Microneedling Protocol and Guidelines
For optimal microneedling outcomes, perform 3-4 treatment sessions spaced one month apart using needle depths of 0.25-2.5mm (adjusted by treatment area), followed by maintenance every 6-12 months, and strongly consider combining with autologous platelet concentrates (PRP/PRF) for superior results. 1, 2
Pre-Treatment Preparation
- Apply compounded topical anesthesia (pharmacy-based, not over-the-counter) for at least 30 minutes prior to the procedure 1
- Completely remove all anesthetic before beginning treatment to prevent interference with the procedure 1
- Map out problem areas such as acne scars or deep scarring for targeted stamping techniques at greater depths 1
Technical Specifications and Device Settings
- Use automated, electrically powered microneedling devices (such as DermaPen) with 12 microneedles operating at 3,000-5,000 RPMs 1, 2
- Needle depth ranges from 0.25-2.5mm maximum, adjusted based on treatment indication and anatomical area 1, 2
- The device delivers a vibrating stamp-like motion creating controlled microtrauma 2
Intra-Procedure Technique
- Ensure skin is well lubricated with autologous platelet concentrates (APCs) throughout the procedure to avoid dry tugging sensation 1
- Follow directional and depth guidance charts for optimal coverage 1
- Do not microneedle over tattoos or permanent makeup 1
- Use stamping techniques at greater depths for problem areas like scarring 1
Adjunctive Therapy for Enhanced Results
Combining microneedling with autologous platelet concentrates produces synergistic effects superior to microneedling alone, with mean improvement of 70.43% versus 39.71% for microneedling alone. 3
- PRF (platelet-rich fibrin) demonstrates 3-fold higher therapeutic response than PRP when combined with microneedling 2, 3
- Apply APCs to skin before and during microneedling while in liquid form 1
- Important timing consideration: PRF will clot within 20-40 minutes, so work efficiently 1
- For targeted deep wrinkles (crow's feet, glabellar lines, nasolabial folds), consider intradermal APC injections using 30-gauge, 4mm needles spaced 5mm apart before microneedling 1
Treatment Schedule and Frequency
- Initial series: 3-4 sessions spaced at least one month apart 1, 2, 3
- Alternative protocol: 4-6 sessions spaced 3-4 weeks apart 2
- Maintenance: Every 6-12 months thereafter 1, 2, 3
Post-Treatment Care
- Avoid sunlight exposure for 24 hours post-procedure 1, 2, 3
- Avoid heavily scented facial creams and products for 24 hours 1, 3
- Use gentle, non-drying cleansers and non-comedogenic products during healing 3
- Expected downtime is typically 24-48 hours, significantly shorter than lasers or deep peels 1, 2
Safety Profile and Advantages
- Minimal risk of post-inflammatory hyperpigmentation or bruising since maximum needle penetration is only 2.5mm 1, 2
- Safe for all Fitzpatrick skin types (I-VI), including types III-VI where lasers cannot always be safely employed 1, 2, 3
- Well tolerated by patients with minimal adverse effects 1
- Particularly ideal for thin, sensitive, or ethnic skin types 1
- Effective for smokers and individuals exposed to external pollutants 1
Mechanism of Action
- Creates controlled microtrauma triggering neovascularization and rapid neocollagenesis 2, 4
- Stimulates release of growth factors (PDGF, TGF-β) that enhance collagen type I expression 2
- Produces collagen in normal lattice pattern rather than parallel bundles seen in scars 5
- Improves skin thickness, hydration, and normalizes collagen/elastin matrix in reticular dermis 2, 5
Important Caveats and Contraindications
- Patient age and chronicity of skin damage may negatively correlate with degree of improvement 2
- One documented case of fractional microneedling radiofrequency inducing rosacea highlights need for cautious treatment in susceptible patients 3
- For rosacea patients with acne scars, ensure rosacea is well-controlled before initiating microneedling 3
- Ensure proper skin preparation and sterilization to minimize infection risk 5