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Scalp Microneedling Alone: What a 2023 Trial of 30 Men Found
Opublikowano przez Paula Kakizaki, Leticia A. Contin et al. opublikow ano 02 September 2026
Scalp microneedling is the practice of creating controlled micro-injuries in the scalp with fine needles to trigger the skin's wound-healing response and, in combination protocols, to improve the delivery of topical treatments to the hair follicle. Can it regrow hair on its own, without minoxidil or any other treatment? A 2023 randomised trial from Brazil tested exactly that in 30 men with pattern hair loss, and the answer was sobering: four monthly sessions of microneedling by itself produced no measurable improvement in hair density. The result matters because it clarifies what microneedling really is: a powerful delivery and stimulation method that works best combined with a topical treatment, not a standalone cure.
Study by Kakizaki, Contin, Donati and colleagues, published in Skin Appendage Disorders (2023). Summarised by Malcolm Smith, Founder of Hairgenetix. Medically reviewed by Dr. Esther Bodde, MD, Cosmetic & Plastic Surgeon. Last updated 2 September 2026.
Quick answer
Microneedling alone did not increase hair density in this randomised trial of 30 men with male pattern hair loss, across 4 monthly sessions and 16 weeks of follow-up.
A few patients improved visibly, but most did not: 4 of 12 in the roller group and 2 of 14 in the tattoo-cartridge group looked better at first follow-up, and only half of those kept the improvement.
The skin itself did respond: biopsies showed new collagen formation, and there were no adverse events and no scarring signals of concern.
The practical lesson: use microneedling to boost a topical treatment. In trials that combined the two, results were dramatically better.
Almost every strong microneedling result in the research record comes from studies that combined needling with a topical treatment, usually 5% minoxidil. The landmark Dhurat 2013 trial reported 91.4 additional hairs per square centimetre from the combination, four times the gain of minoxidil alone. That left a basic question unanswered: how much of the effect comes from the needling itself?
Kakizaki and colleagues designed the missing experiment. By testing microneedling with no topical agent at all, they isolated the physical stimulus. The study was randomised and single-blinded, and it even compared two different device types head to head.
What did the researchers do?
The team recruited 30 men with male pattern hair loss at a hospital clinic in São Paulo, Brazil. Each received 4 monthly scalp microneedling sessions, with no minoxidil, no finasteride and no other active treatment.
Participants were randomised to one of two devices: a classic derma roller (15 men) or a motorised tattoo-style cartridge device (15 men). Scalp coverage and hair density were measured 4 weeks and 16 weeks after the final session, and scalp biopsies were taken before and after treatment to examine what the needling did to the skin itself.
What did they find?
Outcome
Roller group
Tattoo-cartridge group
Visible improvement at first follow-up
4 of 12 evaluable patients
2 of 14 evaluable patients
Improvement sustained to week 16
About half of responders
About half of responders
Hair density change
No significant benefit
No significant benefit
Adverse events
None reported
None reported
The headline finding is the density row: neither device produced a measurable hair density improvement when used alone. A minority of patients looked better in standardised photographs, but the effect was small, inconsistent and faded in half of them by the last visit.
Two secondary findings are worth holding onto. First, the biopsies showed neocollagenesis, meaning new collagen formed in the treated skin, which confirms that needling genuinely triggers the wound-healing response that the combination trials build on. The biopsies also noted elastolysis, a breakdown of some elastic fibres, a reminder that needling is a real injury and technique matters. Second, safety was clean: no adverse events were reported in either group.
Does this mean microneedling does not work?
No. It means microneedling is an amplifier, not a standalone treatment. The contrast with combination studies is stark: where this trial found no density gain from needling alone, Gupta 2022 and later meta-analyses covering hundreds of patients found significant, clinically meaningful gains when needling was paired with a topical agent. The most likely explanation is delivery: micro-channels dramatically increase how much of a topical reaches the follicle, so the needling contributes most when there is something useful to deliver.
That is also why this trial does not contradict Dhurat 2013. Dhurat tested needling plus minoxidil against minoxidil alone; Kakizaki tested needling against nothing. Both can be true at once: needling alone does little, and needling plus a topical outperforms the topical alone.
What about the two devices?
This is one of the very few randomised comparisons of a rolling device against a vertical-entry cartridge device on the scalp, and neither outperformed the other. Device choice, in other words, matters less for results than what you pair the needling with, though stamps and cartridges give better depth control on a curved, hair-covered scalp. Our derma stamp vs derma roller comparison covers the practical differences, and our at-home device buyer's guide ranks the current options.
A vertical-entry microneedling device. In the trial, neither the roller nor the cartridge type produced density gains when used without a topical.
Figure 1, above: a vertical-entry microneedling device of the type compared against rollers in the trial. Neither device produced hair-density gains when used alone, which is why pairing the needling with an active serum is the evidence-backed pattern.
Limitations to keep in mind
This was a small trial: 30 participants, with a few lost to follow-up. Four monthly sessions is also a modest dose compared with the weekly protocols used in several combination trials, and 16 weeks of follow-up is short for a slow biological process like hair growth. A larger study with more frequent sessions could still find a small standalone effect. What the trial does establish is that any such effect is too small to rely on, which is precisely what someone deciding on a treatment plan needs to know.
What does this mean for your routine?
Treat microneedling as the delivery half of a two-part protocol. The evidence-backed pattern is a needling session paired with a topical active, which is the approach our Copper Peptide Derma Stamp Set packages: the stamp creates the micro-channels and the serum supplies the actives. The complete guide covers depth, frequency and aftercare step by step.
Frequently asked questions
Does microneedling work for hair growth without minoxidil?
In this randomised trial, microneedling alone produced no measurable hair density improvement in 30 men over 4 monthly sessions. The strong results in the research record come from combining needling with a topical treatment.
Which device was better in the trial, the roller or the cartridge?
Neither. Visible improvements were rare in both groups and did not differ meaningfully between devices. Device choice matters less than what the needling delivers.
Was scalp microneedling safe in this study?
Yes. No adverse events were reported in either group, and biopsies showed no concerning scarring. The biopsies did show both new collagen formation and some elastic-fibre breakdown, so correct technique and sensible frequency still matter.
How many microneedling sessions did the trial use?
Four sessions, one per month, with outcomes measured 4 and 16 weeks after the final session.
What should I combine microneedling with?
The best-studied partner is a topical active. Trials pairing needling with 5% minoxidil report the largest gains, and copper peptide serums are studied as a delivery-friendly alternative for people who do not tolerate minoxidil.
References
1. Kakizaki P, Contin LA, Barletta M, et al. "Efficacy and Safety of Scalp Microneedling in Male Pattern Hair Loss." Skin Appendage Disorders, 2023. PubMed 36636456.
2. Dhurat R, Sukesh M, Avhad G, et al. "A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia." International Journal of Trichology, 2013. PubMed 23960389.
3. Gupta AK, Quinlan EM, Venkataraman M, Bamimore MA. "Microneedling for hair loss." Journal of Cosmetic Dermatology, 2022. PubMed 34714971.
4. Faghihi G, et al. "Comparison of two different depths of microneedling in androgenetic alopecia." Journal of Research in Medical Sciences, 2021. PubMed 32897622.
Scalp Microneedling Alone: What a 2023 Trial of 30 Men Found
Scalp microneedling is the practice of creating controlled micro-injuries in the scalp with fine needles to trigger the skin's wound-healing response and, in combination protocols, to improve the delivery of topical treatments to the hair follicle. Can it regrow hair on its own, without minoxidil or any other treatment? A 2023 randomised trial from Brazil tested exactly that in 30 men with pattern hair loss, and the answer was sobering: four monthly sessions of microneedling by itself produced no measurable improvement in hair density. The result matters because it clarifies what microneedling really is: a powerful delivery and stimulation method that works best combined with a topical treatment, not a standalone cure.
Study by Kakizaki, Contin, Donati and colleagues, published in Skin Appendage Disorders (2023). Summarised by Malcolm Smith, Founder of Hairgenetix. Medically reviewed by Dr. Esther Bodde, MD, Cosmetic & Plastic Surgeon. Last updated 2 September 2026.
This article is part of our complete guide to microneedling for hair growth.
Why does this study matter?
Almost every strong microneedling result in the research record comes from studies that combined needling with a topical treatment, usually 5% minoxidil. The landmark Dhurat 2013 trial reported 91.4 additional hairs per square centimetre from the combination, four times the gain of minoxidil alone. That left a basic question unanswered: how much of the effect comes from the needling itself?
Kakizaki and colleagues designed the missing experiment. By testing microneedling with no topical agent at all, they isolated the physical stimulus. The study was randomised and single-blinded, and it even compared two different device types head to head.
What did the researchers do?
The team recruited 30 men with male pattern hair loss at a hospital clinic in São Paulo, Brazil. Each received 4 monthly scalp microneedling sessions, with no minoxidil, no finasteride and no other active treatment.
Participants were randomised to one of two devices: a classic derma roller (15 men) or a motorised tattoo-style cartridge device (15 men). Scalp coverage and hair density were measured 4 weeks and 16 weeks after the final session, and scalp biopsies were taken before and after treatment to examine what the needling did to the skin itself.
What did they find?
The headline finding is the density row: neither device produced a measurable hair density improvement when used alone. A minority of patients looked better in standardised photographs, but the effect was small, inconsistent and faded in half of them by the last visit.
Two secondary findings are worth holding onto. First, the biopsies showed neocollagenesis, meaning new collagen formed in the treated skin, which confirms that needling genuinely triggers the wound-healing response that the combination trials build on. The biopsies also noted elastolysis, a breakdown of some elastic fibres, a reminder that needling is a real injury and technique matters. Second, safety was clean: no adverse events were reported in either group.
Does this mean microneedling does not work?
No. It means microneedling is an amplifier, not a standalone treatment. The contrast with combination studies is stark: where this trial found no density gain from needling alone, Gupta 2022 and later meta-analyses covering hundreds of patients found significant, clinically meaningful gains when needling was paired with a topical agent. The most likely explanation is delivery: micro-channels dramatically increase how much of a topical reaches the follicle, so the needling contributes most when there is something useful to deliver.
That is also why this trial does not contradict Dhurat 2013. Dhurat tested needling plus minoxidil against minoxidil alone; Kakizaki tested needling against nothing. Both can be true at once: needling alone does little, and needling plus a topical outperforms the topical alone.
What about the two devices?
This is one of the very few randomised comparisons of a rolling device against a vertical-entry cartridge device on the scalp, and neither outperformed the other. Device choice, in other words, matters less for results than what you pair the needling with, though stamps and cartridges give better depth control on a curved, hair-covered scalp. Our derma stamp vs derma roller comparison covers the practical differences, and our at-home device buyer's guide ranks the current options.
Figure 1, above: a vertical-entry microneedling device of the type compared against rollers in the trial. Neither device produced hair-density gains when used alone, which is why pairing the needling with an active serum is the evidence-backed pattern.
Limitations to keep in mind
This was a small trial: 30 participants, with a few lost to follow-up. Four monthly sessions is also a modest dose compared with the weekly protocols used in several combination trials, and 16 weeks of follow-up is short for a slow biological process like hair growth. A larger study with more frequent sessions could still find a small standalone effect. What the trial does establish is that any such effect is too small to rely on, which is precisely what someone deciding on a treatment plan needs to know.
What does this mean for your routine?
Treat microneedling as the delivery half of a two-part protocol. The evidence-backed pattern is a needling session paired with a topical active, which is the approach our Copper Peptide Derma Stamp Set packages: the stamp creates the micro-channels and the serum supplies the actives. The complete guide covers depth, frequency and aftercare step by step.
Frequently asked questions
Does microneedling work for hair growth without minoxidil?
In this randomised trial, microneedling alone produced no measurable hair density improvement in 30 men over 4 monthly sessions. The strong results in the research record come from combining needling with a topical treatment.
Which device was better in the trial, the roller or the cartridge?
Neither. Visible improvements were rare in both groups and did not differ meaningfully between devices. Device choice matters less than what the needling delivers.
Was scalp microneedling safe in this study?
Yes. No adverse events were reported in either group, and biopsies showed no concerning scarring. The biopsies did show both new collagen formation and some elastic-fibre breakdown, so correct technique and sensible frequency still matter.
How many microneedling sessions did the trial use?
Four sessions, one per month, with outcomes measured 4 and 16 weeks after the final session.
What should I combine microneedling with?
The best-studied partner is a topical active. Trials pairing needling with 5% minoxidil report the largest gains, and copper peptide serums are studied as a delivery-friendly alternative for people who do not tolerate minoxidil.
References
1. Kakizaki P, Contin LA, Barletta M, et al. "Efficacy and Safety of Scalp Microneedling in Male Pattern Hair Loss." Skin Appendage Disorders, 2023. PubMed 36636456.
2. Dhurat R, Sukesh M, Avhad G, et al. "A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia." International Journal of Trichology, 2013. PubMed 23960389.
3. Gupta AK, Quinlan EM, Venkataraman M, Bamimore MA. "Microneedling for hair loss." Journal of Cosmetic Dermatology, 2022. PubMed 34714971.
4. Faghihi G, et al. "Comparison of two different depths of microneedling in androgenetic alopecia." Journal of Research in Medical Sciences, 2021. PubMed 32897622.