What are the indications and guidelines for microneedling (percutaneous collagen induction therapy)?

Microneedling: Indications and Guidelines

Microneedling is primarily indicated for acne scarring, skin rejuvenation, fine lines and wrinkles, with a recommended protocol of 3-4 sessions at 2-4 week intervals and maintenance treatments every 6-12 months. 1

Primary Indications

Microneedling (percutaneous collagen induction therapy) is indicated for:

• Acne scarring - Most established indication with significant evidence 1, 2
• Skin rejuvenation and anti-aging - Including fine lines, wrinkles, and texture improvement 1
• Photodamage - Improvement of sun-damaged skin 2
• Surgical and traumatic scars - With demonstrated 50-75% improvement in over 80% of patients 3
• Melasma and hyperpigmentation - Particularly beneficial for darker skin types 2, 4
• Transdermal drug delivery - Increases absorption of topical substances by 5-10 times 1
• Stretch marks - Effective for improving appearance 4
• Alopecia - Emerging application 2, 4

Treatment Protocol

Pre-Procedure Preparation

• Cleanse face thoroughly to remove makeup, oils, and debris 1
• Apply topical anesthetic 30 minutes before procedure if needed 1

Procedure Technique

• Depth recommendations by region:

  • Forehead and periorbital areas: 0.25-0.5mm 1
  • Cheeks and perioral areas: 0.5-1.5mm 1
  • Problem areas (acne scars, deep wrinkles): 1.5-2.5mm 1

• Treatment schedule:

  • 3-4 sessions at 2-4 week intervals 1
  • Maintenance treatments every 6-12 months to sustain results 1

Combination Therapies

• Microneedling with PRP/PRF:
  • Superior outcomes compared to microneedling alone (70.43% improvement in scar appearance) 1
  • PRF shows 3-fold higher therapeutic response than PRP for acne scars 5
  • Significantly improves skin firmness, wrinkle reduction, and collagen deposition 1

Contraindications

Microneedling should be avoided in patients with:

• Active skin infections or inflammatory conditions 1
• Open wounds or sunburned areas 1
• Over tattoos or permanent makeup 1

Post-Procedure Care

• Avoid sun exposure for 24-48 hours 1
• Apply soothing products such as hyaluronic acid serums 1
• Use broad-spectrum SPF 30+ sunscreen (SPF 70+ recommended) 1
• Avoid heavily scented facial products for 24 hours 1

Clinical Pearls and Pitfalls

• Safety profile: Microneedling is particularly safe for darker skin types where risk of post-inflammatory hyperpigmentation is high with other techniques that damage the epidermis 4
• Transient side effects: Most common adverse events include temporary erythema and potential post-inflammatory hyperpigmentation 2
• Technique considerations: Ensure skin is well lubricated with PRP/PRF to avoid dry tugging during the procedure 1
• Efficacy considerations: PRF microneedling appears to be more effective than PRP microneedling, with PRF showing 3-fold higher "excellent" reported outcomes 5

Advantages Over Other Procedures

• Preserves the epidermis (non-ablative) 6
• Reduces inflammation, downtime, and risk of dyspigmentation compared to laser resurfacing 6
• Universal application for all skin types 1
• Minimally invasive with expedient recovery 7

Microneedling represents a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling, with significant clinical results and limited side effects 7.