Microneedling acne scars

Microneedling is an entry level treatment for acne scars. It involves using a mechanical pen (or roller) to make thousands of vertical columns in the skin’s surface. 

This produces limited skin injury that in turn stimulates collagen.  The commercial term for this is called CIT or collagen induction therapy. 

Needle can be delivered via –

• A handheld pen; Dermapen or SkinPen are common brands
• A roller; usually 256 or 512 short needle tips
• A stamper; with needles ranging from 0.1 to 1.5 mm
• Energy assistance: either RF insulated or non-insulated

Depending on how it’s performed, microneedling will improve most scar types- including superficial boxcar scars and pick scars. Microneedling does not improve ice pick scars (marginal at best), nor does it improve deep rolling atrophic scars.

The argument is not that microneedling is a bad treatment, it is based upon the fact there are other better treatments for specific scar types. Read more to understand how dermatologists approach acne scars. 

Here is a concept. A carpenter needs to build a table. He only has a Swiss army knife & no other tools. A table can be built, but it is not the best finish, and it takes ages to complete. 

Same concept with acne scarring. Approach scar revision based upon scar type, then match a treatment. Examples include- 

• Ice pick scars; do best with TCA CROSS, angled lasers, excision
• Boxcar scars; do best with ablative lasers, TCA
• Rolling scars; are best treated with subcision
• Large volume atrophic scars; are best treated with filler/fat transfer

Yes. That is the major advantage of microneedling as it does not produce heat. The flipside is that new lasers with specific settings do the same, but with a lot more efficiency & efficacy. 

Pico lasers and short pulse duration ablative lasers can safely treat dark skin, in addition to delivering faster results than microneedling. 

Dermatologists employ appropriate treatments for specific conditions. This means we always match treatments to scar types. I

n some cases, microneedling may be the treatment of choice, for example in the treatment of white scars (hypopigmentation) or slightly raised hypertrophic scars. In this situation we use microneedling to deliver actives into the dermal layers of skin. 

Read more about how we match treatments to scar patterns. This gives a bespoke customised approach to scar revision. This means faster results.

No. Our nurses and therapist use numbing gel prior to each treatment. For RF microneedling, we often use blocks or laughing gas. 

If you have PIH or dark scars, do not microneedle. *Deeper needles push pigment into the deep dermal layers of skin converting brown pigment to grey. PIH should be treated with pico lasers. 

*Short needles of <0.1 mm can be used to enhance topical pigment correctors, however in reality increased absorption is not required. You can achieve this with a loofa in the shower. 

3-8 sessions for best outcomes. Treatments follow the law of diminishing gains, the more sessions after number 3, the less the improvement. If scars remain after 3 sessions, it’s time to move the game on. 

The great thing about microneedling is it takes away the ‘thinking’ required for true scar revision, namely everyone gets the same setting, same passes, same procedure. It is a great treatment for SOP or standardized operating protocol scar revision. 

1- 4 plus days. The shorter the needles, the quicker the recovery. High pass microneedling or RF microneedling has a recovery period of 4 days or longer. Your treating nurse will discuss downtime with you.

Marginally. Growth factor injections can improve healing times. As to the result, that depends on the papers you read. There is some evidence that Growth factor injections can improve scar outcomes. Discuss this with your treating dermatologist as they will have individual viewpoints on this procedure. 

*Growth factor injections stands for platelet rich plasma. It is frequently used with microneedling and has more evidence in the treatment of hair loss.

Heat. Microneedling does not provide heat. Heating is required for maximal collagen remodelling (around 67-68 degrees). RF microneedling is on average 2-4 times more effective than non-energy microneedling. 

The RF devices we use are insulated. This means only the tip of the needle is heated, as compared to devices like Secret RF whereby the whole needle conducts energy. Insulation protects the skin from collateral damage.