Unveiling A New Era Of Possibilities: Introduction To The Microneedling
Hair loss affects both men and women of all ages on large scale and often significantly affects physical appearance. There are several types of hair disorder which affects human beings, such as: Telogen Effluvium, Alopecia Areatas, Trichotillomania, Traction Alopecia, Tinea Capitis, and Androgenetic Alopecia.
Androgenetic alopecia (AGA), which affects up to 80% of men and 50% of women throughout their lives, is one of the most progressive hair loss disorders. The main cause of this condition is the overexpression of an enzyme in the patient’s scalp.
Fortunately, there are various types of treatment available for hair disorders, such as Hair transplant surgery, Laser therapy, Medications, and Microneedling technique.
Definition of Scalp Microneedling
Microneedling (also called “percutaneous collagen induction”) is a very engaging technique for hair regrowth. In this technique, multiple fine needles are rolled over the skin to puncture the stratum corneum (the outermost layer of the skin) to obtain mechanical stimulation and therapeutic as well as cosmetic effects. It has been used to treat a wide range of dermatologic conditions, including androgenetic alopecia (AGA) and alopecia areata (AA).
Overview Of The Benefits Of Scalp Microneedling
One of the key benefits of microneedling is its ability to induce collagen formation in the treated areas. Collagen is helpful in the holding of hair, giving it volume and increasing the overall health of the hair.
In 2013, a landmark study done by Dhurat et al. on 100 AGA subjects found that over 12 weeks, once-weekly microneedling combined with twice-daily 5% minoxidil (a medicine used to grow hairs on bald scalp) was significantly efficient compared to minoxidil monotherapy. Since then, investigators have continued to assess the effects of microneedling as both a standalone and combination therapy for hair loss.
Purpose of the Article
This article summarizes the last decade of research on microneedling techniques for treating alopecia and promoting hair regrowth and provides a comprehensive evaluation of this field.
What Is Scalp Microneedling: Understanding The Basics For Healthier Hair
Background Behind The Origination of Microneedling Therapy
Orentreich and Orentreich first defined microneedling in 1995 for the treatment of wrinkles. In response to this theory, Fernandes developed Percutaneous Collagen Induction therapy in 2006. Later in 2011, Escobar-Chavez and Bentilla-Martinez reported that microneedling is a technique that increases the efficiency of drug delivery.
Explanation Of The Procedure: How Scalp Microneedling Works To Promote Hair Growth
In the mircroneedling therapy, firstly, the trichologist (a specialist in hair and scalp health) will cleanse the scalp or the area where hair growth stimulation is desired. Then, they will use a topical serum to desensitize the area so that the treatment is not painful. The outermost layer of the skin is micropunctured using an equipment derma roller embedded with small needles. These tiny punctures help in the production of collagen and elastin, which can improve the health of the hair follicles and promote hair growth. The number of sessions ranges widely in the literature, but few publications suggest fewer than three sessions in a month.
Scalp Microneedling vs. Traditional Hair Restoration Treatments:
Medicine is very useful in treating alopecia. Currently, minoxidil and finasteride are the only FDA-approved first-line medications for alopecia. These drugs differ in their mode of action as well as their mode of administration. Minoxidil, when used topically, is a blood vessels dilator. On the other hand, finasteride, when used orally, is an enzyme (5α-reductase) inhibitor, but its side effects, such as loss of libido and ejaculation disorder, limit its use. Therefore, there remains a demand for a novel and effective hair loss treatment. To overcome the limitations of previously used treatments, microneedling was introduced to treat hair disorders. It is used as a standalone or combination therapy for the treatment of alopecia.
It has been successfully combined with minoxidil, platelet-rich plasma, and topical steroids, and shown to stimulate hair follicle growth. Microneedling is thought to improve the absorption of minoxidil medicine by creating channels in the epidermis (surface of the skin). 
A second theory suggests that microneedling may increase the follicular sulfotransferase enzymes, which help in the conversion of minoxidil to its active metabolite, minoxidil sulfate, by initiating wound repair mechanisms. Due to this, microneedling (MN) is more acceptable to patients.
Commonly Used Tools and Techniques:
This technique has developed quickly in recent years. In this, many instruments are used, such as microneedles, manual rollers, automated pens, manual stamps, and automated fractional radiofrequency pens. Microneedles can be classified depending on the preparation material and design of the microneedles, including solid microneedles, coated microneedles, hollow microneedles, dissolvable microneedles, hydrogel-forming microneedles.
How Does Scalp Microneedling Work For Hair Regrowth?
Mechanisms of Action
Firstly, microneedles puncture the stratum corneum (outermost layer of the skin) by penetrating the skin several times using small needles. As a result, the bleeding process starts at the wound’s surface, and several growth factors are released. Monocytes release a particular type of growth factor to increase the production of collagen. Collagen increases scalp thickness and helps in the regrowth of hairs in alopecia. Collagen III deposited after 5 days post-injury, causes skin tightening that lasts for another 5-7 years. Six months after treatment, skin that had four microneedling sessions spaced one month apart showed up to a 400% increase in collagen and elastin deposition, whereas a year later, the layer of skin was thickened and appeared normal.
Efficacy of Scalp Microneedling in Promoting Hair Regrowth
Numerous clinical investigations have shown the benefits of microneedling for a variety of conditions, both on its own and in conjunction with other therapies, including radiofrequency, subcision, and platelet-rich plasma. It has shown promising results in hair regrowth.
Purpose: To investigate the efficacy of microneedling in promoting hair growth in patients with AGA.
The inclusion criteria were met by twenty-two clinical studies, consisting of seventeen randomized trials and five non-randomized prospective cohorts. Among these twenty-two studies, sixteen were carried out on individuals with AGA, four on individuals with alopecia areata, one on individuals with alopecia totalis, and one on individuals with both AGA and telogen effluvium (TE). In total, 1127 subjects were included, comprising 856 males and 269 females, who exhibited various types of hair loss.: AGA (n = 911), AA (n = 201), AT (n = 8), and TE (n = 7).
For AGA total, 536 subjects received MN therapy, while 375 received other hair loss interventions.
For AA and AT in total, 114 subjects received MN therapy while 95 received other hair loss interventions.
Result of the Study
In 17 investigations, comprising 911 individuals with androgenic alopecia (AGA), it was found that microneedling improved hair parameters when used in combination with 5% minoxidil, growth factor solutions, and/or platelet-rich plasma.
Conclusion of the Study
The inclusion of 22 clinical studies involving 1127 subjects demonstrated that MN as an adjunct therapy was effective in improving hair parameters for both genders and across a variety of hair loss types and severities. The study also revealed that this improvement was observed using needling devices with depths ranging from 0.50 to 2.50 mm and session frequencies ranging from once weekly to once monthly. No serious adverse events were reported. Nevertheless, it is important to interpret these results with caution, as there was significant heterogeneity in study interventions, comparators, and MN procedures.
Postoperative care: A Comprehensive Guide To Take Care Of Your Scalp After Microneedling For Optimal Hair Regrowth
The swollen area should be covered with damp swabs to absorb any bleeding. Topical antibiotic cream (mupirocin) should be applied in 3-4 coats for a few days to minimize the chance of bacterial infection. Painkillers and anti-inflammatory drugs should be prescribed to the patient. The patient should avoid sun exposure for 7-10 days and cosmetic procedures on the face for at least 3-4 weeks.
Benefits of Scalp Microneedling For Hair Regrowth
Promotion of Hair Growth: Studies suggest that microneedling increases the expression of a protein (Wnt – Wingless-related integrated site), which is essential for hair growth.
Stimulation of Hair Follicles: When microneedling is combined with other drugs, such as minoxidil and topical steroids, it may help these first-line drugs get to their target tissues and increase hair follicle growth.
Enhancement in Hair Regrowth: Microneedling has been proved to promote hair regrowth by activating the hair bulge (generating new follicles in the hair cycle) and triggering the release of wound-healing-related growth factors that increase blood circulation in the hair follicle.
Increased Blood Circulation And Oxygenation To The Scalp: The equipment used in microneedling creates superficial punctures (small holes), which boosts blood flow in the treated area.
Improvement of Hair Thickness and Density: Increased blood flow to the area helps in improving hair thickness and density.
Reduced Hair Loss And Improved Hair Quality: Microneedling reduces hair loss and improves hair quality by inducing stem cells. These stem cells are responsible for producing new hair follicles and are crucial for healthy hair growth.
Suitable For All Hair Types and Scalp Conditions: It is suitable for all hair types and scalp conditions but gives more promising results in alopecia areata.
Risks and Side Effects Of Scalp Microneedling
There are no serious side effects linked with microneedling, and it has a high safety profile. The side effects associated with it are usually short-lived. According to the American Academy of Dermatology (AAD), most side effects diminish within 5 days after treatment.
Pain and Discomfort: As we know, there will always be a certain level of pain because it involves needles piercing the skin. Dr Gohara says she would rate the procedure a 4 out of 10 on the pain scale and thinks a bikini wax is worse compared to microneedling.
Overcoming Pain and Discomfort: To overcome the pain and discomfort caused by microneedling, patients often demand anesthesia to ease the discomfort. The patients are advised to wear a frozen hypothermic gel helmet or Cryo-cap cooled in the refrigerator for 20-30 minutes before the procedure. This is helpful in lowering pain during the procedure.
Bleeding and Bruising: As this procedure involves the use of needles, bleeding is associated with it. Bleeding can be reduced by using 1.5 mm needles that are well-tolerated by patients. Bruising does not happen if the proper procedure is followed.
Infection and Scarring: The utilization of an unclean tool can lead to infection and scarring; however, this issue can be resolved by employing a sanitized tool and maintaining a hygienic environment.
Allergy: There have been instances where individuals have developed allergic contact dermatitis after being exposed to needles. Therefore, to avoid this allergy, it is essential to prevent contact with needles.
Microneedles offer various advantages, such as increasing the drug concentration at the target site, reducing the number of doses required, and improving patients’ compliance. In addition, microneedling is a safe method for hair regrowth, with no associated side effects, except for patients with blood clotting disorders. Microneedling has shown promising results, particularly when used as an adjuvant therapy with minoxidil and finasteride, compared to the monotherapy of microneedling. Furthermore, it has demonstrated greater benefits in treating alopecia compared to traditional pharmaceutical forms. However, limited research is available to verify the use of microneedling as a mono therapy for hair regrowth. Thus, conducting further research on microneedling as a monotherapy in larger randomized controlled trials will help determine its safety, effectiveness, and position in the treatment of androgenic alopecia.
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