What is microneedling? 

While techniques vary, microneedling involves the creation of small skin wounds using tiny needles that range in size from 0.25 mm to 5 mm (Iosifidis & Goutos, 2019).  In med-spas and dermatology clinics, this is often performed using a machine with a needle attachment that punctures the skin in a repetitive fashion while a clinician guides the device over a targeted area.  

Typically, topical anesthetic is applied to improve comfort during procedures. The procedure typically takes around 30 minutes per session. 

Post procedure care involves use of mild skin cleansers and moisturizers, and avoidance of sun exposure for several days after the procedure (Jaiswal & Jawade, 2024).  

Microneedling punctures cause minimal damage to the epidermis, but significantly stimulates the healing cascade within the skin (English et al., 2021; Sing & Yadav, 2016).  The micro-trauma during microneedling induces release of the following growth factors:

• Platelet derived growth factor
• Transforming growth factor alpha and beta
• Connective tissue activating protein
• Connective tissue growth factor
• Fibroblast growth factor
• Vascular endothelial growth factor
• Relative to hair growth promotion: microneedling promotes anagen-initiating Wnt/β-catenin signaling and dermal papillae stem cell proliferation

Microneedling helps (English et al., 2021; Jaiswal & Jawade, 2024; Sing & Yadav, 2016):

• Break down scar tissue threads and fibrotic tissue
• Creation of new blood vessels to supply skin
• Creation of new collagen within the cell matrix of the skin
• May be preferred treatment for those with darker skin tones compared to laser therapy related to less potential to cause pigmentation changes
• Is considered more gentle than laser therapy, microdermabrasion, with less down time

Research shows that 4 sessions of microneedling spaced apart by 1 month resulted in a 400% increase in elastin and collagen production deposits within the treated skin by 6 months post-procedures (Sing & Yadav,, 2016).

Interestingly, because the needles do not cause any real trauma to the skin, yet stimulate the skin’s healing mechanisms, the collagen is deposited in a pattern consistent with healthy skin as opposed to patterns associated with scar tissue (Sing & Yadav, 2016).  

One other advantage of microneedling is that it opens channels into the vascularized dermal layer, allowing for deposition of treatments such as Botox, platelet rich plasma (PRP), or other treatments directly into the target area (Sing & Yadav, 2016).

What is microneedling with RF? 

Microneedling with fractional radiofrequency (RF) involves the use of microneedling with microelectrodes that emit bipolar, non-ablative radio waves into the tissue surrounding the needle insertion points (Alexiades, & Munavalli, 2021).

These radiowaves heat the dermal layers, causing the breakdown of local collagen, and stimulating the healing response to a greater degree, with the results leading to new collagen, hyaluronic acid, and elastin production (Alexiades, & Munavalli, 2021). 

What skin conditions does microneedling treat?

Microneedling has been shown to be effective for a variety of conditions.  Uses include (English et al., 2021; Singh & Yadav, 2016):

• Reduction of fine lines and wrinkles
• Reduction of pore size
• Improvements in suppleness/ ability to spring back to shape
• Improvements in skin elasticity
• Reduction of scarring / scar tissue, including atrophic acne scars
• Combining microneedling sessions with application of serums such as vitamin C, tretinoin (vitamin A derivative), and other treatment serums 
• Treatment of atrophic scaring
• Actinic keratosis
• Pigmentation issues such as milasma and vitiligo 

Microneedling for scars, skin tightening, and rejuvenation

Skin laxity and fat deposits

A study of 31 females receiving one treatment of microneedling with fractional radiofrequency (RF)  at a total of 62 treatment areas to the following locations to address laxity and cellulite/ fatty tissue deposits::

• 22 had treatments to upper arms, 
• 34 had treatments to the skin above the knee, 
• 6 had treatments to the bra line evaluated treatment effects on skin laxity and fat deposits (Alexiades, & Munavalli, 2021).

Independent evaluators assessed treatment areas at 1 month, 3 months, and 6 months, and patients also rated their improvements at the same time intervals.

Findings were as follows:

• 100% of participants noted improvements in their skin appearance and laxity for bra line treatments and upper arms.

• • Improvements in the skin area above the knee was noted by 92% of participants by the 3 month mark following a single microneedling treatment, with improvements decreasing to 65% at 6 months following a single microneedling treatment
  • Rating the treatments as achieving satisfactory or very satisfactory results:

• 100% of participants who had upper arm laxity treatment were satisfied or very satisfied at 3 and 6 months following the procedure

• • 40% of participants were satisfied or very satisfied with their treatment of the bra line areas at 1 months and 3 months, but satisfaction climbed to 80% six months after the single microneedling procedure of the bra line area
  • 50% of patients were satisfied with treatment of the skin above the knee at 1-month post procedure, this climbed to 77% at month 3, and back down to 65%

Wrinkles and skin rejuvenation

A small study of 32 participants evaluated the effectiveness of microneedling on treating wrinkles on the neck area.  Four microneedling sessions were separated by one month each, using 2.5 mm needle depth (Alqam et al., 2022).  

Pictures were taken of the necks of the participants before and after treatment (90 days post procedure), and rated by blinded evaluators.  Participants also completed satisfaction questionnaires at 30 and 90 days following the treatment (Alqam et al., 2022).

Wrinkle improvement according to the Global aesthetics scores rated improvement in wrinkles as significant at 90 days following treatment.  Participant satisfaction scores rated high, with:

• 93% of participants rating their improvement as very high level, 
• Overall satisfaction rated at 87%
• 80% of participants noted they would recommend the procedure to friends and family.   

A few pictures are available in the study, scroll down to see the differences observed before and after treatments after clicking here.  

Scarring 

A small randomized trial treated 20 persons with keloids testing application of either microneedling alone, silicon gel alone, or both treatments combined.   

Results showed that keloid scars improved by 68% with the combined treatment versus 52% improvement with microneedling alone (Iosifidis & Goutos, 2019).  Use of silicon gel alone for keloids resulted in 47% improvement.

A study evaluating use of vitamin A and vitamin C twice daily applied to burns for one month, followed by 1-3 microneedling sessions, noted significant improvements per patient self visual assessments and by independent observers.  Biopsies noted significant improvements in reductions of scar tissue, though complete elimination of the scar did not occur (Iosdifidis & Goutos, 2019). 

A small study of 11 patients with scarring from acne found significant improvements in the scar appearances along with biopsy results showing significant improvements in skin elastic fiber content (Iosdifidis & Goutos, 2019).   

A group of 15 patients pretreated for scars and stretch marks with vitamin C and vitamin A ointment twice daily x 1 month followed by 1 to 4 microneedling sessions noted significant improvements in patient visual assessment scores as well as independent reviewers of the treated areas (Iosdifidis & Goutos, 2019).   

Limitations of these studies 

Microneedling studies tend to be small in size, lack control groups or placebo groups, or groups randomized to receive other interventions (such as Botox) for comparison.  Nonetheless, participant satisfaction post procedure is consistently rated very high.

It is interesting to note that for the limited number of studies reviewed for specifically scarring, all of these involved treatment with ointments in addition to microneedling.  For lax skin and wrinkles microneedling was typically the sole intervention.  

Is microneedling effective for hair loss? 

A 12 week randomized-controlled clinical trial with 100 men suffering from androgenic alopecia evaluated the use of microneedling weekly x 12 weeks PLUS minoxidil 5% twice daily versus a control group who just used minoxidil 5% twice daily with no microneedling (Dhurat et al., 2013).  

Results found that the group that added microneedling to their minoxidil regimen experienced:

• Substantially greater increases in hair count per 1 cubic cm compared to the minoxidil only group (91.4 hairs/ ccm average vs 22.2 hairs/ ccm)
• 80% of those in the microneedling + minoxidil group reported greater than 50% improvement in hair growth versus only 4.5% of clients reporting this level of improvement in the minoxidil only group
• Photos of participants scalps at the end of the 12 week trial are available in the study showing the difference between groups and they are pretty substantial, available by clicking here and scrolling down till you see the images
• New hair growth was visible at 6 weeks in the microneedling group versus 10 weeks in the minoxidil only group
• A follow up at 8 months post-treatement noted reports of sustained results

Separately, a systematic review of 22 studies (17 of which were randomized trials) with more than 1,000 participants in total evaluating microneedling treatments for hair loss reported the following (English et al., 2021) results below.

• 6 studies on androgenic alopecia noted that microneedling alone produced higher hair counts in 2 studies, 1 study found greater density and hair diameter, and 3 studies found no effects from microneedling alone.
• 6 of 7 studies evaluating microneedling PLUS minoxidil 5% versus minoxidil 5% alone noted that microneedling PLUS minoxidil produced significantly better results versus minoxidil alone
• 0.6 mm needle length demonstrated superior results with hair diameter and hair counts benefiting compared to 1.2 mm needle lengths which improved only hair counts
• A split scalp study showed that microneedling plus PRP did not produce superior results to microneedling alone.
• Microneedling twice per month boosted results for females using minoxidil 5% after they had previously plateaued on the minoxidil therapy alone
• Alopecia areata and alopecia totalis were evaluated in 5 studies.  Of the five studies, one study of microneedling alone showed improvements in alopecia areata but caution is advised as sample sizes were very small.  Other studies for these types of alopecia involved various additional interventions such as PRP, cryotherapy, and 5-aminolevulinic acid–so no consistent results for specifically microneedling with these other types of alopecia can be determined.
• No serious adverse effects were reported in any of the studies

Limitations of the studies on microneedling and hair loss

Studies on hair loss and microneedling involve studies shorter than a year, and hair growth cycles can vary with seasons.  Studies also involve smaller sample sizes.  Additionally, studies of microneedling for hair loss often include a variety of adjunctive therapies, making it difficult to determine consistency in treatment protocols (English et al., 2021)..  

Summary for microneedling and hair loss

The evidence for combining microneedling treatments weekly to twice per month with minoxidil 5% twice daily seems to consistently outperform minoxidil therapy alone–sometimes with striking results.  The other studies of microneedling for hair loss (alone, or with PRP or other treatments) are more limited and less convincing at this time.  

Side effects and safety

Repeatedly, microneedling has been shown to be safe.  Side effects include (Jaiswel & Jawade, 2024):

• Skin redness as the most common side effect, which fades after a few hours up to a few days 
• Mild swelling can occur for a few days, alleviated by cool packs
• Temporary hyper-pigmentation may occur in darker skinned individuals and fades after a few weeks, sunscreen is important to reduce this risk
• Rarely, infections can occur if area is not properly cleansed and cared for after the procedure or if hygienic practices are not followed during the procedure
• Allergic reactions are possible, particularly if different medications or salves are being applied during the procedure
• Scarring is rare but possible particularly for persons with a history of keloid formation or if procedure is not performed correctly
• Active skin infections are contraindications to treatment and must be resolved prior to treatment

How Lancaster Wellness can help

Lancaster Wellness offers microneedling with RF at both our Lititz and Lebanon offices, along with additional services such as microneedling + Botox/ Daxxify/ Xeomin procedures, PRP, hyaluronic acid, or peptides designed to minimize fine lines and wrinkles, and vitamin C serum.

Book your free skin consultation if you are interested in learning more about microneedling or other services we offer, or book an appointment for the procedure here when ready!

Feel free to contact us at 717-297-7900 with any questions!!

References

Alexiades, M., & Munavalli, G. S. (2021). Single Treatment Protocol With Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits. Lasers in surgery and medicine, 53(8), 1026–1031. https://doi.org/10.1002/lsm.23397 

Alqam, M., Wamsley, C. E., Hitchcock, T., Jones, B. C., Akgul, Y., & Kenkel, J. M. (2022). Efficacy and Tolerability of a Microneedling Device for Treating Wrinkles on the Neck. Aesthetic surgery journal, 42(10), 1154–1160. https://doi.org/10.1093/asj/sjac085 

Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A., & Pund, P. (2013). A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. International journal of trichology, 5(1), 6–11. https://doi.org/10.4103/0974-7753.114700

English, R. S., Jr, Ruiz, S., & DoAmaral, P. (2022). Microneedling and Its Use in Hair Loss Disorders: A Systematic Review. Dermatology and therapy, 12(1), 41–60. https://doi.org/10.1007/s13555-021-00653-2

Iosifidis, C., & Goutos, I. (2019). Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature review. Scars, burns & healing, 5, 2059513119880301. https://doi.org/10.1177/2059513119880301

Jaiswal, S., & Jawade, S. (2024). Microneedling in Dermatology: A Comprehensive Review of Applications, Techniques, and Outcomes. Cureus, 16(9), e70033. https://doi.org/10.7759/cureus.70033 

Singh, A., & Yadav, S. (2016). Microneedling: Advances and widening horizons. Indian dermatology online journal, 7(4), 244–254. https://doi.org/10.4103/2229-5178.185468

Sitohang, I. B. S., Sirait, S. A. P., & Suryanegara, J. (2021). Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials. International wound journal, 18(5), 577–585. https://doi.org/10.1111/iwj.13559