Microneedling With Light Therapy for Skin, Scalp and Hair

Microneedling is a minimally invasive procedure that can be applied to a range of dermatological conditions, including androgenic alopecia (AGA), telogen effluvium (stress induced hair loss), as well as scalp and facial skin conditions. 

Men and women who suffer from hair loss due to androgenetic alopecia may benefit from the combined effects of microneedling and light therapy. Microneedling, also known as dermal needling, involves using tiny needles to cause a controlled injury to the surface of the skin including the scalp. The resulting trauma encourages the body’s innate healing process to kick-in to stimulate collagen and elastin production and naturally boost skin, hair, and scalp health.

LED as a Combination Therapy

Microneedling and LED light therapy can be paired together in the same treatment session to improve skin, scalp health, and promote hair growth. Adding an LED treatment after a microneedling treatment compliments and enhances the overall experience and outcomes for patients with compromised skin and scalp conditions.

Additionally, LED therapy can be combined safely and effectively with a wide number of treatment modalities including laser, microdermabrasion, microneedling, peels, injections, pre- and post-surgery, PRP, and much more.

In most instances, LED can be used prior to any of these treatments to vitalize and prepare the tissue. However, maximum benefit may be achieved by using LED post-procedure to facilitate healing, reduce discomfort and down time, and to increase anti-aging and skin rejuvenation benefits. When it comes to hair loss, light therapy protocols are lengthy and require a serious commitment, usually for several months, on the part of the patient.

What the Experts Say

According to Lance Setterfield M.D., LED therapy should always be used following microneedling.  Dr. Lance Setterfield, one of the world’s foremost dermal needling (microneedling) experts, is an educator, skin treatment specialist & international speaker. Author of “Concise Guide to Dermal Needling” he draws from 37 years of medical experience. 

Dr. Setterfield was one of the first physicians in Canada to incorporate medical needling into his practice in 2005, and consequently supports clinics in many parts of the world as a consultant and key opinion leader. His special interest is cell-to-cell communication, researching effects of dermal needling on the epidermis (cosmetic) & dermis (medical).

With more and more patients seeking less invasive treatments for skin and hair loss issues, the popularity and demand for microneedling and low-level light therapy has increased. And the combination of these two modalities only serves to further enhance results. To quote Dr. Setterfield, “great results are possible with a paradigm shift of a “less is best” approach that facilitates greater patient compliance (not as painful), less risk of complications, and a price-point that creates access to a much broader market.  The possibility of healthy skin and results is now attainable for the many, instead of the few.”

Best Time to Use Light Therapy

Despite Dr. Setterfield’s teaching, there remains some confusion for the practitioner as to the best time to apply light therapy after microneedling. 

In his book, Concise Guide to Dermal Needling Expanded Medical Edition Textbook Binding – 2013, Dr. Setterfield further explains, "A question has arisen as to whether one should treat clients with LED immediately after medical needling. Opponents to this do so on the basis that inflammation has been taught traditionally to be an integral necessity in the process of rejuvenation, but is it? The absence of inflammation, and therefore scarring in embryo wound healing, allows us to conclude that not only is it NOT essential, but actually precludes optimum results. It is, in fact, on the basis of inflammation that scar tissue results, and this is obviously not desirable. Inflammation attracts myofibroblasts, as opposed to normal fibroblasts. The former makes abnormal scar tissue, as opposed to normal basket-weave collagen from fibroblasts. (In the Expanded Medical Edition of my book, I explain this concept in detail on page 78 to page 90.)

Therefore, applying LED immediately after a needling treatment (or any treatment involving injury to the skin), as well as using products in the ensuing days that switch the inflammatory process off ASAP, should be the goal."

Microneedling & Light Therapy to Promote Hair Growth and Scalp Health

Light therapy benefits for hair loss and restoration have been well studied and documented. In fact, studies have shown that light therapy successfully stimulated hair growth in both men and women and studies with large randomized controlled trials demonstrated statistically significant hair regrowth by terminal hair count in both males and females.  

According to Michael Hamblin, et al¹, “…The exact mechanism of action of LLLT in hair growth is not known; however, several mechanisms have been proposed. Evidence suggests that LLLT acts on the mitochondria and may alter cell metabolism through photodissociation of inhibitory nitric oxide (NO) from cytochrome c oxidase…causing increased ATP production, modulation of reactive oxygen species, and induction of transcription factors such as nuclear factor kappa B, and hypoxia-inducible factor-1. These transcription factors in return cause protein synthesis that triggers further effects down-stream, such as increased cell proliferation and migration, alteration in the levels of cytokines, growth factors and inflammatory mediators, and increased tissue oxygenation.”

Light therapy is a proven² and attractive option for the treatment of hair loss due to androgenetic alopecia, especially for those individuals looking for an alternative to pharmaceutical drugs or invasive surgical treatments to promote hair growth and encourage scalp health.

Light Therapy Protocols (LED) for Hair & Scalp

The Celluma RESTORE is the only Celluma device with an FDA-cleared program especially for the treatment of hair and scalp conditions.

To obtain the best results, use Celluma RESTORE to treat the scalp every other day, for 16 weeks. Treatment may continue beyond 16 weeks if desired.

• Each Treatment: 30 min over the scalp
• Before use ensure that your hair and scalp are clean
• Before use ensure that your hair and scalp are completely dry
• Ideally, separate the hair before illumination to expose the parts of the scalp suffering from hair loss

Understanding Hair Growth Cycles

There are three phases to the hair cycle.  The anagen stage represents the growth stage of the hair cycle and may last 2 to 6 years.

The catagen stage, which generally lasts 1 to 2 weeks, is when transitioning of club hair is observed; as it progresses towards the skin pore, and the dermal papilla begins to separate from the hair follicle.

The telogen stage which lasts from 5 to 6 weeks, exhibits a complete dermal papillary separation from the hair follicle. Lastly, the cycle progresses again towards the anagen stage as the dermal papilla joins up with the hair follicle and the hair matrix starts synthesizing new hair. Light therapy is thought to prolong the anagen phase and delay the onset of the catagen phase.

The Research

Facial microneedling and its benefits are well understood and established.  What is lesser known, is that microneedling’s rejuvenation abilities extend to the scalp as well.  Today, microneedling the scalp is an increasingly sought-after treatment to promote scalp health and encourage hair growth especially for those suffering from androgenic alopecia which affects both men and women alike.

Several studies focused on scalp procedures to promote hair restoration have emerged and highlight the potential for combining light therapy with microneedling and or PRP to optimize patient results and satisfaction.

Microneedling the scalp may not be suitable for everyone or every scalp or hair condition, be sure to consult with a qualified Practitioner

Studies & Articles

Advances in hair growth - Dmitri Wall, Nekma Meah, [...], and Rodney Sinclair.  Published in Faculty Reviews and published by Faculty Opinions.

Microneedling is the process of using a roller device apparatus of small fine needles to micro-puncture the stratum corneum of the epidermis. Although the procedure alone can stimulate neovascularisation, growth factor activity and Wnt protein expression, it is often used in AGA in conjunction with hair growth stimulants: minoxidil, plasma-rich protein or topical steroids. When combined, microneedling can facilitate the percutaneous delivery of topical therapies. Lee et al. conducted a split-scalp study in 11 women with FPHL¹¹⁰. Microneedling was performed on half the scalp treated with growth factors and the other half treated with normal saline. At 5 weeks, the microneedling with growth factor–treated scalp had an increase in hair count (52.91 ± 10.85) compared with the microneedling with saline-treated scalp (45.91 ± 9.98) (P = 0.0001).

Low-level laser therapy (LLLT) is occasionally synonymous with red light therapy, cold laser and soft laser¹¹¹. It is thought to exert a biomodulation/biostimulation effect on tissue, promoting anti-inflammatory effects^111–115. The exact mechanism of action in stimulating hair regrowth is not known. Improved cellular activity, reduced inflammation and improved microcirculation may be involved¹⁰⁸. The therapeutic effects are delivered in wavelengths ranging from 500 to 1100 nm (red to near infrared) at low energy density (3 to 90 mW/cm²)^111,116. A variety of LLLT devices, including in-salon hoods or overhead panels, are available to patients with hair loss. Bonnets, helmets or hand-held combs are suitable for home use. Both the HairMax^® LaserComb and the head cap TOPHAT 665 have had FDA clearance for treatment in AGA.

Kim et al. conducted a 24-week, double-blind randomised controlled trial (RCT) comparing sham device to LLLT helmets (emitting wavelengths of 630-nm, 650-nm and 660-nm light-emitting diodes) in 40 patients with AGA¹¹⁷. The mean hair density was significantly greater in the LLLT group versus the sham group. A 26-week RCT involving 269 patients with AGA produced similar results. Patients were randomly assigned to receive different models of the HairMax^® LaserComb (7-beam, 9-beam, 12-beam and 9- and 12-beam) or a sham device. The mean terminal hair count at 26 weeks from baseline was higher in the LaserComb subjects compared with the sham-treated subjects. The LaserComb patients also reported a higher percentage of overall improvement with their hair (with respect to hair thickness and fullness) compared with sham-treated subjects¹¹⁸. However, in an earlier case series of seven patients receiving twice-weekly LLLT, the findings were not conclusive. Although increases in terminal hairs and in hair shaft diameter were noted, the findings were not statistically significant and global image assessment did not support an improvement with LLLT¹¹⁹. Liu et al. conducted a system review and meta-analysis of RCTs, reviewing eight studies with 11 double-blind RCTs, and concluded that LLLT resulted in a significant increase in hair density and that low-frequency treatment can result in a better effect than high, and types of devices and course duration did not impact the effectiveness on hair growth¹²⁰.

Combining Microneedling, Light Therapy and PRP for Hair loss

The following study examines the combined use of microneedling, light therapy and Platelet Rich Plasma (PRP) for patients with hair loss due to androgenetic alopecia.

A randomized blinded retrospective study: the combined use of micro-needling technique, low-level laser therapy and autologous non-activated platelet-rich plasma improves hair re-growth in patients with androgenic alopecia

Pietro Gentile ¹, Laura Dionisi ², Jacopo Pizzicannella ³, Barbara de Angelis ¹, Domenico de Fazio ⁴, Simone Garcovich ⁵ Epub 2020 Jul 27.

Abstract

Introduction:

Mini-invasive therapies based on autologous non-activated Platelet Rich Plasma (ANA-PRP), Low-Level Laser Therapy (LLL-T), and Micro-Needling Technique (MN-T) used in combining for hair re-growth need to be standardized.

Objectives:

The work aims to show in vivo outcomes resulted from retrospective case-series study in which ANA-PRP + MN-T + LLL-T were used in combined in patients affected by Androgenic alopecia.

Methods:

23 patients were treated, of which 13 males were classified in stage I-V by the Norwood-Hamilton scale, and 10 females were classified in stage I-III by the Ludwig scale. Assessment of hair re-growth was evaluated with photography, physician’s, and patient's global assessment scale, and standardized phototrichograms during a follow-up: T0 - baseline, T1 - 12 weeks, T2 - 23 weeks, T3 - 44 weeks, T4 - 58 weeks.

Results:

Interesting outcomes represented by a hair density increase of 81 ± 5 hairs/cm² and 57 ± 7 hairs/cm² respectively at T1 and T2 compared with baseline (173 ± 5 hairs/cm² at T1 and 149 ± 9 hairs/cm² at T2 versus 92 ± 2 hairs/cm² at baseline) were observed using computerized trichograms.

Expert opinion:

The main limitation in the autologous regenerative therapies and biotechnologies in hair-regrowth is the extreme variability of PRP products used, in the absence of standardized protocols and widely shared. Appropriate PRP preparations have to be picked after carefully thinking about their bio-molecular specifications and intended indications for use in patients. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment. The combined use of biotechnologies as the association of PRP with micro-needling and low-level laser therapy may improve the results in terms of hair count and hair density compared with those obtained by alone PRP. All the procedures must be performed in the full respect of international and local rules.

Conclusions:

The effect of the combined use of MN-T, LLL-T, and ANA-PRP has been demonstrated.

Keywords: 

Light Therapy for the Mature Individual

Wondering which Celluma device is going to meet your needs? Celluma devices are FDA-cleared to treat a variety of skin and pain conditions as well as hair loss.

Learn More about the complete Celluma Collection

If you have any of the common concerns that come with aging, then the all-in-one Celluma RESTORE is ideally suited to meet your needs. The multifunctional Celluma RESTORE is FDA-cleared to treat aging skin, pain and hair loss conditions and is ideally sized for easy placement anywhere on the body including over the scalp to promote hair growth and restoration.

Conclusions

Treatment of AGA remains a challenge and patients with AGA often have a heterogenous response to treatment, partly because the complex aetiopathogenesis, particularly in affected women, has not yet been fully elucidated. Intricate pathways regulate hair cycling and anagen duration and determine hair growth. As we discover more about these pathways, we move into an era of a growing number of potential therapeutics for hair growth promotion. A number of ongoing clinical trials are exploring novel treatments; however, it is unlikely that one therapy alone will result in a desired, sustainable outcome. Combination therapy incorporating systemic therapy and adjuvant procedural modalities (PRP, LLLT or fractional laser) may well represent the optimal strategy to produce long-lasting results, prior to surgical considerations.

References:

1. Low-Level Laser (Light) Therapy (LLLT) for Treatment of Hair Loss

Pinar Avci, MD1,2,3, Gaurav K. Gupta, MD, PhD1,2, Jason Clark, MD1,2, Norbert Wikonkal,

MD, PhD3, and Michael R. Hamblin, PhD1,2,4,*

1Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts

2Department of Dermatology, Harvard Medical School, Boston, Massachusetts

3Department of Dermatology, Venereology and Dermato-Oncology, Semmelweis University

School of Medicine, Budapest, Hungary

4Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts 02139

2. Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study

Joaquin J. Jimenez • Tongyu C. Wikramanayake • Wilma Bergfeld • Maria Hordinsky • Janet G. Hickman • Michael R. Hamblin • Lawrence A. Schachner