Unlimited Donor with Verteporfin - Should We Be Experimenting?

[tripleg]

1 hour ago, NARMAK said:

Hopefully the Doctor here will get their supply soon of the treatment to be able to conduct a trial with patients that sign up for it 

Personally i think there's a few exciting potential options on the line and Stemson manage to create a well of unlimited grafts and Vertoporfin etc. might not be necessary at all. 

I think within the next 10-15 years hopefully we can once again move the needle of progress forward again for hair loss and restoration. 

10-15 years? Vertoporfin is here NOW! And if it works, it works NOW!

[tripleg]

1 hour ago, HairRun said:

Would love to see @Melvin- Moderator ask this directly in his interviews. I would imagine someone like Hassan/Wong...

Hassan/Wong are exactly the kind of doctors I had in mind. They were FUT masters, but experimented early on with FUE to the point where now they consider it better than FUT. These are the type of pioneering docs who move the field forward. So far I'm only aware of DrTBarghouthi taking an interest in trying out Vertoporfin.

[NARMAK]

15 minutes ago, tripleg said:

10-15 years? Vertoporfin is here NOW! And if it works, it works NOW!

It only works now if people are willing to use it though. 

So far in terms of clinical studies for its application where hair transplants are concerned, there's nothing really available so it would be an area that needs somebody to take those steps to document and empirically show it works and the method. 

I believe the Dr here has agreed to do it but cited a shortage of the Vertoporfin which would be an issue if more decided to try also use it. 

[DrTBarghouthi]

We are actually making progress with supplying and will be drawing up a protocol for use very soon. Hopefully things will progress in a positive way from here. 

[NARMAK]

16 minutes ago, DrTBarghouthi said:

We are actually making progress with supplying and will be drawing up a protocol for use very soon. Hopefully things will progress in a positive way from here. 

Thank you for replying Doctor. I think the community is waiting to see your findings using the drug and how effective it is for hair transplants. 

I'm a bit hesitant to call it a game changer just yet but it could prove to be a very valuable tool in the procedure. 

[MrFox]

2 hours ago, HairRun said:

Would love to see @Melvin- Moderator ask this directly in his interviews. I would imagine someone like Hassan/Wong who are currently developing next gen techniques might be interested in developing a protocol around this. 

As long as there are no bad side effects, I would be willing to pay extra money during my procedure for the scar treatment. Even if it ends up doing nothing, it would be worth the financial risk. 

Completely agree. The entire field has gotten to this point because people were willing to take informed risk on procedures. I don't see why patients shouldn't be allowed to sign a waiver and pay for the extra cost involved with the application of the medicine. Hasson/Wong are currently developing topical formulas for Dutasteride/Finasteride, which is being used off-label. I don't see why Verteporfin could not be tested in a similar manner at clinics. 

[Fox243]

If anyone wants to be added to our group who has experience with drug solubility, please DM me. 

[Dillpickle123]

Haven’t had a hair transplant yet but I’ll do it ✋🏼For science! Lol this is promising 

[SLA]

22 hours ago, DrTBarghouthi said:

We are actually making progress with supplying and will be drawing up a protocol for use very soon. Hopefully things will progress in a positive way from here. 

Thank you doctor! Looking forward...

[NARMAK]

On 4/13/2022 at 3:15 PM, HairRun said:

Would love to see @Melvin- Moderator ask this directly in his interviews. I would imagine someone like Hassan/Wong who are currently developing next gen techniques might be interested in developing a protocol around this. 

As long as there are no bad side effects, I would be willing to pay extra money during my procedure for the scar treatment. Even if it ends up doing nothing, it would be worth the financial risk. 

Lol, don't give them all ideas. They already seem to have blown the doors off with some clinics charging $10k+ for like PRP. 

[MrFox]

On 1/20/2022 at 4:27 PM, DrTBarghouthi said:

 

Apologies for not getting back earlier. So yes this medication is FDA approved for some types of wet macular degeneration which is an age related retinal disease. This was the drug of choice to that condition years ago but has been abandoned with newer agents like Avastin etc. 

I spoke to some colleagues and it seems there is or has been recent delay or even shortage in production (possibly due to reduced demand?) 

I know it is hard to source here where I practice because ophthalmologist are no longer using it. It is around 1800 usd per vial but I’m not sure how much donor will this cover. 
I will try to source it and maybe get help from some of my ophthalmologist colleagues in preparing it and possibly testing it on some FUT scars as well as FUE scars hopefully. I just need to see what the requirements might be along with doing more reading about it (has been quite a busy period lately to do an extra reading unfortunately). 
Will keep you posted with how things go hopefully.

Obviously there is still a lot of testing that needs to be done to see if the this an effective treatment, and this is more of a theoretical question, but I am curious how this would be applied in the use of FUT scars? For the FUE scars it seems pretty straight forward with removing the small scars with a punch similarly used in the procedure to begin with and ejecting Verteporfin, maybe putting some protective dressing over while it heals. With an FUT scar would the scar be excised and then stitched/stapled together and injected with verteporfin? I don't think that would be the best solution. In theory wouldn't it be better to remove the scar tissue and basically allow the amount of skin tissue that was originally removed to regenerate? 

Edited April 15, 2022 by MrFox

[DrTBarghouthi]

1 hour ago, MrFox said:

Obviously there is still a lot of testing that needs to be done to see if the this an effective treatment, and this is more of a theoretical question, but I am curious how this would be applied in the use of FUT scars? For the FUE scars it seems pretty straight forward with removing the small scars with a punch similarly used in the procedure to begin with and ejecting Verteporfin, maybe putting some protective dressing over while it heals. With an FUT scar would the scar be excised and then stitched/stapled together and injected with verteporfin? I don't think that would be the best solution. In theory wouldn't it be better to remove the scar tissue and basically allow the amount of skin tissue that was originally removed to regenerate? 

I agree. It seems that the most ideal time to inject the medication is at the time of excision whether FUE or FUT. So it technically should be injected at the time an FUT is sutures to allow for the stitched skin to heal via a different mechanism than what currently happens. Same applies to older scars- you need a freshly made incision- so the old scar needs to be removed and the new wound stitched and injected with Verteporfin.

[NARMAK]

1 hour ago, DrTBarghouthi said:

I agree. It seems that the most ideal time to inject the medication is at the time of excision whether FUE or FUT. So it technically should be injected at the time an FUT is sutures to allow for the stitched skin to heal via a different mechanism than what currently happens. Same applies to older scars- you need a freshly made incision- so the old scar needs to be removed and the new wound stitched and injected with Verteporfin.

Doctor, i am but a pleb on the internet as we would say in the UK lol

However, i am curious that in the case of FUT, would it be possible if say two FUT patients were willing to perhaps try two methods. 

One of which is how you mentioned but a 2nd method whereby perhaps instead of the same linear strip scar removed and stitched, you punch equal distance FUE excisions into the scar and inject the Verteporfin. A bit almost like how people use FUE method to implant grafts into a linear FUT scar to hide it but in this case, as a means to inject the medication. Therefore you theoretically have a chance to have faster healing than creating another FUT style cut and healing process. 

Do you concur? 

[DrTBarghouthi]

3 hours ago, NARMAK said:

Doctor, i am but a pleb on the internet as we would say in the UK lol

However, i am curious that in the case of FUT, would it be possible if say two FUT patients were willing to perhaps try two methods. 

One of which is how you mentioned but a 2nd method whereby perhaps instead of the same linear strip scar removed and stitched, you punch equal distance FUE excisions into the scar and inject the Verteporfin. A bit almost like how people use FUE method to implant grafts into a linear FUT scar to hide it but in this case, as a means to inject the medication. Therefore you theoretically have a chance to have faster healing than creating another FUT style cut and healing process. 

Do you concur? 

Yes I do understand and it could make good sense. I have to look closely to see if that could theoretically work because punching in an FUT scar doesn’t eliminate the whole scar tissue. It is important to prevent the scarring cascade from the beginning and that’s why a fresh wound is advised. However, this can also be looked at. Remember this is all still up for investigation and there could be numerous ways to go about it. 

[NARMAK]

4 hours ago, DrTBarghouthi said:

Yes I do understand and it could make good sense. I have to look closely to see if that could theoretically work because punching in an FUT scar doesn’t eliminate the whole scar tissue. It is important to prevent the scarring cascade from the beginning and that’s why a fresh wound is advised. However, this can also be looked at. Remember this is all still up for investigation and there could be numerous ways to go about it. 

Yes, you're absolutely right doctor that it probably wouldn't. However for a scientific study case in a clinical study, i think it would certainly create a good point of comparison if you could potentially contrast the two methods. 

I would like to think as well, that the healing comparison time between the two methods and outcome of the results would be an interesting thing to have data on. 

If you were to excision an FUT scar in a near identical manner to when it's originally performed, it would also be interesting to observe the potential scalp laxity and way that the original scar appears after Verteporfin. 

[MrFox]

10 hours ago, DrTBarghouthi said:

I agree. It seems that the most ideal time to inject the medication is at the time of excision whether FUE or FUT. So it technically should be injected at the time an FUT is sutures to allow for the stitched skin to heal via a different mechanism than what currently happens. Same applies to older scars- you need a freshly made incision- so the old scar needs to be removed and the new wound stitched and injected with Verteporfin.

Would it be possible to not stitch the two edges together after the scar is excised? In another Stanford porcine study they used a drug similar to Verteporfin but it was incorporated in hydrogel patches which they changed ever other day. Again I realize we are a long way from knowing if the drug will be as affective in humans and will produce the results that are we are hoping it will. If it does work accordingly it seems like the later method would be a more ideal treatment pathway as you would be restoring the original amount of skin that existed before the surgery.  

 https://www.nature.com/articles/s41467-021-25410-z#Sec9 

Additionally I've seen a lot of discussion about using this as a conjunction with hair transplantation surgery to prevent scarring. I personally feel like restoring the donor region with scar revision surgeries w/ Verteporfin makes complete sense, but I don't quite see the logic behind using the drug in conjunction with doing a new hair transplant surgery if it works to fully regenerate follicles. It seems most patients are already using drugs such as Dutasteride and Finasteride which blocks the further progression of hair loss, so why not just use Verteporfin in the balding areas and not bother with transplanting follicles? It feels like this would potentially provide the most natural and asthetic results for patients. It would allow for each patients own natural hair patterns and densities to be restored and would take out a lot of inherent risks with transplantation away. I understand that there may be individuals who have bad reactions to the drugs or do not want to continue taking the drug long term, so perhaps transplantation makes sense for those patients. Again I understand this is the early stages and we do not understand all of the variable as of yet. 

Edited April 15, 2022 by MrFox

[DrTBarghouthi]

4 hours ago, MrFox said:

Would it be possible to not stitch the two edges together after the scar is excised? In another Stanford porcine study they used a drug similar to Verteporfin but it was incorporated in hydrogel patches which they changed ever other day. Again I realize we are a long way from knowing if the drug will be as affective in humans and will produce the results that are we are hoping it will. If it does work accordingly it seems like the later method would be a more ideal treatment pathway as you would be restoring the original amount of skin that existed before the surgery.  

 https://www.nature.com/articles/s41467-021-25410-z#Sec9 

Additionally I've seen a lot of discussion about using this as a conjunction with hair transplantation surgery to prevent scarring. I personally feel like restoring the donor region with scar revision surgeries w/ Verteporfin makes complete sense, but I don't quite see the logic behind using the drug in conjunction with doing a new hair transplant surgery if it works to fully regenerate follicles. It seems most patients are already using drugs such as Dutasteride and Finasteride which blocks the further progression of hair loss, so why not just use Verteporfin in the balding areas and not bother with transplanting follicles? It feels like this would potentially provide the most natural and asthetic results for patients. It would allow for each patients own natural hair patterns and densities to be restored and would take out a lot of inherent risks with transplantation away. I understand that there may be individuals who have bad reactions to the drugs or do not want to continue taking the drug long term, so perhaps transplantation makes sense for those patients. Again I understand this is the early stages and we do not understand all of the variable as of yet. 

Not stitching the wound would probably cause an increased load on the healing tissue and would heal with secondary intention- meaning the edges will heal without controlled approximation of wound edges as in the case of suturing. This leads to scarring that is not usually pleasant and also to a bigger surface area of scar tissue for the drug to work on.
 The problem is that if verteporfin doesn’t work, then you end up with a scar that doesn’t look good. I think that minimizing the area of scarring (suturing) or punching in FUE would give higher chances of the drug working because it is less of healing that needs to be done. 

Furthermore, it seems that any hair regeneration is based on the fact that it restores the tissue in the donor to what it was originally. So you go back to normal scalp and normal donor hairs. However, it doesn’t act on restoring hair that is undergoing progressive thinning as in male pattern hair loss if you know what i mean. 

[MrFox]

First I appreciate your responses Dr. Barghouthi. I think the initial testing of the drug would benefit from the process you are describing, minimizing the amount of tissue that needs healing in case the drug does not work as well as we hope. That being said, I don't quite understand the reasoning behind minimizing the amount that needs to be healed if it works as well as it did in the mouse study in humans. This drug as the potential to heal deep full thickness wounds, with large sections of skin. I believe from all of the literature I have read that if Verteporfin brings back fully functional skin tissue than secondary intention will not be an issue, because scar tissue is not forming in the first place. Additionally with all due respect we have no information proving that this will not work on balding areas, that is purely speculative in my opinion. All of the testing as been on mice and pigs, who do not suffer from alopecia. We simply do not know that it won't regrow hair in balding areas if it works in other areas as well. Additionally there are instances of hair neogensis occurring in humans, who suffer from alopecia, we know that it is possible but extremely rare. The article linked below concerns a man who suffered from 3rd degree burns on his head. Any lingering follicles he had would have been destroyed but that deep of a burn, and the man was clearly suffering from alopecia before this burn occurred. He clearly has had at least some follicle neogensis occur.

https://www.bmj.com/content/bmj/293/6562/1645.1.full.pdf

[DrTBarghouthi]

18 minutes ago, MrFox said:

First I appreciate your responses Dr. Barghouthi. I think the initial testing of the drug would benefit from the process you are describing, minimizing the amount of tissue that needs healing in case the drug does not work as well as we hope. That being said, I don't quite understand the reasoning behind minimizing the amount that needs to be healed if it works as well as it did in the mouse study in humans. This drug as the potential to heal deep full thickness wounds, with large sections of skin. I believe from all of the literature I have read that if Verteporfin brings back fully functional skin tissue than secondary intention will not be an issue, because scar tissue is not forming in the first place. Additionally with all due respect we have no information proving that this will not work on balding areas, that is purely speculative in my opinion. All of the testing as been on mice and pigs, who do not suffer from alopecia. We simply do not know that it won't regrow hair in balding areas if it works in other areas as well. Additionally there are instances of hair neogensis occurring in humans, who suffer from alopecia, we know that it is possible but extremely rare. The article linked below concerns a man who suffered from 3rd degree burns on his head. Any lingering follicles he had would have been destroyed but that deep of a burn, and the man was clearly suffering from alopecia before this burn occurred. He clearly has had at least some follicle neogensis occur.

https://www.bmj.com/content/bmj/293/6562/1645.1.full.pdf

Thank you for your response. That is true indeed in that we wouldn’t know the full spectrum of its work on humans. Whether only on scarring, on scars with DHT insensitive follicles or whether it can actually induce regrowth of DHT sensitive hairs. 
With regards to any proposed protocol, we have to test each of these separately- with the most probable hypothesis taking precedence over the others in terms of order. It definitely would be something to consider testing on recipient areas if there proves to be good evidence of regrowth in scarred donor areas ofcourse. I guess with the way how this proposed testing is going, we have to minimise the risk taken by individuals. So in the first step, a suitable cohort would be people willing to undergo a Hair transplant or at least a limited extraction from the donor. In this way, if it works- great, but if it doesn’t then the risk is low. A separate cohort will be needed for only injecting in the recipient areas as we don’t want to overload anyone with the medication should this thing proceed. 

[MrFox]

6 hours ago, DrTBarghouthi said:

Thank you for your response. That is true indeed in that we wouldn’t know the full spectrum of its work on humans. Whether only on scarring, on scars with DHT insensitive follicles or whether it can actually induce regrowth of DHT sensitive hairs. 
With regards to any proposed protocol, we have to test each of these separately- with the most probable hypothesis taking precedence over the others in terms of order. It definitely would be something to consider testing on recipient areas if there proves to be good evidence of regrowth in scarred donor areas ofcourse. I guess with the way how this proposed testing is going, we have to minimise the risk taken by individuals. So in the first step, a suitable cohort would be people willing to undergo a Hair transplant or at least a limited extraction from the donor. In this way, if it works- great, but if it doesn’t then the risk is low. A separate cohort will be needed for only injecting in the recipient areas as we don’t want to overload anyone with the medication should this thing proceed. 

I couldn't agree more with minimizing risk, especially in the early stages of testing the drug. Wouldn't there need to be some method of injuring the skin in the recipient areas in order for the drug to have an affect? 

[DrTBarghouthi]

3 hours ago, MrFox said:

I couldn't agree more with minimizing risk, especially in the early stages of testing the drug. Wouldn't there need to be some method of injuring the skin in the recipient areas in order for the drug to have an affect? 

Yes would probably need to. It might simply be the needling itself or might require a more pronounced injury site. 

[MrFox]

On 12/8/2021 at 7:47 PM, BeHappy said:

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.

 

I've been thinking about this as well, but ultimately I think the only way we are going to know is by trying. As far as the scar tissue I think as long as the scar was removed, the drug would behave in a similar fashion to a wounded area without a scar. The mechanism is the same regardless. I don't think your body would lose the capacity to regenerate a wound just because it has been longer. Dr. Longaker has stated that he believes it will work with scars. With regards to miniaturized hair I would argue that a terminal hair unaffected by DHT would be the most likely scenario, as the only reason the follicle is miniaturized is because of long term exposure to DHT. That being said I think it would be likely that hair regrown would be susceptible to miniaturizing again, and therefore drugs such as finasteride would be needed to prevent that. It seems to me that the underlaying mechanism for whether a hair would be terminal or vellus comes to down to the individual genetics. I agree I think if you never had a terminal hair in a certain location it would not suddenly become terminal, so I do not think it would have much usefulness for beard growth. 

[MrFox]

On 12/13/2021 at 11:53 AM, Melvin- Moderator said:

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

@Melvin- Moderator What did they have to say?

Edited April 19, 2022 by MrFox
Tagging Moderator

[MrFox]

Not sure if I tagged the last post properly....

[MrFox]

I felt like this video was relevant to this/our discussion @DrTBarghouthi. The case study of the 78 year old man in this video received full thickness burns to his scalp. The total surface area was rather large and he refused any sort surgical intervention. This is an example of hair neogensis and skin regeneration occurring naturally in nature, given the right circumstances. If verteporfin works to elicit this process doesn't it stand to reason that even large wounds, such as from FUT, would be able to reproduce the lost skin? Would be great to hear other's opinions on this as well!!!