Is Microneedling Old Fashioned ?

Dr Bev Darwin BDS (Newcastle Upon Tyne , U.K 1985)

Professional Bio:

Beverly Darwin began her career in aesthetics in 2005 as the founder of BeauMedix Clinic UK. Over the years, she has trained extensively across nearly every aspect of aesthetic medicine, gaining comprehensive expertise in both clinical techniques and patient care.

Through experience and results-driven practice, she has refined her focus to the treatments that deliver the most consistent outcomes and that she finds most rewarding to perform. Her approach blends technical skill with a deep understanding of skin health and rejuvenation, reflecting nearly two decades of dedication to the art and science of aesthetics.

https://www.instagram.com/bev_darwin/

Microneedling old fashioned?

Well yes, but only in the sense that it is one of the oldest aesthetic skin regenerative treatments known and has evolved since 1905 and retained its important position in Aesthetic Medicine still having an important role and also a future.

Background

Microneedling in its basic form began in 1905 when a German dermatologist used rotating wheels and dental burns to treat scars. This being the earliest ancestor of microneedling or dermabrasion.

The beginning of ‘needle’ based Skin Therapy started with the needle stamp in 1995 and progressed to the Dermaroller in the early 2000’s. The Dermaroller spread globally in both medical and home-use forms and are still available today for home use.

In 2010 we saw the first automated pen devices which have been modified and updated to be more efficient and ergonomic pens we have today. Best examples are believed to be the Dermapen medical no 4 and the IMEDPEN hand pieces, both similarly priced at between £1,500 and £2,000, making it a highly affordable investment for Aesthetic Practitioners. (Needles and other consumables vary in price from £10 to £15 each).

In the 2020’s microneedling has been combined with other regenerative treatments including radio frequency, PRP (platelet rich plasma ) and its variations, chemical peels, polynucleotides and more recently Exosomes.

It remains on our treatment menu because it is one of the best devices to create micro-channels in varying depths of the skin allowing a variety of regenerative concoctions to be delivered transdermally.

These micro-channels temporarily increase skin permeability enabling delivery of actives, thus improving outcomes vs microneedling alone.

Mechanism of Action

Microneedling works by causing a controlled dermal injury. The reaction to this injury by the skin is the wound healing response. Wound healing is a cascade of events beginning with a surge of nutrient rich blood arriving at the injury site. This blood brings with it inflammatory factors,including adrenaline,noradrenaline, prostaglandins and serotonin. Vessel permeability becomes enabled via histamine release, enabling anti-inflammatory leukocytes and plasma to enter vessels with ease. Macrophage derived growth factors are released, and lymphocytes also release epidermal and fibroblast growth factors.

Vascular endothelial growth factors promote angiogenesis (this is helpful for skin issues of chronic redness and rosacea).

A new extra -cellular matrix is cultivated via fibroblast release of collagen and fibronectin. Epithelial cells proliferate, providing dermal coverage, repair and protection.Elastin proliferation by fibroblasts occurs over several weeks to months helping restore skin elasticity and recoil.

Myofibroblasts contract the wound, apoptosis removes cells which are no longer needed and as the skin matures type 111 collagen is replaced by type 1 collagen and collagenase regulates and balances collagen production. This last phase can last from about day 20 following the needle injury up to 24 months.

NB – If healing is too rapid this may result in over-production of scar-type connective tissue, hence it has been found that having the end-point of micro-needling as the inflammatory (erythematous) response, rather than visible point bleeding is key to new skin quality.

Dermaroller (home devices) vs automated (in clinic) pens

Dermarollers…

Many companies now produce home Dermaroller devices, varying in needle depth and obviously quality and price. Aesthetic practitioners need to be aware of this and dissuade their patients from using them, thinking this will be cheaper (from £10 up to £60) and just as effective as clinic treatments. The reasons for this are as follows :

1. Poor quality home devices needles have been known to bend or even break during usage and become impaled in the skin. This is a safety issue. 
2. Sterility issues are inevitable with home usage as rollers are very often difficult to sterilise and are often not even washed between usage, and can give rise to infections especially if the skin is not clean or the user has active acne. Skin debris may also remain on the device and is difficult to detect even after cleaning.
3. Needle depth is not variable and different areas of the face require optimum needle depth to give optimum results.
4. The action of rolling needles onto the skin produces a tearing of the skin as the needles enter and leave the skin at different angles, this tearing the skin(See diagram) . Eventual blunting of the needles with repeated use is also too traumatic for the skin as an even wider wound is created.
5. Difficulty in treating hard to reach areas due to size of the roller head.
6. Wider wound TCA uses longer downtime and recovery.

Automated Microneedling Pens…

1. Automated microneedling devices are more expensive than home Dermaroller devices (ranging from £1,500 to £3,000)
2. These devices usually come with quite a long guarantee period after purchase and some company’s replace outdated versions for free to Medical Practitioners for remaining with their company as a loyalty reward. Safety of the device is paramount and repairs to the devices are done quickly so as not to desrupt clinics
3. Sterility is maintained by single use needles which come in sterile packs
4. Needle depth for different areas of the face,neck and décolletage are taught as part of training and a training manual always comes with the device.
5. The action of the stamp like needle containing 20 good quality needles which enter the skin in a perpendicular manner means there is no drag effect on the skin,thus delivering an efficient micro-channel capable of healing, producing a high quality wound of new stronger skin.

Clinical Indications

Conditions effectively treated by an Automated Microneedling Procedure include the following :

• Collagen Induction Therapy (allowing what is now referred to as Collagen Banking)
• Skin Rejuvenation
• Ageing /fine lines and wrinkles
• Ultra Violet Damage
• Hyperpigmentations (age spots /melasma/chloasmapost inflammatory pigmentations )
• Hypopigmentation
• Vitiligo
• Rosacea
• Telangiectasia (thread veins)
• Sebhorrhea
• Problematic break out skin (not active acne)
• Enlarged /Dilated Pores
• Milia
• Keratosis Polaris
• Scarring (from acne and or traumatic scarring)
• Striae (stretch marks)
• Hair loss/alopecia

Combined microneedling treatments

The needling device can be used in conjunction with delivering the following:

• PRP and other variations of plasma formulations
• PDRN’S (certain Polynucleotides including Polyphil, Plinest etc … check with manufacturers as some polynucleotides molecule size may only allow delivery by injection.
• Vitamin Cocktails providing these are water based and NOT oil based
• Baby Botox (any brand diluted x 3 usually)

Contra-Indications

Microneedling should not be performed on any of the following active conditions:

• Papulopustular Rosacea
• Acne Vulgaris stage 3 to 4
• Herpes simplex
• Warts
• Scleroderma
• Bacterial/fungal infections
• Open lesions
• Solar keratosis
• Skin cancer
• Haemophilia

Conclusion

Microneedling has endured in the field of Aesthetics for decades, maintaining its reputation as one of the most effective and sought after skin rejuvenation treatments- valued both on its own and when integrated with other advanced procedures.

• A trade article (“Micro-treatments are on the rise”, NewBeauty) reports that in 2023 some 40% of respondents had received microneedling treatment, and 36% were planning it within the next 12 months — showing strong patient demand.

• According to an industry-market report: the global microneedling devices market is expected to reach US $2.27 billion in 2024 (and grow further) — indicating strong adoption into professional practice.

Summary Conclusion:

Microneedling continues to be one of the most widely performed skin rejuvenation procedures in aesthetic practice due to its proven efficacy, safety, and versatility.

By harnessing the skin’s natural wound-healing response to stimulate collagen and elastin, it delivers visible, natural-looking improvements in texture, tone, and scarring with minimal downtime. Its compatibility with all skin types, affordability, and ability to enhance the transdermal delivery of active ingredients have further cemented its place as a cornerstone treatment—both as a stand-alone therapy and in combination with other advanced modalities.

References:

• Advanced Skin Innovations with Dermapen www.DermapenWorld.com
• Aesthetic Medicine … aestheticmed.co.uk
• The ConciseGuide to Dermal Needling by Dr Lance Setterfield MD