###### Abstract  
A procedure based on Microneedling (MND) with Low-Level Led Therapy (LLLT) and Growth Factors (GFs) could be a booster for hair re-growth (HRG) in patients assuming Finasteride(r). The study examined the clinical outcomes of a multicentric, observational, retrospective, case-series investigation in which MND with LLLT and GFs was applied to patients suffering from androgenic alopecia (AGA) who were prescribed Finasteride(r). Twenty-one patients were initially enrolled, of which seventeen males were classified in stage II-VI by the Norwood-Hamilton scale, and four females were classified in stage II-III by the [PERSON] scale. One male patient was excluded after screening (exclusion and inclusion criteria evaluation). Twenty patients were analyzed, of which ten patients' hair growth has stalled after taking Finasteride(r), and ten patients did not achieve good results from Finasteride(r). HRG assessment was evaluated with photography, physician's, and patient's global assessment scale, in addition to standardized phototrichograms during a short follow-up: T0--baseline, TI--20 weeks (wks). A statistically significant improvement in HRG (\(p\) = 0.0822) and an increase in hair density of 19 \(\pm\) 2 hairs/cm2 at TI after 20 wks (20 wks vs. 0 wks) in the targeted area over baseline (74 \(\pm\) 2 hairs/cm2 at TI versus 55 \(\pm\) 2 hairs/cm2 at baseline) were reported and described as encouraging results. The effectiveness of MND with LLLT and GFs use was demonstrated in patients whose hair growth stalled after taking Finasteride(r) and in patients who did not achieve good results from Finasteride(r). h air growth; hair growth finasteride; low-level LED therapy; microneedling in hair growth; finasteride and micro-needling; regenerative plastic surgery; plastic surgery Article  
Hair Growth Booster Effects of Micro-Needling with Low-Level Led Therapy and Growth Factors on 00133 Rome, Italy  
+++ ==WARNING: Truncated because of repetitions==
ling with Low-Level Led Therapy and Growth Factors on 00133 Rome, Italy  
2  
++  
Several biomolecular mechanisms have been postulated to explain the usefulness of these strategies in HRG. The activation of mitochondria found in the stem cells of the hair bulge is the biomolecular mechanism trough it LLLT acts with the aim stimulate HRG. Cytochrome c-oxidase (CCO), which is located in the membrane of mitochondria, is the target chromophore of red light that initiates mitochondrial respiration. The stimulation of cellular migration, proliferation, and oxygenation by reactive oxygen species (ROS) and adenosine triphosphate (ATP) subsequently stimulate hair development [10]. Commonly, the purpose of using PRP, HFSCs, and LLLT is to stimulate human dermal papilla cells proliferation through the stimulation of the ERK pathway and Wnt/-catenin signaling [1; 2; 3; 4; 5; 6; 7; 8; 9; 11]. Numerous treatments have been used to treat AGA, but only oral Finasteride(r) (a selective 5-alpha-reductase inhibitor), topical Minoxidi(r) in 2% and 5% solutions or foams, and low-level LED/light/laser therapy have received FDA approval to treat MPHL [12; 13]. The FDA has also given approval to Minoxidi(r) 5% foam for FPHL. Finasteride(r) is demonstrated as useful in treating MPHL, but it has mostly failed to treat FPHL [14]. Additionally, Finasteride(r) may determine anomalies in the external genitalia of male fetuses and for this reason is unsuitable for use by premenopausal women [15]. In contrast, daily administration of Finasteride(r) has been demonstrated to improve hair density (HD) by increasing anagen phase transition in MPHL hair follicles and stimulating a 70% decrease in serum dihydrotestosterone (DHT) levels [16; 17]. HD-significant improvements may require up to one year of taking Finasteride(r) and male users may experience libido reduction, which may persist after the medication is discontinued [18]. Additionally, the results obtained may be, in some cases, stagnating or ineffective.