What is the recommended treatment approach for acne scarring using microneedling?

Microneedling Treatment for Acne Scarring

The recommended treatment approach for acne scarring is microneedling combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP), with PRF being superior, administered in 3-4 sessions at 4-week intervals, followed by maintenance treatments every 6 months. 1

Optimal Protocol for Microneedling in Acne Scarring

Treatment Regimen

• Number of sessions: 3-4 treatments 1
• Interval between sessions: 4 weeks apart 2, 1
• Maintenance: One treatment every 6 months 1
• Needle depth:
  • 0.5-1.5mm for general acne scarring 1
  • 1.5-2.5mm for deeper, more problematic scars 1

Enhanced Results with Platelet Products

• PRF vs PRP: PRF produces 3-fold better outcomes than PRP when combined with microneedling 1
• Application timing: Apply PRP/PRF prior to microneedling rather than after for optimal results 1
• Improvement rates:
  • Microneedling alone: 39.71% improvement 1
  • PRP alone: 48.82% improvement 2
  • Combined therapy: 70.43% improvement 2, 1

Technique Specifics

1. Cleanse face thoroughly to remove makeup, oils, and debris 1
2. Apply topical anesthetic 30 minutes before procedure if needed 1
3. Hold skin taut with one hand while performing microneedling 1
4. Ensure skin is well lubricated with PRP/PRF during the procedure 1
5. Use directional strokes following facial contours 1
6. Work systematically across facial regions 1

Scar-Specific Approach

By Scar Type

• Rolling scars: Respond best to microneedling with PRP/PRF 2
• Boxcar scars: Second best response to treatment 2
• Ice pick scars: More challenging but still show improvement 2
• Pigmented scars: Microneedling is effective for both scarring and associated pigmentation in darker skin types 3

Post-Treatment Care

Immediate Care

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

Long-Term Care

• Strict sun protection using broad-spectrum SPF 70 or higher to prevent hyperpigmentation 1
• Follow homecare routine to prevent further acne breakouts 2
• Use gentle, non-drying face wash and non-comedogenic products 2

Expected Outcomes and Monitoring

Clinical Improvements

• Significant reduction in scar severity grade in all patients 2
• Higher patient satisfaction with combined therapy (75% satisfaction in 36% of patients) compared to microneedling alone (75% satisfaction in only 3% of patients) 2
• Improvements in skin texture, elasticity, and overall facial appearance 1

Histological Changes

• Increased collagen types I, III, and VII production 4
• Decreased total elastin with increased newly synthesized tropoelastin 4
• Increased dermal thickness 1

Contraindications and Precautions

Avoid Microneedling Over:

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

Potential Side Effects:

• Transient erythema and edema (common) 3, 5
• Mild dryness and small hematomas (temporary) 3
• Post-inflammatory hyperpigmentation (rare with proper technique) 5

Common Pitfalls to Avoid

• Incorrect depth: Using insufficient needle depth for deep scars or excessive depth for superficial areas
• Improper timing: Applying PRP/PRF after microneedling rather than before reduces efficacy 2, 1
• Inadequate sessions: Expecting complete resolution after 1-2 sessions instead of completing the recommended 3-4 sessions
• Poor aftercare: Neglecting sun protection post-procedure can lead to hyperpigmentation
• Treating contraindicated areas: Performing microneedling over active acne or inflamed skin

Microneedling with PRP/PRF represents a significant advancement in acne scar treatment with minimal downtime and impressive results when performed correctly according to the protocol outlined above.