The Science Behind Microneedling: Are We Seeing A True Regeneration?

Dr Shreya Seth

Introduction

Microneedling has been around for many years, but has recently gained popularity in the medical aesthetics world (Walsh, 2019). It is a minimally invasive procedure, which consists of small needles puncturing the dermis (Litchman, 2022; Jaiswal, 2024; Singh, 2016). This creates controlled trauma, which signals the body to start the healing cascade (Singh, 2016).

History

The concept of microneedling was first described in 1905, by a German dermatologist. However, many argue that the concept is similar to acupuncture, which was first described in China in 100 BC (Walsh, 2019).

In 1905, Dr Ernst Kromayer described a motorized device which gently treated pigmentation and skin scarring (Singh, 2016; Walsh, 2019). Following on in 1997, Dr Andre Camirand was able to improve the colour, texture and overall appearance of post-surgical facelift scars through the use of tattoo guns (Singh, 2016; Walsh, 2019). The Dermaroller was then developed in 2006 by Dr Desmond Fernandes (Iriate, 2017). All of these developments have led to microneedling as we know it today.

Background

Skin

The skin is the largest organ in the body and consists of the epidermis, dermis and hypodermis, as illustrated in image 1 (Abdo, 2020; Mayhew). Skin provides a barrier from

bacteria, helps retain water in the body and protects against chemicals, ultra-violet radiation and heat-related injury. Each layer consists of different cells, which have their own function (Abdo, 2020). The skin also contributes to homeostasis, synthesises vitamin D and responds to sensory stimuli (Abdo, 2020; Mayhew).

The epidermis is the most superficial layer, which consists of mature keratinocytes (Abdo, 2020; Mayhew; Yousef, 2024). There are also melanocytes, which produce melanin; Langerhans cells, which are dendritic cells; and Merkel cells, which detect stimuli (Abdo, 2020; Mayhew; Yousef, 2024). The epidermis can be further divided into five layers, which have different stages of keratinocytes in their maturation process.

The dermis is the middle layer of the skin and consists of two layers, called the papillary layer and the reticular layer. Within this layer, there are many types of cells and structures (Abdo, 2020; Mayhew; Yousef, 2024). Fibroblasts contribute to the production of collagen and elastin, which maintain tissue structure (Mayhew; Boraldi, 2024). They also produce growth factors and cytokines, which aids tissue healing and remodelling. The epidermis also contains blood vessels, nerves, hair follicles, glands and nails (Abdo, 2020).

The final layer is the hypodermis. This is where fat is stored subcutaneously, as well as nerves, blood vessels and hair follicles (Abdo, 2020; Mayhew; Yousef, 2024).

Mechanism of Action

Microneedling works in a few ways; by increasing collagen production, improving hyperpigmentation and reducing scar appearance. It also helps with improving drug absorption.

Collagen is increased through controlled micro trauma to the the dermis, which triggers the release of growth factors (Jaiswal, 2024). This includes connective tissue growth factor, transforming growth factor alpha (TGF-α), transforming growth factor beta (TGF-β), platelet derived growth factor (PGF), and fibroblast growth factor (Singh, 2016). A combination of these growth factors stimulate the fibroblasts to improve tissue structure by producing collagen (Jaiswal, 2024). Additionally, these growth factors cause neovascularisiation, which is the process of new blood vessels being formed (Jaiswal, 2024; Singh, 2026). For patients with acne vulgaris, the production of keratinocytes is reduced (Singh, 2026). A combination of all of the above improves skin quality (Jaiswal, 2024; Singh, 2016). It is also thought that microneedling has a role in hair restoration (Starace, 2019). The micro-trauma caused by the microneedling device actives the healing cascade, which stimulates a new hair cycle (Starace, 2019).

The micro channels formed during the process allows products to reach a deeper level of the skin, thus improving absorption and effectiveness (Jaiswal, 2024; Singh, 2016). Examples include exosomes, vitamins or growth factors can be applied topically following the procedure; the combination of both can lead to excellent patient results (Jaiswal, 2024; Singh, 2016; Wan, 2025).

Discussion

Many studies have looked into the efficacy of microneedling with improving skin conditions, such as acne, vitiligo, hair loss, melasma and skin rejuvination (Hamed, 2024; Alqam, 2022).

One literature review in 2015 found 12 out of 18 studies showed a statistically significant improvement in acne scaring (Hamed, 2024; Harris, 2015). In 2018, Ramaut et al found microneedling to be safe when treating skin conditions, such as aging and acne (Ramaut, 2018). Additionally, this systematic review found it had minimal side effects and could be used alone or in a combination with topical products or radiofrequency (Ramaut, 2018). A case study published by Costa et al found microneedling improved varicella scarring for a patient with Fitzpatrick Skin Type 6 (Hamed, R, 2024; Costa, 2014).

When considering hair loss treatment, studies have found improvements for both microneedling and microneedling combined with solutions such as platelet-rich plasma, minoxidil and growth factors (Hamed, 2024; English Jr, 2021). Faghihi et al noted a statistical improvement in thickness and number of hairs when microneedling with minoxidil, compared to minoxidil alone (Faghihi, 2021).

Throughout the literature, the lack of side effects and minimal down time has made microneedling a desirable procedure (2,11-16). Whilst some studies single-blinded or randomised their trial, the lack of double-blinded randomised control trials reduces the reliability of current research (Hamed, 2024; Harris, 2015; Ramaut, 2018; English, 2021). Many systematic reviews noted flawed methods and one review commented on research not publishing statistical significance; by conducting randomised trials, treatment protocols can be developed (Hamed, 2024; Harris, 2015; English, 2021; Faghihi, 2021).

Conclusion

Microneedling is a minimally-invasive procedure, which is preferred by patients due to the low side effect profile. Whilst systematic reviews have found some medium-level studies showing good results, more high-quality studies need to be conducted to improve treatment protocols.

References

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• Alqam, M., Wamsley, C.E., Hitchcock, T.M., Jones, B.C., Akgul, Y., Kenkel, J.M. (2022) ‘Efficacy and Tolerability of a Microneedling Device for Treating Wrinkles on the Face’, Journal of Cosmetic Dermatology, 22(1), 201-213.
• Boraldi, F., Lofaro, F.D., Bonacorsi, S., Mazzilli, A., Garcia-Fernandez, M., Quaglino, D. (2024) ‘The Role Of Fibroblasts in Skin Homeostasis and Repair’ Biomedicines, 12(7), 1586.
• Costa, I., Costa, M.C. (2014) ‘Microneedling for Varicella Scars in a Dark-Skinned Teenager’, Dermatological Surgery, 40(3), 333-334.
• English Jr, R.S., Ruiz, S., DoAmaral, P. (2021) ‘Microneedling and Its Use in Hair Loss Disorders: A Systematic Review’, Dermatology and Therapy, 12(1), 41-60.
• Faghihi, G., Nabavinejad, S., Mokhtari, F., Naeini, F.F., Iraji, F. (2021) ‘Microneedling in Androgenetic Alopecia; Comparing Two Different Depths of Microneedles’, Journal of Cosmetic Dermatology, 20(4), 1241-1247.
• Hamed, R., Nahia, B.J.A., Alkilani, A.Z., Al-Adhami, Y., Obaidat, R. (2024) ‘Recent Advances in Microneedling-Assisted Cosmetic Applications’, Cosmetics, 11(2), 51.
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• Iriarte, C., Awosika, O., Rengifo-Pardo, M., Ehrlich, A. (2017) ‘Review of Applications of Microneedling in Dermatology’, Clinical, Cosmetic and Investigational Dermatology, 10, 289-298.
• Jaiswal, S., Jawage, S. (2024) ‘Microneedling in dermatology: A Comprehensive Review of Applications, Techniques, and Outcomes’, Cureus, 16(9), e70033.
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• Starace, M., Alessandrini, A., Brandi, N., Piraccini, B.M. (2019) ‘Preliminary Results of the Use of Scalp Microneedling in Different Types of Alopecia’, Journal of Cosmetic Dermatology, 19(3), 646-650.
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• Wan, J., Yoon, S.E., Yi, K.H. (2025) ‘The Efficacy of Combined Exosomes (Exodew) and Microneedling Treatment for Facial Pore Reduction and Skin Texture’, International Open Access Journal of the American Society of Plastic Surgeons’, 13(6), e5849.
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