Is microneedling effective for treating acne scarring?

Microneedling for Acne Scarring

Microneedling is highly effective for treating acne scarring, and combining it with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) produces significantly superior results compared to microneedling alone. 1

Treatment Efficacy

Microneedling works through controlled micro-injury that stimulates neovascularization and neocollagenesis, producing collagen in a normal lattice pattern rather than the parallel bundles seen in untreated scars. 2 The evidence consistently demonstrates substantial clinical improvement across multiple studies:

• All 33 clinical trials reviewed showed improvement in acne scar appearance after microneedling treatment. 3
• Goodman-Baron scar grades improved from baseline 3.45 to 1.47 with microneedling plus PRP, compared to only 3.33 with control treatments. 1
• 73% of Grade 4 scars improved by 2 grades, and 70% of Grade 3 scars improved by 2 grades after treatment. 4

Combination Therapy: The Superior Approach

PRF combined with microneedling shows 3-fold higher therapeutic response compared to PRP, making it the preferred adjunctive treatment. 1 The comparative data is compelling:

• Microneedling plus PRP: 70.43% mean improvement 1, 5
• PRP alone: 48.82% mean improvement 1, 5
• Microneedling alone: 39.71% mean improvement 1, 5

Patient satisfaction scores are significantly higher with combination treatment (5.95 vs 5.35 for single modality). 1 The excellent response rate reaches 43% with combined PRP treatment versus only 20% with single modality approaches. 1, 5

Critical Technical Detail

Apply PRP or PRF BEFORE microneedling, not after—this allows the needles to push platelets deeper into the dermis for enhanced delivery. 5, 6 This timing distinction significantly impacts outcomes.

Optimal Treatment Protocol

Perform 3-4 treatment sessions spaced exactly one month apart, with maintenance treatments every 6 months. 1, 2

Technical Parameters:

• Needle depth: 1.5 mm for acne scarring 1, 5
• Device: Electrically powered hand-held microneedling device with adjustable depth (0.25-2.5 mm range) 1, 6
• Anesthesia: Compounded topical anesthetic for at least 30 minutes prior 1

Scar Type Response Hierarchy

Rolling scars respond best, followed by boxcar scars, with ice pick scars being most resistant to treatment. 1 This hierarchy should guide patient expectations and may influence the decision to add combination therapy for more resistant scar types.

Safety Profile

Microneedling is remarkably safe with minimal adverse effects—a systematic review of 1,029 patients found only expected transient erythema, pain, edema, and temporary skin irritation. 7 The downtime is typically only 24-48 hours, significantly shorter than ablative laser treatments. 1, 2

Importantly for diverse patient populations, microneedling is safe for darker skin types (Fitzpatrick III-V) without risk of post-inflammatory hyperpigmentation, unlike many laser treatments. 8 In fact, microneedling effectively treats both acne scars AND associated hyperpigmentation simultaneously in darker skin. 8

Common Pitfalls to Avoid:

• Do not microneedle over tattoos or permanent makeup 1
• Ensure skin is well lubricated with APCs during treatment to avoid dry tugging sensation 1
• Advise patients to avoid sunlight and heavily scented facial products for 24 hours post-treatment 1
• Never apply PRP/PRF after microneedling—always apply before 5, 6

Clinical Implementation

For patients seeking treatment of acne scarring, offer microneedling combined with PRF as first-line therapy, with 4 monthly sessions planned from the outset. 1 This approach provides the highest likelihood of excellent outcomes with minimal risk and short recovery time compared to more invasive alternatives like ablative lasers or deep chemical peels. 9