Microneedling – Is it safe and effective? | Ask Doctor Anne

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I have talked about different procedures you can do in the office and at home, but so far never touched on microneedling. One of the reasons for that was that I never had it done professionally and am not a big fan of microneedling at home for reasons I will talk about later on.

 

Stop! Why microneedling at home might not be your best idea.
Stop! Why microneedling at home might not be your best idea.

 

But first, let’s talk about what microneedling actually is, what it can be used for and if there is data behind it.

Have you had it done professionally or do you microneedle at home?

 

 

What is microneedling?

Microneedling basically means you take tiny needles and poke holes in the skin, ideally penetrating the stratum corneum. This physical trauma induces a wound healing cascade with recruition of platelets and neutrophils that release growth factors like TGF-alpha, TGF-beta and platelet derived growth factor, which in the end result in stimulation of the fibroblasts to produce new collagen.

This mechanism is similar to things like radiofrequency or ultrasound that also set a trauma by heating up the tissue to stimulate collagen production, but the trauma is a different one. (More info: Radiofrequency for the skin – Does it work?)

To achieve the best effect here, you should reach the Stratum papillare, which is right where the epidermis meets the dermis, so the needles should be long enough to penetrate the whole epidermis, which is depending on the area of your body between 0,03 mm around the eyes up to 4 mm on the soles of your feet. On average it is at around 0,5 mm though.

The small channels created by the needle stay open for around 24 hours, so products applied immediately before, during or shortly after the microneedling process can get deeper into the skin as they don’t need to penetrate the epidermis. That effect is strongest for skincare used directly with microneedling and fades over time.

 

A common dermaroller for microneedling the face
A common dermaroller for microneedling the face
Image by Ilona Pokallo from Pixabay

 

Which skin condition is microneedling good for?

Microneedling can be used to treat a variety of skin conditions, the first use was for atrophic or indented acne scars as early as 1995, but since 2006, when the prototype of the popular dermaroller was invented, it has been used for a multitude of things like pore tightening, wrinkles, skin laxity, stretchmarks and various forms of pigmentation issues of the skin as well as for the treatment of alopecia or hair loss. (More info: The reasons for hair loss in men and women)

 

Male pattern hair loss – what we usually think of
Image by kalhh from Pixabay

 

Is there data on microneedling?

Microneedling for different skin conditions has been studied, but the amount and quality of data we have differs depending on the condition. (My sources are listed below)

For the treatment of atrophic scars, both from acne or for other reasons there are several that show the efficacy with histological samples that show a statistically significant increase in both collagen quantity and quality, and that effect has also been demonstrated in different ethnicities and in comparison to other treatments like in office peels or laser. For both the effects were comparable, but downtime and side effects for microneedling lower. As the increase in collagen quantity and quality is what we are looking for in the treatment of wrinkles, skin laxity, stretchmarks and pore size, it seems safe to transfer these results to those skin conditions as well, despite having less data looking for those endpoints. (More info: Can you make your pores smaller?)

For the pigmentation disorders we have to differentiate between hyperpigmentation like sun spots, pigmented acne scars and melasma and depigmentation like Vitiligo. (More info: The different types of hyperpigmentation explained)

For hyperpigmentation, studies are there, but of varying quality and most often combined the use of microneedling with skincare like Tranexamic Acid, TCA peels or Hydroquinone used alongside the needling, which doesn’t tell us if microneedling alone would have a similar effect. For only microneedling combined with sunscreen there is much less data, but the data we have seems promising. (More info: The benefits of Tranexamic Acid in skincare and The benefits of Hydroquinone in skincare)

For depigmentation on the other hand it is too early to say and more studies are needed to determine if it is beneficial.

Quickly touching on hair loss or more specifically androgenetic alopecia: Here microneedling has shown to improve the results of topical minoxidil and/ or oral finasteride compared to topical or oral treatment alone and even rendered results in people unresponsive to topical treatment before.

For all studies done you have to note though that both the frequency as well as the needle length had great variations, so we can’t yet say which protocol or needle length is the most effective.

 

This is a stamping device for at home use - the Banisher 2.0
This is a stamping device for at home use – the Banisher 2.0
(Source: Banish website)

 

Which microneedling tools are there?

When looking at the tools available for microneedling, you can divide them roughly in rollers and in stamping devices: Rollers are rolled over the face vertically, diagonally and horizontally. The stamping devices are either automatic, like the Dermapen which also allows you to adjust the needle length based on area of the face you are treating, or are stamped into the skin manually one area at a time.

Some of these devices come with additional things like radiofrequency admitted through the needles, but those are usually only used in-office.

 

Hand on heart - this is not how your bathroom looks like.
Hand on heart – this is not how your bathroom looks like.
Image by sungmin cho from Pixabay

 

What is the difference between at home and in office microneedling?

While you might expect that there would be a difference in needle length between devices used by professionals and the ones for at home use, that isn’t always the case. You can easily buy rollers or pens with up to 2 mm needle length off of amazon, and at least the rollers are quite cheap, no matter the length.
The deeper you go, the higher the risk for injuries to skin structures like nerve endings or bigger blood vessels.

Different is the way you can take care of your device though – no matter how thorough you are, at home you are only able to cleanse and disinfect the device, it will never be sterile as that needs a specified process involving equipment you don’t have at home. Medical devices meant to puncture the skin, like needles for taking blood, need to be sterile. Devices that don’t puncture the skin, like a blood pressure cuff, will be disinfected between uses, that is a difference you need to be aware of. The only way you can get sterile equipment at home is by using a new head or roller every time you microneedle.

The last and probably biggest difference between in office and at home is that if you do the procedure in office, you (hopefully) have someone that knows what they are doing and can judge the right products to use alongside the treatment, the right depth and intensity, while at home you have to rely on what you taught yourself.

 

Redness is very common as side effect.
Redness is very common as side effect.
Image by Youssef Labib from Pixabay

 

What are the side effects of microneedling? Is microneedling safe?

While microneedling is usually safe, a few things can happen. The most common are transient redness through the increase in blood flow as well as pinpoint bleeding that always occurs. Major bleeding on the other hand is very rare, even if you are on blood thinners. Depending on the needle depth, you could injure skin structures like nerve endings or, when used around the eye where the skin is thin, even the bone or the eyeball.

Whenever you puncture the skin, be it accidentally or on purpose, you have a risk for infection, so when you puncture hundreds of holes in your face, that risk increases. Dirty skin or contaminated equipment needs to be avoided to keep the risk for infection as low as possible.

There is also a risk for postinflammatory hyperpigmentation as well as a risk for keloid scarring in those prone to that, which increases if the needling isn’t done properly. (More info: PIH vs PIE – what is the difference?)

It not being done properly is actually the biggest risk I see, especially with rollers of low quality and blunt needles: To create minimal trauma and side effects, you should puncture the skin as straight as possible, so if you don’t know what you are doing or your rollerhead is loose or the needles are blunt, chances are you are not creating a vertical puncture, but you are dragging the skin, which leads to microtears at the skin surface. There are a few videos on TikTok where people demonstrate that with a banana, and the difference between a roller and stamping devices in the way the skin is bruised is huge.

Other, rare side effects would be so called tram track scarring where the pinpoint bleeding doesn’t go away, but a lasting redness where the roller went stays, looking like a tram track, and granulomas forming beneath the skin surface. Granulomas are small, hard nodes that develop when particles are brought beneath the skin barrier that don’t belong there and trigger an inflammation which, in the process, encloses the particle. This could be either small dirt particles or skincare you needled into the skin that wasn’t supposed to go there.

 

Lots of skincare products from e.l.f., Banish and Alpha-H lined up
So many different skincare bits to chose from – which one is best for microneedling?

 

Which skincare should I use with microneedling?

Microneedling increases the absorption of your skincare because it allows it to bypass the skin barrier through the tiny holes. Traditionally microneedling was done with NaCl, a saline infusion, to make it easier for the rollers to glide over the skin, the addition of things like hydrating or skin brightening ingredients came later.

If you decide you want to use skincare with your needling device, make sure it is specifically designed and tested for that purpose. Skincare is formulated for topical application, you don’t know how products formulated to be applied on the epidermis will react when the epidermis is bypassed. They come in contact with different cells from the immune system down there for example, which could sensitize you for different ingredients. It could lead to much higher concentrations and subsequently irritation and in some cases even to granulomas, small hard nodes underneath the skin as part of the body’s defense against intruding particles.

 

Snail mucin is refined before it is put into your skincare.
There is a huge difference between a doctors office and your bathroom.
Image by Michal Jarmoluk from Pixabay

 

Why I don’t think microneedling at home is the best idea

Microneedling is affordable, works on a lot of skin conditions and different ethnicities and is considered safe when done properly. The “when done properly” part is what worries me though, as there are many things you can do wrong when you do it at home.

It starts with the quality of the needles, as cheap ones will get blunt quickly, the risk for infection as you need to change the head with each use if you want to make sure it isn’t just clean, but sterile and goes on with desire to experiment and do a little more than recommended when we are left to our own. Obviously we know our skin very well, but I am sure there is someone out there with a video microneedling Tretinoin into their face, and if it is out there, someone else will surely follow their lead.

If you decide to microneedle at home, I suggest you use a stamping device rather than a roller, change the head with each use and not use products that aren’t specifically designed to be used with exactly your device. Oh, and limit the needle length so you don’t accidentally puncture your eyeball.

 

How long does it take to see results with microneedling?

For optimal results you should get 6-8 sessions that are spaced 3-4 weeks apart. The collagen induction needs time and repair, so needling your face every day will not increase the speed, nor will you be able to judge the effect after one treatment.

 

How long is the downtime after microneedling?

The downtime after microneedling depends on the area treated and your individual reaction to trauma. Pinpoint bleeding, so red dots on the skin, are visible for at least 24 hours, and you should avoid using makeup or skincare not designed for microneedling for 3-7 days afterwards, depending on the irritation potential. The risk for postinflammatory hyperpigmentation increases with UV exposure, so ideally you don’t do it right before a beach holiday and wear sunscreen or use other means of sun protection afterwards.

 

How long do microneedling results last?

As far as how long the results last, it is the same as with other devices: The collagen induction is permanent, but the new collagen will degrade just like any other with time, so firmness will increase and then decrease again with the natural aging process. Atrophic scars and stretchmarks however will not reappear over time, so there the results are permanent. For hyperpigmentation you will obviously have to continue to avoid UV exposure so it won’t reappear.

 

TL;DR

Microneedling is affordable, works on a lot of skin conditions and different ethnicities and is considered safe when done properly. It works by poking small channels into the skin that go deeper than the epidermis, which induces a wound healing response triggering formation of new collagen. That can help with skin laxity, wrinkles and atrophic scars, either from acne or stretchmarks.
The channels also allow products used simultaneously to penetrate the skin deeper by bypassing the first protective layer.
While considered safe when done by a professional, at home use has a higher risk for side effects like infection and scarring.
To see best results, you need 6-8 treatments spaced 3-4 weeks apart, but your ideal treatment plan should be discussed with your treating professional.

 

Is Microneedling at home safe?
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Sources:

Alster, T. S., & Graham, P. M. (2018). Microneedling: A review and practical guide. In Dermatologic Surgery (Vol. 44, Issue 3). https://doi.org/10.1097/DSS.0000000000001248

Hou, A., Cohen, B., Haimovic, A., & Elbuluk, N. (2017). Microneedling: A Comprehensive Review. In Dermatologic Surgery (Vol. 43, Issue 3). https://doi.org/10.1097/DSS.0000000000000924

Iriarte, C., Awosika, O., Rengifo-Pardo, M., & Ehrlich, A. (2017). Review of applications of microneedling in dermatology. In Clinical, Cosmetic and Investigational Dermatology (Vol. 10). https://doi.org/10.2147/CCID.S142450

Ziaeifar, E., Ziaeifar, F., Mozafarpoor, S., & Goodarzi, A. (2021). Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: A comprehensive review study. In Dermatologic Therapy (Vol. 34, Issue 6). https://doi.org/10.1111/dth.15159

 

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