Is hyperpigmentation normal after microneedling? (Photos)

Question

Got microneedling done today. Immediately was really red. The practitioner said she went really heavy over my dark spots. (Under eye/cheek area) After going home and the initial redness faded, areas that she went really heavy have dark pigmentation. Is this permanent? Is it normal to turn dark after microneedling? And there appears to be stripes on my forehead.

Jason Emer, MD · Answer

This looks like normal healing and you should be doing LED treatments, skin care with enzymatic exfoliation and sun protection at this time.  Best, Dr. Emer.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted several good photos of what you appeared like the same day as a microneedling procedure, and ask if it’s normal to have hyperpigmentation after microneedling. You describe your practitioner went aggressively in the cheek area because of pigmentation, and you you feel like there are stripes in your forehead afterward, so it’s clear you want some guidance.
I can describe how I help my patients with similar problems as yours 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. Microneedling is a significant part of my practice, and is one of the many solutions we offer in addition to the many lasers and other options. We often combine microneedling with platelet-rich plasma (PRP) and I’ll explain why as I describe for you the thinking behind this kind of treatment. 
I think it’s interesting you’re asking a question like this because from my perspective, the total treatment plan also requires an aftercare plan with an explanation why aftercare is necessary.
Microneedling is using fine needles adjusted to different depths anywhere from a half a millimeter to 2.5 millimeters. They go through the skin first to create micro injuries that stimulate new collagen and improve skin quality to address fines lines, wrinkles, sun damage, and pigmentation. 
When we do microneedling in our practice for the same issues including fine lines, wrinkles, and sun damage, we combine it with platelet-rich plasma (PRP) to help with hyperpigmentation. Skin types like yours are at a higher risk for hyperpigmentation, whether it’s the slightest pimple, or a laser procedure. Anyone who has a darker skin (type 3 skin or higher) is at a higher risk for hyperpigmentation. When we use platelet-rich plasma, which is a concentration of the wound healing factors derived from your own blood which is used for  improving the rate of wound healing, because it has a very specific benefit on hyperpigmentation. AI use platelet-rich plasma topically after microneedling, as well as laser. We use platelet-rich plasma as an injection to help with sun damage, brown spots, as well as dark under eye circles. The point is I’m trying to be proactive when I treat my patients for hyperpigmentation. I’m not saying your practitioner did something wrong, but with that thought process in mind, I hope there was counseling for you regarding the use of sunblock which you can start wearing the day after because the the epidermis would have healed over. You also want to ask your practitioner about any topical aftercare that includes topical anti-inflammatory or steroid, a topical therapeutic ointment or cream, and whether there’s a role for a bleaching cream prior to or afterwards. 
When you do any dermatologic treatment, it’s very important to also manage healing. Unlike surgical procedures, for example if I take out bags under someone’s eyes, there’s a very specific aftercare recommended for the first 24-48 hours, then for 1 week etc. For dermatologic care, there are many things that can be managed to try to mitigate the skin’s natural response to injury, which in darker skin types is to create something called post-inflammatory hyperpigmentation. If you didn’t get clear information on what to do after this treatment, which is maybe why you’re asking this question, contact your practitioner and ask this question because if you go to the sun unprotected, your skin will get darker just by nature of the behavior. Darker skin tends to attract more sun, and absorbs more sunlight, so in your situation, you have temporary darkness that can become long-term darkness - not necessarily permanent, but it is very important to manage that. 
As far as the broad question, if this is a normal appearance after microneedling, yes, it is a normal appearance. Those stripes on your forehead are reflective of the pattern the practitioner was using to ensure uniform coverage, which should fade as long as it doesn’t get too dark. If it does get dark, there are ways to manage that with bleaching creams and other modalities. Make sure you have these instructions clear, and most importantly, protect your skin with sunblock and allow the skin to heal. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Is hyperpigmentation normal after microneedling? (Photos)

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Is hyperpigmentation normal after microneedling? (Photos)

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