporfin would only work in the "safe donor zone" or where existing hair follicles are present. There is absolutely no evidence that it works that way, and why would it?! The only reason we started in the donor area, to begin with, was that that option provided the least risk to the patient. Scarring would be in an area that is easily disguised. 

5 minutes ago, mr_peanutbutter said:

so basically this combined with hairtransplant would be the cure..

We still don't know how much hair can be regenerated by Verteporfin, we still need a lot more testing. If it recovers follicles and skin fully, then yes I would say it is the cure. That being said I don't personally believe transplantation will be needed. As long as the patient stayed on dutasteride or finasteride (topical or oral) you could potentially injure the area being affected by balding inject vertporfin and have hair grow in the balding area rather than transplanting hair from another region. This could be a potential cure for several types of alopecia.  I also believe there would be a large need to heal existing scars from previous transplantation. 

16 hours ago, Nexhat said:

The question is what will happen if they were to remove old scar tissue from a past FUE hair transplant and then use Verteporfin on that area meybe hair will grow back ?

Everything I have read and heard indicates that as long as the scar tissue is completely removed then the wound would heal the same as any other wound that was treated with Verteporfin. The lead researcher Dr. Longaker has been quoted as saying this multiple times. Obviously we need a test to verify it though. 

7 minutes ago, Melvin- Moderator said:

I should reach out to him, having an FUT surgeon test this out would be great.

From the discord group it sounded like he already has a patient in mind but it is still figuring out all the variables involved. Definitely good to have more testing going on! 

On 12/2/2022 at 8:28 PM, sr1486 said:

Hey Dr…. Any interest on trying Verteporfin on a keloid FUT scar? I got one that makes me keep my hair longer and use hair fibers over it. I had 6 sessions of smp into that did nothing (did not stick). It’s kind of got my romantic life on hold for a while 

Perhaps reach out to Dr. Bloxham, he has shown interest in testing Vert on FUT. 

1 hour ago, alopeciaphobia said:

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.

Is there any strong evidence that FAK works better than Verteporfin though? I know it works upstream of Verteporfin but does that mean it will undoubtedly provide better results?

On 11/1/2022 at 3:02 PM, shiba1985 said:

 

Oral minoxidil IS FDA approved for hypertension and been used for decades. So you can prescribe it for NON FDA approved indications based on physician discretion. 

Subq verteporfin is not been approved for any indications. only use has been IV and for optho purposes. Almost a surety u would get on the FDA's naughty list in USA if you try doing research like this. 

 

Wasn't that the same for Botox though? It was not approved to be used for facial wrinkles but they started using it off label by 1993. I don't think it was FDA approved for facial wrinkles until 2013, but clearly was widely used before that point. Why would it be different with Verteporfin? Even Dr. Longaker has stated he thought it would be used off label almost immediately. 

On 10/11/2022 at 8:35 PM, Carlos0 said:

So, I’ve been following this thread for several months now. Usually, I just come by to check on Dr.Barghouthi’s amazing trials and that’s pretty much it. But today, I wanted to share something That caught my attention on “RealSelf” just recently. 
 

So, apparently someone in the previously mentioned website commented something about  he allegedly having scar revision where he had some type of necrosis going on his skin and “Verteporfin” caused scarless healing with some redness on it and hair growing back. I’ll leave the link down if you are interested in checking it out. I am interesting in hearing other peoples thoughts if this is real or not.

So this is a picture he shared how he would normally scar. You can see it looks “hypertrophic”:

Up next, is how the area looked before having scar revision. And, how it looks after having mentioned procedure. 

There’s also a few interesting comments below where he took the time to answer. 
 

Here is the link guys: 

https://www.realself.com/review/scar-removal-scarless-healing-verteporfin-scar-revision

 

 

I think this may be someone who tried multiple scar revisions with Verteporfin and was updating people on Telegram. He did use Verteporfin so this is promising. It's not the most controlled experiment, but that being said the skin really does look like the surrounding tissue, minus the redness. 

3 hours ago, Phil28 said:

@Melvin- Moderator 

Do you know when we can expect new follow up pictures?

thanks!

Should be on or around October 9th. 

59 minutes ago, Ganderson said:

I’d like to be able to see what the donor area looks like as as if we were looking at it with the naked eye. I doubt anyone here can look at the zoomed in photos and get a sense of what the scarring actually looks like given that the pictures are taken with a microscope camera - I want to know if it’s going to change the actual scarring profile …. And how it looks to the naked eye … isn’t that generally one of the main points of the experiment ? 

I agree that a zoomed out image or even a video at the end would be helpful. It's hard to tell with the flash sometimes what is scar tissue and what is skin. Even when we look at what we know is scar tissue it can be hard to distinguish when zoomed in. If the area is shaved and you zoom out you will definitely see the pattern of follicle extractions if there is scar tissue. It catches our eyes easier because we can distinguish the pattern.