There are now various ways to counteract hair loss. Some are conventional, FDA-approved medications like minoxidil and finasteride.
Others are not approved by any regulatory body. Yet scientific research suggests they can be just as effective, if not more.
One of the more promising treatments in the latter category is microneedling (1). Over the last decade, multiple clinical studies have found that when combined with minoxidil, it can enhance its effect two to four times over.
More recent research suggests that microneedling is also effective on its own, without minoxidil.
In this article you’ll learn what microneedling is, the results you can expect, how to perform it and what to look out for. After reading, you will know if microneedling is a viable treatment option for you or if you should consider alternatives.
What is Microneedling?
Microneedling is a very recent invention in dermatology (2). It is based on the principle of making microscopic, controlled wounds to the skin in order to stimulate healing.
The wounds are made with handheld instruments that are covered in needles. These needles are not deep enough to cause permanent scarring. On the other hand, they are sufficient to stimulate the release of endogenous growth factors, prompting the skin to essentially repair itself.
Doctors first started using it in the mid to late 1990s to heal scars from plastic surgery.
They noticed that microneedling disrupts the collagen that forms scars. This results in remodeling of the skin tissue and significant cosmetic improvement.
To this day, the most popular application of microneedling is for the treatment of scars (3).
Healthcare professionals also use it to treat:
- skin damage from UV radiation
- pigmentation disorders like vitiligo and melasma
- some doctors also use it to enhance the absorption of various topical medications
How Can Microneedling Help with Hair Loss?
Most studies that have looked at microneedling for hair growth have combined it with topical minoxidil. The results suggest that added to an otherwise standard minoxidil treatment, it can significantly increase regrowth.
The exact mechanism by which it does this is not yet clear. The published research suggests there are two different components to its efficacy:
- It enhances the absorption of minoxidil (and possibly most other topical stimulants).
- Microneedling also promotes hair growth on its own, without the help of minoxidil. This probably happens through various means. One is stimulating the dermis to release growth factors in response to the injury from the needles. It probably also activates stem cells in the hair bulge area.
Microneedling: An Effective Treatment Method for Male-Pattern Baldness
Regardless of how microneedling works on a physiological level, the evidence suggests it is one of the most powerful hair loss treatments available. We will now look at the studies with balding men.
Combination Treatment With Minoxidil
In 2013, researchers in India recruited men with mild to moderate androgenetic alopecia, ages 20 to 35 (4).
Forty-four of the men were treated with 5% minoxidil only, which they applied twice daily.
Another 50 men received the minoxidil in combination with weekly microneedling sessions. On the day of the microneedling sessions, these men didn’t apply any minoxidil. They just had the microneedling. Every other day of the week, they applied the minoxidil exactly like the first group of men.
Treatment in both groups lasted 12 weeks.
Results vs Standalone Minoxidil
Results were measured in two ways. Firstly, by taking hair counts in a well-defined area of the vertex that was 1cm in diameter.
Secondly, through before and after photos of the entire head. These were evaluated by a doctor who wasn’t involved in treating the men. The doctor also didn’t know whose photos he was looking at.
The doctor classed each pair of before and after photos as showing either no change, or mild, moderate, or marked improvement.
The minoxidil-treated men got the typical results seen in minoxidil studies: 36% of patients had no change, and the remaining 64% showed mild improvement (regrowth that is barely visible to the naked eye).
The men in the microneedling group had significantly better results.
You can see them in this table:
All men who got the microneedling showed some improvement. 20% had mild, 44% had moderate and 36% had marked improvement.
Marked improvement is the best possible outcome in hair loss studies. You can see some examples of marked improvement from this study in the photos below.
From left to right are the before and after photos of two men in the microneedling group with marked improvement.
The large qualitative differences between the two groups were also reflected in the hair counts. The men in the minoxidil group had an average increase of 22 hairs in the target area. The improvement in the microneedling group was more than 4 times larger, namely 91 hairs.
This is one of the largest differences between two active treatments in the entire hair loss literature.
Research teams from other institutions have since replicated these results.
For example in 2018, there was a similar study out of India (5).
34 balding men were randomly allocated to minoxidil monotherapy, or to minoxidil plus microneedling. Treatment lasted 12 weeks.
Every man in the combination group had increased hair counts at 12 weeks, whereas 24% in the minoxidil-only group showed no increase.
The average increase in the combination group was 12.8 hairs, compared to 1.9 hairs for minoxidil alone. This was a 6-fold difference in regrowth.
Response to Microneedling Treatment in Men Resistant to Conventional Therapy
The research team that published the first paper on microneedling, produced a follow-up study two years later (6).
They studied a small group of 4 men who had been on conventional hair loss treatments with poor results. These were oral finasteride plus 5% topical minoxidil, for a minimum of 2 years and a maximum of 5.
This is typically the most powerful hair loss regimen most doctors will prescribe.
These 4 patients had stabilized their hair loss but had no regrowth.
They then received weekly microneedling sessions as part of the study. The sessions were carried out for 6 months. The first month they were treated weekly, and then once every 2 weeks thereafter. They also continued to take finasteride and minoxidil throughout.
All men saw moderate or marked regrowth. Results appeared as early as 1 month into treatment.
In these photos you can see the head of one patient at the start of the study:
And after treatment:
Can You Use It Without Minoxidil?
Up until recently, there were no studies on microneedling monotherapy. In other words microneedling on its own, without minoxidil or another topical stimulant.
In 2020, researchers from China reported very interesting results on microneedling monotherapy (7).
They recruited 71 male volunteers, ages 20-60, stages 3-6 on the Norwood-Hamilton scale.
The men were randomly split into 3 groups:
- The first applied 5% topical minoxidil daily, with no microneedling.
- The second group received microneedling alone, once every 3 weeks, for a total of 8 sessions.
- Men in the third group received combination treatment: daily minoxidil plus microneedling sessions once every 3 weeks. On the day of the microneedling this group skipped the minoxidil
Treatment lasted 24 weeks, and participants also returned 6 months later for a follow-up evaluation.
The primary outcome measure was the number of new hairs in a one-centimeter squared balding area.
Microneedling vs Minoxidil vs Combination Treatment
Here are the results:
- Group 1, minoxidil alone, had an average of 14 new hairs per centimeter squared.
- Group 2, microneedling alone, had an average 21 new hairs per centimeter squared.
- And Group 3, microneedling in combination with minoxidil, had an average of 40 new hairs per centimeter squared.
The combination group had nearly 3 times as many new hairs compared to minoxidil monotherapy – 2.8 to be exact.
Remember the original 2013 study had found a 4.1 times advantage to the combination, but with weekly microneedling. Here the sessions were every 3 weeks.
The new information in this study was from group 2: the men who microneedled as a standalone treatment – without any minoxidil.
Remarkably, these men had one and a half times the regrowth of the minoxidil group. One microneedling session every 3 weeks outperformed daily minoxidil.
If valid, this is a remarkable finding.
How Permanent Is the Regrowth?
This study also included a 6-month follow-up period, where the participants received no further hair loss treatments. After these 6 months were up, they came back for the follow-up assessment.
The researchers found that 90% of the men who had been treated with minoxidil alone lost all their new hair.
The men in the two microneedling groups had better retention: 10% of these men lost all their newly formed, hair, 70% had mild to moderate hair loss, and 20% retained their hair.
These results suggest that a) microneedling as a standalone treatment is superior to minoxidil, and b) results tend to last longer.
The same Chinese team had previously published very similar results from earlier research (8). They assigned 60 balding men to the same three treatments as in their slightly larger 2020 study.
After 24 weeks of treatment, the change in hair counts in a balding area that was 1cm squared were as follows:
- minoxidil group: 19 new hairs
- microneedling group: 23 new hairs
- combination group: 39 new hairs
Again, the combination group had the best results. This was followed by men in the microneedling only group, who once again slightly outperformed minoxidil monotherapy.
Microneedling for Alopecia Areata
Aside from male pattern baldness, microneedling is also effective for other types of hair loss. One promising indication is Alopecia Areata (AA).
This is an autoimmune condition that leads to abrupt and patchy hair loss (9). Unlike pattern baldness, AA often reverses completely in some patients. Others, however, will not respond to any treatment.
A 2014 study looked at the effects of microneedling in combination with a topical corticosteroid (10).
Two patients, one male and one female, presented with alopecia areata that had not responded to various prior treatments. You can see the man’s head prior to the combination treatment in these photos.
With the use of microneedling therapy, he experienced complete regrowth:
The woman also showed significant regrowth, though not complete.
These results suggest that microneedling in combination with topical steroids can be effective in resistant AA. Future studies can look at the potential of microneedling to reverse AA on its own, without a topical steroid.
Clinic or At-Home Sessions?
You can perform microneedling in a clinic or at home.
The benefits of in-clinic treatment include the use of high-quality tools and access to professional knowledge and expertise.
Licensed microneedling professionals such as dermatologists and beauticians will perform your treatments with the appropriate device and technique.
They will also ensure there is no serious or permanent damage from the procedure. For this reason, if you are interested in microneedling, you can do well to speak with your healthcare provider and explore your options.
On the other hand, a clinical session can be cost-prohibitive. If your insurance does not cover it, a single session can cost between $200-700.
For this reason, many users opt to perform microneedling at home. The downside is a high chance of improper technique and poor results. Also, if you use poor hygiene, you also risk infection to your scalp.
To begin microneedling therapy at home, you have a few options:
We will look at each of these in turn.
This is the most common dermarolling device.
It consists of a handle attached to a rotating barrel. On the surface of the barrel are between 100-200 needles. As you roll the dermaroller over your scalp, they penetrate the skin.
The advantage of the dermaroller is that it’s quick. Because you just roll it across the skin, you can cover large areas of the scalp in a short time.
(Claim your free dermaroller here)
To use the dermaroller effectively, focus on the direction of application as well as the pressure applied. Roll it two or three times over a certain area, in all directions: up and down, sideways, and diagonally.
The dermaroller should not cause pain, though you may experience discomfort. Also, try not to draw blood. This means you should only apply enough pressure for the needles to penetrate the scalp superficially.
With the dermastamp you stamp the needles vertically stamped into the skin, instead of rolling them.
This makes the device more precise and causes less damage.
You can find dermastamps with fixed or adjustable needle lengths. In the adjustable versions, you rotate the handle of the device, and depending on the rotation the needles protrude to various degrees.
Derma stamps are somewhat less common than dermarollers, but still quite easy to find online.
To use the stamp, apply horizontally to the area you wish to target and hold in place for 3 – 5 seconds. Rotate the stamp vertically and apply pressure, and then rotate diagonally and do the same.
This is a device that is similar to the dermastamp, but battery-operated. A dermapen typically uses a disposable microneedle tip in the form of a cartridge. The cartridge pulsates up and down at a certain frequency. This means you can slowly glide it along your scalp rather than lifting and stamping. The dermapen will do most of the work for you.
Because the needles are mechanically stamped into your skin at high speeds, you need fewer of them to get the job done. There are typically only 5 to 9 needles per cartridge.
The advantages of the dermapen are that it is fast, effective, and fully customizable.
On the other hand, being electrified, it is a more complicated device. This makes it more likely to break down and require replacement.
It also costs more. Prices start from around $20-30 for cheap, no-name devices. This goes all the way up to several hundred dollars for branded, quality devices.
Then there is the cost of the cartridge, which you have to replace after each use.
Regardless of which device you use, proper sanitation is key.
First and foremost, always sterilize the instrument before use. Two ways to do this are to soak it in alcohol or boil it. Either way, allow the device to air dry.
Second, wash your scalp and hair carefully prior to application. Ideally, you should aim to let your hair air dry.
Potential Side Effects and Complications
As microneedling involves intentional wounding, there is always the risk of complications and adverse effects.
The most common side effects include redness, tingling and irritation, bruising, and even oozing from the wounds. Redness and inflammation are very common. According to the American Academy of Dermatology, they should subside after 5-10 days.
Certain patient populations should not perform microneedling without proper medical supervision. These include:
- pregnant women
- people with hemophilia or other conditions that inhibit healing
- patients on blood thinners or similar medications
- people with acne, eczema or any other skin condition
Regardless of which device you use, over time the needles will become blunt. When that happens, you should dispose of them and replace them with a new device (or cartridge in the case of a dermapen).
Finally, never share your dermaroller with anyone else.
Side Effects In Combination With Minoxidil
As shown in the studies we reviewed, microneedling can increase the absorption of minoxidil and maximize regrowth. However, it is best not to use minoxidil on the days you microneedle. Applying it immediately after a microneedling session can cause the following side effects:
The most severe complication is infection. This is always a concern whenever a wound is present. To prevent this from happening, you should keep the scalp clean and sanitize the tool before each use as described above.
As a natural and easily accessible hair loss treatment method, microneedling stimulates new cell production and encourages the growth of new hair.
Research suggests that added to minoxidil, microneedling can increase its effectiveness up to four times. There is also evidence to suggest it is effective as a stand-alone treatment.
Though possibly one of the most effective hair loss treatments currently available, microneedling is not the magic bullet for baldness.
Like other treatments, results will typically last as long as the treatment. When you discontinue treatment, it is likely you will lose most of the hair you have regrown.
Nevertheless, its high efficacy, low cost, and relatively small time demands will make it an attractive option for many men with hair loss. Another advantage is that with proper technique, serious adverse effects are rare. As always, it is highly advisable you consult a healthcare provider or dermatology practitioner prior to starting treatment.