Microneedling: a powerful, under-researched hair loss therapy
In the last five years, microneedling therapies have exploded in popularity – especially among hair loss sufferers.
Research now shows that microneedling can increase hair counts by 15%. And as clinical evidence for microneedling continues to grow, so do the devices available to consumers: microneedle rollers, microneedle stamps, and even automated needling devices – with needle lengths ranging from 0.25mm to 2.5mm (and higher).
But with microneedling research still in its infancy, there’s one big question that researchers have yet to answer:
When it comes to treating pattern hair loss, what’s the best microneedling needle length? 0.25mm? 0.5mm? 1.0mm? 1.5mm? 2.0mm? Higher?
Despite what microneedling manufacturers tell you, there is no clear-cut answer.
Rather, the evidence indicates that when it comes to treating pattern hair loss, the right microneedling needle length is highly contextual. It depends on (1) how frequently you plan on microneedling and (2) whether you’re combining microneedling with other treatments.
This article dives into the research to uncover the evidence, and how to best position yourself for hair regrowth if you decide to start microneedling.
What is microneedling?
Microneedling is a stimulation-based therapy for hair loss. Similar to platelet-rich plasma therapy and massaging, microneedling leverages acute wounding in balding scalp skin (via medical-grade needles) to evoke growth factors. Over time, these growth factors may help to (1) promote the formation of new blood vessels, (2) reduce the appearance of scar tissue, and (3) promote hair follicle proliferation.
Yes, the therapy hurts. And yes, microneedlers look like small medieval torture devices.
A microneedle roller used for hair loss
But despite the pain involved in therapy, microneedling – when repeated once or twice-weekly, and for 3-6 months – have been shown to greatly improve hair growth in men with androgenic alopecia (AGA).https://link.springer.com/article/10.1007/s13555-021-00653-2
Just see the results of this 2017 study, which demonstrated hair count improvements of ~15% for those using microneedling devices without any other treatments.
Microneedling for AGA: results over six months (bi-weekly sessions)
Or the results of this 2013 study, which found that microneedling enhanced the regrowth achieved from 5% minoxidil by 400%.
Microneedling + 5% minoxidil for AGA: results over three months (weekly sessions)
In short: microneedling is effective at improving pattern hair loss (AGA) in men. But questions still remain as to its best practices. Questions like:
- How far apart should we space our sessions? Daily? Weekly? Monthly?
- How long should our sessions be? Five minutes? Ten? Twenty?
- What’s the best needle count? 192 needles? 540 needles? More?
- What’s the best needle length? 0.25 mm? 1.0 mm? 2.0 mm? More?
…and many more.
The truth is that it’s impossible to answer any one of these questions without answering the others. After all, these questions are all interlinked. The smaller the needle length, the quicker your healing, the more frequently you can microneedle. And the higher your number of needles, the more inflammation you can evoke, and the shorter your sessions can be.
Having said that, the best needle length debate might be answerable by itself. Why? Because at different needle lengths, microneedling has different effects.
Microneedling needle lengths: different puncture depths, different effects on the hair follicles
Our scalp skin consists of three main layers: the epidermis, dermis, and hypodermis (i.e., subcutaneous layer).
The thickness of our scalp (and its subcomponents) is influenced by our age, gender, and degree of balding. But in general, our scalp skin is just 5mm to 6mm thick.
Within that skin, our epidermis is usually less than 0.5mm thick, our dermis is 1-2mm thick, and our subcutaneous layer is 3mm thick.
This has significant relevance to microneedling needle lengths. Why? Because the depths at which these needles puncture our scalps has a direct influence over which regions of the hair follicles we will stimulate.
Needle lengths of 0.25 mm to 0.5 mm may improve topical absorption
At shorter needle depths (i.e., 0.25mm to 0.5mm), microneedling only wounds the top layers of the skin (the epidermis). This will improve the absorption of topicals (i.e., minoxidil). However, these shallower depths likely won’t evoke the growth factors necessary to encourage hair follicle proliferation. For this effect to occur, we need to incur wounds deeper – specifically, we need to wound the dermis.
Needle lengths of 1.5 mm to 2.5 mm may evoke growth factors for hair follicle proliferation
At longer needle depths (i.e., 1.5mm to 2.5mm), microneedling needles will puncture the dermis of our scalp skin. This has important ramifications to hair follicle proliferation, because the dermis is where the hair follicle stem cell bulge resides. It’s also where there are vascular networks – such that punctures at this depth ofte lead to swelling and/or pinpoint bleeding.
What is the hair follicle stem cell bulge?
The hair follicle stem cell bulge is located 1.0 mm to 1.8 mm deep in our scalp skin near the isthmus (upper third) of the hair follicle – and can usually be found at the base of the arrector pili muscle.
This hair follicle stem cell bulge is sort of like the “source material” for a hair follicle. These stem cells help replenish and repopulate the cells that constitute each hair follicle. If a hair follicle’s stem cell population is completely depleted, hair follicles can no longer replace old cells, and the hair follicles will stop proliferating (or growing).
Hair follicle stem cell bulge
Interestingly, we can stimulate these stem cells via wounding. If wounds are incurred surrounding these stem cell bulges, the growth factors stimulated during wounding can even signal to these hair follicle stem cells to initiate a new anagen phase of the hair cycle.
For pattern hair loss sufferers, this often means increases to hair counts within the realms of 15% – and that’s without any other therapies. That’s an impressive improvement. But again, it bears repeating…
We only see these hair count increases from studies using microneedling devices (by themselves) that puncture 1.5mm to 2.5mm deep. In other words, we only see these hair count increases at microneedling lengths that stimulate the hair follicle stem cell bulge.
Long-story short: we likely need to microneedle at depths of 1.5mm to 2.5mm if we’re to expect appreciable stimulation of the hair follicle stem cell bulge, and thereby appreciable hair follicle proliferation (i.e., hair regrowth).
Now, it’s worth noting that studies testing microneedling as a monotherapy have only ever investigated needle lengths of 1.5mm and greater. So, the absence of evidence should not imply evidence against shorter needle lengths. But we also have to make recommendations based on what is known, not postulated. So, consider these limitations as you keep reading.
So, should we all microneedling at needle lengths of 1.5mm or greater?
When it comes to needle depths, there is an upper limit. Specifically, we want to avoid puncturing something called an emissary vein.
Emissary veins are bi-directional blood vessels that run from the scalp’s hypodermis (i.e., muscle tissues) through the cranium (i.e., skull bone) and into the brain. When brain infections occur following scalp injuries, they are almost always the result of a puncture to the emissary vein – as an open emissary vein can allow pathogenic bacteria from the epidermis to bypass the skull plate and migrate directly into brain tissues. This can cause serious health ramifications, and even death.
Emissary veins aren’t everywhere on the scalp. And in general, they’re located at depths deeper than 5mm – at the bottom edges of the hypodermis.
There’s no reason for us to risk wounding an emissary vein via microneedling – especially because we can stimulate the hair follicle stem cell bulge at shallower depths (i.e., 1.5 mm to 2.5 mm).
Moreover, the studies that we do have on microneedling for pattern hair loss don’t test needle lengths above 2.5mm. So, don’t deviate from what is clinically supported; don’t go deeper than needle lengths of 2.5mm.
So, now that we’ve established a lower and upper limit for mironeedling needle lengths, let’s revisit that question: which needle length is best for regrowing hair?
Microneedling for hair growth: what’s the best needle length?
Since microneedling research is still in its infancy, we don’t yet know the best needle length. But we can give you a general idea of the best needle lengths based on the clinical studies on microneedling published so far.https://link.springer.com/article/10.1007/s13555-021-00653-2
- In a 2013 study, participants used 5% minoxidil twice-daily alongside microneedling with a 1.5mm needle roller once-weekly. Over three months, the author (Dr. Dhurat) found that the 1.5mm needle roller improved hair regrowth from minoxidil by 400%.
- In a 2015 study, participants used minoxidil and finasteride daily alongside microneedling with a 1.5mm needler roller either once-weekly or twice-weekly. After six months, the researchers found significant increases to hair counts. (5)
- In a 2017 study, participants used 5% minoxidil alongside a 1.5mm to 2.5mm automated needler once every two weeks. Over six months, the investigators found comparable hair count increases to that of Dr. Dhurat’s 2013 study. They also found that microneedling alone improved hair counts by ~15%.
- In a 2020 study, participants applied 5% minoxidil twice daily and microneedled once every two weeks with either a 0.6mm or 1.2mm needle length roller for 12 weeks. They found that microneedling with either length was more effective than 5% minoxidil twice daily by itself. In terms of statistical significance, the study showed that there was no statistical difference between the two lengths with respect to improved hair counts: in conjunction with minoxidil, the 1.2mm needle improved hair counts by about 15% while the 0.6mm needle improved hair counts by about 19%.
But these aren’t the only studies done on microneedling for hair loss. There are many more, which we’ve discussed in our systematic review on the subject (recently published in Dermatology and Therapy).https://link.springer.com/article/10.1007/s13555-021-00653-2
What do all of the studies tell us?
- So far, we’ve clinically tested microneedle lengths from 0.25mm to 2.5mm for men with androgenic alopecia (AGA).
- However, only needle lengths of 1.5mm to 2.5mm were tested as a monotherapy (i.e., not in conjuction with minoxidil or other treatments).
- At depths of 0.6mm to 2.5mm, microneedling is suspected to increase both topical absorption (with minoxidil) and hair follicle proliferation (as a standalone treatment).
And while the 2020 study demonstrates shorter needle lengths may produce results comparable to longer needle lengths (at least with respect to hair counts), the majority of evidence still supports the use of a 1.5mm to 2.5mm needle length.
The rationale? There are two factors to the depth of penetration when using microneedles: needle length and applied pressure. In earlier studies, 1.5mm needles were used to evoke erythema (skin redness) whereas, in the 2020 study, the authors aimed to evoke bleeding.
This is an important distinction to make.
Because evoking bleeding involves more pressure than just evoking erythema, it’s possible that both the 2020 study (using 0.6mm and 1.2mm needles) and the earlier studies (using 1.5mm needle lengths) penetrated to similar depths — simply due to differences in applied pressure.
The equation also gets more complicated when we evaluate not just “session endpoints”, but also the fact that microneedling rollers versus automated pens puncture at different depths in the scalp skin… even when controlling for the same exact needle length.
Why? Because microneedling rollers “roll” the needles onto the skin. That means the depth those needles actually penetrate is subject to angulation changes and user pressure variability (i.e., how hard someone presses down). However, with automated microneedling pens, studies suggest that needling penetration depths near-perfectly match needle lengths (up to 1.5mm, at least).
Resultantly, the best data we have suggest that microneedling rollers penetrate, on average, just 50-75% of their actual needle length. This makes it even more difficult to make needle length recommendations, because the actual microneedling device influences the answer.
What can be gleaned from all of the data?
Taking into account session endpoints, device differences, hypothetical mechanisms, and clinical outcomes from our latest systematic literature review on microneedling for hair loss, here are the needle lengths we currently recommend:
- Microneedling roller. Use a 1.0-1.5mm needle length.
- Microneedling automated pen. Use a 0.6-0.8mm needle length.
These recommendations will hopefully improve topical absorption, stimulate growth factors linked to hair follicle proliferation, and minimize any concerns over infection or the puncturing of short an emissary vein.
Moreover, stick with needling once weekly, or once every two weeks. Again, it’s clinically effective. Other recommendations on other websites are theoretical, anecdotal, and generally unsubstantiated.
What about microneedling every day with a 0.25 mm or 0.5 mm needle length?
As stated earlier, it’s important to note that the absence of evidence does not imply evidence against any treatment protocol.
In other words, just because we don’t have studies trialing needle lengths smaller than 1.5mm for pattern hair loss (as a standalone treatment), this does not mean that smaller needle lengths are ineffective. It’s just that evidence supporting smaller needle lengths is unsubstantiated.
There are some YouTube personalities claiming to see great microneedling results from microneedling nightly with a 0.25mm and then immediately applying topicals. There are some men on HairLossTalk who are demonstrating results from microneedling every night with a 1.0mm roller.
There may be some benefits to microneedling more frequently – particularly if you’re also using a topical. For example, due to the relatively short half-life of topical minoxidil, users must apply minoxidil twice-daily in order to elicit a significant effect on miniaturizing hair follicles. Microneedlers with needle lengths of 0.25mm to 0.5mm help to increase topical absorption. Moreover, because these needle lengths typically only puncture the epidermis, they can be used more frequently (i.e., once daily) versus microneedlers with needle lengths of 1.5mm+ (i.e., once every week or more).
Thus, some might argue that daily microneedling with a smaller needle length might help to more regularly promote topical absorption, and that this benefit might outweigh the stimulation of growth factors elicited from needle depths of 1.5mm and beyond.
But again, these stories are just anecdotes; and the rationales behind shorter needle lengths and more frequent needling are just hypothetical. While we do have people trialing augmented microneedling lengths and schedules in our membership community (with great success), we can’t yet extrapolate their results to what all pattern hair loss sufferers should expect.
Long story short: until these anecdotes stand the test of a clinical trial, we must make our recommendations based on the evidence already available… and that means recommending a 1.5mm to 2.5mm needle length.
The bottom line: for now, stick with 0.6-0.8mm needle lengths for automated pens, and 1.0-1.5mm needle lengths for rollers
These needle lengths are what worked in clinical trials, and they seem to be working well for the people inside of our membership site.
Questions? Comments? Please reach out in the comments section.
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published five peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.
87 thoughts on “Microneedling For Hair Loss: What’s The Best Needle Size?”
Wayne here. Thanks for the informative article! Would you recommend using a dermaroller, a stamp, or a pen? And how much time to spend on an area (maybe in relation to needle count?)? Thanks!
I am a female with receding hair loss. I was wondering what type cartridge size should I use? Some say 12 others say 36?
Also I have seen great results on line for males microneedling once per week. Does this also apply if you are female?
Thanks for reaching out. The short answer is that there is not yet any research confirming that for female AGA patients, microneedling is as effective as it is for male AGA patients. Having said that, if your female hair loss is truly androgenic in nature, than it’s presumable that microneedling might help.
As far as microneedling timings, I don’t believe the recommendations would vary greatly across genders. Here’s an article that helps explain a bit more about microneedling intervals, and which ones may make the most sense. Full disclosure: microneedling frequency is highly dependent on needle length:
In my opinion, this all depends on personal preference. Of the two clinical study we’ve seen on minoxidil + microneedling, one used a roller and the other used an automated needling pen. Both achieved the same ballpark for results.
From personal experience, the rollers hurt a lot more than the pens or stamps. The automated pens can drastically reduce the amount of time required rolling. At the same time, the pens are a lot more expensive.
In any case, I think the rollers or automated pens are the way to go. I find the stamps a bit tough to use especially in regard to repeat wounding of the same areas. The rollers / pens make that process a lot easier to track – as you can simply change the direction of your roll / drag.
Thanks for article!
Does microneedling helps with fibrosis and calcification? I used dermapen for more than three months (+- weekly) but I didn’t get any results at all. I read on reddit and hairlosstalk that most people using dermarolling only didn’t get much results as well altough studies might claim something else. After that I started with scalp massages (30 min a day) and the benefits were definetely much better. 3 months in and shedding decreased by 50%, scalp is looser but zero regrowth so far. I’m really wondering how does microneedling + minoxidil helps with scalp condition in terms of fibrosis and calcification and loosening the scalp because the results of using this method are sometimes really spectacular compared to minoxidil or dermarolling only.
Thanks for reaching out. Microneedling seems to help reduce the appearance of fibrosis – with some studies showing improvements to acne scars with repeated treatments over 3+ months: https://www.ncbi.nlm.nih.gov/pubmed/26203319
From what I saw on HairLossTalk, a lot of people saw significant results with microneedling / microneedling + minoxidil. This thread is a great resource: https://www.hairlosstalk.com/interact/threads/microneedling-photo-results-summary.121072/
Since microneedling is still relatively new, it’s unclear the effects this therapy might have on calcification. It does seem to improve fibrosis in many cases, though this has only been predominantly studied in acne patients and only theorized to potentially translate to pattern hair loss sufferers. In terms of microneedling + minoxidil – I think the bigger benefit to this combination therapy is the potential for enhanced topical absorption, and less so an impact on fibrosis.
We have a paper coming out about fibrosis and AGA that will help to explain the point at which fibrosis onsets in the hair follicle miniaturization process. It’s a bit later than most people think. This is why you can still recover lots of hair without directly targeting fibrosis if your hair follicles are still early on into the process of active miniaturization. Fibrosis hasn’t yet set in.
Congrats on your progress so far with massaging! Please keep me posted with your results. A decrease in shedding often comes 4-5 months before increases to hair density. It sounds like you’re on the right track.
Hi Rob, this article is really useful.
You mentioned shedding slowing down around 4-5 months.
Now you have your user group, have you had many other people experiencing long standing shedding from any scalp activity?
Hey Jasper – there are a few people I’ve worked with who haven’t responded positively to any stimulation-based therapies: platelet-rich plasma, low-level laser therapy, microneedling, or massaging. In these scenarios where someone’s hair loss is also strictly AGA, the effects of DHT-mediated hair follicle miniaturization just seem too difficult to overcome without anti-androgenic interventions. When we add in a range of DHT reducers, things often turn around.
“We have a paper coming out about fibrosis and AGA that will help to explain the point at which fibrosis onsets in the hair follicle miniaturization process. It’s a bit later than most people think.”
Interesting post Rob. If miniaturization starts before onset of fibrosis, does this mean that targeting fibrosis (via stimulation methods) doesn’t actually help (and if they do help, it’s by some other mechanism)?
Thanks Stefano! It’s likely that fibrosis begins to accumulate during the transitional and end-stages of hair follicle miniaturization. This suggests that fibrosis is a rate-limiting recovery factor, but not necessarily a driver, of AGA.
Having said that, the massages (if they work through the mechanisms we believe they do) should still help throughout all stages of hair follicle miniaturization. The acute inflammation should help kickstart a new anagen phase for miniaturizing hair follicles, and in doing so, potentially increase hair thickness (as we’ve seen in other studies on skin stretching via scalp massaging). In transitional and end stages, the growth factors elicited from massaging should also help to attenuate or maybe even partially reverse fibrosis… thereby helping to remove on a factor that likely prevents significant hair regrowth in most pattern hair loss sufferers.
This question is regarding your answer that fibrosis begins to accumulate during the transitional and end-stages of hair follicle miniaturization. Particularly the sentence “In transitional and end stages, the growth factors elicited from massaging should also help to attenuate or maybe even partially reverse fibrosis…”
This is very interesting to me. I started your massages about 9 months ago (doing it correctly) and now I have fully regrown the FUE transplants in my hairline (transplanted in 2010) that I had largely lost. The other parts of my scalp where I have not had transplants, I can see small white-ish hairs all over.
I assume based on your comments, that my FUE transplants had less fibrosis and thus regrew faster than other hairs on the top of my head?
Is it reasonable to think that with enough time, these white-ish non-fue hairs will continue to mature into proper hairs?
Multiple thank you for the answer! Wishing you a great day!
Hey Fredrik – thanks for reaching out. This article might help clarify things about FUE. Interestingly enough, transplanting healthy hairs into balding regions might actually help reverse some of the scar tissue already present there.
Thanks for the response Rob. Does this new info (about which stage of follicle miniaturisation begins onset of fibrosis) conflict with the model proposed in your first paper? As I understood it you proposed that fibrosis reduced bloodflow which lead to the miniaturisation. If it’s miniaturising before fibrosis begins then do you have a potential explanation for how it’s occuring? I really enjoy reading your works and look forward to your next published paper!
Hey Stefano! Thanks for the kind words. The new information doesn’t conflict much with the older model; rather, it just expands upon an aspect of the original paper that I felt was too nuanced to cover in the first manuscript. For example: miniaturization can occur in the absence of fibrosis. In these scenarios, we see dermal sheath thickening + the “building blocks” of fibrosis present surrounding the hair follicles; it’s just that these building blocks haven’t yet resolved to scar tissue.
The new manuscript argues that AGA’s classification as a non-scarring alopecia resides more so in (1) the speed at which scarring presents, and (2) histological research in AGA favoring transitional-stage miniaturizing hair follicles rather than end-stage miniaturized hair follicles. In my opinion, there shouldn’t really be separate classifications for scarring versus non-scarring alopecias; nearly all alopecias resolve to scarring if left untreated.
Yeah I have seen that thread on hairlosstalk too and it’s truly amazing. Most of these guys used Dermaroling + Minoxidil 5% and some of them got pretty solid results only after 3 months. In case of Min and Fin when pacient leaves the treatment the hairloss is often huge but it doesn’t seem to be the case with Dermarolling+Minoxidil. I don’t know whether the results are maintained as long as with scalp massages but it definetely seems to be better than Min or Fin only. (Btw. there is guy on YT called Hairliciously who gathers many other results of guys who used Min+Microneedling)
Regarding my treatment I’m using scalp massages+dermapen(sometimes) so if I get some regrow I definetely let you know.
Thanks and good luck.
hello Rob thanks for this great article. regarding microneedling, is there a risk of cancer? Thank you in advance for your reply good continuation
There is a relationship between chronic wounding in the epidermis and cancer formation – as highlighted in these studies:
This risk is less specific to microneedling and more specific to chronic inflammatory skin diseases. In my opinion, if you follow the proper microneedling guidelines (i.e., sessions limited to 1-4 times per month), you’ll likely significantly mitigate this increased risk. But there just isn’t enough data yet to say with certainty.
I was worried about this possible side effect, too. Not so much as regards microneedling, but concerning the massages since wounding occurs much more frequently here – actually as soon as the healing process is over if we follow the suggested rotations. What are your thoughts on this, Rob? After all, we are constantly wounding the same tissues over months…
Interesting article as always. I’m having some success in the crown area with your daily scalp massage routine, which has improved in density and reduced shedding, but due to some arthritis in my finger joints from various wear and tear in life, I might have to reduce the massage time with my fingers or find other ways to implement the massage (I can do some of the pinching, stretching, pressing with the palm/outer part of my hand and apply more pressure w/out finger pain, but it’s a bit less precise and tricky to do on some areas). I was wondering if it is still possible to massage effectively without the finger pressing motion or using other parts of the hand instead like the palm area? or would a reduced massage approach (say 3-x a week) still yield beneficial results? Ultimately my aim is predominately about maintenance and hairloss prevention instead of regrowth.
As for micro-needling, I may try that at some point, but right now I think I’ll stick with the scalp massage.
Congrats on your progress so far! Have you been able to track your hair changes with photos?
In all likelihood, it’s probably fine to reduce your massage efforts to 3x weekly until your fingers feel better. The results from our survey study suggested that when it comes to producing positive results, massage effort accumulates – meaning that the best predictor of success is just putting in time to massaging. In other words, even if you take a few days (or a few weeks) off, this shouldn’t hugely impact your results.
In the meantime, it’s totally fine to augment the massage techniques. There’s a high degree of variability in techniques across everyone trying the massages. If you find that results are starting to negate after a few months of the new techniques, reach back out and we can find a workaround.
Keep us posted!
Thanks for the response. That makes sense..I’ll give my fingers a break for a week and then get back to it. For the time I’ll probably continue using the palm/outer area of the hand which works ok for some of the exercises.
As for photos, I’m trying to remember to chart the progress every month or so but it’s still early days. I feel that the last crown pic looked slightly fuller than the pic taken before I started (no change with temples yet). That said it’s quite tricky taking accurate photos, as one pic taken on the same day can look different depending on light, hair positioning…but generally in the mirror I tell it looks better now than at the beginning of winter.
Hi josh were you using any other treatments for this regrowth? How long do you massage for? Thanks
thanks for your reply. Would you recommend microneedling alongside the massages? If I recall correctly, somewhere you argued that the two approaches target different tissue depths. If this is so, they might complement each other. On the other hand, I understand that needled skin needs more time to heal than ‘massaged’ skin. So is it really advisable to combine the two?
There are a lot of people seeing success by combining both approaches. Most people tend to take a few days off massaging after a microneedling session to avoid over-inflaming the scalp. Others don’t. Both groups anecdotally seem to report similar degrees of success, but I’d recommend taking a few days off – at least to stay on the safe side.
another good article!
Have you seen the leaked Follica trial presentation though?
There is a lot of information in there which at least hints at their needling protocol’s properties. This includes, for example:
– The importance of needle density (there seems to be a density threshold for regeneration)
– successful trials at very shallow depths (0.25 mm and less), reason being that follicle neogenesis happens quite high up in the skin (i.e. at shallow depths) and then newly generated follicles seem to move deeper into the skin
– the importance of quorum sensing (which may or may not imply ineffectiveness on the temples)
– timeframe between needling and neogenesis
I highly recommend having a look at the leaked slides. I consider especially the info about density to be very valuable. Maybe you could augment your post here with that information to have a better view of the whole picture.
Thanks! I haven’t read the presentation in detail. I’ll check it out and update this post with any findings – thank you!
If there were comparative studies across needle lengths, that would be incredibly helpful. I have reservations about taking in-house data presented during an investor presentation at face-value – mainly because the data hasn’t undergone peer-review and there are many incentives to skew data to appear more favorable. But regardless, there has to be value there. And if so, I’ll update this post accordingly.
just wanted to let you know that I found the patent for Follica’s needling protocol and summarize it here:
I also shortly touch on a potential contradiction regarding needling depth with their device patent here:
Maybe you’ll find it interesting!
Thx for your precious and valuable article.
I am Following Your Instructions ‘Bout Scalp Massage and I’m in 4th Month.
My Scalp Feels Looser and My Hairs are Thicker Than Before, Shedding Decreased but not Completely.
I Really Feel that I Get Rid of Excessive Sebum on My Scalp, which was Realy Bothering Me Before.
But There’s No Regrow . I’m 24 and Since 2018 I Suffer From Hair loss with Norwood5 Scale!
Do You Think Is There Any Chance For me to Regrowing?
Thank you for a detailed overview of microneedling for hair loss. I was thinking to combine scalp massages with microneedling at 1.5 mm at a two week interval. Since the scalp of course needs to heal after microneedling, after how many days do you think it would be okay to resume the massages? And is there much benefit of a microneedling device over a dermaroller?
I wanted to ask, is needling with a low depth (say 0.25-0.50mm) as good as massaging?
I assume needling will also improve bloodlow a lot right?
It’s tough to say if needling with a 0.25mm is as good as massaging. This is because we don’t have any comparative studies, nor do we know if a 0.25mm needle depth is better than a 1.5mm needle depth. But my guess is that massaging is likely better – as it’s an exercise that also manipulates galeal tissues and not just the epidermis.
There’s also a lot of debate over the right needling frequency. I wrote an article about this here:
Hi Rob! Excellent review. What are your thoughts on Danny Roddy s aproach ( he mentions you in one of his videos) on microneedling or massage incrising nitric oxide in scalp tissue as a biomarker of stress and aging meaning the cosmetics results depends on an adaptative response..so..it will be temporary results?
It’s a great question. For starters, I appreciate Danny Roddy’s work, but we disagree on a few points. For instance, DR emphasizes the importance of improving the thyroid for those with androgenic alopecia (AGA). While it’s true that hypothyroidism at high severities can lead to a hair shedding disorder called telogen effluvium, this form of hair loss is different from AGA. The hallmark of AGA is hair follicle miniaturization, whereas telogen effluvium rarely (if ever) presents with hair follicle miniaturization, but rather, only an increased telogen:anagen ratio. We shouldn’t conflate the two because the causes of telogen effluvium and AGA are different, as are their histological presentations. In any case, there are a lot of people with both AGA + hypothyroid-rlated hair loss, and in these situations, improving the thyroid will help.
In terms of massaging / microneedling increasing nitric oxide and how these results depend on adaptive responses and therefore the results will be temporary – I’d need to unpack this and really understand his argument (at the time of this writing, I’m unclear of what exactly he’s arguing and I don’t want to misquote him since I haven’t watched the video in a while). But technically speaking, there are a lot of therapies / mechanistic processes that (1) benefit humans in the long-run (not temporarily) that also (2) depend on adaptive responses. Hormesis is one example.
I think there’s a better case to be made here against microneedling / massaging – not regard in to adaptive stress and nitric oxide, but in regard to therapeutic targets. There are well-regarded researchers who argue that any treatment for AGA that doesn’t target androgens will only lead to increased hair counts in the medium-run, since hair follicle miniaturization is DHT-mediated, and if you’re not attacking DHT, you’re not stopping AGA. While I don’t fully agree with that argument, I think it’s the stronger one to make.
Sorry this is a little unrelated, but I didn’t really know where to post.
I’ve read almost all of your work and I had query regarding hair loss and medication.
Currently I’ve been taking Lymecycline (Tetracyl) for a couple of years in order to treat moderate acne.
I was wondering whether the same inflammation responsible for acne causes hair loss in some people.
Additionally, is regularly taking anti-biotics harmful towards my gut-health and could this be damaging towards my hair.
These resources might be helpful:
The short answer: acne is likely more associative than it is causative to AGA, but acne that inflames the infundibulum / isthmus of the hair follicle may lead to temporary shedding in the form of telogen effluvium. Severe long-standing acne might scar the follicles and make it more difficult for hair to grow.
Antibiotics might be harmful to hair in certain circumstances, and (paradoxically) helpful in others. Expect an article on this soon!
I just want to take this opportunity to thank you for what clearly has been thousands of hours of work.
I’m a very young guy and my hair-loss has made me miserable, but reading your work has given me a lot of hope.
All the best.
Thank you Mark! I appreciate your comments and am glad that the information here is helping you. Please keep us posted with how things go.
I just googled to find a microneedle kit for hair and so many options popped up. Is there a brand you recommend?
I make a few recommendations inside our membership site. But in general, the right product, needle length, needling frequency, etc. all depend on your specific hair loss situation – your type of hair loss, how severe it is, and whether you’re needling alongside other treatments.
Hey thus is slightly off subject of dermarolling but has anyone thought whether regularly worn tight sunglasses could contribute to hair loss?
Somewhere around where the arms go, there’s a big group of veins that feed to our scalp.
Just a thought.
Hey Jasper – there’s a form of pressure alopecia that fits with what you’re describing. It’s observed in people who constantly wear high socks and lose the hair around their calves, and people who wear glasses (they develop small lines along the sides of their scalps where the glasses press against the skin. In almost all cases, this form of pressure alopecia is temporary.
“At shorter needle depths (i.e., 0.25mm to 0.5mm), microneedling only wounds the top layers of the skin (the epidermis). This will improve the absorption of topicals (i.e., minoxidil). However, these shallower depths likely won’t evoke the growth factors necessary to encourage hair follicle proliferation. For this effect to occur, we need to incur wounds deeper – specifically, we need to wound the dermis.”
If this is true then how simple mechano stimulation with hands could release growth factors ?
Also, I just wanted to say that I have a device for body massage, it looks like a dermaroller but the needles are made of hard gummy plastic. I’ve been using it once a day to mass my scalp and my scalp skin became very flexible because of it.
Thanks for your great articles, Rob !
While microneedling wounds the epidermis, massaging may activate an acute inflammatory response in deeper tissue layers of the scalp skin. This is because massaging allows for the pinching, pressing, and manipulation of all scalp skin layers (i.e., we can pinch and lift skin that includes the dermis and maybe hypodermis), whereas microneedling with short needles only wounds the very top layers.
That’s great news about the device! How long have you been using it? Hopefully, that newfound elasticity will start turning to hair improvements soon!
Hi Rob, Thank you for tour reply.
Ive been using it on and off for about 4 months. I do 5 minutes of this on my whole scalp (including sides and forhead). I also do another 5 minutes right After this with a regular boar bristle brush. Also my protocol is to let 24 hours between each session.
It looks exactly like a dermaroller, but a lot bigger and made of wood. The ‘needles’ are made of a gummy but hard plastic. It s painful but doesnt make you bleed at all even if you apply strong pressure on the scalp with it.
What i experienced since at this point, After several months of use :
– 1. huge improvement in scalp flexibility.
– 2. 90% réduction of dandruff.
– 3. I believe my hairloss has stabilised with even light regrowth on my left temple. But i’m drill waiting to recover fully what ive Lost.
Where did you get that massager? Maybe you can post a link where you bought it?
I’ve read on your site that hair regained through mechanical stimulation, be it scalp massages or microneedling, is not immediately lost upon cessation of treatment in stark contrast to that regained through anti-androgen medication. Is that assertion the result of medical research or anecdotal evidence?
It’s 100% anecdotal – based on (1) post-publication qualitative interviews with our massage study participants, and (2) my own experience with a tapering protocol over the past few years. Theoretically, if fibrosis is a partial driver of AGA, and if stimulation-based therapies help to diminish some of that fibrosis, then it would make sense for results to stick around for a bit longer than anti-androgenic therapies (that is, if the effects of anti-androgenic therapies don’t also help to reverse some fibrosis). At the same time, all we have at this point are anecdotes.
Im 32 lightly losing crown and started thinning so im on finastride and menoxdill
Can i use 1.5 still on the my head in your opinion ?
Also can i do the whole head even where hair seems fine
Thanks in advanced
There’s evidence that microneedling enhances the efficacy of finasteride + minoxidil, especially for people who are non-responders to both FDA-approved treatments. The studies that build the basis of that evidence used 1.5mm needles. So, it sounds like a reasonable approach!
Hey Rob, what are the effects of masturbation (particularly masturbation frequency) on hairloss. Kind of a strange question, I know, but I was curious if you might be willing to expound on it, as it is something that we have been discussing in the forums and on the discord server. Hope to see you more often on the Discord as well! Thanks for everything.
Is there an easier way to do the massages on my hair. I struggle with doing the pinching a lot and I’ve only been massaging for a week. I’m 18 years old with temple thinning (Minor on my left but moderate on the right). I believe I got hair loss from excessive masturbation for 2 years, but now I’ve already stopped and had regretted it ever since it also made me feel much weaker, too. Also, I got a dermapen and have been using it for 3 weeks already (1.5mm x1 a week). Thanks.
Hi rob, I’ve been microneedling for about 7 months and about 3 months into scalp massage, I have achieved great improvements, my hairline is growing back gradually, and my crown is fuller than before, I think my hairloss had stopped since my scalp became very elastic, I would have a hair cut every 2 months without trimming my hair on top, I just leave them be, although they are regrowing, but still much slower than my hair on side and back of my head, my hair on back and side almost grow back within a month, while my hair on top don’t seem to have too much difference (but I know they are regrowing, just much slower). Is there any connection between hair growth and vessel distribution on scalp? I studied about the structure of our head and found that blood flow on top of our head is much weaker, can this be the cause ?
Sorry for my poor English 🙁
Hey Rob, I have been using a 1.5mm dermaroller weekly for about 4 months now, and I haven’t noticed any results. I normally would be more patient, but why I’m asking for advice is because the area I dermaroll(hairline) is actually looking like it is becoming damaged, as the skin has become red and a bit bumpy. I have put my dermarolling on pause to allow it to heal, but in the future when I resume, do you recommend I use a smaller needle size? Or should I put more effort into taking care of my skin after/increase sanitation efforts on my dermaroller?
Hello, thank you for your articles. They are very helpful in better understanding how to reverse or prevent hair loss.
Sorry for the unrelated question to the article, but what are your thoughts on eating natto daily to reduce/prevent hair loss? I believe I read in one of your articles that higher levels of estrogen can lead to early hair loss in men; however, I have read that natto doesn’t lead to increased estrogen production since it is fermented? It also supposedly increases circulation thus reducing inflammation through its high content of vitamin K-2 found in the nattokinase of the food.
Howdy Rob 🙂
Hey man, I’m wondering whether sleep bruxism may play a role in the scalp tension theory?
I stress like a mofo constantly and my shoulders, neck muscles etc are usually always tense.
I clench my teeth hard all night, I’ve always had headaches and neck aches and now in my forties I’m losing my hair line.
I was reading about sleep bruxism and the temporal is muscles get a work out from sleep bruxism.
It may have nothing to do with it but it just might be a contributor.
Please could you recommend some high quality dermaroller I’m gonna start with 1,25mm . Also how lond do i need to wait to apply the minoxidil?
Hey Rob. Have you ever looked into the fasting technique? Not intermittent or short term fasting, but longer fastings; weeks long to month longs fastings during which you only drink water. The point is to shut down the digestion system, resting it, so that the body draws it’s nutrients from impurities in different tissues (cleansing, if you will). Research also implies that one increases the growth hormone by 200-400 % if I recall correctly, while stabilising other hormones. It is even said that fasting can effectively fight some cancers. It is in many ways an ancient medicine that is in recent times getting the dust cleaned off.
Now with all these claimed benefits, I’m wondering if this might be used to fight calcification in the scalp as well, regulating androgens, and regrow hair?
I haven’t looked too much into this yet myself, but my father is very enthusiastically reading about it and plans on starting practicing it.
I though this might be a potentially beneficial field in improving hair health which you might be interesting in looking at?
How do you exercise on a fasting regime? I wouldn’t think it possible.
What are your thoughts on spermidin? It seems to have promising effects on hair growth.
Great article! Thank you for laying this information out for all of us.
I would like to know your thoughts of combining both lengths: 1.5-2.5 mm once per week, and maybe .25 mm 3 or 4 times per week. Does that make sense?
Thanks for reading! This article might help answer your question:
The short answer is that it’s hard to say what the best combination of needle length and frequency might be. This is mainly because most of the clinical studies on microneedling, at least for AGA, have more or less followed the study design of the first microneedling-AGA study from 2014 – which used a 1.5mm needle length and wounding intervals of once every 1-2 weeks.
In any case, you can certainly find anecdotes online of people seeing success with combinations of microneedling lengths and frequencies. 0.25mm is a pretty shallow depths, and likely mainly just promotes topical absorption; those smaller wounds should heal relatively quickly. If you end up giving this a go, let us know how you progress!
Thanks for all the work you do, it ‘s just amazing.
One question, it seems you have never talked about: is there an add risk of dermal cancer when you practice daily scalp massages?
As, maybe, you create micro injuries on the skin of your head each day.
Sorry for my English this is not my native language.
Thanks again for all you have done and for your incredible work.
Any thoughts on this? How long does inflammation last for scalp exercises? Can it be distinguished from being chronic,
Howdy Rob, hope you are keeping good man.
Hey you have most likely already seen this before, but if not, this might be of interest to you.
We know how some hair loss drugs work by increasing blood flow.
I thought about this and figured Viagra or cialis may do something similar, along with the usual benefits hahaha.
I was looking online about it and found a trial using generic viagra.
Also effecting the same vital areas hahaha I read about a new drug called xiaflex or generic collagenase Clostridium histolyticum.
This is used to eliminate scar tissue or scar plaque for guys who develop a bend in their junk due to injury or fracture, as it’s known.
What might be of interest is that these injections are now being used as alternatives to surgery where scar tissue is present and problematic.
So it may be that guys and girls with chronic scalp scarring may at some point find this drug useful for reversing the fibrosis aspect of hair loss.
Hope this is of use to you and as always, thank you and keep up your great work!
Hey Rob really enjoy your articles. I have very fine hair and I don’t know what’s causing it it has been this way for a long time and doesn’t seem to be getting worse I am a 21 year old male I’m pretty sure I don’t have mpb because my hair is not falling out it just is very thin all over what would you r commend I look into? Thanks again
Hey John! I’d recommend seeing a dermatologist who specializes in hair loss disorders. If you’re in a major city, this shouldn’t be a problem. In general, it’s really important to identify the drivers of your hair loss first, then treat second. So in your case, a dermatologist will (hopefully) save you the headache of years of personal experimentation with varying treatments.
In the interim, I’d also recommend reading more about what causes hair shedding disorders versus androgenic alopecia versus autoimmune alopecias. We’ve got a few articles coming out about these topics in the near future.
First of all: amazing article. I would argue that this blog is one of the, if not the best sources of truth when it comes to finding the right information about hair growth and fighting baldness.
Quick question: what do you know about taking (liquid) amino acids to promote collagen production, perhaps in combination with micro needling? There is some research that suggests this might be, to some extent, effective.
Curious to hear your thoughts on this!
Thanks for the kind words. I’m all for experimenting with topicals + microneedling, so if you try liquid amino acids + microneedling, please let us know how that goes. Having said that, it’s still really unclear how microneedling enhances the efficacy of other topicals beyond minoxidil – mainly because the studies have not yet been conducted.
From a theoretical perspective, if we believe the scalp tension hypothesis as a major contributor to most people’s AGA, then this implies that since the source of inflammation (and consequently, disorganized collagen cross-hatchings) is from tension and/or pinched blood vessel networks, then applying topicals to improve collagen synthesis is more like putting a bandaid on a chronic wound, rather than addressing that chronic wound’s source. There’s also the fact that topical amino acids may synthesize differently in the skin (and thereby have a different effect) than when taken orally – similar to how DHT behaves differently depending on the location of the body. So, it’s always important to keep these things in mind.
I think if you’re going to experiment with this approach, it’s also best to target to relieve any scalp tension you might have, too. At worst, you may spend time adding on something to your regimen that doesn’t work for you. At best, you might really enhance the effectiveness of that topical + microneedling combination.
Thanks for your reply, Rob. Just to clarify here, I take amino acids orally in a liquid form. I therefore ‘do not’ apply them topically. Instead, I actually use Nanoxidil (as Monoxidil cannot be bought easily here in Europe.)
With regards to your scalp tension theory, I’ve actually been experimenting with scalp massages since I found out about your articles. So I am very curious to see how this might show improvements further down the line!
Do you think that microneedling has greater potential for receding hairline? I’ve been doing massages for 6 months and my hair got at least 10% thicker but my hairline is still receding altough I’ve been massaging my hairline area most. Is it possible that my AGA is just too strong?
Hi rob. Thanks for the article. I wanted to ask you, I have been massaging for quite a long time. Progressively, the scalp loosened up, relieved the tension but I did not see any regrowth till i added dermarolling + minoxidil. What theory can possibly explain this case? I plan on quitting minoxidil altogether. I have tapered it off and so far maintained my growth.
Is it OK to microneedle my scalp 12 months after having a hair transplant?
There are some studies demonstrating that microneedling improves transplant survival rates… and these microneedling sessions are literally conducted during the transplant! So, my takeaway is that you’re probably fine to do this a few months post-op, and almost certainly 12 months post-op.
Your article is useful , thanks a lot…
My doctor did Microneedling in my scalp in depth of 3 mm…
Does this depth of needle destroy the hair follicle?
Thanks for reaching out. Interestingly, there’s some research that microneedling at depths of 3mm doesn’t technically penetrate as deep as the needle length; rather, it seems to only penetrate about 60-80% the depth of the needle setting. This is due to user variances in the pressure applied for automatic needling devices.
A depth of 3mm is pretty deep, and in general, the evidence suggests that you don’t have to go that deep. But I don’t think a single session at that depth would harbor any long-term issues. In any case, you can save a lot of money by self-administering microneedling at-home! I’d recommend buying a roller ($15) or an automated device ($150-$300) and saving yourself thousands of dollars in markup fees over several doctor appointments.
Some people say microneedling made it worse for them. Do you have a theory why it works great for some people while other lose more hair?
It really depends on dozens of factors, but here are two possibilities that stand out to me:
1. Microneedling seems great for AGA, but there’s limited evidence of its effectiveness for other hair loss disorders. On that note, there’s growing anecdotal evidence that it might worsen outcomes for those with telogen effluvium. An alarming percentage of AGA men also have telogen effluvium and don’t know it. So this is one possible explanation.
2. Technique matters, as does needle length. It’s unclear if needling daily with a 0.5mm needling device is any better than what the clinical outcomes suggest: once every week with a 1.5mm needling device. A lot of people on forums are experimenting outside of the methodological scopes of the clinical studies. We’ve had some people inside our membership do this with success, but any time you deviate from the clinical evidence, you increase your risk of an alternative outcome.
I hope this helps!
PHH member here! I notice the marketing blurb for derma pens claims that the straight-up-and-down wounds in the scalp that they make is better than the slightly wider nature of a derma roller’s wounds due to the rolling movement. In your opinion is this actually of any consequence in terms of results and any risk of scarring?
I guess it could even be a positive if technically the hole being made in the scalp is slightly larger/creates a bit more trauma?
Thanks for all you do!
Hi, the 2017 study – it says results with dermarolling alone were from biweekly rolling. By biweekly do they mean twice per week (which seems a lot for a 1.5mm needle) or every two weeks? The dictionary definition suggests biweekly can mean both hence the question!
Oh and also I have a 1mm roller. It definitely reddens my scalp and can cause blood spots when I press harder. Is this likely to be enough when using it alone (minoxidil just never worked for me and so I don’t want to use it)? I was thinking of using it every 10 days to allow for healing time. a 15% increase in hair in thinning spots like that 2017 study would at least be something.
Hi Rob, is there a topical that someone good use alongside a once weekly dermarolling regime that isn’t minoxidil? I had a bad experience with minox years ago where I shed quickly and that hair where I used it never came back so am quite reluctant to use it again. Also i know there may be an issue of dependency with minox. Also is some sort of topical DHT blocker needed for those who aren’t/don’t want to use finasteride?
I’m thinking of having some plasma extracted from my blood in a laboratory and apply it on my scalp after using my 1.5mm dermapen. What are your thoughts on that?
I am very thankful to you for all the effort u have put in order to give us all this knowledge for free.
Thanks for the contribution!
I just ordered 3mm. Is that also possible or is it a security risk? And where is the galea tendon? Are the veins above or below the tendon? To pierce this vein you would have to pierce the galea, right?
Thank you for sharing your results man
I have gotten infected AGA fro 5 years ago(when i was 28 years old)that I was used to many ways to reduce DTH or regrowth hair such as just Minoxidillor, Minoxidil + Finasteride tablet/solution Minoxidil+Caffein+Finastride that it could never stop hair loss for a long time or even never stop the loss
but when I use solution Minoxidil +Finastride +Dutastride +Latanoprost the results were significant even stop loss hair for more than 6 months and even demonstrated some new small thin hair after 3 months(( At that times to have sex was done just 3-5 times in a month)) BUT suddenly after 15 times sexual connection at 2 weeks at 4 months ago, the hair loss has got started since 3 months ago until now that the ways no more answer (only the dutasteride solution, or even using only latanoprost lead to increase much more the hair loss )
I have to mention it there hasn’t been any relation sex from 4 months ago until now
Rob from last week I have got started the Messo Mcroneedling with size 1-1.5 mm but I know the significant item to get best results I have to control DTH but I don’t know what to do ???? I take dutasteride only every two days and multivitamin tablets.
I wonder if you can help me what is the best way to control DHT as long as using the Microneedling ?? or PRP??
I have disappointed after 5 years of trying to use many ways but …..
I just wanted to thank you for the voluminous info you provide! Your knowledge is only (possibly) second to your amazing altruism.
Finasteride has kept most of my hair since I started receding 22 years ago. I’m 42 now, and have receded quite a lot on the temples, but nothing on the top or back.
Just wondering a couple of things:
1) Does scalp massage and/or microneedling work in temples?
2) What do you think of nanoxidil? It contains azelaic acid (I remember I got onto Xandrox back in 97 when I was researching – it seemed to be better than standard minoxidil) and DHT suppressants.
Here is the write-up to save you time:
“Spectral.DNC-N® is the first topical hair-loss treatment to employ 5% Nanoxidil®, a powerful new alternative to Minoxidil, a compound with high efficacy, low molecular weight, and no known side effects. It arms men and women with a powerful new tool against hair loss. The compounds used in Spectral.DNC-N, have shown in various clinical studies to promote hair growth and prevent hair loss through opening ion channels within cells, suppress dihydrotestosterone (DHT), prevent perifollicular fibrosis, provide antioxidant effects, prolong the anagen phase of hair follicles, increase expression of vascular endothelial growth factor, suppress protein-kinase-C (PKC) isozymes, and block chronic inflammation. These compounds may also exert beneficial effects on other processes that are not yet fully understood. The use of Nanosome technology helps to enhance the active transport of these substances significantly into the skin and to prolong their actions. The advanced therapy for hair regrowth treats continuously for over 12 hours—significantly longer than conventional alopecia treatments—due to our proprietary Nanosome encapsulation.”
I totally don’t expect a response because I know you are super busy, Rob. I’ll just be happy if you realise how many people you are helping and that it is not unappreciated 🙂
Hello Rob- Very informative and great work. This week there is a news about micro-needling and applying cerium nanoparticles, resulting in hair growth.
Interested to know your thoughts on it.
I was a non responded to topical minoxidil so I take .25mg oral. Though I see everyone say you should come one minoxidil with dermarolling for more effectiveness. I assume they mean topical? Should I apply topical minoxidil on nights that I dermaroll as well as the oral?
People have also told me I need to start an oral anti-androgen in combination with minoxidil or I won’t have healthy regrowth. What do you think?