Some studies indicate that the results obtained with Minoxidil in androgenetic alopecia are dramatically improved when the application of the active ingredient is combined with a weekly procedure known as microneedling or dermarolling: this involves irritating the scalp with tiny needles. There is no minoxidil application on the day the microneedling is performed; on the other days, minoxidil is applied to the scalp twice a day as usual.
Of the 50 men who combined minoxidil with microneedling in the pilot study, 41 (82%) estimated that their hair growth had improved by more than 50% after three months, compared to 2 out of 44 (2.5%) in the minoxidil-only control group. Objectively, the researchers counted more than four times as many new hairs on the heads of the microneedling group in the study area as on the heads of the control group. The photos published in the study are also very impressive .
Some case reports also suggest that even in men who had no new hair growth as a result of conventional treatment with minoxidil and finasteride, four weekly microneedling sessions achieved a clearly visible increase in hair density, which was maintained for 18 months after the intervention .
Microneedling has also been used in individual case reports for the treatment of alopecia areara  In addition to the combination with minoxidil, it can also be used together with platelet-rich plasma (PRP)  or other locally applied therapeutics.
The researchers suspect that the acceleration and intensification of minoxidil-induced hair growth by microneedling is triggered by growth factors, whose increased synthesis in the skin is stimulated by the numerous tiny skin lesions.
Details of the Treatment
There are still no officially recognised guidelines for carrying out the microneedling procedure in alopecia. However, many dermatologists and cosmeticians offer the procedure – it has several other promising applications, e.g. in the treatment of acne scars.
In the microneedling procedure, a sterilized so-called derma roller – a plastic roller fitted with several hundred small stainless steel needles – is rolled several times horizontally, vertically and diagonally over the disinfected scalp.
The domestic use of the Dermaroller is to be seen critically: If the device is not sterilized before each use, there is a certain risk of infection and unpleasant inflammation.