Microneedling: Safety, Benefits, Before and After

Microneedling is a cosmetic procedure that involves using small, sterilized needles to create tiny punctures in the skin. This face needling treatment is a form of collagen induction therapy used to treat wrinkles, sagging skin, fine lines, scars and hair loss. Microneedling devices such as the Dermaroller® and DermaPen® are primarily used on the face to reduce the appearance of acne scars, dark spots, wrinkles, and large pores.

Microneedling has become a popular skin treatment for aging skin due to its ability to restore collagen. It is also used to treat hyperpigmentation, scars and stretch marks. We perform microneedling in my dermatology practice and I have a chapter on it in my dermatology textbook called Baumann’s Cosmetic Dermatology (McGraw Hill 2022). This blog will give you the highlights of what my book says and what I tell my patients about microneedling. I will discuss what microneedling is, its benefits, cost, safety considerations, what to do before and after the procedure and how to choose the right needle size if you choose to do microneedling at home. Microneedling can also be used to treat hair loss but this blog will focus on microneedling of the face.

Miconeedling is not right for all skin types

Best for acne scars and aging skin

Professional is better than DIY!

A good skin care routine can give the same results

What is Microneedling?

Microneedling is when needles are used to systematically and intentionally wound the skin. This causes a wounding response in the skin and turns on different cell signals like growth factors that result in the induction of collagen production.

Microneedling may be done by a dermatologist, physician assistant, nurse practitioner or aesthetician. The law about who can do microneedling depending on which state and country you live in. In some instances, microneedling can be done at home. This article will discuss best practices and help you decide if you should do microneedling and what to do to increase safety and reduce the risks.

Microneedling with PRP

Platelet-Rich Plasma (PRP) is a component of blood that is rich in growth factors and healing proteins. The PRP is extracted from your own blood, which is processed to concentrate the platelets. (A blood draw is performed in he medical practice.) When combined with microneedling, PRP enhances the skin’s natural healing process. The growth factors in PRP stimulate collagen production, accelerate tissue repair, and improve overall skin texture and tone. This synergy between microneedling and PRP results in more pronounced and faster improvements.

There have been reports in Florida of patients getting HIV after this procedure because they were treated with an HIV+ person’s blood. So when your medical provider draws your blood- ask them to write your name on the blood tube in front of you to help prevent a mix up with another person’s blood. This is one of the many reasons you need a reputable doctor who will not cut corners.

Radiofrequency (RF) MIcroneedling

Radiofrequency (RF) microneedling combines the collagen-stimulating benefits of traditional microneedling with the tissue-tightening effects of radiofrequency energy. RF energy is delivered through the microneedles into the deeper layers of the skin, causing controlled thermal damage that leads to collagen contraction and stimulation of new collagen production. While this technique can effectively tighten skin and improve its texture, the heat generated by RF can increase the risk of side effects such as hyperpigmentation, especially in darker skin tones. Therefore, careful consideration and professional expertise are essential when using RF microneedling.

MIcroneedling as Skin Care Delivery

Microneedling can significantly enhance the delivery of skincare ingredients that are typically too large to penetrate the skin, such as peptides. By creating micro-channels in the skin, microneedling allows these active ingredients to reach deeper layers where they can be more effective. This method can improve the efficacy of topical treatments, making them work better and faster. Although the use of microneedling for enhanced drug and cosmetic delivery is not yet FDA-approved, ongoing studies are investigating its potential. The results so far suggest that microneedling could be a valuable tool for maximizing the benefits of advanced skincare formulations.

Microneedling at Home

At-home microneedling devices generally feature shorter and thinner needles compared to professional devices, making them less effective for significant skin improvements. One of the main challenges of at-home microneedling is ensuring the needles enter the skin at a precise 90-degree angle, which is difficult to achieve due to the curved surface of the face. This can lead to inconsistent results and increase the risk of complications. While at-home microneedling is more cost-effective, it can result in costly side effects such as scarring and post-inflammatory hyperpigmentation if not done correctly. For optimal and safe results, it is recommended to undergo microneedling treatments performed by trained professionals.

Before and After

In my experience, the best before and after resutls are seen in the treatment of acne scars as seen in the photos below.

Benefits

Microneedling offers numerous benefits for skin health and appearance:

Improved skin texture

Less obvious scars

Less obvious stretch marks

Increased skin thickness

Fewer fine lines and wrinkles

Decreased dark spots

Improved skin firmness

Many people believe it reduces pore size but this may just be due to swelling after the procedure.

Who Benefits Most?

Microneedling has many benefits but it is not right for everyone. I highly recommend you see a reputable doctor or medical provider to discuss if you can benefit from this cosmetic procedure. In general, here is a guide to who will benefit from needling devices:

Melasma: Microneedling is not safe due to the risk of post-inflammatory hyperpigmentation. Skin care and oral tranexamic acid are far superior for treating melasma.

Acne: Microneedling is effective.

Acne Scars: Microneedling is better than skincare for treating acne scars.

Rosacea: Not recommended.

Wrinkles: Can be beneficial but depends on skin type.

Sensitive Skin: Generally not recommended.

Resistant Skin: Can be effective for product absorption.

To get more personalized advice, take our skin type quiz to identify your skin’s barriers to skin health before you get any procedures done.

Microneedling is generally not recommended for sensitive skin types or many dry skin types. The only skin types that should do Microneedling my option are light skinned individuals with these skin types:

Baumann Skin Type 16:DRNW (Dry Resistant Non-Pigmented Wrinkle-Prone)

Baumann Skin Type 12: ORNW (Oily Resistant Non-Pigmented Wrinkle-Prone)

These skin types tend to have a strong skin barrier, making it difficult for products to penetrate effectively. Microneedling can enhance antiaging ingredient absorption for these types. However, using the right skincare products is often more effective than microneedling.

Cost

The price of microneedling depends on the area treated and the condition treated. Averge cost is $350 for the face per treatment. A treatment series of 4 treatments may cost around $1500. Price varies greatly but this is one of those situations where if you decide to do microneedling- splurge on a goood doctor because side effects can be very bothersome and expensive and may be permanent.

Skin Problems That Improve with Microneedling

Scars

Microneedling can treat several different types of scars and is particularly beneficial for treating atrophic scars, which are depressed or sunken into the skin. These scars, often resulting from acne or chickenpox, can significantly improve with microneedling. The procedure also shows promise for hypertrophic scars, which are raised above the skin surface, and keloid scars, which are thick and irregular. By breaking down old scar tissue and promoting the growth of new, healthy skin, microneedling can reduce the appearance of these scars.

Microneedling treatments for scars require multiple sessions – usually 6-8- to see optimal results. Depending on the severity and type of the scar, treatments are usually spaced about 4-6 weeks apart, with noticeable improvements often seen after 3-6 sessions. Clinical studies have shown that microneedling can improve scar appearance by 50% or more after several treatments. (3)

Enhancing the efficacy of microneedling can be achieved by combining it with topical treatments. Applying skincare products such as retinoids, hyaluronic acid, or growth factors post-procedure can further enhance collagen production and improve skin texture. However, it’s important to note that consistent use of the correct skincare routine is much more effective and safer in the long run than microneedling alone. Long-term use of retinoids, for example, has been proven to slow aging, whereas the inflammation caused by microneedling could potentially accelerate skin aging. Additionally, there are no long-term studies on the effects of this procedure for skin aging, so a cautious approach is advised. Microneedling is highly effective for acne scars but is not recommended for melasma due to the risk of post-inflammatory hyperpigmentation. For melasma, skincare and oral tranexamic acid are superior treatment options.

Acne Scars

There are several types of acne scars that are defined by their shape such as:

ice pick

rolling scar

box car

atrophic

Box car and rolling scars seem to respond best to microneedling treatments. Ice pick scars do not improve with this procedure. For optimal results in treating acne scars, needle lengths between 1.5 to 3.0 mm are recommended.

A study by Alster in 2020 (4) evaluated the efficacy of microneedling on scars in 120 patients with diverse skin phototypes (I to VI). These patients had facial and nonfacial scars from various causes, including acne, trauma, and surgery. Using a mechanical microneedling device, patients received one to six monthly treatments without any additional topical or intralesional therapies. Two blinded assessors rated the clinical improvement of scars at 1, 3, 6, and 12 months post-treatment on a five-point scale, and side effects were monitored.

The study found that all scars showed at least 50% improvement after an average of 2.5 treatments. Over 80% of patients experienced 50-75% improvement, and 65% demonstrated more than 75% improvement. Importantly, the study noted minimal side effects, even in darker skin types.

Stretch Marks

Microneedling is a treatment option for striae distensae (stretch marks), but can lead to hyperpigmentation in dark skin types. According to a study by Alster and Li (5), this procedure is particularly effective for both light and dark skin tones due to its lack of thermal injury, which minimizes the risk of post-inflammatory hyperpigmentation. The study involved 25 adults with stretch marks on their trunk and extremities. Patients received one to three monthly treatments, with all showing at least 50% improvement after an average of 1.8 treatments. Remarkably, 28% of patients exhibited more than 75% improvement. Striae in thicker skin regions, such as the buttocks and thighs, responded comparably well to those in thinner areas, like the breasts, without requiring additional sessions. Side effects were minimal, primarily limited to transient erythema, with no infections or dyspigmentation observed. This study supports this treatment as a safe and effective treatment for stretch marks across various skin types and body locations, with further studies anticipated to standardize treatment protocols. Always wear sunscreen and sun protective clothing over the treated area to decrease the risk of post inflammatory hyperpigmentation.

Wrinkles

In a recent study (10), 35 subjects received four monthly microneedling treatments to treat skin aging. The results were promising: facial dermal and epidermal density increased by 101.86% and 19.28%, respectively, three months post-treatment. Additionally, facial elasticity improved by 28.22%, and collagen type III and elastin gene expression significantly increased. This is a good sign that this procedure can result in skin rejuvenation. However, in my opinion and experience as a dermatologist, a good skin care routine can show similar results. It just takes a bit longer but skin care is much safer than purposely wounding the skin. For example- topical defensins can have similar result on the epidermis.

Microneedling Tools: Pens, Rollers, and Needles

Needle Length

The width and length of the needles is the most important factor when deciding which needle, roller or pen device is best. The best needle length depends upon what you are treating and which areas of the face you are treating. The Microneedling Depth Chart below gives you guidance on what the best needle length is for each area of the face. (1)

FDA Approved Microneedling Tools

Many of the tools used for microneedling are not FDA approved.

Here is a list of FDA-cleared microneedling devices:

SkinPen Precision

MicroPen EVO

Dermapen 4

These devices have been approved for specific uses such as improving the appearance of facial acne scars and wrinkles on the neck. They are designed to ensure safety and efficacy when used by trained professionals.

DermaRoller

Dermaroller is the name of the most popular and first microneedle roller for at home use. It has been around for decades but has gotten more popular for at home microneedling in the last 5 years.

Microneedling Pen

There are many good pens for this procedure. I suggest buying one of the FDA approved ones listed above. However, please don’t do microneedling yourself at home. Its just a terrible idea for many reason including:

Sterility

Ability to consistently have needles enter skin at a 90 degree angle

Technique

Safety of needle size choice requires knowldege of skin thickness in various areas

Summary

Microneedling can offer significant benefits for certain skin types, however, it is not suitable for all skin types. Consulting with a dermatologist and using the right skincare products after microneedling is often a more effective and safer approach. If you decide to proceed with microneedling, ensure it is performed by a qualified professional to minimize risks and maximize benefits.

DQH Knowledge drop: In your 20s, your skin cell turnover decreases. (Cell turnover is a key component in keeping your skin youthful.) You know what else slows down? Your collagen production. Starting in your 20s, collagen decreases by about 1 percent per year. Should you want to prevent fine lines and wrinkles, start by eliminating behaviors that contribute to premature aging. “If it’s bad for you, it’s bad for your skin,” says dermatologist Michel Somenek. “Cigarette smoking reduces blood flow to the skin and causes premature wrinkling and a dull skin texture. Making the repeated pursed motion to inhale can also cause smoker’s lines. Alcohol and recreational drugs are toxins for the skin that damage its cellular structure and DNA,” Somenek tells us. “The faster you eliminate vices while you are young, the better chance your skin and body have to recuperate.” Also, adopting an anti-aging routine in your 20s is key. After all, the best offense is a good defense. We spoke to Somenek and experts Joshua Ross and Audrey Kunin to find out more. Keep reading for the best anti-aging products for your 20s, according to skincare professionals. Sunscreen “We all know that the sun is the number one cause of skin aging and starting the prevention in your 20s is very important,” Ross says. “The majority of your sun damage won’t start to appear until you’re in your 30s, so don’t wait until you see it surface or you’ll be behind the curve. Stay ahead of it with a good-quality zinc-based sunscreen worn daily.” Farmacy Green Defense Daily Mineral Sunscreen An invisible sunscreen with SPF 30, plus botanical extracts meant to protect skin with tons of antioxidants. Bonus: It’s clean and fine to use under makeup. Bareminerals Complexion Rescue™ Tinted Moisturizer Broad Spectrum SPF 30 Although we recommend you use your SPF and moisturizer separately, we also understand moments when you don’t have time or energy for that extra step. For those times, this bareMinerals moisturizer is a great thing to have on hand. Vitamin C Serum “A great introduction to anti-aging is to start with a vitamin C serum in your morning skincare routine,” Ross says. “It’s a powerful antioxidant that will neutralize free radicals and brighten the skin.” He adds that it’s a great way to counteract the effects of the sun’s harmful rays, which, as previously mentioned, are among the biggest causes of premature aging. Drunk Elephant C-Firma™ Vitamin C Day Serum The Drunk Elephant C-Firma is a lightweight serum that promises to give skin a glow by combining the brightening powers of vitamin C with ferulic acid, l-ascorbic acid, and vitamin E. The included sodium hyaluronate is meant to replace hydration loss, so you shouldn’t have to deal with any irritation. Sunday Riley C.E.O. Rapid Flash Brightening Serum This potent serum is jam-packed with vitamin C (15 percent, to be exact), which means it’s a potential superstar at both brightening skin and dousing it in antioxidants. Peptides Using peptides on your skin has many benefits, says Somenek. “The skin barrier is what defends the body against pollution, UV rays, bacteria, and toxins. It can be damaged by several everyday factors. Using topical peptides aids in building a stronger barrier,” he says. “Peptides comprise elastic fibers, which are a type of protein. These fibers help to make skin appear taut and firm. Peptides can also help repair damaged skin, relieve inflammation, and even out skin tone. Some peptides can kill acne-causing bacteria that is common in 20-somethings.” Kunin agrees, saying, “Peptides are an excellent entry point for supporting collagen.” She recommends looking for face and eye treatments that contain these collagen-boosting powerhouses. Charlotte Tilbury Magic Eye Rescue Cream This Charlotte Tilbury super-emollient eye cream has a base of coconut oil and shea butter (read: it’s incredibly hydrating). Botanicals plus peptides are meant to help reduce dark circles and boost collagen, respectively. This creamy moisturizer serves up potent collagen-boosting peptides and pycnogenol, and antioxidant-rich vitamin C. “Instead of sitting on top of the skin, peptides penetrate the outer layer so they go deep. The ‘signals’ they send tell the cells to produce elastin and collagen, which are needed for youthful-looking skin,” explains Somenek. At-Home Peel Pads Remember that skin cell turnover fiasco we talked about earlier? One way to help support it is by exfoliating. “Exfoliation is important to help keep skin fresh and luminous,” Kunin says. She recommends using at-home peel pads as an easy and effective way to exfoliate. “The goal in your 20s is to fight the slowing pace of cell turnover. It is wise to use products that gently exfoliate, yet still remove oil and other impurities. Products that have Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) are a good choice.” According to Somenek, you should only exfoliate two to three times a week. “People of all ages are guilty of over-exfoliating and that can be too much of a good thing,” he says. Dermadoctor Kakadu C Intensive Vitamin C Peel Pad A few swipes of this Derma Doctor powerful peel pad promise to leave your skin glowing and smooth, thanks to the seven (yes, seven) types of chemical exfoliants, including AHA and BHA. It also contains vitamin C via Kakadu plum extract for added brightening and antioxidant protection. KEY INGREDIENTS Kakadu plum extract is sourced from the Kakadu plum, a fruit grown in northern Australia. It contains vitamin C, which restores the skin’s natural barrier, increases collagen production, and soothes irritation. Dr. Dennis Gross Skincare Alpha Beta® Universal Daily Peel Pads These are the gold standard of peel pads, with a cult following and over 900 five-star reviews on Sephora. They’re easy to use and contain a blend of anti-aging exfoliating acids. Emollient Night Cream “In your 20s, you need to start upping the hydration in your skincare routine. You may have been cautious of over-moisturizing because of acne in your teens, but as you enter your 20s, your skin transitions and becomes drier,” Ross says. “I recommend an emollient night cream added into your evening skincare regimen.” “Twenty-somethings need to make sure that they are not using creams that will clog their pores and cause excess oil production,” says Somenek. Opt for non-comedogenic products. Cerave Skin Renewing Night Cream One great choice is the CeraVe Skin Renewing Night Cream, which is a non-comedogenic night cream that leaves skin soft and glowy. It combines the moisturizing powers of ceramides and hyaluronic acid. RoC Retinol Correxion Max Hydration Creme “The best night cream ingredients contain retinol, benzoyl peroxide, and/or salicylic acid or hyaluronic acid. The goal is to moisturize, yet remove excess oil,” says Somenek. This Roc Retinol Correxion cream fits the bill as it contains both hyaluronic acid and retinol so it promises to moisturize while also being non-comedogenic.

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