Microneedling for Acne Scars: Are There Any Risks?

Since its introduction in the 1990s to treat wrinkles and fine lines, microneedling has grown in popularity as a treatment for acne scars. Microneedling is one of many treatment options available for acne scars. The type and severity of the acne scarring dictate the best treatment options. Read on to learn the effectiveness and risks of microneedling and how it compares to laser treatments.

What are acne scars?

Acne scars are caused by inflammation and trauma from acne breakouts, picking or squeezing the acne lesions, and infection caused by picking at acne lesions. Depending on the inflammation's depth, the scars can be superficial, deep, or moderate. There are two basic types of acne scars: atrophic and hypertrophic.

1. Atrophic acne scars are indentations in the skin. They can be ice-pick, rolling, or boxcar scars. Ice-pick scars are thin, deep scars. Rolling scars are wide, shallow, and have a rolling appearance. Boxcar scars are oval-shaped or round and less wide than rolling scars.
2. Hypertrophic acne scars are raised and can be more common in people with darker skin tones. The scars are usually thick and lumpy.

Ice-pick scars are typically the result of cystic acne caused by inflammation deep inside the pore. These types of scars go deep into the skin's dermal layer and are the hardest to treat because they are the most severe. Ice-pick scars are deeper than boxcar or rolling scars, and their narrow appearance also makes them difficult to treat.

How microneedling works

Microneedling is a minimally invasive dermatological procedure that's simple, safe, and effective. Initially used for skin rejuvenation, microneedling is now commonly used for acne scar treatments, post-traumatic/burn scar treatment, and stretch marks treatment, among others. Think of microneedling as giving your skin a gentle prick and prod to encourage it to heal and reveal fresher and more radiant skin. An alternative known as radiofrequency microneedling involves the combination of microneedles and radiofrequency energy.

During microneedling, tiny fine microneedles (usually 0.5–3 mm in length and 0.1–0.25 mm in diameter) in a microneedling pen are pricked into an area of skin to create tiny punctures. This form of controlled skin injury does not damage the epidermis, the outermost layer of the skin. It helps stimulate the skin's normal healing process, stimulating collagen and elastin production and reducing the excess growth of skin cells.

Does microneedling work for acne scars?

Yes, microneedling can help improve the appearance of acne scars. Microneedling, also known as collagen induction therapy, involves creating micro-injuries to the skin with numerous tiny needles that stimulate the production of new and remodeled collagen. This new collagen leads to improvement in skin texture and scar tissue.

Actual results can differ based on various factors and can vary for each individual. Consult with a qualified professional to understand what results you might expect

Microneedling works best on atrophic scars, especially rolling and boxcar acne scars. Only minimal improvement is achieved in ice-pick scars. It is best to avoid microneedling for hypertrophic and keloid scars, as they could worsen.

Beyond its ability to smooth out acne scars, microneedling has other skin benefits. It can even skin tone, giving you a brighter complexion and helping fade discoloration associated with acne scars. It can also improve the appearance of fine lines and wrinkles.

Microneedling treatment process

After cleansing and numbing the skin, an electronic microneedling device with numerous tiny needles treats the area with acne scars. Some opt to treat their entire face to reap the rejuvenation benefits in unaffected areas of the face. The average microneedling session takes about 30 minutes. You will notice mild, pinpoint bleeding that resolves before leaving your appointment.

Immediately after the session, your skin will appear red and swollen, which may last several days. You may also experience dryness and peeling that lasts a few days after the microneedling procedure. Some experience mild discomfort or soreness and possible itching.

A typical microneedling session is described below:

1. Consultation and cleansing. A dermatologist assesses your skin before thoroughly cleansing and prepping the treatment area.
2. Numbing. To minimize discomfort, a numbing cream is applied.
3. Microneedling. The microneedling device is moved across your skin to create micro punctures.
4. Serum application. A serum like maybe hyaluronic acid or vitamin C may be applied to boost the microneedling effects.
5. Post-treatment care. Because your skin might be red, a soothing serum or cream, as part of post-treatment care, may be applied to calm your skin.
6. Aftercare and follow-up. The dermatologist will provide you with aftercare instructions. Depending on your skin's condition and needs, your dermatologist may recommend follow-up sessions.

Some people apply PRP (platelet-rich plasma) or PRF (platelet-rich fibrin) after the microneedling session. PRP and PRF contain growth factors extracted from the blood's plasma. These growth factors are used to speed the healing and treatment of scars.

Some apply special serums after the microneedling session. These serums may contain antioxidants and hyaluronic acid. Applying these serums immediately after microneedling will enhance the penetration of these ingredients, leading to better and faster results.

How many sessions are needed?

Generally, it can take 4–6 sessions to improve acne scars, depending on the scarring's depth, severity, or extensiveness. The more severe, the more sessions it will take. The sessions are usually performed monthly to allow the skin to heal fully. Deep scars will require deeper microneedling, which needs more downtime and could result in more possible side effects. These deeper treatments may need to be spaced out every 6–8 weeks for recovery.

Maintenance microneedling sessions can be performed periodically to retain skin improvement. If you have an acne breakout in the future, you will need more microneedling sessions. It's best to treat scars after your acne is under control and not experiencing breakouts.

Regular follow-up microneedling treatment is advisable for long-lasting results, such as sustained collagen production, long-term skin health, and regression. Proper follow-up care is critical to promoting healing, maximizing the treatment benefits, and avoiding potential complications. Some follow-up care includes using sunscreen regularly (day and night), avoiding heat exposure, and avoiding picking or scratching.

At-home microneedling vs. professional treatments

There are different ways to approach microneedling, including at-home treatments and professional procedures. Each option offers distinct advantages and considerations, depending on skin type, desired results, and budget.

Microneedling for acne scars at home

There are at-home dermarollers for microneedling. Because the needles on these at-home devices will not penetrate as deeply as the professional ones, you will not get the same results as a professional treatment. Also, without proper training, you can cause permanent scarring by doing it yourself. Since there is no way to sterilize your at-home device properly, you risk developing an infection that could require hospitalization or lead to permanent scarring.

Microneedling vs. laser treatments

Microneedling and laser are good treatment options for acne scars. The choice depends on the type of scar, downtime, side effects, and skin type. Microneedling may be better for darker skin types and those who can't have an extended downtime or are concerned about laser risks. Laser treatments may give faster and better results for some but require more downtime and have more risks. Some lasers may not be used on darker skin types because of depigmentation risks.

Another important consideration is the budget. Microneedling is typically less expensive than laser treatments. The costs of microneedling can make it more attractive for those on a budget. However, more microneedling treatments may be needed to improve scarring, making it more time-intensive.

Risks and side effects of microneedling

Microneedling, like any procedure, has associated risks and side effects. Some are minor, and others are severe. The potential side effects and risks can be lessened by strictly following your doctor's pre- and post-op guidelines. Minor side effects usually subside within a few hours or days, while serious risks can take longer to resolve. Following pre- and post-treatment guidelines provided by your dermatologist is crucial when managing any side effects you may experience.

Who should not have microneedling?

Some patients are not good candidates for microneedling. Patients with certain medical conditions or on certain medications are at increased risk for side effects. It is best to discuss this with your dermatologist to see if microneedling is right for you. These medical conditions include:

• Bleeding disorders
• Active infection
• Keloids
• Pregnancy
• Skin conditions (eczema or psoriasis)
• Diabetes
• Problems with wound healing
• Medications (blood thinners or immunosuppressants)

Microneedling aftercare

Your dermatologist should provide you with enough detailed information on how to care for your skin after your microneedling sessions. Some aftercare tips include the following:

1. Sun protection. Avoid sun exposure by protecting your skin from direct sunlight for at least 24–48 hours after your microneedling session. This is because the skin is susceptible and prone to sun damage after microneedling. If you need to go outside, use a broad-spectrum sunscreen with an SPF of 30 and above.
2. Avoid scratching or picking. Even if you experience peeling or flaking, it is important to avoid scratching or picking as this can cause scarring or infection.
3. Avoid makeup and skincare products. Using makeup, exfoliants, or harsh skincare products should be avoided at least 24–48 hours post-treatment because these can irritate the skin. Try to stick to gentle cleansers and moisturizers.

Ensure to use skincare products that are hydrating after a microneedling session. Hydrating moisturizers can help promote healing and maintain the skin barrier's function. Use gentle moisturizers containing hydrating ingredients like hyaluronic acid and glycerin.

Needling away acne scars: the verdict

Acne scars can cause significant physical and psychological distress. Good acne treatments instituted early and proper acne care may prevent acne scars. If unpreventable, treatments are available to help fade acne scars, such as microneedling. Microneedling can be a safe and effective treatment by a properly trained professional. The lower cost of microneedling compared to laser makes it an attractive treatment option for acne scars. Always consult with a dermatologist for personalized advice regarding microneedling.

Article history

Our experts strive to provide up to date information and update articles when new information becomes available

August 28, 2024

Fact checked by Alifia Fernandes Jokubauskienė, MPharm

August 28, 2024

Updated by Dr. Abimbola Aminu, PhD

March 29, 2023

Written by Jennifer T. Trent, MD FAAD