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Microneedling: Where do we stand now? A systematic review of the literature
Abstract and Figures
Background
Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.
Objective
This review aims to evaluate the current evidence in the literature on microneedling.
Methods
A systematic literature review was performed by searching the electronic databases Pubmed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence.
Results
Microneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distentiae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed significant results when used on its own and when combined with topical products or radiofrequency. When compared to other treatments, it showed similar results but was prefered due to minimal side-effects and shorter downtime.
Conclusion
This systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings and further research is required to truly establish microneedling as an evidence based therapeutic option for treating scars, wrinkles and other skin conditions.
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... So, no scarring is expected in this procedure [11]. In facial treatments microneedling in combination with PRP has been shown to enhance percutaneous collagen induction [11,16]. Moreover, significantly better improvement of acne scars was reported with PRP plus microneedling vs. microneedling alone [17]. ...
... According to literature, Maximum effects are seen 12-24 weeks after microneedling. For PRP treatments, the maximal improvements of the skin were reported to occur between 1 and 3 months after the treatment lasting for up to 6 months [16,24]. Therefore, the positive effects observed in our study could be underestimated as our last follow-up was four weeks after the final treatment. ...
... These observations could imply that besides the predicted cellular change in the dermis and subdermis, the neural cells and skin adnexal structures are affected as well [8,25]. Other potential adverse effects such as postinflammatory hyperpigmentation, transient erythema, edema, bruising, post-injection burning, or stimulation of hair growth, which have been reported in the literature, did not occur in our study [8,16,24,26]. Since no serious adverse effects occurred, PRP plus microneedling implies to be a safe treatment in scar management. ...
... Systematic reviews evaluating microneedling across various skin conditions, including atrophic acne scars, hypertrophic scars, keloids, and striae distensae, have also reported noteworthy improvements when microneedling is used alone or combined with adjunctive treatments. Importantly, these reviews highlight microneedling's comparable effectiveness to other established modalities but with fewer adverse effects and shorter recovery periods, further supporting its potential application to visible and cosmetically sensitive areas like the anterior neck [19,20] Given that the neck is similarly exposed and holds high cosmetic importance, it is reasonable to hypothesise that microneedling would offer comparable benefits for anterior neck scars. ...
... One prospective study assessed microneedling outcomes across various scar types, including facial surgical scars, and found that all patients experienced at least a 50% improvement in scar appearance after an average of 2.5 treatments. Notably, over 80% of patients observed a 50% to 75% improvement, and 65% of patients demonstrated over 75% improvement in their scar scores (p < 0.001) [20]. These results indicate that microneedling is effective for surgical scars and especially advantageous for scars in prominent areas, such as the face and, by extension, the anterior neck. ...
... MN is a minimally invasive procedure that involves puncturing the skin surface, specifically the scalp, to produce localised redness and pinpoint bleeding. This method is fast, inexpensive and associated with few side effects [5,8,10,[21][22][23][24][25][26]. The most common devices used for the procedure are derma-rollers or pens. ...
... In the case of MN, the range of algorithms presented in the literature is very wide. The number of treatments in the algorithms ranges from 3 to 52, intervals from 1 week to 1 month, and penetration depths from 0.25 mm to 2.5 mm [3,6,7,[23][24][25][29][30][31][32][33][34]. The choice of 3 treatments at 1-month intervals was guided by the choice of parameters to an effective minimum. ...
Introduction
Androgenetic alopecia is the most common form of non-cicatricial hair loss in men. The condition also affects young adults and can cause significant psychological distress. In addition to widely accepted methods, clinicians have at their disposal a number of therapies for which there are no established treatment algorithms.
Methods
The study was conducted on a selected group of 92 men aged between 20 and 50 years. The patients were divided into three groups, each with a different therapeutic algorithm: group A – three microneedling treatments 1 month apart, group B – three microneedling treatments 1 month apart and daily topical application of 5% minoxidil, group C – three platelet-rich plasma treatments 1 month apart.
Results
Each group showed an increase in mean hair number and density. However, only group C demonstrated a statistically significant increase in hair shaft thickness.
Conclusions
Currently, there is no clear consensus in the literature regarding algorithms for microneedling and platelet-rich plasma treatment of the scalp. For the study, we selected a minimum effective algorithm that yielded satisfactory results.
... In addition to rejuvenation, microneedling has been used to treat post-acne or burn scars, melasma, enlarged pores, and androgenetic alopecia and alopecia areata [68]. first type of device is a rolling device, or a dermaroller, which is a drum-shaped tool with a cylindrical head that is applied on the skin back and forth to induce micropores in the papillary dermis [69]. It comes in different shapes and sizes depending on the brand, and some devices can be utilized for home use. ...
... Microneedling pens can also be used for the delivery of radiofrequency or products like hyaluronic acid or vitamins or platelet-rich plasma. Fractional microneedling radiofrequency FMRF device uses thermal injury by the generation of electric current through insulated microneedles [69]. Another innovative type of device is the light-emitting microneedling device which includes titanium microneedles and LED light. ...
Background
The demand for aesthetic procedures aimed at restoring and preserving a youthful appearance is growing. While numerous non‐surgical facial rejuvenation techniques are available, there is a need for a comprehensive review of clinic‐based procedures targeting non‐facial body parts.
Aims
This review aims to describe and evaluate clinic‐based techniques for rejuvenating the neck, chest, and hands, focusing on various types of fillers and other non‐invasive procedures.
Methods
In this first part of this review, we conducted an extensive literature review on PubMed, reporting the effectiveness of different fillers, detailing their preparation, required volume per area, injection methods, durability, and any associated side effects. We also discuss the use of mesotherapy, microneedling, chemical peeling, and Profhilo in these specific body areas.
Conclusion
The review synthesizes the latest data on the effectiveness and safety of these procedures, highlighting the advancements in filler technology and the growing popularity of non‐invasive techniques for body rejuvenation. This article serves as a valuable resource for practitioners and patients interested in non‐surgical body rejuvenation, providing insights into the best practices.
... By utilizing specialized devices equipped with fine needles to create micro-perforations in the skin, microneedling initiates the skin's natural regeneration and repair mechanisms. As a result, this procedure can lead to improved skin texture, enhanced wound healing, and a potential reduction in the visibility of acne scars [7,8]. ...
... This process stimulates the skin's natural healing response, leading to the production of collagen and elastin. The length of the needles can vary depending on the specific treatment requirements and the targeted skin condition [7,10]. ...
Acne vulgaris, the most prevalent skin disorder among teenagers and young adults, is often perceived as a moderate skin condition; however, it imposes a substantial economic and psychological burden on individuals and society. Microneedling emerges as a valuable therapeutic option for acne vulgaris. The procedure involves using fine needles to create controlled micro-injuries in the skin, stimulating collagen production and enhancing the skin’s natural healing processes. This minimally invasive technique effectively reduces acne lesions, improves skin texture, and increases collagen production with minimal adverse effects and downtime. This narrative review evaluates the efficacy and safety of microneedling procedures in treating acne vulgaris. A comprehensive research strategy was employed across various databases (PubMed, Google Scholar, Cochrane Library) to identify relevant studies. Inclusion criteria encompassed studies investigating microneedling procedures for acne, including controlled trials and case studies. Outcomes such as reduced acne lesions, improved skin texture, adverse effects, and patient satisfaction were analyzed. While further well-designed studies are warranted to elucidate optimal treatment protocols and long-term outcomes, current evidence supports the integration of microneedling into managing acne-prone skin. Moreover, the long-term consequences of microneedling in acne management remain an area for future research.
... Notably, microneedling is considered particularly safe for individuals with darker skin types, where the risk of post-inflammatory pigmentation is increased with other procedures. Numerous studies have shown the effectiveness of microneedling in addressing various types of scars, including surgical scars, highlighting its versatility and suitability for diverse patient populations [63][64][65][66]. ...
Microneedles (MNs) represent a groundbreaking technology at the intersection of medicine and cosmetics, providing innovative, minimally invasive solutions for drug and nutrient delivery. This chapter examines MNs systems, detailing their mechanisms of skin penetration and comparing passive and active delivery strategies. We discuss their wide-ranging applications in medicine, including vaccine administration, pain management, and chronic disease treatment, as well as their cosmetic uses for anti-ageing, skin hydration, and rejuvenation therapies. A focus on clinical efficacy and safety is provided, supported by a synthesis of key studies and an overview of existing regulatory standards. Additionally, the chapter addresses the current challenges hindering widespread adoption and identifies future directions for MNs innovation and market expansion. By integrating current knowledge with an outlook on forthcoming advancements, this chapter aims to deepen the understanding of MNs as a versatile platform for the safe, effective delivery of therapeutic and cosmetic agents, fostering new avenues for clinical and commercial applications.
... Although no clinical trials have directly addressed the efficacity of NCTF135HA combination with technologies, many studies have supported the benefits of technology combination [38,39]. These advanced techniques provide less invasive solutions for skin rejuvenation, scar management, wrinkle reduction, and the improvement of skin texture and tone [40][41][42][43][44][45][46][47][48][49]. Additionally, combination of such technologies together or with topical agents and surgery has been shown to increase their efficiency without altering safety of the procedures. ...
Objective
NCTF135HA, a versatile polyrevitalizing solution, is a potent agent for enhancing skin quality, radiance, moisture, vitality, and diminishing fine wrinkles caused by aging factors. Data demonstrate a divergence in its application from skin quality enhancement to treatment of vitiligo lesions. To know more precisely about the protocol of use among providers, alone or in combination with other procedures, we performed an international survey.
Method
A Steering Committee of dermatologists, aesthetic surgeons, and physicians developed a 32‐question questionnaire based on a literature review. Hosted online from January to March 2024, it targeted healthcare professionals experienced in polyrevitalization. Responses were analyzed anonymously and reported descriptively.
Results
Practitioners adopt a balanced approach: half of their patients receiving classic Polyrevitalization (NCTF135HA alone) and the other half undergoing combination therapy (NCTF135HA with another aesthetic procedure). Most administer NCTF135HA across multiple sessions, typically three (39.7%). In combination therapy, 55.5% of practitioners use NCTF135HA for medical purposes, targeting Melasma (53.1%) and Rosacea (45.0%) for instance. Aesthetic use is prevalent, with 94.2% employing NCTF135HA for skin wrinkles (79.9%), and refreshment, rejuvenation, and hydration (73.4%). Combining NCTF135HA with hyaluronic acid (71.2%) and botulinum toxin (49.1%) is common, alongside microneedling (50.2%), peelings (32.4%), and fractional radiofrequency (25.6%).
Limitations and Conclusion
Our survey showed a homogenous distribution of NCTF135HA utilization, indicating a consensus on its application across diverse demographics. This consistency highlights its widespread acknowledgment and efficacy in various aesthetic and clinical settings. Limitations include a large respondent group from Mexico and many respondents with less than 10 years of experience.
Microneedles are tiny, minimally invasive needles that are made to create microchannels over a subcutaneous layer of the skin. These micro-injuries encourage the secretion of growth factors and prompt collagen synthesis. The reasons for using microneedling therapy have increased significantly, leading to its widespread adoption in dermatology. This review article discussed recent advances and challenges of microneedle technology for enhanced topical treatment of skin disorders. It discussed the effective and safe use of microneedles for treating different types of skin conditions like acne, scars, alopecia, melasma, skin rejuvenation, and photo-damage. The drug delivery through the skin was enhanced and rare or permanent adverse effects were not mentioned, while temporary redness and post-inflammatory hyperpigmentation were frequently seen. Microneedling seems to be a generally reliable and secure treatment choice for various skin conditions. More extensive and randomized clinical trials were necessary to ensure their safety and efficacy across diverse populations, conditions, and treatment durations. This trial helps to identify optimal dosages, long-term outcomes, and any adverse effects that may not appear in smaller studies. They also enable comparisons with existing therapies, ensuring the technology’s generalizability and value. Moreover, such trials are essential for regulatory approval and to determine which microneedle technologies work best for specific uses.
Microneedling, a minimally invasive technique traditionally used in dermatology, has emerged as a promising approach to cancer therapy. The procedure involves creating microchannels in the skin using fine needles, enhancing the delivery of therapeutic agents directly into tumor tissues. This method overcomes the limitations of conventional cancer treatments, such as systemic toxicity and poor drug penetration, by facilitating localized and controlled drug delivery. Microneedling can also stimulate immune responses and induce tissue regeneration, potentially enhancing the effectiveness of immunotherapy and promoting tumor suppression. Recent studies have shown that microneedling can be combined with nanoparticles, chemotherapeutics, or gene therapies, allowing for a more precise and targeted treatment of cancer cells while minimizing damage to healthy tissues. Additionally, microneedling-based drug delivery systems can improve the bioavailability of drugs, reducing required dosages and associated side effects. The technique has been instrumental in treating skin cancers, such as melanoma, but its potential application in other solid tumors is currently being explored. While promising, further clinical studies are needed to optimize microneedling parameters and evaluate its long-term safety and efficacy in cancer therapy. As the field progresses, microneedling may revolutionize the delivery of cancer therapeutics, offering a cost-effective, patient-friendly option that complements existing treatments. Keywords: Microneedling, Cancer therapy, Nanoparticles, Immunotherapy.
Introduction
Facial microneedling (MN) represents a contemporary approach to skin rejuvenation that has garnered increasing popularity in recent years. This technique is distinguished by its cost‐effectiveness and widespread adoption across various age groups. While MN is associated with substantial improvements in skin appearance and texture, it is also accompanied by a range of potential adverse effects.
Aim
This paper outlines to present the categorized side effect and complications of MN.
Methods
In this paper, published studies and colleagues’ experiences were used to classify and present the results.
Conclusion
There is currently insufficient research on the complications and side effects of MN, highlighting the need for a comprehensive and organized review in this area. This study systematically investigates MN‐related complications in six key areas: operator, patient, procedures and materials, sterile devices and skin, aftercare, and standard device classification and evaluation.
Objective:
To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids.
Materials and methods:
Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars' thickness, skin ultrasound, and modified Vancouver Scar Scale were performed.
Results:
Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel.
Conclusions:
In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.
Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm(2) (15-250cm(2)) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars.
Background:
The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH).
Objective:
To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars.
Methods:
Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated.
Results:
Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group.
Conclusion:
This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.
Fractional microneedling radiofrequency (FMR) is one of the promising methods in acne treatment. Moreover, bipolar radiofrequency (BR) generates heat thereby which induces neocollagenosis. FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar. This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment. Furthermore, mechanism of the FMR treatment was investigated through skin tissues obtained from subjects. Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR. Two sessions of treatment was done 4 weeks apart in a total 12-week prospective single-blind, randomized clinical trial. Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety. Skin tissues were acquired for investigation of molecular changes. FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR. Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks, respectively. FMR treatment resulted in significant reduction of sebum excretion. Both treatments showed no severe adverse effects other than erythema. The FMR showed superior efficacy in acne and acne scar compared with BR. Increased expression of TGFβ and collagen I and decreased expression of NF-κB, IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR.
Introduction:
Skin aging occurs through both intrinsic and extrinsic processes. Fractional radiofrequency (RF) with a microneedling array is the newest form of fractional therapy to be useful in treating aging skin. The current study utilized a noninsulated fractional RF microneedling system.
Methods:
This multicenter clinical trial saw 49 patients complete 3 monthly treatments with the new fractional RF microneedling treatments and be followed for 3 months following their last treatment. Pain during treatment was recorded as well as overall improvement using a GAIS scale. Adverse events were also noted.
Results:
Forty-nine patients completed all of the treatments and follow-ups. Mild to moderate erythema were reported immediately after treatment which lasted up to 12 hours after the treatment. Pain, as measured on a 1-10 VAS, was noted to 4, on average. The average Fitzpatrick's wrinkle scale score at baseline was 5.04 ± 1.22, 1 month after 3 treatments 3.829 ± 1.69 and 3 months after 3 treatments 3.5 ± 1.66. These results are statistically highly significant (correlated T-test, P < 0.001). Improvement was shown in 100% of patients while 65% of patients had significant improvement (GAIS levels 3-5). Significant skin tightening and skin lifting were also observed. No unusual adverse events were noted throughout the course of the study.
Conclusion:
This multicenter study showed significant wrinkle reduction, skin tightening, and lifting of the mid and lower face with the noninsulated fractional RF microneedling system. Lasers Surg. Med. 2016 9999:1-7. © 2016 Wiley Periodicals, Inc.
Background and objectives:
Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae.
Methods:
Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO2 laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment.
Results:
Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO2-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement.
Conclusion:
The results support the use of microneedle therapy over CO2 lasers for striae treatment.
Platelet-rich plasma (PRP) contains autologous growth factors, which could act synergistically with growth factors induced by skin needling in order to enhance the wound-healing response. The combination of treatments, carried out by using skin needling and PRP application, should enhance both efficacy of skin needling and PRP application. The objective of this study is to establish the effectiveness of the combined use of skin needling and PRP application in acne scarring treatment. Twelve patients affected with rolling acne scars were enrolled. Each patient underwent 2 sessions of treatments, each consisting of skin needling followed by PRP application on the right side of the face and skin needling alone on the left side of the face. Digital photographs of all patients were taken. Photographic data were analyzed by using the Sign Test (α<.05). The study showed that the scars severity grade in all patients was greatly reduced on all of the face, but the improvement was more efficient on the side treated with both skin needling and PRP. Our study showed that the combined use of skin needling and PRP is more effective than skin needling alone in improving acne scars.
Objective To compare the efficacy and safety of dermaroller treatment with that of TCA CROSS in acne scars. Methods We selected thirty patients of atrophic acne scars for the study. Group I patients underwent four sessions of dermaroller therapy four weeks apart. Group II were treated with four sessions of TCA CROSS technique four weeks apart. Results After four sessions of dermaroller and TCA CROSS each, marked improvement was seen in 40% patients in the dermaroller group and in 60% patients in the CROSS group. Moderate improvement was seen in 40% patients in dermaroller group and in 26.6% patients in the CROSS group and mild improvement was seen in 20% patients in dermaroller group and 13.3% patients in the CROSS group. Side effects were mild and infrequent in both groups. Conclusion Both treatments are equally effective and safe for the treatment of acne scars.