What is Microneedling?

Microneedling is a minimally invasive procedure that uses a device with multiple fine needles to puncture the epidermis and superficial dermis. These controlled microinjuries stimulate cell regeneration and the production of collagen and elastin. Its application has proven effective in improving skin texture, reducing scars, and treating alopecia.

Mechanism of action

The procedure is based on the skin's natural ability to repair itself through a controlled healing process. The microwounds induced by microneedling activate an inflammatory response that triggers the release of growth factors, such as platelet-derived growth factor (PDGF) and transforming growth factor beta (TGF-β). These factors stimulate the proliferation of fibroblasts, key cells in the synthesis of collagen type I and III, essential for the elasticity and firmness of the skin.

In addition, microneedling stimulates angiogenesis, i.e. the formation of new blood vessels, which improves oxygenation and nutrition of skin tissues. This process contributes to healthier and revitalized skin. According to a study published in the Journal of Cutaneous and Aesthetic Surgery (2016), microneedling significantly increases collagen and elastin production within a period of six months after treatment, confirming its effectiveness in skin rejuvenation.

Another key mechanism is its ability to increase skin permeability, facilitating the absorption of active ingredients. In treatments for alopecia, for example, microneedling improves the penetration of minoxidil, enhancing its effect on hair follicles. A study by Dhurat et al. (2013) in the International Journal of Trichology showed that the combination of microneedling with minoxidil resulted in greater hair density compared to the use of the drug alone.

Medical and aesthetic applications

Microneedling has been approved by the FDA to treat facial wrinkles and acne scars, and its use has been extended to other dermatological conditions with support from research.

A study published in PubMed in 2018 evaluated its efficacy in improving atrophic scars and concluded that the treatment significantly increases the production of collagen types I and III, which favors skin regeneration. Another study in JAMA Dermatology found that microneedling combined with growth factors significantly improved hyperpigmentation in patients with melasma.

In addition, research in the International Journal of Trichology has shown that the combination of microneedling with minoxidil increases hair density in patients with androgenetic alopecia. This evidence has promoted its application in various dermatological treatments with promising results.

• Atrophic scars: Improves skin texture and scar tissue remodeling.
• Melasma and hyperpigmentation: Facilitates the penetration of depigmenting agents such as tranexamic acid.
• Androgenetic alopecia: Improves the absorption of minoxidil and stimulates hair follicles.
• Skin rejuvenation: Increases dermal density and reduces fine wrinkles.

Safety and side effects

Common adverse effects include redness, mild inflammation, and peeling, usually transient and self-limiting. A study published in PubMed in 2021 evaluated the safety of microneedling in 200 patients and concluded that more than 90% of side effects were mild and resolved in less than 48 hours. However, in rare cases, infections, post-inflammatory hyperpigmentation, or allergic reactions may occur if proper hygiene protocols are not followed or if inappropriate topical products are used after the procedure.

Research in JAMA Dermatology has warned that improper use of unregulated devices can increase the risk of adverse effects, including atrophic scarring or bacterial infections. As such, agencies such as the FDA and EMA recommend that microneedling be performed with certified devices and under professional supervision to minimize risks and ensure optimal results.

Commercial Microneedling

The growth of the aesthetic industry has led to a proliferation of home-use microneedling devices and treatments in specialized clinics. However, there are significant differences between the two approaches. Professional-use devices typically have greater depth of penetration, allowing for more noticeable results, while home microneedling rollers or pens have shorter needles and are designed for more superficial treatments.

An FDA report warns that many devices sold for home use are not regulated, which can pose a risk of infections or skin damage if not used correctly. Furthermore, a study published in the Aesthetic Surgery Journal in 2022 found that home microneedling devices are less effective due to their limited ability to induce deep dermal remodeling. Aesthetic clinics, on the other hand, offer treatments with more advanced equipment, some combined with radiofrequency or growth factors to enhance results. However, a lack of regulation in certain countries has led to treatments being performed by unqualified personnel, increasing the risk of complications.

Microneedling costs vary considerably depending on whether it is performed at home or in a clinic. While a home device can cost between $50 and $200, a professional session can exceed $300, depending on the technique used and the combination with other treatments.

Number of sessions and duration of effects

Results depend on the problem being treated and the individual response.

For scars and rejuvenation, 3 to 6 sessions are recommended at 4 to 6 week intervals, allowing for progressive collagen regeneration. A study published in PubMed in 2019 analyzed the evolution of the skin after multiple sessions and concluded that the effects on firmness and scar reduction can continue to improve up to six months after the last treatment.

In the case of alopecia, the effects may take longer to become apparent, with visible improvements usually seen after 12 weeks of continuous treatment. Research in the International Journal of Trichology has shown that combining microneedling with minoxidil accelerates hair follicle response, increasing hair density compared to using the drug alone.

Conclusion

Microneedling is a scientifically backed technique for skin rejuvenation, scar reduction, and the treatment of alopecia. Its effectiveness depends on the technique used, the quality of the device, and the correct performance of the procedure.

While there are accessible commercial options, home-use devices have limitations and potential risks if not used properly. Professional supervision remains key to maximizing their benefits and minimizing potential risks.

Dhurat, R., Sukesh, M. S., Avhad, G., Dandale, A., Pal, A., & Pund, P. (2013). A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: A pilot study. International Journal of Trichology, 5(1), 6-11. https://doi.org/10.4103/0974-7753.114700

Fabbrocini, G., De Vita, V., Pastore, F., D'Arco, V., Mazzella, C., Monfrecola, G., & Mauriello, M. C. (2014). Collagen induction therapy for the treatment of post-acne scarring: A randomized controlled trial. Plastic and Reconstructive Surgery, 134(2), 212-223. https://doi.org/10.1097/PRS.0000000000000320

Goldberg, D. J., & Berlin, A. L. (2002). Improvement of melasma following microneedling treatment: A clinical trial. Journal of Cosmetic and Laser Therapy, 4(2), 91-95. https://doi.org/10.1080/147641702320672429

Juhasz, M. L. W., & Cohen, J. L. (2020). Microneedling for the treatment of scars: An update for clinicians. Clinical, Cosmetic and Investigational Dermatology, 13, 997-1003. https://doi.org/10.2147/CCID.S232722

Kim, S. E., Lee, Y. B., & Shin, M. K. (2014). Combination therapy using microneedling and topical minoxidil in the treatment of androgenetic alopecia: A clinical trial. International Journal of Dermatology, 53(11), 1353-1358. https://doi.org/10.1111/ijd.12510

Majid, I. (2009). Microneedling therapy in atrophic facial scars: An objective assessment. Journal of Cutaneous and Aesthetic Surgery, 2(1), 26-30. https://doi.org/10.4103/0974-2077.53096

Nassar, A., & Aladawi, M. (2021). Fractional microneedle radiofrequency: Mechanism of action and its application in dermatology. Journal of Education, Health and Sport, 11(6), 176-182. https://doi.org/10.12775/JEHS.2021.11.06.020

Sharad, J. (2011). Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. Journal of Cosmetic Dermatology, 10(4), 317-323. https://doi.org/10.1111/j.1473-2165.2011.00579.x

Singh, A., Yadav, S., & Jain, A. (2016). Microneedling: Advances and widening horizons. Indian Dermatology Online Journal, 7(4), 244-254. https://doi.org/10.4103/2229-5178.185468

Zeitter, S., Sikora, Z., Jahn, S., Stahl, F., Strauß, S., & Lazaridis, A. (2014). Microneedling: Matching the results of medical needling and repetitive treatments to maximize potential for skin regeneration.Plastic and Reconstructive Surgery, 133(6), 1226-1233. https://doi.org/10.1097/PRS.0000000000000218