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Microneedling For Hair Loss: What’s The Best Needle Size?

When it comes to microneedling for hair regrowth, researchers aren't yet sure which needle size elicits the best results. In clinical studies, needle lengths of 1.5mm to 2.5mm (used once weekly or bi-weekly) have been shown to improve hair counts in men with androgenic alopecia (AGA). Even still, there's debate over whether shorter needle lengths (used more frequently) might lead to better results. Read on to see the evidence, mechanisms, photos, theories, and results.

Written and reviewed by:
Rob English, Medical Editor

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 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).

Just see the results of this 2017 study, which demonstrated hair count improvements of ~15% for those using microneedling devices without any other treatments. (1)

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%. (2)

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.

Here’s why.

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).

Three layers of skin

The thickness of our scalp (and its subcomponents) is influenced by our age, gender, and degree of balding (3). 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 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 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.

What is the hair follicle stem cell bulge?

The hair follicle stem cell bulge is located 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

Hair follicle stem cell bulge

Interestingly, we can stimulate these stem cells via wounding (4). 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 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).

So, should we all microneedling at needle lengths of 1.5mm or greater?

Not necessarily.

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 never went 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.

  • In this 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%. (2)
  • In this 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 this 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%. (1)

These are the only studies we have on microneedling for pattern hair loss. So, what do they tell us?

  • So far, we’ve only clinically tested microneedle lengths of 1.5mm to 2.5mm for men with androgenic alopecia (AGA).
  • At depths of 1.5mm to 2.5mm, microneedling seems to increase both topical absorption (with minoxidil) and hair follicle proliferation (as a standalone treatment).

The bottom line: stick with a 1.5mm to 2.5mm needle length. Why? It’s clinically effective, it increases both topical absorption and hair follicle proliferation, and it’s short enough to avoid puncturing 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?

Before we go further, 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, 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 a 1.5mm to 2.5mm needle length

This needle length is what worked in clinical trials, and it seems to also be working well for the people inside of our membership site.

Questions? Comments? Please reach out in the comments section.

 

45 thoughts on “Microneedling For Hair Loss: What’s The Best Needle Size?”

  1. Hi Rob,

    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!

    Reply
  2. Hey Wayne,

    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.

    Best,
    Rob

    Reply
  3. Hi Rob,

    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.

    Reply
    • Hey Dawe,

      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.

      Best,
      Rob

      Reply
      • 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.

  4. 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.

    Reply
  5. hello Rob thanks for this great article. regarding microneedling, is there a risk of cancer? Thank you in advance for your reply good continuation

    Reply
    • Hey Anissa,

      There is a relationship between chronic wounding in the epidermis and cancer formation – as highlighted in these studies:

      https://www.ncbi.nlm.nih.gov/pubmed/21321207

      https://www.ncbi.nlm.nih.gov/pubmed/21321199

      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.

      Reply
      • 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…

  6. Hi Rob,

    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.

    Reply
    • Hey Josh,

      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!

      Reply
      • 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.

  7. Hi Rob,
    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?

    Reply
    • Hey Wayne,

      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.

      Reply
  8. Hi Rob,

    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.

    Cheers
    benjt2

    Reply
  9. Hi Rob

    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?

    Best Wishes

    Reply
  10. Hi Rob,

    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?

    Reply
  11. Hi Rob!

    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?

    Reply
    • Hey Peterson,

      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:

      https://perfecthairhealth.com/microneedling-frequency-how-often/

      Best,
      Rob

      Reply
  12. 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?

    Reply
    • Hey Paul,

      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.

      https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.13197

      Best,
      Rob

      Reply
  13. Hi Rob,

    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.

    Best wishes,
    Mark

    Reply
    • Hey Lori,

      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.

      Best,
      Rob

      Reply
  14. 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.

    Reply
    • 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.

      Reply
  15. “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 !

    Reply
    • Hey Kev,

      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!

      Best,
      Rob

      Reply
      • 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.

  16. Hi Rob

    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?

    Reply
    • Hey Jeff,

      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.

      Best,
      Rob

      Reply
  17. 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.

    Reply
  18. Hi Rob,

    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.

    Reply
  19. 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 🙁

    Reply
  20. 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?

    Reply
  21. 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.

    Thanks!

    Reply
  22. 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.

    Reply
  23. Dear Rob,

    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?

    Regards,

    Alejandro Iglesias

    Reply

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