Plain Microneedling is Safe and Effective for Acne Scars in Rosacea Patients
Plain microneedling (without radiofrequency heat) is safe for individuals with rosacea who want to treat acne scars, provided the rosacea is well-controlled before initiating treatment. 1
Critical Distinction: Plain vs. Fractional RF Microneedling
The safety profile differs significantly between plain microneedling and fractional radiofrequency (RF) microneedling:
- Plain microneedling uses only mechanical needle penetration (0.25-2.5mm depth) without heat energy, creating controlled microtrauma that triggers neocollagenesis 2
- Fractional RF microneedling adds radiofrequency heat energy, which has documented risk in rosacea patients—one case report describes a 61-year-old woman who developed rosacea symptoms after FMR treatment for wrinkles 3
- This distinction is crucial: the documented adverse event involved the heat component (FMR), not plain mechanical microneedling 3
Safety Evidence for Plain Microneedling
Plain microneedling demonstrates excellent safety across all skin types:
- A systematic review of 1,029 patients found microneedling is "relatively safe with minimal adverse effects," including only expected erythema, pain, edema, and temporary skin irritation 4
- Minimal risk of post-inflammatory hyperpigmentation and lower scarring risk compared to lasers 1
- Safe for Fitzpatrick skin types III-VI where lasers may be contraindicated 1
- Maximum penetration depth of only 2.5mm limits complication risk 2
Optimal Treatment Protocol for Rosacea Patients with Acne Scars
Pre-Treatment Requirements
- Ensure rosacea is well-controlled before initiating microneedling using phenotype-based management strategies 1
- Begin with 1.5mm needle depth for initial treatment to assess tolerance 1
Treatment Schedule
- 3-4 sessions spaced 1 month apart for the initial series 1, 5
- Needle depth: 1.5-2.5mm depending on scar severity 1
- Maintenance every 6-12 months thereafter 1
Technical Specifications
- Use automated, electrically powered device delivering 3,000-5,000 RPMs 2
- Apply compounded topical anesthetic for minimum 30 minutes prior, completely removed before starting 2, 5
- Ensure skin is well lubricated during procedure to avoid dry tugging sensation 5
Enhanced Results with Autologous Platelet Concentrates
Combining plain microneedling with PRP or PRF produces significantly superior outcomes:
- Mean improvement of 70.43% with combined therapy versus 48.82% for PRP alone or 39.71% for microneedling alone 1
- PRF demonstrates 3-fold higher therapeutic response than PRP when combined with microneedling 1
- Apply APCs prior to microneedling when in most liquid form for optimal delivery 5
- PRF will clot within 20-40 minutes if left in syringe, faster if exposed to oxygen 5
Post-Treatment Protocol for Rosacea-Prone Skin
Strict post-procedure care is essential to prevent complications:
- Avoid sunlight for 24 hours post-procedure 1, 2
- Avoid heavily scented facial products for 24 hours 1, 5
- Use gentle, non-comedogenic products during the 24-48 hour healing period 1
- Minimal downtime of 24-48 hours, significantly shorter than lasers or deep peels 2
Common Pitfalls to Avoid
- Do not use fractional RF microneedling in rosacea patients—stick to plain mechanical microneedling without heat 3
- Do not microneedle over tattoos or permanent makeup 5
- Do not proceed if rosacea is actively flaring—wait until controlled 1
- Ensure topical anesthetic is completely removed before starting to avoid chemical irritation 2
Evidence Quality Note
The recommendation for plain microneedling safety in rosacea is based on: (1) large systematic review data showing overall safety 4, (2) specific protocols from major dermatology societies 1, and (3) the critical distinction that the only documented adverse rosacea event involved fractional RF (heat), not plain microneedling 3. The evidence strongly supports plain microneedling as safe when rosacea is controlled, while cautioning against the RF variant.