40 year old female, will my hair come out where the micro needling was done before it grows back? (photos)

Thank you for your question. You submitted two photos, and state you’re 40-years-old dealing with some hair loss, so you underwent a microneedling treatment. Soon thereafter, your hair was coming out in clumps, so you’re trying to understand what is going on and what to expect.
I can share with you my opinion on what you’re going through even without the exact details of your treatment. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers based on a system we developed in our practice starting seven years ago that is a non-surgical solution for hair loss for both men and women using PRP and Acellular matrix. 
When it comes to hair loss, it’s very important to have an understanding of the underlying cause. When we think about hair loss in women around age of 40, I think first of female pattern hair loss and telogen effluvium. Female pattern hair loss is genetic pattern loss, so when I evaluate patients, I look at their family history to see if other women in either side of the parents’ families had hair loss around that particular age, the nature of the hair being lost in terms of the degree of shedding, and just the characteristics of the awareness of the quantity of hair over the course of time. Female pattern hair loss is slow, progressive thinning of hair. In contrast telogen effluvium is very often preceded within two to five months by significant stress which can result in hair shedding. 
Let’s say you have female pattern hair loss. Microneedling has a limited but a significant role in the treatment of hair loss for both men and women. The skin is traumatized with a needle like a dermaroller, or a microneedling device that is adjustable, you get a healing response that sometimes results in growth of short fine hairs often referred to as vellus hairs. A lot of people come to our practice saying they regularly microneedle their scalp to try to stimulate hair growth, so they are convinced of the effectiveness. However, when I ask them how long does the hair grow and they answer, not very long because it’s not a hair that will continuously grow like what we call terminal hair. 
When microneedling is done, depending on the depth and aggressiveness of the treatment, what you are experiencing is not uncommon. My general perception is the process of microneedling at the superficial level of hair in women may induce some inflammation, which causes the hair to go into telogen or shedding phase, or the microneedling can penetrate the skin deep enough to break the shafts of hair. I think it will be difficult to actually damage the follicles, even though not impossible. If the hair breaks, it sheds out so the hair will continue to grow. 
If you have a question about whether or not you have female pattern hair loss, then get a proper diagnosis before you have any treatment. 
To help you understand our approach with female pattern hair loss, I would explain a little about Hair Regeneration referred to earlier as TrichoStem™ Hair Regeneration Centers. When we were doing a lot of hair transplants, we tried to expedite the healing process and stimulate the growth of the grafts, and discovered thinning hair became thicker. When we started this about about 7 years ago, what we figured over time was  a way to treat female pattern hair loss with a combination of platelet-rich plasma derived from your blood, combined with a material called Acellular matrix used for advanced wound healing. What we’ve been able to do is stop the progression of thinning, reactivate hair that is not growing, and induce the shed of thinning hairs so thicker hairs grow in. 
This has been a major milestone in the treatment of female pattern hair loss, and now we treat patients from all over the world. This approach has been sustainable where one injection, or at most 2 injections over the course of up to 18 months can sustain growth for 5 years according to data we accumulated for the past 7 year, with the largest bulk of patients being in the past 5 years. We have an alternative you might be interested in pursuing besides microneedling to help you with your hair loss. Again, it’s very important to have a proper diagnosis first. 
I would discourage you from microneedling for hair loss. I realize there are a lot of people who believe in it, and often put topical PRP, which they feel is an effective treatment. I don’t mean to offend anybody, but when I look at my practice and how I help my patients, clinically speaking, there is no comparison with the Hair Regeneration injection treatment and microneedling.
We do microneedling in our practice for fine lines and wrinkles, and acne scars, so it definitely has a very good role - it has a lot of benefits for the skin, but when it comes to hair thinning, I think it’s not that effective. We’ve done microneedling in the early to middle stages of the development of our hair loss treatment, and there is some potential value, but I feel it may have role in non-hair-bearing skin, or areas where it doesn’t look like there’s any existing hair. Where there is existing hair and density, the trauma of microneedling is likely to create an issue like yours where hair can break and shed, and we have the long-term data to make these observations. Although microneedling has been and can occasionally be part of our process, I feel it has to be for the right situation. Generally speaking I think microneedling is probably unnecessary moving forward.I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Hi coren.  It is difficult to say without knowing more details of the microneedling--it will take some time before you will see new hair growth anyway.  I have had better success with injecting ultraconcentrated PRP directly, and it is a shorter, less painful process for the patients.  Be sure to use a sulfate free shampoo, and consider taking RegeneMax Plus, a Xymogen supplement with clinical trials demonstrating improvement in hair, skin and nails.  Consider increasing your protein intake, warmth & gentle scalp massage to encourage blood flow.  Be sure to follow up with your practioner-best wishes.

The needle length and amount of pressure applied to the scalp is important.  Most critical is the length of the needle roller.  If it did not penetrate the dermis (if you did not see blood), then your hair will come back in 3-6 months.  If the needle went deep into the dermis and transected the follicles, some will come back and some may not.