Microneedling: How Effective Is It for Acne Scars, and Are At-Home Needle Rollers Safe?

What is microneedling and how does it work?

Microneedling devices have many fine needles on their surface. These needles enter and leave the skin repeatedly, making small punctures that are hard to see with the naked eye. The needles may be arranged on a cylinder (a needle roller) or fitted to the tip of a motorised, pen-shaped device. With motorised devices, the depth and speed of the needles can be adjusted.

As the skin repairs these small injuries, it produces new collagen (the supporting protein that gives skin its firmness). This is why the method is also known as collagen induction therapy. Recovery is shorter than with most laser treatments; the effect is also slower and more modest.

Devices that deliver heat into the skin through the needle tips are a separate method. We do not repeat that method here; the details are in our article “Radiofrequency Skin Tightening and Radiofrequency Microneedling”, and the safety communication issued by the US Food and Drug Administration (FDA) about these devices is covered in our article “Problems after HIFU and Radiofrequency”.

Which problems does microneedling help with? What does the evidence say?

Microneedling is recommended for many different problems; however, the evidence behind these uses is not equally strong. The FDA has authorised microneedling devices only for specific uses: improving the appearance of facial acne scars, facial wrinkles and abdominal scars in people aged 22 and over. The agency states that the risks of uses outside these, and of using the device together with other products, are not known.

A review that systematically examined the published studies concluded that microneedling is an option for scars and wrinkles; however, it also stressed that the studies had methodological shortcomings and that more research is needed for the method to become established as an evidence-based treatment. Which method is right for your acne scars depends on the type of scar; we cover this in our article “Acne Scars”.

Who is it suitable for?

People who have depressed acne scars or mild textural irregularity, who have no active skin disease and who can accept a modest change that appears slowly over several sessions may benefit. Because the method does not rely on light or heat, it can be used on different skin colours.

Even so, the risk of darkening after the procedure should not be overlooked in darker skin. The FDA draws attention to the risk of darkening or lightening of the skin in darker skin types and states that some of the devices it has authorised have not been studied in people with dark skin. For the precautions to take according to your skin colour, see our article “Laser, IPL and Chemical Peels on Olive and Darker Skin”.

Who is it not suitable for, and what should you watch out for?

The main situations listed in the patient information from the FDA and the American Academy of Dermatology (AAD) are as follows; in some of them the procedure is not carried out, in others it is postponed.

• Active infection, an active cold sore, inflamed and painful acne or a rash in the treatment area
• A history of keloids (excessive scarring) or wounds that heal slowly and poorly
• Bleeding and clotting disorders, or use of blood-thinning medication: do not stop your medicine on your own.
• A suppressed immune system due to illness or medication; diabetes that is not under control
• Conditions that can flare after skin injury, such as eczema, psoriasis or vitiligo
• Warts, moles, birthmarks or crusted sun-related lesions in the treatment area: the needles can spread contagious lesions such as warts to the surrounding skin.
• Use of an oral acne medicine derived from vitamin A (isotretinoin): be sure to say if you are currently taking it or have recently stopped; your physician will decide on the timing.
• Recently sun-exposed or tanned skin, or plans for intense sun exposure in the weeks after the procedure
• Pregnancy and breastfeeding
• Allergy to stainless steel (metals such as nickel) or to numbing creams; cancer treatment or radiotherapy to the area

This list is not complete. During the consultation, mention the medicines and skin products you use and any scarring or pigmentation problems you have had before; suitability is decided by a physician's assessment.

What is the difference between treatment in a clinic and a needle roller at home?

The devices used in a clinic truly puncture the skin; the needle depth is adjusted according to the type of problem and the area, the skin is cleaned with an antiseptic beforehand, the needle tip is single-use and an examination is carried out before the procedure. According to the AAD, products sold for home use are not designed to puncture the skin and therefore give less noticeable results than treatment carried out by a physician.

What are the risks of using a needle roller at home?

The AAD states that at-home microneedling can be risky and lists the following problems:

• Overuse: frequent or prolonged use irritates the skin and can make the problem you want to treat more noticeable.
• Infection and scarring: when the product punctures the skin, it can lead to infection or scarring.
• Spreading viruses: infections such as warts and cold sores can be carried to other areas of the skin along the path of the roller.
• Pressing too hard: this can damage the skin and leave scarring, discolouration or textural changes.

A few practical problems add to these: a roller cannot be sterilised at home, and its needles become blunt or bent over time and can scratch the skin; sharing it with someone else carries a risk of blood-borne infections. Serums made for use on the surface of the skin can also cause allergic and inflammatory reactions when they enter the skin through the punctures. For these reasons we do not recommend using a needle roller at home; if you have acne scars, seeing a physician is a safer route.

Is microneedling together with PRP or serums safe?

Applying a serum, a vitamin mixture or platelet-rich plasma (PRP) prepared from the person's own blood to the skin during microneedling is a common practice. The AAD lists microneedling with PRP among the options physicians use for acne scars. On the other hand, the FDA clearly states that microneedling devices have not been approved for delivering cosmetic products, medicines applied to the skin, vitamin solutions or blood products such as PRP into the skin. In other words, this combined use is outside the use for which the devices have been reviewed.

Two safety points are especially important. The first is that the product applied to the skin may not be suitable for entering the skin: the medical literature contains reports of cases in which granulomas (inflammatory tissue the body forms in response to a foreign substance) developed on the face after a skin care product was applied during microneedling, and treatment took months. Mixtures with unclear contents and products whose evidence is still at the research stage should be avoided; we touch on this in our article “Exosomes and Polynucleotides”.

The second is that every item that comes into contact with blood must be single-use. The FDA states that reusing a needle tip is not safe, even if the tip has been cleaned; the tip must be new for every patient and for every session of the same patient. A report published in 2024 by the US Centers for Disease Control and Prevention (CDC) described HIV cases associated with microneedling with PRP carried out at an unlicensed facility. We do not repeat the details of that report or the safety precautions specific to PRP here; you can find them in our article “Problems after PRP”.

Who should perform it, and where?

The FDA points out that microneedling intended to change the structure of the skin may be considered a medical procedure rather than a cosmetic treatment, and recommends choosing a trained healthcare professional. The AAD likewise states that the risk of infection, scarring and long-lasting discolouration increases when the procedure is carried out by people without medical training. It is recommended that the procedure be carried out under the responsibility of a physician, in a healthcare facility. For the rules on who is authorised in Turkey, see our article “Who Can Perform Medical Aesthetic Treatments?”.

Preparing for the procedure

• Avoid sunbathing and sunbeds in the period before the procedure; the risk of pigmentation increases in tanned skin.
• If you have a history of cold sores, say so; your physician will assess whether preventive medication is needed.
• You may be asked to pause products containing retinoids and acids before the procedure; your physician will set the period.
• If you take blood-thinning medication or supplements, say so; do not stop your prescription medicines yourself.

The day of the procedure, step by step

1. Your medical history, medicines and expectations are discussed; the problem to be treated and your skin type are assessed.
2. The informed consent form is read; the recovery process and risks are discussed and the form is signed.
3. The area is cleaned, and a numbing cream is usually applied some time beforehand. These creams have their own specific risks; the details are in our article “Numbing Cream Safety”.
4. The cream is wiped off, the skin is cleaned with an antiseptic and a new, sterile needle tip is fitted.
5. The device is moved over the skin area by area. You will feel prickling and vibration; slight pinpoint bleeding is to be expected.
6. At the end of the procedure the skin is cleaned, a soothing product is applied and aftercare advice is given.

After the procedure: the first 24 hours, the first week and the first month

Immediately after the procedure the skin turns red, much like sunburn, or looks darker in darker skin; there may be warmth, tightness and mild swelling. According to the AAD, these reactions mostly settle within a few days to a week, and most people can return to their daily life the same day. In the following days, dryness, roughness and fine peeling may be seen.

• The first day: apply only the products your physician recommends to the skin; you are usually asked to wait until the next day for make-up.
• The first days: avoid saunas, Turkish baths, swimming pools and exercise that makes you sweat heavily; touch your face with clean hands and change your pillowcase.
• The first week: do not pick off peeling skin; do not start retinoids, acid-containing or irritating products until your physician allows it.
• The first weeks: protect yourself from the sun; stay in the shade, wear a hat and apply a broad-spectrum sunscreen from the time your physician recommends.
• The first month: the appearance of the skin changes gradually. Your physician will set the timing of the next session; if you notice darkening, report it without waiting.

Expected side effects and risks

The side effects the FDA lists as common are: dryness, roughness, tightness, redness, itching, peeling, discomfort and a burning sensation, bruising, bleeding and crusting. Most side effects appear shortly after the procedure and resolve.

Less common ones are darkening or lightening of the skin, reactivation of cold sores, infection, swollen lymph nodes, and stinging or itching when a cosmetic product is applied. A systematic review listed darkening after the procedure, linear scars resembling tram tracks and granulomatous reactions among the serious, long-lasting problems; it stated that active infection, darker skin colour and metal allergy increase the risk. The FDA also notes that some side effects may not be reversible. No procedure is free of risk.

When is the result seen, and how long does it last?

The change appears slowly, along with collagen production: the AAD states that improvement may be noticed within a few weeks, while the full result is mostly seen after a few months.

For most problems one session is not enough; sessions are usually planned a few weeks apart. How many sessions will be needed depends on the type of scar and how your skin responds. The improvement achieved in acne scars is expected to be maintained for a long time; with treatments for wrinkles and texture, however, the effect fades over time because the skin continues to age.

Realistic expectations: what can microneedling not do?

• It does not erase acne scars; it aims to reduce their appearance, and the degree of improvement varies from person to person.
• For narrow, deep (ice-pick) scars it may not be enough on its own; it may need to be planned together with other methods.
• It does not correct marked sagging, volume loss or deep folds.
• It does not close pores or remove dark spots on its own; a noticeable result is not expected from a single session.

Alternatives

This content is for information only; it does not replace a consultation. The method that is right for you can only be determined by a physician's assessment.