Why Am I Shedding After Microneedling?

Article Summary

Temporary hair shedding is commonly reported after men & women start hair loss treatments like minoxidil. But is temporary hair shedding also normal when starting microneedling? On the one hand, microneedling induces acute inflammation. A little inflammation might benefit hair growth, while too much inflammation might accelerate hair loss. In this article, we’ll explore how to know if shedding from microneedling is within normal ranges or perhaps something that requires further troubleshooting.

Full Article

Microneedling is a popular hair loss intervention, with some clinical studies supporting its use for pattern hair loss. Some studies even suggest that microneedling is as effective as platelet-rich plasma therapy (PRP) at regrowing hair.

Having said that, some users report an increase in hair shedding after starting microneedling – especially in the first 1-3 months. Is this increased shedding normal and expected? Or is it an indication that microneedling is making your hair loss worse, not better?

The answer has to do with how microneedling works, how shedding after starting wound-healing therapies differs from shedding after starting therapies like minoxidil, and how to troubleshoot if this shedding is perhaps a good or bad sign.

How Does Microneedling Work?

When pressed into the skin, microneedling rollers, pens, and stamps generate acute inflammation. This inflammation is suspected to support hair regrowth in a number of ways:

1. Increased drug delivery. Microneedling creates micropunctures in the skin that help increase the penetration of drugs – like minoxidil – into the dermis of the skin. This is where drugs must reach in order to interact with hair follicles and exert their effects.
2. Increased drug activation. Not only do these micropunctures increase drug penetration, but they also might enhance drug activation. Specifically, these micropunctures create acute inflammatory reactions in the scalp skin. This inflammatory response activates an enzyme called sulfotransferase, which is needed to active topical minoxidil so that it can exert its effects on hair follicles.
3. Increased growth factors & platelets. In addition to increased drug penetration & activation, the micro-tears from microneedling also bring forth growth factors and platelets to the scalp skin. Many of these proteins are causally linked to the initiation of the anagen (i.e., growth) stage of the hair cycle.
4. Tissue remodeling. With repeated sessions, microneedling might also help improve scalp skin quality. In balding scalps, fibrosis (i.e., scarring) forms around hair follicles, and is believed to act as an impediment to their growth. Repeated microneedling might help reverse some of this scarring, and in doing so, perhaps allow hair follicles to resize as larger in future hair cycles.

In effect, microneedling may promote hair growth through mechanisms mainly related to acute inflammation. According to clinical research, a little inflammation might benefit hair growth. Having said that, too much inflammation can be problematic.

This makes it hard to discern if hair shedding from these therapies is a good or bad sign. Is shedding from microneedling a sign of hair growth to come? Or is it an indication that your scalp isn’t handling the therapy very well?

We’ll explore a number of potential causes in the rest of this article.

Why Am I Shedding After Microneedling?

Hair shedding after beginning treatment is not necessarily a bad sign. In fact, it’s sometimes an indication that a treatment is working.

Treatment-induced hair shedding has been clinically observed with topical minoxidil, and anecdotally reported with oral finasteride (men), oral dutasteride (men), oral contraceptives (women), and oral spironolactone (women).

Long-term clinical studies suggest this shedding is temporary, and that it might even be required to initiate hair follicle resizing and bigger hair gains.

Having said that, microneedling represents a unique class of hair loss treatments. For starters, it’s experimental; there aren’t (yet) robust studies evaluating its long-term safety or efficacy. Therefore, we cannot presume the rules of minoxidil-induced shedding also apply to the rules of microneedling-induced shedding.

Secondly, microneedling generates acute inflammation. A little inflammation might benefit hair growth. Too much inflammation might accelerate hair loss. So how do we know if we’re getting benefit from microneedling, or hurting our hair gains?

It’s not necessarily an easy question to answer. But here are our opinions given the current landscape of research.

Should Microneedling Cause Temporary Hair Shedding, Like Minoxidil?

Maybe.

If we expand our scope to all experimental hair loss interventions that evoke acute inflammation (i.e., microneedling, platelet-rich plasma (PRP) therapy, mesotherapy injections, and scalp massages), temporary increases to hair shedding have been reported.

For instance, in a small clinical study of 10 men testing standardized scalp massages, temporary hair shedding was reported in the first few months of treatment, which reversed by month 6 and resolved into thicker hair gains by the end of the study.^[1]Koyama T, Kobayashi K, Hama T, Murakami K, Ogawa R. Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue. … Continue reading

In this respect, perhaps shedding from microneedling is similar to that of shedding from minoxidil.

Having said that, these therapies also evoke inflammation. In all likelihood, there’s a fine line between adequately inflaming the scalp versus over-inflaming it. This is what makes answering this question so difficult to answer. How can we discern the “good” shedding from the “bad” shedding?

Until more studies are published, consider the following rule of thumb:

For any hair loss therapy that evokes inflammation, slight temporary upticks in hair shedding are probably normal, just as we’d expect from better-studied hair loss treatments. However, this shedding should never lead to cosmetic decreases in hair density.

If you’re experiencing severe shedding from these therapies, stop & evaluate if you:

• Have underlying scalp inflammation (i.e., seborrheic dermatitis, which may become agitated after microneedling)
• Have hair loss types aside from androgenic alopecia (i.e., telogen effluvium, alopecia areata, and/or scarring alopecias)
• Are going too hard (i.e., microneedling too frequently or deeply, massaging too aggressively, or spacing PRP sessions too close together – which won’t allow for enough healing between sessions)

If any factor is present, address it prior to reinitiating your experimental therapy. And also consider multi-targeting your hair loss with better-supported interventions so you can maximize your upside for hair regrowth.

Otherwise, here are additional troubleshooting steps that might help elucidate if your shedding from microneedling is a positive or negative sign.

#1. Evaluate the kinds of hairs you’re shedding (anagen vs. telogen)

To troubleshoot hair shedding after microneedling, you may want to evaluate if the hairs that are shedding are anagen or telogen hairs.

Anagen hairs are hairs that were still supposed to be growing, but were perhaps sheared prematurely or yanked out. Telogen hairs are hairs that are undergoing (in most cases) a natural shedding process.

You can tell the difference between anagen vs. telogen hairs by looking at the root of hairs that have shed.

Specifically, you’ll want to see if the root of the hair strand appears misshapen or sheared (as is the case with anagen hairs that were just yanked out or cut), or if the root appears rounded like a bulb (as is the case with telogen hairs that are undergoing natural hair cycling).

So, after a microneedling session, look down at your fallen hairs and ask yourself the following question:

Do the hairs that fall during or after a microneedling session have a hair bulb? The hair bulb (as in photo B) is a rounded bulb-like structure found at the base of a hair strand. The bulb can often be seen or felt by running the fingers down the strand of the hair.^[2]Xu L, Liu KX, Senna MM. A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents. Front Med (Lausanne). 2017 Jul 24;4:112. doi: 10.3389/fmed.2017.00112. PMID: … Continue reading