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Verteporfin HAIR REGENERATION HUMAN TRIAL Dr. Barghouthi *OFFICIAL THREAD


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14 minutes ago, sansi said:

@Killian hi, hope everything heals well. I believe today is 4 weeks post op, anything notable to share ?

It is as I suspected looking more like a mixed matrix. 

Some areas have no scar tissue formation visible and appear as normal skin appendeges with more hair present - these are where the punch out technique/FUE was done, and possibly where some minor superficial excision was done but it is too early to tell

In one area excised I see signs of scar tissue being laid down. There is erythema, which is seen in premature scars. There are signs of capillary dilation and inflammation induced angiogenesis which happens in early scar remodeling here. 

I note that in areas of greater tension the signs of scar tissue being laid down is prevalent. In areas of lesser tension, there are signs of normal skin appendeges. 

I would stand by my original speculation that it will be a matrix of scar tissue and normal skin appendeges, and ultimately not a silver bullet to yield a scarless hair transplant nor unlimited donor. 

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Posted (edited)
10 minutes ago, Killian said:

It is as I suspected looking more like a mixed matrix. 

Some areas have no scar tissue formation visible and appear as normal skin appendeges with more hair present - these are where the punch out technique/FUE was done, and possibly where some minor superficial excision was done but it is too early to tell

In one area excised I see signs of scar tissue being laid down. There is erythema, which is seen in premature scars. There are signs of capillary dilation and inflammation induced angiogenesis which happens in early scar remodeling here. 

I note that in areas of greater tension the signs of scar tissue being laid down is prevalent. In areas of lesser tension, there are signs of normal skin appendeges. 

I would stand by my original speculation that it will be a matrix of scar tissue and normal skin appendeges, and ultimately not a silver bullet to yield a scarless hair transplant nor unlimited donor. 

Thank you for sharing, you are great !

"The more hair Present" is the absence of shock loss or some new hairs are popping out ?

Edited by sansi
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15 minutes ago, Killian said:

It is as I suspected looking more like a mixed matrix. 

Some areas have no scar tissue formation visible and appear as normal skin appendeges with more hair present - these are where the punch out technique/FUE was done, and possibly where some minor superficial excision was done but it is too early to tell

In one area excised I see signs of scar tissue being laid down. There is erythema, which is seen in premature scars. There are signs of capillary dilation and inflammation induced angiogenesis which happens in early scar remodeling here. 

I note that in areas of greater tension the signs of scar tissue being laid down is prevalent. In areas of lesser tension, there are signs of normal skin appendeges. 

I would stand by my original speculation that it will be a matrix of scar tissue and normal skin appendeges, and ultimately not a silver bullet to yield a scarless hair transplant nor unlimited donor. 

I have noticed that Dr Saifi uses a very small punch size. Maybe the absence of scar tissue in FUE punch out is due to doctors skill with a small punch than verteporfin. I think he uses 0.7mm which is also used in beard extraction that leads to almost no scar.

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FYI, from a word document I keep: 

22Jul2023

Verteporfin 50mg x2 in refrigeration, exp: Jul2024

 

Concerns prior to injection.   

1) Effect of blocking YAP in area of severe tension (post-strip period in repeat strip cases which will last for weeks/months) as seen throughout stage one and two of the healing process AND and early remodelling. Injecting visudyne will theoretically prevent/augment the formation of fibrotic tissue/reorganisation of ECM. Fibroblastic phase lasts till week 5 post-op under normal healing circumstances and results in formation of scaffold and skin repair by contractionWill inhibiting this in an area of tension increase propensity for stretching further down the line I wonder? no scaffold or contraction will occur when area is being pulled apart by forces of tension. Tension will be greater in repeat FUT cases and increased further depending on factors such as strip removal against collagen directionality (opposing poles of the strip especially) and strip height owing to a longer period of tension. I suspect stretching and great caution should be applied.

 

2) Effect on homeostasis vs proliferative. YAP activation enacts a reversible pro-proliferative transcriptional proma in keratinocytes and dermal cells that results in accelerated re-epithelialization of the wound bed. Verteporfin is a YAP inhibitor. Epithelialization occurs in proliferative phase allowing cells to migrate and repair the wound. Effect of blocking this??

 

3) Remodelling begins once myofibroblasts begin contraction. Myofibroblasts increase expression of actin stress fibers and integrins, in order to produce the contraction needed to realign collagen. Reduce size of wound and secrete ECM proteins. Blockfing fibroblasts will prevent this, what will be the outcome in, again, an area of tension? 

 

4) Any chemical interaction between tumescence and Visudyne. Unlikely - no

 

5) Hair length essential to cover/reduce light exposure - time taken to inject and scope of area to be treated considering light. 

 

6) Effect of prolonged tension timeline to collagen basket weave structure formation period? 

 

No one fits all protocol may be possible, too many factors in FUT technique and case dependency to consider. Tension timeline will be variable. FUT leaves an atypical healing environment encompassed in tension. A more superficial scar removal later on in the remodelling phase may be safer when scalp laxity has returned and the approximated scalp has healed and is held together by the a deeper scar layer of collagen bundles closer to the galea – must wait till 8 months post op to be safe, ~80% tensile strength return by M6. Virgin FUT patients will have a quicker return to "normal" scalp laxity but repeat FUT patients will have increased tension over a much longer time period and this should be taken into consideration when blocking YAP in the early stages of wound repair.  Leaving bridges of scar tissue present in repeat cases to "hold together" and reduce propensity for tension associated risks - shorter and thinner width FUTs may be safer in repeat cases. Should another full strip be possible bridges of scar tissue are essential, I suspect the risk outweighs the benefit to have a full strip in a repeat case without these bridges.

 

 

16Feb2024.  

No full strip performed. FUE ~260 in donor.

 

The previous strip donor scar was treated with two techniques: punch-out technique and excision with epithelialisation. Verteporfin was then injected to the dermis. The verteporfin was injected to the upper and lower edges of the incision, then closed in two layers; subcutaneous with absorbable stitches 4-0 vicryl followed by upper layer with 5-0 prolene. Additionally, FUE was performed in the occipital donor area with 0.7mm punch and this was treated also with 50mg verteporfin. The treated area was carried out by injecting every 2cm, while at a 45 degree angle to the dermis.

 

Note: off OM for two weeks to prevent graft pop-out rate from minoxidil API. Commenced 2.5mg this evening and 2.5mg 3X (half life ~4hrs) daily for two weeks going forward to increase growth factor influx from vasodilation, thus expedite the healing timeline and increase graft exposure to hemoglobin/ EGF, TGF-alpha, PDGF, TGF-beta, IGF-I, IGF-II. Grafts will connect to blood supply by 72 and fibrin secreted by day 13/14 for full anchorage – out of the Wds, back to normal as usual by then. 

 

Day 1 (17Feb2024):  

 

No post-operative redness around incision line – atypical.

No inflammatory exudate from FUE extraction in normal tissue – highly atypical. Some form of augmentation in hemostasis has occurred I suspect.

 

Day 2:

 

Same observations, untouched look. No pain. Zero exudate on pillow even though slept on back for a full night.

 

Day 3:

untouched look. No pain

 

Day 4:

No formation of scabbing on the incision line. Interesting, usually along the incision line I can see the clotting/forming temporary scabbing. Change to epithelialisation? Slightly Itchy donor localised to the area treated.

 

Day5 – day 14;

Extremely itchy donor, untouched look, no redness. No effluvium of donor.

 

Day21 – entering remodelling phase. Nothing of note.

 

Day22-28:

 

No effluvium of donor, should have happened by now.

Signs of mixed matrix with erythema around incision – capillary dilation/inflammation induced by angiogenesis suggesting scar tissue will be laid down here. Other areas retain normal tissue colour and appear more akin to normal skin appendages – too early to conclude.  I think there will be scarring warranting a second round later this year. Signs of less effect visible in areas of tension and visa-versa. It looks like as suspected tension is a risk factor and the verteporfin not effective here (or as effective). More time to conclude required, will know for sure by M5. Need to punch out areas we didn’t get and I think the right side will be able to be buzzed after. The left side will be problematic due to tension – may need to switch to punch out technique I suspect. Notable improvement of whole area with no.2 haircut and no visible signs at this length. Day25 - the left side I suspect has minor effluvium or stretching in the last week or combination of both. Pain noted here. I lean more to scar matrix than effluvium. Re-evaluate at M2.

 

 

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Posted (edited)
2 hours ago, Killian said:

It is as I suspected looking more like a mixed matrix. 

Some areas have no scar tissue formation visible and appear as normal skin appendeges with more hair present - these are where the punch out technique/FUE was done, and possibly where some minor superficial excision was done but it is too early to tell

In one area excised I see signs of scar tissue being laid down. There is erythema, which is seen in premature scars. There are signs of capillary dilation and inflammation induced angiogenesis which happens in early scar remodeling here. 

I note that in areas of greater tension the signs of scar tissue being laid down is prevalent. In areas of lesser tension, there are signs of normal skin appendeges. 

I would stand by my original speculation that it will be a matrix of scar tissue and normal skin appendeges, and ultimately not a silver bullet to yield a scarless hair transplant nor unlimited donor. 

Looks like the scarring is mostly limited to the FUT areas. It sounds from your description that FUE area is healing better. 

We are still in the early stages of understanding Verteporfin and you (and thanks again) are the second person whose results have been shown online. 

If there is scarring in the FUE area, would you theorize that these scars could be punched into at a later date with verteporfin, essentially improving the results. 

Edited by Dragonsphere
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5 minutes ago, Dragonsphere said:

Are the areas of potential scarring limited to the FUT areas? It sounds from your description that FUE area is healing better. 

We are still in the early stages of understanding Verteporfin and you (and thanks again) are the second person whose results have been shown online. 

If there is scarring in the FUE area, would you theorize that these scars could be punched into at a later date with verteporfin, essentially improving the results. 

It’s pretty consistent with Dr Barghouthi vs dr Bloxham’s experiments. Seems FUE is the way to go so far. 

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Posted (edited)
31 minutes ago, Fox243 said:

It’s pretty consistent with Dr Barghouthi vs dr Bloxham’s experiments. Seems FUE is the way to go so far. 

 

It appears the areas closer to the FUT scar is where there could be a higher likelihood of scar tissue creation due to the surrounding tension which makes  complete sense.  

From the description @Killian is planning to do a further round punching into any scarring that does appear from the FUE

If the regeneration rate of the second round is the same, e.g. 70% regeneration on the first attempt then on the second attempt the same rate (which would mean an overall regeneration rate of 90%+), could we not consider this to be a cure? 

It would turn a 6k donor area into a 30k+ donor area. 

Hell, you could always do third, forth etc.

 

Edited by Dragonsphere
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1 hour ago, Killian said:

FYI, from a word document I keep: 

22Jul2023

Verteporfin 50mg x2 in refrigeration, exp: Jul2024

 

Concerns prior to injection.   

1) Effect of blocking YAP in area of severe tension (post-strip period in repeat strip cases which will last for weeks/months) as seen throughout stage one and two of the healing process AND and early remodelling. Injecting visudyne will theoretically prevent/augment the formation of fibrotic tissue/reorganisation of ECM. Fibroblastic phase lasts till week 5 post-op under normal healing circumstances and results in formation of scaffold and skin repair by contractionWill inhibiting this in an area of tension increase propensity for stretching further down the line I wonder? no scaffold or contraction will occur when area is being pulled apart by forces of tension. Tension will be greater in repeat FUT cases and increased further depending on factors such as strip removal against collagen directionality (opposing poles of the strip especially) and strip height owing to a longer period of tension. I suspect stretching and great caution should be applied.

 

2) Effect on homeostasis vs proliferative. YAP activation enacts a reversible pro-proliferative transcriptional proma in keratinocytes and dermal cells that results in accelerated re-epithelialization of the wound bed. Verteporfin is a YAP inhibitor. Epithelialization occurs in proliferative phase allowing cells to migrate and repair the wound. Effect of blocking this??

 

3) Remodelling begins once myofibroblasts begin contraction. Myofibroblasts increase expression of actin stress fibers and integrins, in order to produce the contraction needed to realign collagen. Reduce size of wound and secrete ECM proteins. Blockfing fibroblasts will prevent this, what will be the outcome in, again, an area of tension? 

 

4) Any chemical interaction between tumescence and Visudyne. Unlikely - no

 

5) Hair length essential to cover/reduce light exposure - time taken to inject and scope of area to be treated considering light. 

 

6) Effect of prolonged tension timeline to collagen basket weave structure formation period? 

 

No one fits all protocol may be possible, too many factors in FUT technique and case dependency to consider. Tension timeline will be variable. FUT leaves an atypical healing environment encompassed in tension. A more superficial scar removal later on in the remodelling phase may be safer when scalp laxity has returned and the approximated scalp has healed and is held together by the a deeper scar layer of collagen bundles closer to the galea – must wait till 8 months post op to be safe, ~80% tensile strength return by M6. Virgin FUT patients will have a quicker return to "normal" scalp laxity but repeat FUT patients will have increased tension over a much longer time period and this should be taken into consideration when blocking YAP in the early stages of wound repair.  Leaving bridges of scar tissue present in repeat cases to "hold together" and reduce propensity for tension associated risks - shorter and thinner width FUTs may be safer in repeat cases. Should another full strip be possible bridges of scar tissue are essential, I suspect the risk outweighs the benefit to have a full strip in a repeat case without these bridges.

 

 

16Feb2024.  

No full strip performed. FUE ~260 in donor.

 

The previous strip donor scar was treated with two techniques: punch-out technique and excision with epithelialisation. Verteporfin was then injected to the dermis. The verteporfin was injected to the upper and lower edges of the incision, then closed in two layers; subcutaneous with absorbable stitches 4-0 vicryl followed by upper layer with 5-0 prolene. Additionally, FUE was performed in the occipital donor area with 0.7mm punch and this was treated also with 50mg verteporfin. The treated area was carried out by injecting every 2cm, while at a 45 degree angle to the dermis.

 

Note: off OM for two weeks to prevent graft pop-out rate from minoxidil API. Commenced 2.5mg this evening and 2.5mg 3X (half life ~4hrs) daily for two weeks going forward to increase growth factor influx from vasodilation, thus expedite the healing timeline and increase graft exposure to hemoglobin/ EGF, TGF-alpha, PDGF, TGF-beta, IGF-I, IGF-II. Grafts will connect to blood supply by 72 and fibrin secreted by day 13/14 for full anchorage – out of the Wds, back to normal as usual by then. 

 

Day 1 (17Feb2024):  

 

No post-operative redness around incision line – atypical.

No inflammatory exudate from FUE extraction in normal tissue – highly atypical. Some form of augmentation in hemostasis has occurred I suspect.

 

Day 2:

 

Same observations, untouched look. No pain. Zero exudate on pillow even though slept on back for a full night.

 

Day 3:

untouched look. No pain

 

Day 4:

No formation of scabbing on the incision line. Interesting, usually along the incision line I can see the clotting/forming temporary scabbing. Change to epithelialisation? Slightly Itchy donor localised to the area treated.

 

Day5 – day 14;

Extremely itchy donor, untouched look, no redness. No effluvium of donor.

 

Day21 – entering remodelling phase. Nothing of note.

 

Day22-28:

 

No effluvium of donor, should have happened by now.

Signs of mixed matrix with erythema around incision – capillary dilation/inflammation induced by angiogenesis suggesting scar tissue will be laid down here. Other areas retain normal tissue colour and appear more akin to normal skin appendages – too early to conclude.  I think there will be scarring warranting a second round later this year. Signs of less effect visible in areas of tension and visa-versa. It looks like as suspected tension is a risk factor and the verteporfin not effective here (or as effective). More time to conclude required, will know for sure by M5. Need to punch out areas we didn’t get and I think the right side will be able to be buzzed after. The left side will be problematic due to tension – may need to switch to punch out technique I suspect. Notable improvement of whole area with no.2 haircut and no visible signs at this length. Day25 - the left side I suspect has minor effluvium or stretching in the last week or combination of both. Pain noted here. I lean more to scar matrix than effluvium. Re-evaluate at M2.

 

 

I've mentioned before the use of hgh to expedite healing this is possible with a prescription in most countries 

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@Killiani was unaware one shouldn’t use minox until several weeks after a hair transplant. Interesting. Hope I won’t lose all my gains if I stop before/after my next FUE

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1 minute ago, sr1486 said:

@Killiani was unaware one shouldn’t use minox until several weeks after a hair transplant. Interesting. Hope I won’t lose all my gains if I stop before/after my next FUE

One should stop two weeks prior as it makes implanting more difficult - the grafts become slippery and increase in graft pop-out rate is seen. One shouldn't use topical right after transplant which is correct, but one may use oral Minoxidil right after transplant as it isn't applied to the scalp. 

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On 3/15/2024 at 8:11 PM, Dragonsphere said:

 

It appears the areas closer to the FUT scar is where there could be a higher likelihood of scar tissue creation due to the surrounding tension which makes  complete sense.  

From the description @Killian is planning to do a further round punching into any scarring that does appear from the FUE

If the regeneration rate of the second round is the same, e.g. 70% regeneration on the first attempt then on the second attempt the same rate (which would mean an overall regeneration rate of 90%+), could we not consider this to be a cure? 

It would turn a 6k donor area into a 30k+ donor area. 

Hell, you could always do third, forth etc.

 

No I am planning to do a final round into areas we did not reach via the punch-out technique. The punch-out technique was used on a strip scar, and one cannot punch the whole thing out. The punch-out technique may shrink the scar by up to 20-25%. I have no intentions to punch out FUE scars. 

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7 hours ago, Fox243 said:

@Melvin- Adminany update from dr. mohebi?

I think Mohebi, Pitella they lost interest. The only hope is Barghouthi (at least he said there is some progress in the background). I would say we wait till May, and if there is no update from Barghouthi by then, we must find lesser known surgeon who would agree to do a trial and finance him. There are thousands of HT surgeons not as famous and some will surely agree.

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6 hours ago, Nikoni said:

I think Mohebi, Pitella they lost interest. The only hope is Barghouthi (at least he said there is some progress in the background). I would say we wait till May, and if there is no update from Barghouthi by then, we must find lesser known surgeon who would agree to do a trial and finance him. There are thousands of HT surgeons not as famous and some will surely agree.

Dr. Pittella has at least shared that he doesn't want to continue, so I'd appreciate if Dr. Mohebi at least gave information about whether he has lost interest or if there's some way we can help him proceed. If you can find a lesser known surgeon, feel free to go ahead, but I doubt it would be easy to find one.

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Posted (edited)
36 minutes ago, Fox243 said:

Dr. Pittella has at least shared that he doesn't want to continue, so I'd appreciate if Dr. Mohebi at least gave information about whether he has lost interest or if there's some way we can help him proceed. If you can find a lesser known surgeon, feel free to go ahead, but I doubt it would be easy to find one.

Doctors discussed or active on this forum are probably the best ones, but they are tiny margin. There are literary thousands of doctors who haven't heard of verteporfin, there are younger doctors who would like to do it as a marketing. With 15k and help to source verteporfin I believe I can find a doctor. After  all it doesn't add much complexity, you do your usual job and inject verteporfin.
But that again would take time, so the best outcome for all of us would be if Dr. Barghouthi continues the efforts.

Edited by Nikoni
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I think these conversations are really not necessarily. Dr. Barghouthi said he has dates set for trials. But that was two months ago. @Fox243 Can you contact him to see what's going on ?

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Posted (edited)
20 minutes ago, sansi said:

I think these conversations are really not necessarily. Dr. Barghouthi said he has dates set for trials. But that was two months ago. @Fox243 Can you contact him to see what's going on ?

I'm not sure why people are obsessing over Dr. Barghouthi so much. He was kind enough to let us know that he has dates planned and will do it eventually. Most doctors such as Dr. Mohebi haven't even given a single update. If people want it more rushed, then they should contact other doctors, but people are lazy and just enjoy complaining. There's more than enough data at this point, be it from Dr. Barghouthi's experiment, Dr. Bloxham's experiment, or the numerous experiments done by people such as Killian, KK, Sc0t, SweetLiquor, etc., to either do it yourself or convince other doctors to. 

If Arcturus ends up joining and complaining about the 15k he donated, then I understand. But nobody else has contributed anything, so nobody should have any expectations. 

Edited by Fox243
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2 hours ago, Nikoni said:

Doctors discussed or active on this forum are probably the best ones, but they are tiny margin. There are literary thousands of doctors who haven't heard of verteporfin, there are younger doctors who would like to do it as a marketing. With 15k and help to source verteporfin I believe I can find a doctor. After  all it doesn't add much complexity, you do your usual job and inject verteporfin.
But that again would take time, so the best outcome for all of us would be if Dr. Barghouthi continues the efforts.

Agreed. 

By the end of next year we will have the end result of three cases by Dr Bloxham, Killian's result and hopefully the end results of Dr Barghouthi's upcoming test. Coupled with various other none hair transplanted related results, this should be enough for some doctors to start incorporating it. 

I'd much rather this test be in the hands of a reputable surgeon like Dr Barghouthi than some obscure Dr looking to aggrandise himself at other people's expense. 

The self entitlement in this thread is seriously palpable. 

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Posted (edited)

Keep in mind Dr Bargouthi is a pioneer and the first to do a verteporfin hair transplant..and has updated us every step of the way for the patients recovery and results.... he is the reason we have so much hype and data showing it works! .....he should be treated with respect and not doubt...im sure he is just very busy that's why he hasn't updated lately ...im looking forward to Dr Bloxham's next update as well with his FUT trials

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Hello guys, Am I the only one who thinks that there is too much focus on fut method? I mean that obviously FUE is the future and we have doctors and equipment that are capable to eliminate all the pros of FUT. Sorry but I don't really understand why doctors test this breakthrough medication of fut wasting cases that could have been used to test on fue method.

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1 hour ago, Marios said:

Hello guys, Am I the only one who thinks that there is too much focus on fut method? I mean that obviously FUE is the future and we have doctors and equipment that are capable to eliminate all the pros of FUT. Sorry but I don't really understand why doctors test this breakthrough medication of fut wasting cases that could have been used to test on fue method.

"Wasting cases" you think FUT patients are a waste of time? That these people are insignificant and secondary. 

This is just offensive and entitled on every level. These vials of verteporfin aren't a finite resource for certain people. And it's nobody else's business nor concern as to how they're used by the person who paid for them. 

You have no say unless you pay for the vial yourself, and only then do you have say in your case limited exclusively. 

Why do I even bother posting here I think when I read something like this. I am so disappointed and disheartened on every level by this comment. 

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Can you all please refrain from annoying our Irish savior and legend!
FUE, FUT, UFC ..we don't care! We need to know if this sh*t works ffs 

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4 hours ago, Killian said:

"Wasting cases" you think FUT patients are a waste of time? That these people are insignificant and secondary. 

This is just offensive and entitled on every level. These vials of verteporfin aren't a finite resource for certain people. And it's nobody else's business nor concern as to how they're used by the person who paid for them. 

You have no say unless you pay for the vial yourself, and only then do you have say in your case limited exclusively. 

Why do I even bother posting here I think when I read something like this. I am so disappointed and disheartened on every level by this comment. 

Sorry, I hope you realize the rest of us aren't like this and are grateful for you willing to experiment on yourself and sharing your updates so frequently.

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On 3/17/2024 at 7:25 PM, Fox243 said:

I'm not sure why people are obsessing over Dr. Barghouthi so much. He was kind enough to let us know that he has dates planned and will do it eventually. Most doctors such as Dr. Mohebi haven't even given a single update. If people want it more rushed, then they should contact other doctors, but people are lazy and just enjoy complaining. There's more than enough data at this point, be it from Dr. Barghouthi's experiment, Dr. Bloxham's experiment, or the numerous experiments done by people such as Killian, KK, Sc0t, SweetLiquor, etc., to either do it yourself or convince other doctors to. 

If Arcturus ends up joining and complaining about the 15k he donated, then I understand. But nobody else has contributed anything, so nobody should have any expectations. 

Although several experiments have taken place, any hard data on the efficacy of vp is unfortunately not yet present. It might be my autistic fixation on numbers, but I think that having these would go a long way in getting the movement ahead. Pictures can be very helpful, but also misleading due to things like lighting, angles etc and are therefore a lower form of evidence.

If a reputable doc would find that a donor area has 80 grafts per cm2, from which 30 were removed and the part that was tested with vp contains 65 grafts /cm2 while the untreated area consistantly has 50 grafts /cm2, it becomes really hard to ignore the regeneration, especially if the following studies confirm that finding. 

Given that your organisation donated a capable device for this to dr. Barghouthi, you must have some credit in the bank to at least ask him what the plans are, right? Especially since he also got funds from the community to do such an experiment.

That such information is only shared with those who have contributed something is understandable and logical. 

 

 

 

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