Objective To analyze the effect of 0.5 mm scalp microneedling combined with 630 nm LED phototherapy on hair improvement in patients with androgenetic alopecia. Methods A total of 90 patients with androgenetic alopecia admitted to Xuhui Hospital Affiliated to Fudan University from January 2023 to September 2024 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 45 patients in each group. The control group was treated with 630 nm LED phototherapy, and the study group was treated with 0.5 mm scalp microneedling combined with 630 nm LED phototherapy. The hair improvement, scalp fungus detection rate, hair loss improvement degree, adverse reaction rate and recurrence rate were compared between the two groups. Results After 12 weeks of treatment, the hair density and hair diameter in the study group were larger than those in the control group, and the number of hair follicle units per single hair was lower than that in the control group (P <0.05). The positive rate of fungal microscopy in the study group at 12 weeks after treatment was 24.44%, which was lower than 53.33% in the control group (P <0.05). The self-rating scale for hair loss improvement scores and improvement rates in the study group at 12 weeks after treatment and 6 months after treatment were higher than those in the control group (P <0.05). The recurrence rate of the study group at 6 months after treatment was 8.89%, which was lower than 31.11% of the control group (P <0.05). There were no obvious adverse reactions in the two groups. Conclusion 0.5 mm scalp microneedling combined with 630 nm LED phototherapy can rapidly and persistently improve androgenetic alopecia symptoms through multi-target synergistic effect, improve patients' quality of life, and has good safety and durability, which is worthy of clinical application.