Microneedling

Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis, creating microwounds that stimulate the release of growth factors and induce collagen production. ^[1] Also referred to as percutaneous collagen induction therapy, it is nonablative and preserves the epidermis, which reduces inflammation, downtime, and risk of dyspigmentation compared with other resurfacing techniques. ^[2] It has been used for a broad range of applications including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery. ^[3]

Controlled dermal wounding and stimulation of the wound-healing cascade enhances collagen production, which is likely responsible for the clinical results obtained. ^[3] Because the epidermis remains relatively intact, adverse events are limited compared with ablative resurfacing. ^[1] Beyond boosting fibroblast collagen, microneedling helps normalize the function of keratinocytes and melanocytes and can be used to increase absorption of topical medications and growth factors. ^[2]

A systematic review and meta-analysis of 21 articles covering 723 patients undergoing microneedling for facial rejuvenation pooled 83% patient satisfaction, with transient erythema the most common adverse effect. ^[4] A systematic review of microneedling for acne scarring found that all 33 articles evaluated showed improvement of acne scar appearance after treatment. ^[5] A meta-analysis of 12 randomized controlled trials (414 participants) found microneedling without radiofrequency achieved superior scar improvement and caused no postinflammatory hyperpigmentation. ^[6] A systematic review of 22 clinical studies (1127 subjects) found microneedling improved hair parameters as an adjunct across a range of hair-loss types, with no serious adverse events reported, though the data were of relatively low quality. ^[7] International consensus statements on melasma list microneedling among procedural options to enhance topical efficacy, while reserving lasers for refractory cases. ^[8]

Given its expedient recovery, limited side-effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling. ^[3] It combines synergistically with treatments such as platelet-rich plasma, dermal fillers, and laser therapy, producing improved aesthetic results. ^[9]