Microneedling: A New Treatment for Acne Scars -

Sheila Krishna, M.D.

Microneedling is a safe, minimally invasive cosmetic treatment that is available for a variety of skin conditions. The principle of microneedling to improve skin appearance has been studied for over 20 years and microneedling devices have been refined over time for excellent safety and efficacy.

Microneedling is also known as percutaneous collagen induction therapy, and utilizes submillimeter needles arranged in a drum shaped device to disrupt collagen in the skin.

Collagen is a vital component of the skin that contributes to a smooth and supple appearance in healthy skin. When damaged either through scarring, sun damage, or normal aging, collagen can lose its elastic properties resulting in clinically evident scars, wrinkles and volume loss.

Microneedling can restore the normal arrangement and density of collagen by creating small microchannels of controlled skin injury which leads to recruitment of essential growth factors that regrow and rejuvenate the skin. Importantly, studies have shown that these improvements created by microneedling are lasting.

Microneedling is most commonly used for acne scarring and skin rejuvenation. It has also been studied for non-acne scars, melasma, and even transdermal drug delivery. The use of microneedling for acne scarring in particular has been very well studied and found to be safe, effective, and minimally invasive.

Acne scarring can occur in any person who has suffered from acne. It is well known that acne scarring can be persistent and difficult to treat and that it can cause significant psychological consequences.

The best treatment for acne scarring is aggressive treatment of the underlying acne before scars develop. This includes both topical treatments and oral medications. Early intervention in acne can help prevent scarring, and at times, improve existing, early scars.

Once acne scarring has occurred, there are many options to treat it, depending on the type of scar that is present. Acne scarring typically exists as soft rolling scars, ice pick or chiseled scars, or square boxcar scars. Rolling scars are not well defined and cause irregular, wave like depressions in the skin. Boxcar scars are sharply defined and wide, while ice pick scars are sharply defined, narrow and deep. Acne scarring can also leave behind thick, raised scars, called hypertrophic scars.

Conventional treatment for acne scars include surgical removal for a solitary scar, grafting of new skin into the scar, use of dermal fillers such as Restylane or Radiesse to fill the scar, or subcision, in which a needle is used to loosen the scar tissue. Laser resurfacing is another common technique for scar revision. Like microneedling, lasers for scars revitalize collagen and improve the tone and texture of the skin.

Microneedling has been well researched for acne scarring. Studies have shown that after a series of microneedling sessions, the appearance of the scar and overall skin texture improves. These changes can also be observed at the microscopic level, where collagen has reformed and reorganized, with increased expression of healing markers in the skin.

While many studies have been done on microneedling and acne scars, a seminal study in 2014 by Alam and colleagues best demonstrated the safety and effectiveness of microneedling. This study, in which each individual had half of his or her face treated with microneedling for acne scarring, and then scored by a dermatologist, demonstrated that 3 treatments spaced at 2 week intervals improved the appearance of acne scarring by 50-70%. Importantly, participants tolerated the procedure well and did not find the procedure painful, with an average pain score of 1/10 with the use of topical numbing agents.

This basic regimen can be refined in many ways depending on the needs of the individual and their unique skin. There are several different microneedling devices on the market at this time with varying depths of penetration. Most microneedling devices penetrate a few millimeters to where the collagen in the skin can be reached. These devices create both deep and superficial channels to stimulate collagen.

Microneedling devices can be rolled on the skin or stamped on the skin and they vary in needle length, configuration, size, and material. Currently available microneedling devices are typically made with disposable tips to maintain sterility and can be adjusted by the provider for maximal results. A battery operated pen like device is now available and is commonly used by practitioners.

Microneedling can also be augmented with the use of topical retinoids such as Retin-A and antioxidant serums such as vitamin C. Pre-treating the skin in the weeks leading up to microneedling, and in the weeks, after can complement the collagen stimulating effect of microneedling. It has been shown that both retinoids and vitamin C are vital for collagen density and using these with microneedling can prolong the effects of the procedure.

Further studies have demonstrated the safety and versatility of microneedling for people with different types of acne scars. Microneedling is particularly effective for rolling acne scars and boxcar type scars. In addition, it can be used in small areas without concern for producing lines between treated and untreated skin. In contrast, laser resurfacing requires overlap and treatment of larger areas to avoid a patchy appearance after treatment.

Importantly, microneedling is safe for use in all skin types. Specifically, those with tanned or darker skin are often prone to hyperpigmentation, which is darkening of the skin due to any injury. This has traditionally limited the use of many cosmetic resurfacing procedures such as chemical peels, lasers, and dermabrasion in people with darker skin. Microneedling has been shown to be safe and effective in these skin types. Several studies have examined people with darker skin whose acne scars were treated with microneedling and found that results were excellent and lasting.

While microneedling has many applications and is suitable for most individuals, there are some cases where microneedling should not be done. Microneedling should not be done if there is an active infection or any breaks in the skin. Microneedling should be done on skin that is free of any product and is well cleansed. People with a history of forming thick scars or darkening of the skin after any procedure or injury should discuss this with their provider prior to microneedling.

If you choose to pursue microneedling, you can expect that your provider will ask you about your health prior to the procedure. As mentioned above, some common reasons not to microneedle include infections, history of scarring, and history of excessive redness or skin sensitivity. Your provider will review your current skin care regimen and suggest what products to stop before treatment and when to resume them. Your provider will also recommend avoidance of hair removal, chemical peels or other cosmetic procedures prior to microneedling, and will ask you to arrive with a clean face without any lotions or products. Importantly, the skin should not be tanned or burned before microneedling. Microneedling is not currently recommended for pregnant or breastfeeding women.

During a microneedling session, your provider will clean your skin and apply a topical anesthetic to lessen any discomfort. Once your skin is numb, the microneedling device will be rolled along the skin in different directions, with precise control of timing and location to maximize outcomes. You may experience a small amount of bleeding, redness, or swelling after the procedure, which can be managed with gentle cleansers and cool compresses.

Your provider will give specific instructions on how to care for your skin after the procedure and when to re-introduce products into your skin care regimen. There may be mild peeling for a few days after the procedure as well. Most people report minimal downtime and feel that their skin returns to normal after 2-3 days.

Microneedling is safe, effective, and well tolerated. As with any cosmetic procedure, microneedling is best performed by a board certified physician or a mid level provider under close supervision by a physician.

Complications can arise if the technique is not performed under sterile conditions. Specifically, tips should be disposable and the device itself should be cleaned in between treatments just as any medical device would be. In addition, the provider of the treatment must be meticulous in maintaining cleanliness throughout the procedure and should provide excellent counseling before, during and, after the procedure.

Microneedling is an exciting area of dermatology and represents a novel way to address acne scars, fine lines and wrinkles, and a myriad of other skin conditions. It is safe and tolerated in all skin types and can provide durable, long lasting results. When performed by an experienced and well trained provider at regular intervals, it can significantly improve acne scarring with minimal downtime.

Given these benefits, microneedling is an excellent complement to other acne scarring treatments and is a potential alternative to more invasive procedures for skin rejuvenation. The science of microneedling continues to be refined, with more applications constantly being discovered for this unique cosmetic procedure.

References

Alam M, Han S, Pongprutthipan M, Disphanurat W, et al. Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial. JAMA Dermatol 2014;150:844–9.

Alster TS, Graham PM. Microneedling: A Review and Practical Guide. Dermatol Surg. 2018 Mar;44(3):397-404.

Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol 2014;13:180–7.

El-Domyati M, Barakat M, Awad S, Medhat W, et al. Microneedling therapy for atrophic acne scars: an objective evaluation. Clin Aest Dermatol 2015;8:36–42.

Fabbrocini G, DeVita V, Monfrecola A, De Padova MP, et al. Percutaneous collagen induction: an effective and safe treatment for post-acne scarring in different skin phtotypes. J Dermatol Treat 2014; 25:147–52.

Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: a comprehensive review. Dermatol Surg 2016;42:1–19.

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