Microneedling Practice Guidelines
Microneedling should follow a standardized protocol of three treatments one month apart with maintenance every 6 months, using appropriate needle depths based on facial region and combining with platelet-rich fibrin (PRF) for optimal outcomes. 1
Pre-Procedure Preparation
- Thoroughly cleanse the face to remove makeup, oils, and debris
- Apply topical anesthetic 30 minutes before procedure if needed (though many patients tolerate well without anesthesia) 1
- Ensure proper patient selection by avoiding contraindications:
- Active skin infections or inflammatory conditions
- Open wounds or sunburned areas
- Tattoos or permanent makeup 1
Procedure Technique
Optimal Needle Depth by Region
- Forehead and periorbital areas: 0.25-0.5mm depth for superficial collagen stimulation
- Cheeks and perioral areas: 0.5-1.5mm depth for optimal collagen induction
- Problem areas (acne scars, deep wrinkles): 1.5-2.5mm depth for significant collagen remodeling 1
Research shows that 2.5mm needle depth produces significantly better improvement in atrophic acne scars compared to 1.5mm depth, both clinically and histologically 2.
Technique Guidelines
- Hold skin taut with one hand
- Use directional strokes following facial contours
- Ensure skin is well lubricated with PRP/PRF to avoid dry tugging 1
- Work systematically across facial regions
Treatment Protocol
- Standard protocol: 3-4 sessions at 2-4 week intervals 1
- For acne scars: Three treatments one month apart with maintenance every 6 months 1
- For skin rejuvenation: Multiple sessions are required to maintain improvement 3
Enhancement with Platelet Concentrates
- PRF is superior to PRP: Studies show PRF combined with microneedling produces 3-fold better outcomes than PRP with microneedling for acne scars 4
- Application method matters: Apply PRP/PRF prior to microneedling rather than after for better outcomes 4
- Combined approach: Microneedling with PRP/PRF shows statistically significant improvements in:
- Skin firmness
- Wrinkle reduction
- Collagen bundle deposition and thickness
- Overall facial appearance 1
Post-Procedure Care
- Avoid sun exposure for 24-48 hours
- Apply soothing products such as hyaluronic acid serums
- Use broad-spectrum SPF 30+ sunscreen (SPF 70+ recommended)
- Avoid heavily scented facial products for 24 hours
- Apply only recommended post-procedure products 1
Safety Profile
Microneedling is a relatively safe procedure with minimal adverse effects, which are typically transient and include:
- Expected erythema
- Pain
- Edema
- Temporary skin irritation 5
Clinical Pearls and Pitfalls
- Depth matters: Using appropriate needle depth for each facial region is crucial for optimal results without excessive trauma 1, 2
- Combination therapy: Microneedling combined with PRP/PRF shows superior outcomes compared to microneedling alone (70.43% improvement vs. 39.71% with microneedling alone) 4, 1
- Application sequence: Apply PRP/PRF before microneedling rather than after for better outcomes 4
- Multiple sessions required: Single treatments show limited efficacy; multiple sessions are necessary for significant and lasting improvement 3
- Transdermal delivery enhancement: Microneedling can increase absorption of topical substances by 5-10 times compared to topical application alone 1
- Universal application: Safe for all skin types, including darker skin 1