What does microneedling do?
Microneedling uses tiny needles to stimulate the skin to rejuvenate it- tighten it, help with stretch marks, scar remodeling, and hair growth. Its fancier medical name is “percutaneous collagen induction therapy.” It is exciting because it is thought to not have post inflammatory hyperpigmentation, so it is used in darker skin phototypes (Fitzpatrick IV through VI seen in Asia and the Middle East).
How is it thought to help with scars
Microneedling helps in many ways. Studies in animal and human models show:
- Micro wounds are made, which thickens collagen and starts the wound healing cascade.
- There is little epidermal damage and inflammation, which makes it safe to use in darker skin
- Gene expression after treatment shows increase in Type I collagen and increased growth factors of blood vessels, fibroblasts, epidermal growth, and transforming growth factor.
- Histology afterwards shows the epidermis is thicker, the dermis has more collagen and elastin
- Over months, new Type III collagen matures to Type I collagen, which tightens the skin and decreases scars and wrinkles.
Journal article on microneedling of scars- synopsis
This was a study out of dermatology.
- 58 studies were reviewed with 1845 patients treated
- Scars treated: acne, hypertrophic, keloids and those from surgery, trauma, or injections
- They looked at pure microneedling and microneedling with radiofrequency.
Findings?
Both microneedling and microneedling with radiofrequency improved scar appearance from baseline without serious events. They concluded that studies are needed to develop standardized treatment protocols.
When you look at the study, you see they all vary in needle depth, when they start doing microneedling, spacing of treatments, what topical products they put on with the microneedling treatment, and how many treatments they do. Where did they agree?
- Pre treatment numbing. This can hurt. Topical lidocaine was used. (*We have a special blend we use for our patients which is super effective.)
- Multiple treatments.
- The treated area was cleaned well.
- Post treatment regimens with sunscreen, skin care products, and other topicals.
There is very a small risk of issues, which are reported as hyperpigmentation, scabbing, bruise, railroad tracks, acne flare, and herpes reactivation.
What did they conclude from this study? They evaluated scars by the patient and the investigator. They used scar scales to stratify.
- Combination therapy was more effective at scar improvement than microneedling or RF microneedling alone. (Studies used laser, PRP, glycolic acid peel, TCA peel, and topical amniotic stem cells.)
- 50-100% patient satisfied. 1/3 would want further treatment
- 94% would recommend to others.
They conclude that microneedling is well tolerated and gives clinical improvement in scarring. They found patients tolerated it better than laser treatment of scars.
Dr. Greenberg’s thoughts on microneedling scars
I am a fan of microneedling. I see great changes in skin and hair improvement. We have been doing the microneedling with topical Age Zero exosomes, and like our results.
As for scar treatment, I want to know more. I have blogged before about microneedling of scars, and the real question for me is when? how often? what is the spacing? what depth should you aim for?
Though this meta study did not show issues with pigmentation, I always worry about pigmentation in my darker skinned patients. Any inflammation can lead to pigment.
So we offer it, but I cannot fully run with this yet- I need to see better definition of protocols.
Medical Citation
Microneedling for the Treatment of Scars: An Update for Clinicians – PMC (nih.gov), Clinic of Cosmetic Investigative Dermatology, December 2020.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
