Unlimited Donor with Verteporfin - Should We Be Experimenting?

[SLA]

Yes, I saw this video...very good!

What I don't understand is how their could be neogenesis in the donor area if the follicles are removed from there. 

Anyone have any thoughts on how this would be possible?

[MrFox]

15 hours ago, SLA said:

Yes, I saw this video...very good!

What I don't understand is how their could be neogenesis in the donor area if the follicles are removed from there. 

Anyone have any thoughts on how this would be possible?

Hair follicle neogensis means the development of new follicles. The 78 year old burn patient in the video received full thickness burns. In those regions the hair follicle are completely destroyed. So the hair that was present after the burn healed was not old hair that had been triggered to grow, but completely new follicles that he did not have before the burn. In theory this would be the same protocol for hair removed from the donor area. You are creating a wound and the follicle is gone. By injecting Verteporfin, the wound is inhibited from certain mechanical signals and therefore contracture and fibrosis do not occur. The skin is than pushed into a regenerative state, that creates new follicles, adipocytes, sweat glands, sebaceous glands, blood vessels, etc.

[MrFox]

I'm not sure why we are not getting more doctors/clinics to comment on this research. We are not asking them to jump into using the drug without further research being done, it would just be nice to have some sort of dialogue. It has been over a year since the research was published, and we are talking about an already FDA approved drug that could be used off-label immediately. It seems strange to me that none of these top clinics will even make a comment on it, other than they heard about it, and they don't know. We are talking about something that can potentially change the entire industry top to bottom and it seems to me that Hair Surgery Clinics will still be necessary to perform this work with Verteporfin, so it is both in the patients best interest as well as their own. Idk maybe we need to tag some more clinics in this thread....?

Edited April 28, 2022 by MrFox

[SLA]

2 hours ago, MrFox said:

I'm not sure why we are not getting more doctors/clinics to comment on this research. We are not asking them to jump into using the drug without further research being done, it would just be nice to have some sort of dialogue. It has been over a year since the research was published, and we are talking about an already FDA approved drug that could be used off-label immediately. It seems strange to me that none of these top clinics will even make a comment on it, other than they heard about it, and they don't know. We are talking about something that can potentially change the entire industry top to bottom and it seems to me that Hair Surgery Clinics will still be necessary to perform this work with Verteporfin, so it is both in the patients best interest as well as their own. Idk maybe we need to tag some more clinics in this thread....?

Good point, however, what if they discover that if they create wounds in the recipient area and inject this drug that it will grow a full head of hair...hair transplants will then be defunct and every clinic in the world would be out of business- LOL.

I know this scenario is very unlikely :).

[MrFox]

I know you're joking but I think there is a high possibility it works in the recipient area in that manner! Again hair restoration surgeons/clinics would be the ideal people to carry out that treatment. Their clinics are already set up to handle something like that. Not to mention all the money they would be able to make offering scar repair. 

[NARMAK]

Even if Vert does that, somebody has to administer the drug and do it properly so i wouldn't ve surprised to see it offered by Hair Transplant Clinics on an expensive basis potentially as a novel treatment at first. 

That said, there's a little more imo to hair transplants to get somebody a full looking head of hair and if Verteporfin is able to truly regenerate hair follicles then what's to stop a hair transplant clinic doing what they normally do, and then using Vert at the same time to regenerate the donor. Thus resulting in practically an almost perfect way to take a Norwood 7 and make them a Norwood 0/1.

[MrFox]

14 hours ago, NARMAK said:

Even if Vert does that, somebody has to administer the drug and do it properly so i wouldn't ve surprised to see it offered by Hair Transplant Clinics on an expensive basis potentially as a novel treatment at first. 

That said, there's a little more imo to hair transplants to get somebody a full looking head of hair and if Verteporfin is able to truly regenerate hair follicles then what's to stop a hair transplant clinic doing what they normally do, and then using Vert at the same time to regenerate the donor. Thus resulting in practically an almost perfect way to take a Norwood 7 and make them a Norwood 0/1.

Again I think there are only two scenarios where this would be a viable option. People who do not want to stay on drugs long term and perhaps someone who is unhappy with their biological hairline. It may be that the hair would only grow back in the same pattern, as it is genetic/hormonal that affects everyone's hairline, even without any hair loss. So if you were born with a hairline you were unhappy with, it may still be necessary to have some transplantation. Otherwise to me transplanting hairs from the donor area to the top or front of the head seems like an unnecessary step if Verteporfin works to regenerate follicles. I don't see why it should work in the donor area exclusively. Miniaturized hairs are still visible under a microscope, even for severely balding patients. Potentially you would extract the miniaturized hair and a new terminal hair would appear. Perhaps with someone with a higher Norwood scale it would take several sessions. I also believe you could also reverse any transplanted hairs through that process. So if you were unhappy with the results you could basically have those follicles extracted as well. I think that the inherent limitation of hair transplantation could also be avoided through the later process. The hair could potentially grow back to normal hair density (different for each patient) which is known to be difficult to achieve in hair transplantation. Additionally each individual hair follicle would be the right color and diameter, which can also be a variable in hair transplantation. You would also not need to worry about the correct hair angle or depth of implantation. I feel like that is just not possible for any surgeon, no matter how talented they are, to be able to reproduce the naturalness of someone's own native hairline. I don't think there is anybody on this forum who would not sign up to have their hairline from when they were 14 or 15! I mean look at that 78 year old burn patient, that hairline looked extremely natural on him from the burn and that was a completely uncontrolled consequence of wound induced hair follicle neogensis. 

Edited April 29, 2022 by MrFox
Correct spelling error

[RTC]

On 4/24/2022 at 1:14 AM, MrFox said:

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!!!

 

Fascinating.. I took this on board a few months ago and started microneedling (1.5mm) with castor oil once a week, even on areas with supposedly no follicles.

Yesterday Dr Mwamba examined my hair under microscope and noted some very small hairs on my recipient area (which weren't implanted hairs). My receipient area is very barren due to poor implantation from my Turkish botch job, but I think these small hairs have been regenerated by microneedling!

I am going to keep going with this experiment, I've also done the same to my donor area.

[tripleg]

1 hour ago, MrFox said:

 

"You may saaaaay i'm a dreamer but i'm not the only one" 😁

Wouldn't the regenerated hair still be susceptible to DHT necessitating Finasteride? 

Edited April 29, 2022 by tripleg

[NARMAK]

1 hour ago, MrFox said:

Again I think there are only two scenarios where this would be a viable option. People who do not want to stay on drugs long term and perhaps someone who is unhappy with their biological hairline. It may be that the hair would only grow back in the same pattern, as it is genetic/hormonal that affects everyone's hairline, even without any hair loss. So if you were born with a hairline you were unhappy with, it may still be necessary to have some transplantation. Otherwise to me transplanting hairs from the donor area to the top or front of the head seems like an unnecessary step if Verteporfin works to regenerate follicles. I don't see why it should work in the donor area exclusively. Miniaturized hairs are still visible under a microscope, even for severely balding patients. Potentially you would extract the miniaturized hair and a new terminal hair would appear. Perhaps with someone with a higher Norwood scale it would take several sessions. I also believe you could also reverse any transplanted hairs through that process. So if you were unhappy with the results you could basically have those follicles extracted as well. I think that the inherent limitation of hair transplantation could also be avoided through the later process. The hair could potentially grow back to normal hair density (different for each patient) which is known to be difficult to achieve in hair transplantation. Additionally each individual hair follicle would be the right color and diameter, which can also be a variable in hair transplantation. You would also not need to worry about the correct hair angle or depth of implantation. I feel like that is just not possible for any surgeon, no matter how talented they are, to be able to reproduce the naturalness of someone's own native hairline. I don't think there is anybody on this forum who would not sign up to have their hairline from when they were 14 or 15! I mean look at that 78 year old burn patient, that hairline looked extremely natural on him from the burn and that was a completely uncontrolled consequence of wound induced hair follicle neogensis. 

Personally if Vert regenerated hair follicles on the donor area and also your natural hairline. I don't know if i'd want to have them injecting it into the native area personally because i think a hair transplant allows us the liberty in some reason to create a more aesthetic hairline than might naturally be regenerated. 

Especially if the regeneration of the hairlines giving you back your original juvenile hairline design. 

Bottom line is, once you can establish whether it actually works, we can then decide on a case by case basis whatever users are wanting to do and you can tailor your approach imo. So some may choose to do it the way you said, whilst others may choose a more aesthetic way that involves more of a hair transplant approach. 

[MrFox]

12 minutes ago, tripleg said:

"You may saaaaay i'm a dreamer but i'm not the only one" 😁

Wouldn't the regenerated hair still be susceptible to DHT necessitating Finasteride? 

Yes, I think you would be correct. Your genetics are not going to change, so you would more than likely have the same hair loss pattern again and again, if you did not prevent it from doing so with drug intervention. For most it is a well tolerated drug, not to mention there other treatments coming available such as topical dutasteride or finasteride as well as other topical AR antagonists which may have less side effects. Perhaps people who had a very slow progression could get away with just gettin a session every few years as well. I think there would be options, and you would be able to decide what is personally best for you. 

[MrFox]

Completely agree, I think you will have options, which I think is always better for the patient/customer. Also I think this reiterates that the use of this drug is not going to be the end of hair restoration surgery or clinics. I think it actually gives the surgeon and patient more options and better outcomes. Not to mention more people willing to do the procedures. The clinics stand to make at least an equal amount of money and potentially more. I think it is mutually beneficial, so again I'm not quite sure why there isn't more interest here!

[NARMAK]

8 minutes ago, MrFox said:

Completely agree, I think you will have options, which I think is always better for the patient/customer. Also I think this reiterates that the use of this drug is not going to be the end of hair restoration surgery or clinics. I think it actually gives the surgeon and patient more options and better outcomes. Not to mention more people willing to do the procedures. The clinics stand to make at least an equal amount of money and potentially more. I think it is mutually beneficial, so again I'm not quite sure why there isn't more interest here!

I think the hair loss industry is really slow and in many ways doesn't respond quickly to change but also, this is something that would probably be considered a completely unique field and as such requires a proper full clinical study where possible to really help push it. 

[Euphoria]

It’s obvious why the hair transplant doctors don’t want to try this. Theyre simply not qualified enough to handle any serious side effects that could arise. The drug works in a pretty unique fashion for 👁 with photodynamic therapy and not just on its own. I can’t imagine what effects it would have being injected into the scalp and the lightening conditions affecting the blood vessels or other organs.

Clearly, this is something for people with proper knowledge of the drug mechanism and the ability to handle serious side effects should they arise.

A hair transplant surgeon reputation is ruined when some patients hairs don’t grow to full density (like see HLC which is getting bad rep lately on this forum), can you imagine it would be end of life for the surgeon/clinic if some patient dies or suffers life threatening or some serious side effect. 
 

I wouldn’t keep my hopes up about this

 

There’s also the simple fact that doctors earn ridiculous amount of money for transplanting hairs. They’re happy, who’s not happy? Patients with high norwoods. Why would the doctor hurt their own business when they can charge 5-6$ per graft doing something as simple as moving grafts around

 

 

Edited April 29, 2022 by Euphoria

[NARMAK]

9 minutes ago, Euphoria said:

It’s obvious why the hair transplant doctors don’t want to try this. Theyre simply not qualified enough to handle any serious side effects that could arise. The drug works in a pretty unique fashion for 👁 with photodynamic therapy and not just on its own. I can’t imagine what effects it would have being injected into the scalp and the lightening conditions affecting the blood vessels or other organs.

Clearly, this is something for people with proper knowledge of the drug mechanism and the ability to handle serious side effects should they arise.

A hair transplant surgeon reputation is ruined when some patients hairs don’t grow to full density (like see HLC which is getting bad rep lately on this forum), can you imagine it would be end of life for the surgeon/clinic if some patient dies or suffers life threatening or some serious side effect. 
 

I wouldn’t keep my hopes up about this

 

There’s also the simple fact that doctors earn ridiculous amount of money for transplanting hairs. They’re happy, who’s not happy? Patients with high norwoods. Why would the doctor hurt their own business when they can charge 5-6$ per graft doing something as simple as moving grafts around

 

 

Complications aside. If they're charging $5-6 per graft, have a finite supply presently. Assuming they could overcome the risks then this gives them an opportunity to sell a further product (think how PRP is sold nowadays alongside HTs) and benefit from having the customer who does regenerate hair follicles in the donor come back for even more hair transplants you charge them $5-6 per graft for. So it would make no sense not to do it if it works for anybody competent. 

Hair Mills if they tried would possibly have the biggest problem if they're involved in genuine medical botches they can get sued for. 

[MrFox]

3 hours ago, Euphoria said:

It’s obvious why the hair transplant doctors don’t want to try this. Theyre simply not qualified enough to handle any serious side effects that could arise. The drug works in a pretty unique fashion for 👁 with photodynamic therapy and not just on its own. I can’t imagine what effects it would have being injected into the scalp and the lightening conditions affecting the blood vessels or other organs.

Clearly, this is something for people with proper knowledge of the drug mechanism and the ability to handle serious side effects should they arise.

A hair transplant surgeon reputation is ruined when some patients hairs don’t grow to full density (like see HLC which is getting bad rep lately on this forum), can you imagine it would be end of life for the surgeon/clinic if some patient dies or suffers life threatening or some serious side effect. 
 

I wouldn’t keep my hopes up about this

 

There’s also the simple fact that doctors earn ridiculous amount of money for transplanting hairs. They’re happy, who’s not happy? Patients with high norwoods. Why would the doctor hurt their own business when they can charge 5-6$ per graft doing something as simple as moving grafts around

 

 

We're not even sure if we need the photo activated version of Verteporfin yet, but to my knowledge it was not mentioned in the study by Stanford, suggesting that they did not need to control for it. Additionally they inject a larger amount of Vertporfin directly into the bloodstream when treating macular degeneration, so it very unlikely that it will cause serious toxicity in our bodies. Longaker seems to believe the drug will be used in almost every clinical setting at some point, so clearly it cannot be that difficult to control for otherwise there would have been some mention of it. But even if they do have to control for it, its not like the don't already have protocols in place for it. This drug has been used for over 20 years now, and has very low risk profile in comparison to other drugs. Additionally hair transplant surgeons do have to worry about serious consequence already at their practices, there can be serious complications with hair transplantation. You make it seem like it is a risk free surgery. They already inject medication into people scalps, i.e. numbing agents. You don't think they have to control for that? If the drug works as we believe it does, any surgeon would be at disadvantage to not offer it at their clinic. Patients are not going to want to go to any given provider if they offer a lesser service. Why do you think so many clinics have adopted FUE? It's clearly because of patient demand. Idk about you but I would gladly pay more and go to a different clinic if it meant could avoid having scars. 

Edited April 29, 2022 by MrFox
spelling

[HairRun]

9 hours ago, Aslitarcan sucks said:

Fascinating.. I took this on board a few months ago and started microneedling (1.5mm) with castor oil once a week, even on areas with supposedly no follicles.

Yesterday Dr Mwamba examined my hair under microscope and noted some very small hairs on my recipient area (which weren't implanted hairs). My receipient area is very barren due to poor implantation from my Turkish botch job, but I think these small hairs have been regenerated by microneedling!

I am going to keep going with this experiment, I've also done the same to my donor area.

I have a really wide scar from my first transplant, which other doctors suspect was due to poor technique. I've been microneedling that area, just in case microneedling would do something there. It would be interesting to see if something picks up. 

[SLA]

On this topic, I am going to guess that out of all the HT surgeons on planet earth that there is at least one who is experimenting with this drug...and now it is exciting that @DrTBarghouthiwill do a legitimate test.

I did read somewhere on Reddit someone mentioning they know a doctor or doctors that started using this drug on patients with success and follicle regeneration...but who knows how reliable this is or whether this person was hallucinating :).

So excited to see what transpires here.

 

[MrFox]

The following is a presentation given by the team at Stanford about the results of their soon to be published study using Verteporfin on Red Duroc Pigs. I will reiterate that this is something that we seriously need more Hair Restoration Surgeons to show an interest in using off-label! I have included pictures from the summary as well as the link to the video presentation, it is the second lecture. In addition to the pig model, she also spoke about similar findings in a Xenograph model using human skin tissue. The drug was well tolerated in the study, which is something we were already aware off with Verteporfin being FDA approved for over 20 years. @Melvin- Moderator is this something you could share again with more doctors when speaking with them!?

The summary of the methods used were as follows:

"Full-thickness excisional wounds (2x5cm hexagons) were produced on the dorsum of adult pigs. Wounds received intradermal verteporfin (YAP inhibitor; 2mg/mL) or vehicle control (PBS) followed by primary repair with 3-0 Vicryl deep dermal and 3-0 Monocryl running subcuticular sutures. Cutometer measurements were obtained to assess tissue stiffness every two weeks. Wounds and unwounded skin were harvested after 16 weeks for histologic (hematoxylin and eosin staining), mechanical (Instron strength testing), and scRNA-seq (10X Chromium) analyses." 

 

Edited May 19, 2022 by MrFox

[BaldDude]

5 minutes ago, MrFox said:

The following is a presentation given by the team at Stanford about the results of their soon to be published study using Verteporfin on Red Duroc Pigs. I will reiterate that this is something that we seriously need more Hair Restoration Surgeons to show an interest in using off-label! I have included pictures from the summary as well as the link to the video presentation, it is the second lecture. In addition to the pig model, she also spoke about similar findings in a Xenograph model using human skin tissue. The drug was well tolerated in the study, which is something we were already aware off with Verteporfin being FDA approved for over 20 years. 

The summary of the methods used were as follows:

"Full-thickness excisional wounds (2x5cm hexagons) were produced on the dorsum of adult pigs. Wounds received intradermal verteporfin (YAP inhibitor; 2mg/mL) or vehicle control (PBS) followed by primary repair with 3-0 Vicryl deep dermal and 3-0 Monocryl running subcuticular sutures. Cutometer measurements were obtained to assess tissue stiffness every two weeks. Wounds and unwounded skin were harvested after 16 weeks for histologic (hematoxylin and eosin staining), mechanical (Instron strength testing), and scRNA-seq (10X Chromium) analyses." 

 

I'd happily be a human guinea pig for this.

[BaldDude]

"Common side effects of verteporfin include:

• slight changes in vision
• dry eyes
• irritation/redness/swelling/itching of eyelids
• seeing flashes of light
• headache
• weak or tired feeling
• mild skin rash or itching
• nausea
• constipation
• joint pain
• muscle weakness
• flu-like symptoms (fever, chills, body aches, sore throat), or
• injection site reactions (pain, swelling, bleeding, or itching)."
  
  granted this was just for eye injections, but I'm glad to see no sexual side effects 😁

[MrFox]

Just now, BaldBobby said:

"Common side effects of verteporfin include:

• slight changes in vision
• dry eyes
• irritation/redness/swelling/itching of eyelids
• seeing flashes of light
• headache
• weak or tired feeling
• mild skin rash or itching
• nausea
• constipation
• joint pain
• muscle weakness
• flu-like symptoms (fever, chills, body aches, sore throat), or
• injection site reactions (pain, swelling, bleeding, or itching)."
  
  granted this was just for eye injections, but I'm glad to see no sexual side effects 😁

Yes but also remember these are temporary side affects, not permanent.

[SLA]

Thanks for posting @MrFox.

 

I agree that this is very promising. I think @DrTBarghouthihad received shipment of verteporfin and was planning on setting up a protocol to test on patients.

[HairRun]

Which hair transplant surgeons on the recommended list do you think would be open to trying this?

 

[HairRun]

we should submit questions about verteporfin for @Melvin- Moderator 's live interviews , what they think about trying it off label if the patient requests it, etc.