Microneedling has gained a lot of attention in recent years as a potential treatment for hair loss, with some even using it as a solo treatment. However, its effectiveness completely depends on whether it’s paired with Minoxidil. The evidence that microneedling alone can regrow hair is sparse and based on low-quality research. The real benefits of microneedling come when it’s combined with Minoxidil, a well-known hair growth stimulant. On its own, microneedling may improve scalp health, but it doesn’t directly address the causes of hair loss or stimulate significant regrowth.

Many propose that microneedling works by stimulating healing and growth factors in the scalp, which eventually leads to new hair growth. However, even the most well-known study on microneedling examined its efficacy only when paired with Minoxidil.

In the study “A Randomized Evaluator-Blinded Study of the Effect of Microneedling in Androgenetic Alopecia: A Pilot Study,” researchers evaluated how the efficacy of Minoxidil changed when combined with microneedling. To do so, they divided subjects into two groups: one using both microneedling and Minoxidil, and one using Minoxidil alone.

The mean change in hair count at week 12 was significantly greater for the Microneedling + Minoxidil group compared to the Minoxidil-only group. This occurred because microneedling creates small channels in the skin, allowing topical Minoxidil to penetrate more effectively. Clinical research on Minoxidil has shown that a large proportion of people do not respond to treatment, often due to differences in skin chemistry. Since topical solutions rely on penetrating the skin barrier, some individuals have scalp characteristics that make absorption more difficult—this is where microneedling shows promise.

However, microneedling on its own doesn’t significantly regrow hair. The proposed theory is that it recruits growth factors to the scalp, but there is no strong mechanistic evidence or high-quality research to support this claim.

Microneedling also comes with risks. Creating punctures in the skin can increase the likelihood of infection, particularly if proper hygiene practices are not followed. There have been case reports of fungal infections and other adverse skin reactions associated with microneedling.

For this reason, I don’t recommend using the commonly advised 1.5mm microneedling depth frequently. Instead, users should first determine whether Minoxidil alone is effective. Then try the smallest depth possible 0.2-0.5mm to see whether this enhances your minoxidil results. Wait around six months before consideingr using tretinoin cream or switching to a 10% Minoxidil solution.

The reason I recommend trying tretinoin or a higher Minoxidil concentration before using a microneedling device is the potential for scarring. The end stage of DHT-induced miniaturization of hair follicles is fibrosis, where the follicle can no longer grow hair. Repeated skin injury from microneedling has been shown to lead to fibrosis (scarring) in the scalp, which is concerning.

If you are still set on using a microneedling device for hair loss, it’s best to start with a low depth like 0.2-0.5mm and monitor results before increasing frequency or depth.