Verteporfin Hair

Article written by Dr. Blake Bloxham 

One of the most discussed new hair restoration treatments is verteporfin. Verteporfin – brand name “Visudyne” – is different from other potential new or “futuristic” treatments. What makes verteporfin special is its established safety and efficacy profile and US Food and Drug Administration (US FDA) approval. Furthermore, verteporfin has potential applications in both hair transplant surgery and as a stand-alone hair restoration treatment. But what is verteporfin? How does it work and how does it apply to hair loss? Finally, what is the current state of research and is it available to patients? 

Verteporfin (Visudyne) is an FDA-approved drug for treating age-related macular degeneration (AMD) and is also used off-label for central serous retinopathy, two important ophthalmologic conditions which may cause blindness if left untreated. It is typically given through an IV and then “activated” by a very specific light shined through the patient’s eyes.  It is well-tolerated, with minimal side effects like light sensitivity. Until recently, there was minimal research and discussion about verteporfin and how it may treat other conditions. However, this changed a few years back. Research from Stanford University clarified a suspected “off label” use for verteporfin: injecting verteporfin after a wound to promote scarless skin regeneration and restoration of normal skin appendages. These normal “skin appendages” may include hair follicles (which are typically absent in skin healing with scar formation). 

Verteporfin promotes scarless healing and skin appendage regeneration by blocking a crucial protein called “Yes Associated Protein” or “YAP” during wound healing. After a wound occurs, YAP is responsible for traveling to specific fibroblasts or “scar cells” and blocking their activity. This prevents fibroblasts from laying down fibrotic tissue and creating a scar. This allows the body to heal through pathways which promote normal skin healing. In other words: healing without scar tissue and a lack of normal skin appendages like sweat glands and hair follicles. 

A detailed study at Stanford University demonstrated verteporfin’s efficacy in both mice and pig models. In mice, full-thickness skin wounds treated with verteporfin healed to the point of being nearly indistinguishable from normal skin, with complete restoration of skin appendages, ultrastructure, and mechanical strength. In pigs, which are said to be the most suitable model for human skin, full-thickness wounds as wide as a thumb and five inches long were treated with verteporfin around the edges after suturing. After 16 weeks, the treated skin showed dramatically less scarring, appearing almost identical to unwounded skin. 

Initial human trials have demonstrated promising outcomes in hair restoration and plastic surgery procedures. In early-stage experiments conducted by Dr. Taleb Barghouthi, Dr. Blake Bloxham, and Dr. Melissa Toyos, patients receiving verteporfin injections in hair transplants and scar revisions showed significantly reduced scarring and increased new hair growth compared to control areas. These preliminary results suggest verteporfin’s potential to transform hair transplant procedures by minimizing scars and enhancing hair regeneration. To date, there has been no drug that has been able to generate de novo (brand new) hair follicles besides verteporfin. 

Dr. Barghouthi’s Verteporfin Trial:

Dr. Barghouthi conducted a trial using verteporfin on a test FUE hair transplant procedure. Three control sites and three test sites were established across the donor region. Control sites were injected with placebo fluid (saline), while the test sites received verteporfin at different concentrations. 

The patient was monitored weekly for the first month and monthly thereafter. At the four-month mark, visual observations indicated a 33% reduction in scarring in the test sites, with new hair growth seen only in these areas. At nine months, biopsies from the test sites revealed 10 hair follicles, with three in the anagen (growth) phase, compared to only five follicles in the control sites, with just one in the anagen phase. Minimal dermal fibrosis (scarring) in the test sites further supported verteporfin’s effectiveness in promoting hair regeneration and reducing scarring. Results are shown below.

Dr. Bloxham’s Verteporfin Trial:

Dr. Bloxham treated three patients with verteporfin:

Verteporfin Patient #1 (Scar Revision)

A patient with prior FUT surgery had hypertrophic scarring. Four sections of hypertrophic scarring were excised and treated with different dosages of verteporfin, with untreated areas used as controls. A part of the wide scar was also excised without verteporfin to serve as an additional control. Verteporfin-treated sections showed improved healing with reduced scarring compared to the untreated controls.

• Natural hypertrophic scar formation. Would not have have recommended scar revision without verteporfin.
• Prior excisions closed with staples with no deep layers 
• 1cm hairless gap, well defined, fibrotic, no hair growth

• Excision, injection with high dose verteporfin (no deep layers).  
• No hypertrophy, amorphic , supple “skin like” tissue with scar, subtle hair growth scattered throughout.

Verteporfin Patient #2 (FUT) 

Patient photos coming soon!

 A patient with no prior FUT surgery had a section excised from the back of the head and injected with verteporfin, while two other sections were excised without verteporfin. The verteporfin-treated area demonstrated less scarring and better healing outcomes than the untreated controls.

Verteporfin Patient #3  

9 Months After Treatment 

• Excision and closure with no verteporfin
• 4-5mm defined, fibrotic scar
• Void of hair follicles
• Loss of hair under scar

• Excision treatment with 0.4mg/cm^2 verteporfin, and closure.
• 4mm defined fibrotic scar, worst healing at apex (point of highest tension).
• Scar void of hair follicles 
• Loss of hair under scar

• Excision treatment with 0.8mg/cm^2 verteporfin, and closure.
• 1-1.5mm defined amorphic area that appears mixed fibrotic and fibrotic scar tissue. 
• Hair follicles growing through area 
• No obvious defined region of loss under tissue.

Figure 6: Alternate view of patient 3 after 9 months, where the red box is the normal scar revision and green box is the 0.8 mg/cm^2 scar revision with verteporfin. Note the green box being a narrower scar with hair follicles growing through it.