Skin Needling/Microneedling

Compared to many other scar revision treatments, skin needling poses a low risk of side effects. The charts below show the chances of developing various side effects from skin needling.1,3,4-8 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Pain*up to 100%
SHORT TERM Transient redness (erythema)**up to 100%
SHORT TERM Swelling immediately after procedure (edema)up to 100%
SHORT TERM Bleeding/oozing from wound‡up to 100%
SHORT TERM Crustingup to 100%
SHORT TERM Bruising or swelling of clotted blood inside skin (hematoma)incidence not known

*Pain: Skin needling causes temporary pain or a burning sensation.

**Erythema: Mild skin redness after skin needling is normal and usually disappears after 2-3 days.3,4

Edema: Swelling after skin needling is normal and should disappear after 2-3 days at most.3,4

‡Bleeding/oozing from wound: Bleeding or oozing from the wound is normal after skin needling and stops when a crust forms on the skin.

SHORT TERM or LONG TERM Skin darkening (post-inflammatory hyperpigmentation)*up to 13.8%
SHORT TERM Acne flare-upup to 13.3%
SHORT TERM or LONG TERM Train-track scarring**up to 5.3%
SHORT TERM Skin discoloration due to bleeding under the skin (ecchymoses)up to 2.8%

*Post-inflammatory hyperpigmentation (skin darkening): This percentage is based on a single study, which only looked at Asian patients.7 Other studies do not report any hyperpigmentation. In general, needling may carry a lower risk of post-inflammatory hyperpigmentation compared to other scar revision procedures. Post-inflammatory hyperpigmentation is more common in darker-skinned people.

**CAUTION. Train-track scarring: This percentage is based on a single study, which only looked at Asian patients.7 Other studies do not report this side effect. At this time, we do not know how likely train-track scarring is in patients of other races or ethnicities.

Studies:   

Five studies have looked at the side effects of dermabrasion.

  • Study 1:

    • Authors: Cachafeiro et al.8
    • Total # of patients: 20
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 16-50
    • Duration of treatment and follow-up: 3 sessions, follow-up at 6 months
    • Side effects: Post-inflammatory hyperpigmentation: 0%
  • Study 2:

    • Authors: Osman et al.5
    • Total # of patients: 30
    • # of female patients: 20
    • # of male patients: 10
    • Age of patients: 21-41
    • Duration of treatment and follow-up: 5 sessions, follow-up at 3 months
    • Side effects:

      • Crusting: 0%
      • Post-inflammatory hyperpigmentation: 0%
  • Study 3:

    • Authors: Alam et al.1
    • Total # of patients: 15
    • # of female patients: 6
    • # of male patients: 9
    • Age of patients: 20-65 Average: 33.7
    • Duration of treatment and follow-up: 3 sessions, follow-up at 3 months and 6 months
    • Side effects: No side effect reported
  • Study 4:

    • Authors: Leheta et al.6
    • Total # of patients: 15
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: 20-42 Average: 29.7
    • Duration of treatment and follow-up: 4 sessions
    • Side effects:

      • Pain: 100%
      • Transient (average: 3 days) erythema (redness): 100%
      • Acne flare-up: 13.3%
  • Study 5:

    • Authors: Dogra et al.7
    • Total # of patients: 30
    • # of female patients: 8
    • # of male patients: 22
    • Age of patients: Average: 25.5
    • Duration of treatment and follow-up: 5 sessions, follow-up at 1 month
    • Side effects:

      • Pain: 36.1%
      • Hyperpigmentation: 13.8%*
      • Tram-track-patterned scarring: 5.6%*
      • Ecchymosis: 2.8%
      • Infection: 0%

* All patients had Asian skin type.

Study 1: In a study published in 2016 in the journal Dermatologic Surgery, Cachefeiro and colleagues performed skin needling on 20 patients. The patients received 3 sessions at intervals of 1 month and were followed up 6 months after treatment. The researchers observed erythema (redness) which lasted one day. Patients reported that they were able to continue normal daily activities after treatment. The researchers did not find post-inflammatory hyperpigmentation in any of the patients.8

Study 2: In a study published in 2017 in Dermatologic Surgery, Osman and colleagues treated 30 patients with skin needling on one side of the face. The patients received 5 sessions of treatment at 1-month intervals and were followed up 3 months after the final treatment. The researchers found transient erythema (redness), edema (swelling), but no crusting.5

Side effectsDuration: days after microneedling5
Erythema (redness)1.43
Edema (swelling)1.3
Crusting0
Post-inflammatory hyperpigmentation0
Total downtime1.47

Study 3: In a study published in 2014 in JAMA Dermatology, Alam and colleagues randomly treated 15 patients with either skin needling or a placebo treatment on one side of the face. The patients received 3 treatment sessions at 2-week intervals and were followed up after 3 and 6 months. The researchers routinely observed mild transient erythema (redness) and edema (swelling), but did not consider these to be side effects. The patients did not report any side effects.1

Study 4: In a study published in 2011 in Dermatologic Surgery, Leheta and colleagues treated 15 patients with atrophic acne scars with skin needling. Patients received 4 sessions of treatment at 4-week intervals. All patients experienced transient erythema (redness) and edema (swelling) after treatment. The erythema lasted 3 days on average. Two of the patients developed some new acne lesions.6

Study 5: In a study published in 2014 in the Journal of Cosmetic Dermatology, Dogra and colleagues treated 36 patients with atrophic scars with skin needling. However, only 30 patients completed the study. All the patients had an Asian skin type and received 5 sessions of treatment at 1-month intervals. The researchers followed up with the patients 1 month after the last treatment session. 40% of the patients reported side effects, which were mostly mild and transient. These side effects included pain during the procedure, erythema (redness), and swelling, but usually disappeared in 2-3 days. Some patients developed hyperpigmentation after 2-3 sessions. One patient developed ecchymosis (skin discoloration due to bleeding under the skin), which disappeared on its own in 2 weeks.7

References
  1. Alam M, et al.  Efficacy of a needling device for the treatment of acne scars: a randomized clinical trial. JAMA Dermatol. 150(8), 844-9 (2014).
  2. Fabbrocini G, Fardella N, Monfrecola A, Proietti I, and Innocenzi D. Acne scarring treatment using skin needling. Clin Exp Dermatol. 34(8), 874-9 (2009).
  3. Uptodate.com. Management of acne scars. Available from: https://www.uptodate.com/contents/management-of-acne-scars?source=search_result&search=subcision&selectedTitle=1~4. Last retrieved on 5 October, 2017.
  4. Harris AG, Naidoo C, and Murrell DF. Skin needling as a treatment for acne scarring: An up-to-date review of the literature. Int J Womens Dermatol. 1(2), 77-81 (2015).
  5. Osman MA, Shokeir HA, and Fawzy MM. Fractional Erbium-Doped Yttrium Aluminum Garnet Laser Versus Microneedling in Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study. Dermatol Surg. 43 Suppl 1, S47-S56 (2017).
  6. Leheta T, El Tawdy A, Abdel Hay R, and Farid S. Percutaneous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg. 37(2), 207-16 (2011).
  7. Dogra S, Yadav S, and Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol. 13, 180-187 (2014).
  8. Cachafeiro T, Escobar G, Maldonado G, Cestari T, and Corleta O. Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial. Dermatol Surg. 42(2), 232-41 (2016).