Can micro needling make skin sag more? Can it initially look like it?

Microneedling will thicken the skin and dermis and help sagging.During the recovery period there will be water and fluid from the trauma may make you have more sagging temporarily.

Microneedling does not cause skin sagging. Initial swelling may make it seem so, but this is not the case.BestDr Karamanoukian#RealSelf100 Member

Microneedling is based on controlled micro trauma to the dermis, which results in collagen formation and tightening of the skin, not sagging.  Intitially for the 1-2 days after treatment, your skin will appear reddish with some swelling.  Good luck.