Micro needling has brought a lot to the world of scar treatment. Lasers and chemical peels are the gold standards of skin improvement, but sometimes they aren’t the best choice for everyone because they aren’t suited to the condition being treated, the skin type, or the budget.

Micro needling has really filled in a lot of the gaps in scar treatment by offering a less invasive alternative for deep scarring, a less costly alternative for lighter scarring and dark spots, and an all around safer alternative for darker skin tones.

Types of Scars

The best treatment for scarring depends on the type of scar being treated. Scars fall broadly into 3 groups: hypertrophic, atrophic and contracture.

Hypertrophic

Hypertrophic scars are raised formations characterized by an overproduction of collagen fibers. Keloid scars are a subset of hypertrophic scars characterized by overgrowth outside the borders of the original scar.

Micro needling is generally not recommended for keloid scarring and can even make scars worse. For hypertrophic scars in general its highly recommended to consult with a professional because treatment can easily make the problem worse.

Contracture

Contracture scars are usually caused by burns. They make the skin contract or tighten, which can be very uncomfortable and limit movement. Contracture scars are best left to professionals.

Atrophic

Atrophic scars are flat or in more advanced cases recessed indentations in the skin sometimes called ice-pick scars or boxcar scars. These are the scars we most commonly associate with acne. They can also involve hyperpigmentation or dark spots.

micro needling for scars before and after atrophic
micro needling results atrophic scarring

Micro Needling for Atrophic Scars

Most of the research on micro needling for scar treatment focuses on atrophic scars. Since they are so common and respond very well to micro needling, atrophic scars will be the focus of this post.

Micro Needling vs Chemical Peels and Laser Therapy

Compared to other resurfacing procedures, this technique has many advantages. First, it is purposed to be safe in all skin types and to carry the lowest risk of postinflammatory hyperpigmentation when compared to laser resurfacing, chemical peels, or dermabrasion.1,9 Second, the treatment does not result in a line of demarcation between treated and untreated skin. Third, the recovery period of 2 to 3 days is significantly shorter than other resurfacing procedures. Finally, needling is much less expensive to incorporate into a practice compared with a fractional laser or dermabrasion.” Effective Treatments of Atrophic Acne Scars

Before micro needling was discovered treatments like chemical peels, laser therapy and even subscision for very deep scars had one potential drawback: they can be very invasive.

Chemical peels and laser therapy in particular also target the epidermis, the outermost protective layer of the skin. This usually translates to a larger treatment area and more downtime.

Micro needling is a good scar treatment alternative to laser and chemical peels since it’s much less invasive. Treatment only targets the deeper layers of the dermis where it initiates the wound healing cascade that supports new collagen growth.

…very effective in minimizing acne scars and burn scars by removing scar collagen and replacing it with normal collagen. Consequently, scar contractures and depressed scars are improved. …As opposed to ablative laser treatments, the epidermis remains intact and is not damaged.” Combating photoaging with percutaneous collagen induction.

Scar Treatment for Darker Skin Tones

Lasers and chemical peels can be a challenge for people with darker skin tones, since they’ve been known to cause hyperpigmentation.

In ethnic skin, traditional skin resurfacing procedures such as dermabrasion, chemical peels, and laser therapy can be effective but can also be associated with prolonged recovery and risk of complications. These complications can include a higher risk of dyspigmentation and scarring, and unsatisfactory clinical outcomes. …Microneedling may offer a more advantageous safety profile, particularly in the skin-of-color population (Fitzpatrick skin types IV-VI), compared with more conventional resurfacing modalities. Thus far, it has been shown to be effective for a number of dermatologic conditions in this population, including scarring, melasma, melanosis, skin rejuvenation, acne vulgaris, and primary hyperhidrosis.” Microneedling in skin of color: A review of uses and efficacy.

Micro needling is a good alternative for people with darker skin tones since it doesn’t have the same risk of hyperpigmentation as laser and chemical peels do.

micro needling results for hyper pigmentation and scarring before and after
micro needling results for hyper pigmentation and scarring

Most importantly, people with all skin types can effectively use micro-needling throughout the year. Unlike lasers, micro-needling does not depend on chromophores (pigment or color) to work. Therefore, it does not matter how dark one’s skin tone is when considering whether to perform a micro-needling treatment. Micro-needling can provide great results for people with all skin types, which is not the case for lasers.” Fractionated Laser Resurfacing or Micro-needling: Which One Should I Have to Improve My Skin?

Professional vs At Home Needling for Scars

Professional Micro Needling for Scars

Although micro needling is less invasive and can be less costly than laser therapy or chemical peels in general, treatment of very deep scars may only respond to more invasive treatments.

micro needling before and after boxcar acne scars
Micro needling for boxcar type scarring

In those cases, professional micro needling treatment with a longer needle length of 2.5mm or more may be used, which could involve local or general anesthetic and up to a week of downtime.

Is a great alternative to lasers and fillers/surgery but takes many treatments and if your scars are very atrophic, boxcar or pitted, it may only help slightly. I typically do microneedling in combination with laser treatments and fillers.  I suggest seeking the advice of someone who specializes in scars and does the treatments often.” Jason Emer, MD Los Angeles Dermatologic Surgeon

The cost of needling treatment for very deep scars is still less than laser therapy and still less invasive than either laser or chemical peels since it doesn’t damage the epidermis.

Likewise, professional micro needling can be a much safer alternative for darker skin tones.

micro needling before and after results for acne scars and post inflammatory erythema
Micro needling for severe atrophic scarring and post inflammatory erythema

Yes, micro needling/ Dermapen/ Skin Rolling can help. This is a simple form of fractional resurfacing, without the heat associated with laser. In fact micro needling was the fore bearer of fractional laser. Does it work? Yes, it can help improve box cars, and atrophic as well as rolling scars. Is it as good as laser? No, but it is cheaper and in our practice needling is performed by our nurses as an ‘entry level’ to acne scar revision. Like fractional laser, you will need 3-5 treatments for best results. I suggest monthly treatments for 5 months. Unlike laser, needling does not denature collagen by heat, and hence the results are not as good, however if cost is an issue, this treatment is better than creams and LED treatments.” Davin Lim, MBBS, FACD Brisbane Dermatologist

Another benefit of professional needling is that it can be combined with other high-tech procedures like radio frequency and platelet-rich plasma (PLP) facials, which can significantly improve results.

As of Jan 2016, my provisional trials of INFINI RF MICRONEEDLING now makes this my favourite treatment for rolling, mixed, atrophic and tethered scars, as well as small to medium pores. I have started using this system in Sept 2015, and the results for these type of scars are great. This is not just micro needling but energy based micro needling.” Dr. David Lim Dermatologist

micro needling before and after
Micro needling before and after image credit eclipsemicropen.com

At Home Micro Needling for Scars

At home micro needling with either a derma roller or an electric derma pen can really improve the appearance of less severe acne scars and hyperpigmentation. Many can get very good results with just micro needling but the effect is improved with the use of a vitamin C serum, preferably in the form of ascorbic acid.

micro needling before and after results acne scars
Home treatment results after about 6 months. For more information see my micro needling experience.

I really like microneedling. Today there are many devices that do microneedling but to be honest, I like the feel of my own hand applying the necessary pressure of a dermroller on the skin. No machine can beat the feedback of the human hand. It is a great treatment to help improve acne scars, tighten skin, build collagen.” Sameer Bashey, MD Beverly Hills Dermatologic Surgeon

Featured image credit needlelogics.com

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Author

Cristina is the founder and editor in chief of bold + blush. She's been covering the beauty beat here for almost three years, applying the research skills she picked up in law school to cut through the beauty industry hype and find the products and practices that actually work. Her other interests include wellness, yoga and cooking. When she isn't writing about beauty on bold + blush you can usually find her freelancing as a writer, blogging at cristinaskitchen.com, or spending time with her husband and dog at home in Amsterdam. Fun fact: She's usually reading half a dozen books at any given time.

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