Microneedling For Hair Loss

Article written by Dr. Blake Bloxham 

Microneedling, originally popularized for skin rejuvenation, has gained traction as a potential treatment for hair loss. The technique involves using tiny needles to create controlled micro-injuries on the scalp, which can stimulate healing and regeneration, potentially encouraging hair growth under very specific conditions. 

But what happens when those conditions aren’t met? What if the size of the needle or the depth of the wound is incorrect? What if the frequency of wounding is not done properly? Will this actually cause harm? 

The results we see online mixed with these questions make microneedling a controversial subject. Patients must understand the potential risks and benefits. This article will discuss common microneedling protocol; including frequency, recommended tools, and performing the procedure. 

The article will also review the evidence behind microneedling; the efficacy, side effects, and conclusions from researching experts. Finally, we will discuss the controversy behind microneedling. 

Interested in learning more about microneedling? Is it something you want to try, but you’re not sure if it’s effective, evidence-based treatment or something to avoid? If so, read on to learn what you need to know about microneedling for hair loss.

In 2021, Dr. Aditya Gupta (et al) published a comprehensive summary of the microneedling studies. Through this meta-analysis, his team reviewed the evidence behind microneedling, the studies reviewing microneedling, and drew conclusions about its safety and efficacy (Gupta, et al, 2021). 

Dr Gupta’s team evaluated all available published data and refined criteria to include 9 clinical trials. These studies investigated microneedling alone, the combination of microneedling and 5% topical minoxidil (“Rogaine”), and topical 5% minoxidil alone (Gupta et al, 2021). Microneedling alone significantly increased hair count more than topical minoxidil monotherapy by 12.93 hair per square centimeter (hair/cm^2) (Gupta et al, 2021). Furthermore, the addition of 5% topical minoxidil to microneedling increased hair count by 7.6 hairs/cm^2 (Gupta et al, 2021). Based on this evidence, it appears microneedling is an effective hair loss treatment and even more efficacious when used in conjunction with topical minoxidil. 

Dr. Gupta’s team drew several other important conclusions: First, and foremost, quality studies evaluating microneedling for hair loss are lacking. Second, microneedling appears to work better in female patients. Third, the length of the needle and depth of the wound seems to play a role. Fourth, the frequency of microneedling plays a role as well — with increased frequency showing worse and progressively worsening results (Gupta et al., 2021). 

Dr Gupta’s team also found adverse effects minimal and mainly related to temporary pain and irritation from the microneedling procedure (Gupta et al., 2021). 

This analysis suggests microneedling is a relatively safe and effective procedure. So, should you try it? Any other considerations?

So, you reviewed the evidence and decided to microneedle. Now how should it be done and what can you expect? 

How Often Should You Microneedle for Hair Loss?

The frequency of microneedling for hair loss depends on the needle length and individual needs. Here’s a general guideline based upon anecdotal practices:

0.25 mm to 0.5 mm needles: These smaller needles can be used more frequently, such as 2–3 times per week, as they mainly enhance the absorption of topical treatments. Microneedling this frequently with larger needles is not recommended and likely harmful based upon the results of Gupta’s review (Gupta et al., 2021). 

1.0 mm to 1.5 mm needles: For deeper stimulation of collagen production and hair regrowth, these larger needles should be used less frequently, typically once every 2–4 weeks to allow sufficient healing time.

Professional treatments: When done by a dermatologist or trichologist, professional microneedling sessions may be spaced out to every 4–6 weeks, depending on the intensity of the procedure and the patient’s skin response. Seeking professional microneedling treatments is highly recommended.

The size of the microneedling device’s needles plays a crucial role in determining its effectiveness and safety. Here’s a breakdown of commonly used sizes:

0.25 mm: Mainly used to enhance the penetration of topical treatments like minoxidil. It does not stimulate hair growth on its own.

0.5 mm: Effective for improving absorption of topicals while offering some stimulation to hair follicles. It’s commonly used for home treatments.

1.0 mm: This size is considered the minimum for promoting collagen production and inducing hair growth by creating micro-injuries that trigger healing.

1.5 mm: Used for more intense treatments, often in clinical settings. This size deeply penetrates the scalp and can significantly enhance hair regrowth.

For home use, it’s generally recommended to stick with needles no larger than 1.0 mm to minimize the risk of adverse effects. Since clinical evidence shows the greatest efficacy using minoxidil (or potentially other topical treatments) with microneedling and the least potential for damage using the shortest needles, perhaps this approach is best for patients microneedling at home.

Ready to try microneedling at home? Here are some general recommendations:

Cleanse your scalp: Ensure your scalp is clean to reduce the risk of infection.

Sterilize the microneedling device: Soak the derma roller or pen in rubbing alcohol for 5–10 minutes to disinfect it before use.

Roll or stamp gently: Use light pressure to roll or stamp the microneedling device across the scalp in different directions—horizontally, vertically, and diagonally. Avoid overworking any one area.

Apply topical treatment: After microneedling, apply a topical hair loss treatment like minoxidil or a growth serum to enhance absorption.

Sterilize the device again: Clean the device thoroughly after each use to prevent contamination.Microneedling at home with smaller needles (0.25 mm–0.5 mm) is generally safe, but if you use larger needles, limit the frequency and ensure you’re following proper aftercare procedures.

The cost of microneedling for hair loss can vary based on whether you opt for professional treatments or perform the procedure at home:

At-home devices: Derma rollers and microneedling pens for home use typically range from $20 to $150, depending on the quality of the device.

Professional treatments: In-office microneedling performed by a dermatologist or trichologist can cost between $200 and $700 per session. The total cost depends on the clinic, location, and number of sessions required.

Many people choose to combine at-home treatments with occasional professional sessions for more comprehensive results, which can help manage the cost.

When choosing between a 16-pin and 36-pin microneedling device for hair loss treatment, it’s essential to understand how the number of pins affects the procedure’s effectiveness and comfort. Here’s a breakdown to help you decide:

Fewer Pins, Deeper Penetration:

With fewer needles, the device exerts more pressure per pin, allowing for slightly deeper penetration into the skin. This can be beneficial for targeting the dermal layer where hair follicles reside.

Targeted Treatment:

Ideal for smaller or more focused areas, such as thinning spots or localized bald patches.

Less Skin Coverage Per Pass:

Requires more passes to cover larger areas, which could increase treatment time.

Mildly More Discomfort:

Fewer pins can create a sharper sensation during treatment.

More Pins, Shallower Penetration:

The pressure is distributed across more needles, making the penetration slightly shallower but covering a broader area.

Faster Treatment:

Covers larger areas quickly, making it efficient for widespread thinning or general scalp rejuvenation.

Smoother Procedure:

Often less discomfort as the pressure per pin is reduced.

Suitable for Maintenance:

Good for enhancing scalp health and improving absorption of topical treatments (e.g., minoxidil).

Your choice depends on your specific needs:

Opt for 16 pins for targeted, deeper stimulation.

Choose 36 pins for quicker, more comfortable treatments over larger areas.

If unsure, consult a trichologist or dermatologist to determine the most effective option for your hair restoration goals.

Dr Gupta’s review and many anecdotal experiences shared online portray microneedling as a safe treatment. But are we missing anything? Is there any expert opinion to the contrary? 

In 2021, Dr Groana Kuka-Epstein — a plastic surgeon, hair transplant surgeon, and experienced microneedling practitioner — published an interesting review in the International Society of Hair Restoration Journal. In it, she acknowledges the theories behind why microneedling for hair loss may work. However, she also offers an interesting theory: she believes there is a very specific depth at which scalp wounding creates regeneration. At all other depths, it simply creates wounding which ends in fibrosis — IE: scarring (Kuka-Epstein, 2021). 

The depth (in the dermis portion of the skin) will differ slightly for each patient. Therefore the chances of reaching this level consistently without causing fibrosis are “slim.” While it is possible to achieve regeneration with microneedling, it is very likely sub-dermal (below the skin) scarring is occurring as well. It is yet to be seen what this means in the long-term and should be studied further 

Microneedling for hair loss is an understudied and somewhat controversial treatment. Despite some concerns, however, clinical evidence shows it is effective — especially combined with other topical treatments. When used correctly, it may stimulate hair growth, improve scalp health, and boost the effectiveness of topical treatments. Whether done professionally or at home, following the correct guidelines and ensuring proper hygiene is essential for achieving safe and effective results.

References: 

Gupta, A.K. et al. (2021). Microneedling for Hair Loss. Journal of Cosmetic Dermatology. 21: 108–117. https://doi.org/10.1111/jocd.14525

Kuka-Epstein, G. (2021). Regenerative Medicine and Hair Loss: Microneedling – Is the Pain Really Worth it? Hair Transplant Forum International. 31 (1) 18-20; DOI: https://doi.org/10.33589/31.1.18