How to Grow Hair without Drugs - a Tale of Micro-needling

Research shows that micro-needling can increase hair counts by up to 15% without other interventions, up to 100% increase when combined with 2% topical Minoxidil and as much as 400% when combined with 5% topical Minoxidil.

With these staggering results, many people are still shying away from the use of micro-needling for a number of reasons: 

• What needle length do I use when combining derma rolling and minoxidil?
• How often should I be micro-needling?
• How long do I do this for?

The devices used for micro-needling include derma roller, micro-needle stamps and automated stamping devices with needle lengths ranging from 0.25mm to 2.5mm. This can cause a lot of confusion for people.

Research shows that the needle length that is required to stimulate hair growth depends on a few factors and that size does not matter (at least when it comes to micro-needling):

• How often you intend to micro-needle,
• If you are combining micro-needling with other modalities, such as Minoxidil and
• The treatment endpoint.

Shorter needle lengths between 0.25mm and 0.5mm will puncture as far as the epidermis (the upper layers of the skin) and assist with the absorption of topicals into the scalp tissue. Short needle lengths cannot reach the dermis (the middle layers of the skin where the hair follicles and stem cells reside) to activate growth factors and to facilitate the growth of new hair follicles.

Research shows the best results are found with derma rollers containing needle lengths of 1.5mm or more. When using an automated stamping pen, needle lengths can be reduced to 0.8mm to 1.0mm. Automated pens are more precise but they are much more expensive.

Derma rollers penetrate the skin at a 45-degree angle, hence the needle lengths are required to be longer. In contrast, automated pens penetrate the skin at a 90-degree angle; hence, a shorter needle is sufficient.

What is micro-needling and how does micro-needling work?

Micro-needling is a stimulation method that contains hundreds of tiny medical-grade needles. It is believed that micro needling to balding scalp stimulates hair growth by:

1. Stimulation of growth factors to the wounded area,
2. The growth factors (GF) promote the formation of new blood vessels over time and
3. GF and blood vessels (carrying oxygen and nutrients) encourage new follicle growth.

The scalp does not have not be completely bald to see these benefits. This just means that balding men do have the opportunity to regrow hair without expensive hair implants if it is still early stages. Micro-needling also enhances the absorption of topical solutions. For this reason, a non-alcoholic Minoxidil formulation is less likely to cause irritation and burning compared to traditional foams and solutions. Traditional Minoxidil formulations contain up to 70% alcohol and is best avoided on skin with microtears.

 

Evidence for micro-needling for the treatment of hair loss in men.

There are numerous studies showing greater hair improvements when dual therapy is combined, in both men and women. Some studies also included Platelet Rich Plasma therapy (PRP) in combination with micro-needling and minoxidil. This article will only focus on Minoxidil plus micro-needling vs Minoxidil alone.

A 2013 study published in the Journal of Trichology reported that micro-needling plus 5% topical Minoxidil showed greater hair growth compared to Minoxidil alone (mean hair count change was 91.4 vs 22.2 respectively). The randomised controlled study looked at 100 men with mild to moderate (III vertex or IV) androgenic alopecia over twelve weeks.

In 2021, Faghihi concluded that shorter needle lengths combined with 5% topical Minoxidil was able to produce better results compared to longer needle lengths combined with 5% Minoxidil (0.6mm vs 1.2mm) but the session end point had to be more profound i.e. induce pin point bleeding. In order to produce pin point bleeding with a shorter needle length, greater pressure had to be applied. This goes to show size does not matter. 

We have cited only two studies here, but there are many more. 

What conclusions can we draw from these studies? 

Topical Minoxidil combined with micro-needling can produce better results than using Minoxidil alone and that size doesn't matter when it comes to needle lengths. The session end point is also an important factor when it comes to micro-needling.

 

Who will benefit from micro-needling?

We believe micro-needling is beneficial in the following settings:

• If you have mild hair loss and prefer non pharmaceutical interventions,
• If you have restored your hair and want to maintain the growth that you have without using pharmaceutical drugs, and
• As an adjunct treatment if you want fast results. Studies show micro-needling can safely be used in combination with either Minoxidil or Finasteride. Combining these modalities results in greater hair growth compared to using either modalities alone.

How to combine topical Minoxidil and micro-needling for hair growth

Disclaimer: the following advice is to be used a guide only.

STEP ONE:

Pick a day you have time to perform the micro-needling session. 

STEP TWO:

Ensure the area you intend to perform micro-needling is clean and the device is also clean and sterilised. The needles should be at least 1.5mm in length and are medical-grade needles, not hard plastic. Roll the derma roller over the area until there is redness (erythema). You do not want to induce bleeding.

STEP THREE:

Apply your topical Minoxidil as usual. You should repeat this process weekly (or twice a week) for at least twelve weeks. The rest period provides the skin time to heal (similar to the muscle recovery phase). Micro-needling creates minor puncture wounds to the scalp tissue and therefore, also enhances the absorption of topical solutions. For this reason, a non-alcoholic Minoxidil formulation is preferred.

What if you didn't want to do microneedling at home?

Research shows it is possible to achieve similar results when micro-needling sessions are done in the clinic once every four weeks. The session endpoints are more enhanced, resulting in pin-point bleeding. 

 

 

Author: Dan Atkinson  B. Pharm

 

References: 

1.  Lingling, J et al (2022). Effects of microneedling and 5% topical Minoxidil solution combination therapy in androgenic alopecia. Journal of Cosmetic Dermatology. July 21, 2022. Accessed October 16, 2023.
2. Faghihi, G et al (2021). "Microneedling in androgenic alopecia: comparing two different depths of microneedles." Journal of Cosmetic Dermatology.2021 Apr;20(4):1241-1247
3. Dhurat, R et al (2013). "A randomised evaluator blinded study of the effect of microneedling." International Journal of Trichology.2013 Jan;5(1):6-11