Unlimited Donor with Verteporfin - Should We Be Experimenting?

[tripleg]

Imagine if we could have unlimited donor hair reserves! That would be a revolutionary development. There is a drug called veteporfin that may make this possible. 

Veteporfin is still experimental for treating wounds in humans, but it is already FDA approved to treat an eye disease. It's been around  for ~20 years and it has an excellent safety profile. Veteporfin was found to regenerate skin scarlessly with all the dermal appendages, including hair follicles (!) in mice and pigs. Even though pig skin is very similar to human skin, it is unknown whether it will regenerate terminal scalp hair in human hair transplant patients. Clinical trials in humans are in the works, but waiting may take years and the trials may never be completed. 

Since veteporfin is already FDA approved and known to be safe, any doctor can legally and ethically attempt experimental use of this drug off-label with his/her patients with low risk and high potential reward. All that is required is agreement from the doctor and the patient.

I propose that patients willing to try this approach advocate for themselves and discuss it with their hair transplant surgeon. Better yet, if you’re really keen to try this, you may consider speaking to several doctors and find one willing to try this. If doctors hear patients asking about this in consultation they are more likely to pay attention and look into it.

(pic from this paper: https://www.science.org/doi/10.1126/science.aba2374)

The exact protocol would need to be developed by the doctor, but here’s a sketch of what it may look like. The doctor would do a small number of FUE extractions (say 10-20) in a small area, inject vertiporfen around the edges of the extraction wounds and see what happens. First signs of hair growth in donor area may appear as early as 30 days after the procedure, and by 90 days the extraction sites may look indistinguishable from normal skin (with hair!). If successful, the procedure may be repeated with greater number of extractions. Infection control may need more attention, but that's something your doctor should be thinking about.

@Melvin- Moderator It would be great if you could start asking all the HT docs what they think about this when you talk to them. If this approach proves to be successful, any doctors who were pioneers will definitely gain in reputation. I'll quote @toagi "Most researchers don't care about hair loss, so we could sit on a working cure for years waiting for trials to be conducted to test it." This is why I think it's reasonable to at least start bringing this up with doctors. They tend to be conservative by nature, so it's not likely that they will bring this potentially revolutionary enhancement to the patients. Instead I think it's more likely that we as patients will have to initiate the discussion with the doctors.

Of course, It's possible that it won't work, but it would suck if we didn't even try it. If you think I'm way off-base with this one please let me know. I'd like to hear your arguments against it.

Here is an excellent thread by @toagi for more reference. It contains all the scientific details:

Here is video on Veteporfin from Kevin Mann: 

https://www.youtube.com/watch?v=ePlIWf7y3lg

[SLA]

I have read a bit about Verteporfin and it does sound promising especially since they did some testing on pigs and achieved positive results. In the website, 'hair loss cure 2020', one of the Stanford researchers on this drug chimed in positively and said they hope to commercialize in 2-5 years.

What does not make sense to me is how new hair could grow in an area from which follicles have already been removed as in the case of a hair transplant. I am cautiously optimistic that the drug could reduce or prevent scarring.

With all the HT doctors out there, I would be shocked if someone has not already begun experimenting with this. I read someone post on reddit that they knew of a HT doctor already trying it out, but wouldn't disclose the name due to confidentiality, but then again, who know the validity of this statement.

[Melvin- Admin]

@tripleg

Thanks for tagging me in this, let me tag @DrTBarghouthi lets get his thoughts.

[Fego]

Great informations

[Al - Moderator]

There are so many questions. I haven't really read much about it, but I'm thinking this would stop the formation of scars rather than actually regenerate already scarred areas, although I don't know. The reason I say that is because I can't see how it can properly regenerate what was there previously, but has been removed. I mean if you remove a follicle then what kind of follicle would be regenerated? The same type that was there before? What if it was a miniaturizing follicle? Would a new miniaturized and dying follicle be remade? If it's always going to make a good follicle then you could just make a bunch of .8mm punch scars all over the recipient area and regenerate new follicles without ever having to touch the donor area at all. What if there wasn't any hair in the area in the first place? I mean take someone with hardly any beard at all. I don't see how making a scar in the beard area would be able to make new skin that will grow a great beard when the person didn't have any in the first place. There are just so many questions.

 

Edited December 9, 2021 by BeHappy

[jbaro]

Maybe some HT doctors experimenting with EXOSOMES would be good candidates to try Verteporfin as well. Those doctors are generally moving HT techniques forward, so they might be more open to trying VERTEPORFIN after FUE/FUT transplants.

[jbaro]

No link

Edited December 13, 2021 by Melvin- Moderator
Removed link

[Melvin- Admin]

I’ll ask Dr. Hasson about this maybe he will make a video about it, I’ll also ask Bisanga.

[Fego]

13 minutes ago, Melvin- Moderator said:

I’ll ask Dr. Hasson about this maybe he will make a video about it, I’ll also ask Bisanga.

Hope to tell us about the feedback of this point as soon as possible 

[tripleg]

1 hour ago, Melvin- Moderator said:

I’ll ask Dr. Hasson about this maybe he will make a video about it, I’ll also ask Bisanga.

Thanks for acting on this!

I figure the docs will probably want some time to study the literature in depth, but would be great to hear from them as soon as possible!

They may already be very much aware of this for all we know.

[tripleg]

On 12/8/2021 at 7:30 PM, Melvin- Moderator said:

@tripleg

Thanks for tagging me in this, let me tag @DrTBarghouthi lets get his thoughts.

Still hoping to hear from @DrTBarghouthi too.

[Melvin- Admin]

10 minutes ago, tripleg said:

Thanks for acting on this!

I figure the docs will probably want some time to study the literature in depth, but would be great to hear from them as soon as possible!

They may already be very much aware of this for all we know.

I’ve also asked the publisher of follicle thought who wrote this article 

https://www.folliclethought.com/verteporfin-could-create-scarless-hair-transplant-surgery/

[DrTBarghouthi]

Thanks for the tag. I couldn’t go through the posts but will share my opinion shortly. 

[DrTBarghouthi]

Thanks again guys. I have cone across this before and I’m actually researching the original paper to look for any limitations of use etc. Nonetheless, as long as it is safe, I’ll be willing to give it a try to see the effect on scarring and any possible hair regeneration in the donor area. Even if scarring is improved alone, that would be good news to many. Visudyne is the marketed name for the eye medication. 
Again, I’ll read a bit more about some safety issues and update you all on that. I’ll be keen to give it a go if safe to do so. 

[SLA]

15 hours ago, DrTBarghouthi said:

Thanks again guys. I have cone across this before and I’m actually researching the original paper to look for any limitations of use etc. Nonetheless, as long as it is safe, I’ll be willing to give it a try to see the effect on scarring and any possible hair regeneration in the donor area. Even if scarring is improved alone, that would be good news to many. Visudyne is the marketed name for the eye medication. 
Again, I’ll read a bit more about some safety issues and update you all on that. I’ll be keen to give it a go if safe to do so. 

Much appreciated @DrTBarghouthi- It could be revolutionary and since it is already an FDA approved drug, it could be imminent for use in HTs if deemed safe.

[DrTBarghouthi]

27 minutes ago, SLA said:

Much appreciated @DrTBarghouthi- It could be revolutionary and since it is already an FDA approved drug, it could be imminent for use in HTs if deemed safe.

Thank you. I have checked with an ophthalmologist colleague and will look into it further and possibly do a small trial on it to see. Will keep you updated ofcourse. 

[tripleg]

Thank you very much Melvin for asking Dr. Bisanga about verteporfin. It’s at the 45:50 mark in this interview:

https://www.instagram.com/p/CXoq33GP9Ca/

Here is what was said:

Dr. Bisanga: “I heard about it, I didn’t really dive into it because we just had a big global hair loss summit where even people in research were not really talking about it. There are some things that have been done on mice and they are kind of promising, but the problem is [on mice it takes 20 days to get full growth]… then you have to translate what is in the mice to humans - that is why we’re still talking about hair multiplication even today - is because that transition from the lab rat to human is not always that easy because we’re not rats, we don’t have the same physiology. That’s why I say: There is a lot of hype, there are things probably in the pipeline, but we need to make sure, to let researchers finish the process, to do all the steps… To do trials in humans, but we’re not there yet.”

Melvin: “I’ll be honest, I don’t think unlimited donor is gonna happen in our lifetime.”

Dr. Bisanga: “Nothing is unlimited. Our heart is not unlimited - it has a certain number of heartbeats. Our brain cells… We need to get away in the hair industry from thinking that we’re going to give people their hair back completely. People need to be realistic.”

***

First let me say that I hate hype and sort of cringed when I typed the words “unlimited donor” in the title of this thread, but I wanted to draw attention to this possibility. I think many of us here are aware of the various promising treatments that never materialized (not to mention all the scams). I myself am borderline cynical when I hear about the next great thing in hair loss. I think any veteran of the hair loss industry is wise to have that as their default stance. So I fully appreciate Dr. Bisanga’s reasoning.

Dr. Bisanga’s answer was sort of what I expected. First he said he’d heard of it, but didn’t look at it in detail. But this is exactly what we are asking the doctors to do: take a closer look, please! So what is Dr. Bisanga waiting for? He’s waiting for researchers to complete their studies. This can take another 5-10 years or it may never happen due to lack of funding, lack of interest, better opportunities and any number of reasons really. We could sit on an effective treatment for years waiting for trials.

Digression: If you’ve studied the history of science you may be aware that progress doesn’t alway go from research to practice. It goes the other way around too. Sometimes enterprising practitioners start experimenting and getting some initial success and later scientists come along and help improve the process. The steam engine, for example was not invented by scientists, it was invented by engineers and the science was worked out afterwards. Believe it or not, we still don’t fully understand how bicycles work! (https://youtu.be/9cNmUNHSBac?t=573)!

***

Back to verteporfin though.

Should doctors really be trying it out an unproven treatment? Normally no, but verteporfin is an FDA approved medication with 20 years of use by ophthalmologists and an excellent safety profile. Any hair transplant surgeon can discuss it with their ophthalmologist colleagues, like @DrTBarghouthi has done (Thank you!). The key point is that this seems a low-risk high-reward type situation. Any doctor can legally and ethically use this drug off-label with his/her patients. We already use both dutasteride and oral minoxidil off-label, which is what we're proposing with verteporfin

My own view is that there is a 5% chance that all or most of donor hair will be restored and a 20-25% chance that there will be partial restoration of donor reserves, say 50% - so if you extract 2000 grafts you may get 1000 grafts back. Even if verteporfin only reduces or eliminates scarring in the donor area - it would be a win! It may also prove useful in reducing scarring in the recipient area. We may never find out unless we ask the doctors to take a closer look.

***

@Melvin- Moderator- Thanks again for taking this up! I hope you will continue to bring up this subject with the doctors that you speak with. May I ask you to frame the question a little differently?

We probably shouldn’t be asking the doctors what they think about it today because almost none of them have taken a detailed look at it, so they’re likely to give an answer similar to what Dr. Bisanga said - a wise answer all things considered. Instead we should be asking them to take their time to study verteporfin closer and get back to us with their thoughts or concerns about trying it out with patients.

Instead of asking: “What do you think about verteporfin?”, we should say something like: “We think verteporfin is worth trying today because it’s low-risk, high-reward. It’s FDA approved and has an excellent safety profile. We know there are no human trials. We know it’s a long shot and it may not work, but some of us feel it’s worth trying. Would you consider taking a closer look at it and get back to us with your thoughts or concerns?”

We’re trying to get them to take a closer look at it, not to wait for research, which may never be completed or even started. The communication challenge I see is how do we get doctors to take a closer look at this without coming off as naive and uninformed. We should make it clear to the doctors that we are informed about the current state of the research (no human studies), but we feel because the drug is FDA approved with a great safety profile, it’s worth trying despite the lack of human trials to date.

Perhaps it doesn’t even make sense to put them on the spot and ask them on live streams, but rather ask them offline to take a closer look so that it can be discussed once they have done a deep dive. This thread is a great starting point for a deep dive:

https://www.hairrestorationnetwork.com/topic/60076-fda-approved-drug-verteporfin-found-to-fully-regenerate-skin-including-hair-follicles/

Edited December 21, 2021 by tripleg

[Fego]

2 hours ago, tripleg said:

Thank you very much Melvin for asking Dr. Bisanga about verteporfin. It’s at the 45:50 mark in this interview:

https://www.instagram.com/p/CXoq33GP9Ca/

Here is what was said:

Dr. Bisanga: “I heard about it, I didn’t really dive into it because we just had a big global hair loss summit where even people in research were not really talking about it. There are some things that have been done on mice and they are kind of promising, but the problem is [on mice it takes 20 days to get full growth]… then you have to translate what is in the mice to humans - that is why we’re still talking about hair multiplication even today - is because that transition from the lab rat to human is not always that easy because we’re not rats, we don’t have the same physiology. That’s why I say: There is a lot of hype, there are things probably in the pipeline, but we need to make sure, to let researchers finish the process, to do all the steps… To do trials in humans, but we’re not there yet.”

Melvin: “I’ll be honest, I don’t think unlimited donor is gonna happen in our lifetime.”

Dr. Bisanga: “Nothing is unlimited. Our heart is not unlimited - it has a certain number of heartbeats. Our brain cells… We need to get away in the hair industry from thinking that we’re going to give people their hair back completely. People need to be realistic.”

***

First let me say that I hate hype and sort of cringed when I typed the words “unlimited donor” in the title of this thread, but I wanted to draw attention to this possibility. I think many of us here are aware of the various promising treatments that never materialized (not to mention all the scams). I myself am borderline cynical when I hear about the next great thing in hair loss. I think any veteran of the hair loss industry is wise to have that as their default stance. So I fully appreciate Dr. Bisanga’s reasoning.

Dr. Bisanga’s answer was sort of what I expected. First he said he’d heard of it, but didn’t look at it in detail. But this is exactly what we are asking the doctors to do: take a closer look, please! So what is Dr. Bisanga waiting for? He’s waiting for researchers to complete their studies. This can take another 5-10 years or it may never happen due to lack of funding, lack of interest, better opportunities and any number of reasons really. We could sit on an effective treatment for years waiting for trials.

Digression: If you’ve studied the history of science you may be aware that progress doesn’t alway go from research to practice. It goes the other way around too. Sometimes enterprising practitioners start experimenting and getting some initial success and later scientists come along and help improve the process. The steam engine, for example was not invented by scientists, it was invented by engineers and the science was worked out afterwards. Believe it or not, we still don’t fully understand how bicycles work! (https://youtu.be/9cNmUNHSBac?t=573)!

***

Back to verteporfin though.

Should doctors really be trying it out an unproven treatment? Normally no, but verteporfin is an FDA approved medication with 20 years of use by ophthalmologists and an excellent safety profile. Any hair transplant surgeon can discuss it with their ophthalmologist colleagues, like @DrTBarghouthi has done (Thank you!). The key point is that this seems a low-risk high-reward type situation. Any doctor can legally and ethically use this drug off-label with his/her patients. We already use both dutasteride and oral minoxidil off-label, which is what we're proposing with verteporfin

My own view is that there is a 5% chance that all or most of donor hair will be restored and a 20-25% chance that there will be partial restoration of donor reserves, say 50% - so if you extract 2000 grafts you may get 1000 grafts back. Even if verteporfin only reduces or eliminates scarring in the donor area - it would be a win! It may also prove useful in reducing scarring in the recipient area. We may never find out unless we ask the doctors to take a closer look.

***

@Melvin- Moderator- Thanks again for taking this up! I hope you will continue to bring up this subject with the doctors that you speak with. May I ask you to frame the question a little differently?

We probably shouldn’t be asking the doctors what they think about it today because almost none of them have taken a detailed look at it, so they’re likely to give an answer similar to what Dr. Bisanga said - a wise answer all things considered. Instead we should be asking them to take their time to study verteporfin closer and get back to us with their thoughts or concerns about trying it out with patients.

Instead of asking: “What do you think about verteporfin?”, we should say something like: “We think verteporfin is worth trying today because it’s low-risk, high-reward. It’s FDA approved and has an excellent safety profile. We know there are no human trials. We know it’s a long shot and it may not work, but some of us feel it’s worth trying. Would you consider taking a closer look at it and get back to us with your thoughts or concerns?”

We’re trying to get them to take a closer look at it, not to wait for research, which may never be completed or even started. The communication challenge I see is how do we get doctors to take a closer look at this without coming off as naive and uninformed. We should make it clear to the doctors that we are informed about the current state of the research (no human studies), but we feel because the drug is FDA approved with a great safety profile, it’s worth trying despite the lack of human trials to date.

Perhaps it doesn’t even make sense to put them on the spot and ask them on live streams, but rather ask them offline to take a closer look so that it can be discussed once they have done a deep dive. This thread is a great starting point for a deep dive:

https://www.hairrestorationnetwork.com/topic/60076-fda-approved-drug-verteporfin-found-to-fully-regenerate-skin-including-hair-follicles/

I agree with you

Edited December 21, 2021 by Fego

[Al - Moderator]

Most hair transplant Drs are not scientists or biologists who do this type of research, so even if you have something that's FDA approved for use, making it work as something else isn't always so simple. It's easy to say just try it, but what would they even do with it, how much do they use, do they even know much about it, etc, etc. I think asking them to try things they have little knowledge about on their actual patients is something most Drs would not want to risk. Can they do some research and find out more about it? Sure, but the time it may take to really learn about it may be too time consuming and, as I said earlier, not really their area of knowledge. Where does a Dr who already has a months long waiting list find the time? Would it be great if someone with some knowledge did look into a few of these things? Sure, but then that's sort of what is already being done. That's why there have been tests on mice and some initial human trials of some things as well. Most hair transplant Drs will tell you it's better if the people who understand it are the ones who work on it.

 

Edited December 21, 2021 by BeHappy

[SLA]

Very good points, @tripleg! Nice advice for how to approach HT doctors specifically with the word phrasing.

low risk and high reward.

what is encouraging is that the research comes out of Stanford, it is an FDA approved drug and they have seen some good results on pig skin.

I think the plan is to do first human trials on cleft palete surgery.

 

[mmokin]

i had an fue and am trying to get my donor back in good condition by donor farming with oral minox so I can implant new beard hair or chest hair into scalp lmao
i can buy like 100mg of this online for £850 pounds, so you're telling me i could fue grafts out of my scalp, inject this, implant the grafts back into the donor and get 100% density? loooooooooooooool

Edited January 6, 2022 by mmokin

[tripleg]

On 1/6/2022 at 1:06 PM, mmokin said:

i had an fue and am trying to get my donor back in good condition by donor farming with oral minox so I can implant new beard hair or chest hair into scalp lmao
i can buy like 100mg of this online for £850 pounds, so you're telling me i could fue grafts out of my scalp, inject this, implant the grafts back into the donor and get 100% density? loooooooooooooool

First of all - this should be discussed with your doctor and only done with his/her agreement and supervision.

Second - nobody is making any claims that this is guaranteed to work. It might very well fail.

All that we're saying is that there is preliminary research that this works in mice/pigs and it *might* work in humans. Luckily the drug in question is already FDA approved and has an excellent safety profile, so any patient/doctor can use it today if they choose. It's basically a low risk/high reward situation.

This thread is a discussion about having a conversation with your doctor, if this is something you'd like to try.

[SLA]

On 12/14/2021 at 9:55 AM, DrTBarghouthi said:

Thank you. I have checked with an ophthalmologist colleague and will look into it further and possibly do a small trial on it to see. Will keep you updated ofcourse. 

Hi @DrTBarghouthi- I am just checking in to see if you have had the time to investigate verteporfin further. There seems to be so much potential given that it seemed to have worked on mice and pig skin to reduce/eliminate scarring and even regenerate hair.

[Fox243]

@DrTBarghouthiHi dr., just following up again. This would really be great for people who’s hair transplants don’t end up working out, and the clinic could simply advise them to shave. Would also help people who don’t want to take finasteride, as they could shave if too much loss of native hair occurs.

[HairRun]

I think it's worth looking into just for the scar reduction possibilities alone. I feel a lot of people would be willing to drop a few extra Ks for the drug as long as the risk is low enough.