Considering microneedling for acne scars, is there a risk of scar tissue forming and orange peel skin?

Question

I really want to try microneedling for my scars, but I have read some reviews here saying it resulted in permanent "orange peel skin" and major loss of collagen. Also, a highly respected esthetician believes that it doesn't cause the body to create collagen, but instead causes scar tissue to be formed that will result in bad skin in the long run. Any thoughts on her logic, what may have caused the mentioned side effects, and long-term affects?

Jed H. Horowitz, MD, FACS · Answer

If you have a history of scar/keloid formation please be sure to let your provider know. Otherwise,microneedling should not cause any scaring.  It is a great procedure to enhance tone and texture of the skin. Pts are very happy after this procedure

Amiya Prasad, MD · Answer

Thank you for your question. You are concerned about possibly undergoing microneedling to treat your acne scars after a discussion with an aesthetician who said there might be more scarring potential rather than collagen induction as is often the benefit of microneedling. You also state that people who had microneedling developed an orange peel type of skin. You want some guidance on whether or not microneedling really works, and whether or not there is a potential for injury rather than benefit.
I can share with you how I discuss this procedure with my patients in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Among the many things we do in our practice from lasers, injectables, and surgery, we also offer microneedling, so I can appreciate your concerns.
It’s very important for patients who come for an evaluation with the expectation they’re going to have a particular procedure because they made an appointment for that type of consultation. For example, someone like yourself may make an appointment for a microneedling consultation. I often tell our patients to first back away from the treatment strategy, and first define what the problems are. 
The challenge of treating acne scars is first specifying  the types of acne scars you have. A physician tries to define the types of scars the person has, such as rolling scars, boxcar scars, ice pick scars, or a combination. They also look at facial volume loss because they want to look more globally and holistically.
As for the role of microneedling, I think what you are seeing is similar to what people are perceiving as the downsides of a procedure when done aggressively. This reminds me a lot of the perception of lasers in the mid 90s when lasers were very aggressive, and doctors were not always looking at the long-term effect, and the potential to cross the line between stimulation and remodeling, into injury and scarring. The same thing applies to any type of intervention, and microneedling does certainly have that potential. We see patients who have had multiple microneedling sessions done in very short periods of time.
I think it’s important to understand the philosophy of microneedling before the medical microneedling devices, originated with a device called the dermaroller. The central concept of microneedling is collagen induction therapy where a microneedling device, chemical peel, ir laser is inducing a controlled injury. That controlled injury is intended to stimulate a collagen repair response, and a remodeling response to help improve the area of concern. 
Also understand that microneedling can be done at different depths. I certainly that often people are frustrated with the treatment, but this doesn't just apply to microneedling. This also applies to laser and radiofrequency heating devices. It is almost a knee jerk reflex for the practitioner if the patient is not satisfied with a particular outcome, they increase the energy, and depth of treatment - basically increase the aggressiveness. That can result in a lot of challenges because now you crossed the line. 
When I evaluate my patients, after first describing the issues based on a more global evaluation, for example if someone has acne scarring with rolling or atrophic scars, or loss of volume in the tissue, often an injectable filler at a deeper level can improve the contour of the skin so the scars don’t look as deep. We can combine treatments so you don't have to be as aggressive with one treatment, which is something I figured out years ago. 
When people needed laser treatment, resurfacing, or fractional resurfacing, I often combine more conservative fractional resurfacing with platelet-rich plasma. Platelet-rich plasma is derived from your own blood, and also induces collagen and stimulates remodeling, so you can balance the level of aggressiveness. You can use the analogy of overtraining in the gym - you can lift up to a point to stimulate muscle growth, or you can overdo it risking injury. The same thing applies to the skin. Acne scars are very challenging regardless of the modalities. I think it is important to understand your options more globally before committing to any one specific treatment. 
When it comes to skin rejuvenation or skin treatments, we have so many more tools, so it’s combining the right modalities to get the maximum result, while minimizing risk. For example for acne scars, we can do a combination of injectable fillers placed deep or at the dermal level, laser, PRP, or microneedling to get the improvements we want. 
It’s very important for you to choose a practitioner who has a lot of experience, will be clear explaining all of these variables, and understand what kind of outcomes you can achieve. Also understand that a lot of the principles of skin treatment like exercise-induced muscle growth is about treating, then waiting to see how the treatment affects the skin. Often people are subjected to protocols which are not looking at the individual’s response, but rather based on a standardized process. With acne scars, one size doesn't fit all. There are certain protocols that have to do with a non-ablative laser which are little more consistent, but it is important to understand the kind of outcome, and if microneedling is really optimal for you. Are there other options that may be better for you? And perhaps microneedling can be used at a different frame of time. 
Meet with experienced doctors who do this type of work, and learn about your options. Remember when it comes to skincare and skin rejuvenation, especially with acne scars, multiple modalities often work better than just a single approach. It always has to do with customization, and not just about a single device. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Gregg Kennedy, MD · Answer

There are tangible risks associated with microneedling, but only a tiny fraction of clients treated has any problem at all. Scar formation is visible collagen formation, so any procedure or device designed to promote collagen formation can also promote abnormal scarring.  Tell your provider if you have had excessive scarring in the past.
Orange peel skin is specifically caused by blockage of the drainage of lymph from an area of skin.  This should not occur as a result of microneedling alone, in my opinion.
I refer you to the excellent information in Dr. Davin Lim's answer, on this page.  Best to you, Dr. Kennedy

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes, side effects are possible with any treatment, even with really banal treatments like microneedling. I have seen white 'tear scars', as well as grinding. This is vvv rare. See a Specialist, and if in doubt conduct a test spot. 
Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
  
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
  
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
  
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

Considering microneedling for acne scars, is there a risk of scar tissue forming and orange peel skin?

Answers (4)

Answer: Side effects possible with any treatment for acne scarring, including microneedling.

Answer: Side effects possible with any treatment for acne scarring, including microneedling.

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Everything you need to know about Microneedling

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Considering microneedling for acne scars, is there a risk of scar tissue forming and orange peel skin?

Answers (4)

Answer: Side effects possible with any treatment for acne scarring, including microneedling.

Answer: Side effects possible with any treatment for acne scarring, including microneedling.

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Recommended reading

Everything you need to know about Microneedling

Our mission is to create a world where every investment in modern beauty is Worth It.