Microneedling for Facial Fibrosis - will this be effective? (Photos)

Question

I have a small, persistent raised area on my cheek (approx. 8mm x 6mm) that appeared after an acne lesion. It’s skin-coloured, doesn’t feel hard or painful, and hasn’t changed much over time. It feels like normal skin but looks slightly elevated, thicker than the skin around it, and doesn’t fold in the same way the opposite side does. The dermatologists I’ve seen say it’s probably a result of overhealing—fibrosis, mild hypertrophic scarring, or some kind of residual skin thickening, but they can’t confirm without an ultrasound (which I’m working on getting). Thoughts on what it is, and if microneedling could be an effective treatment? If so, what depth? I’m a male, late 30s. Thank you!

Anna Chacon, MD, FAAD · Answer

Microneedling can be effective for certain types of post-acne scarring, but its efficacy depends on the nature of the scar. Based on your description—a small, persistent, slightly raised, skin-colored area after acne, likely representing mild hypertrophic scarring or localized fibrosis—here’s what current evidence and expert consensus suggest:

Microneedling is primarily effective for atrophic (depressed) scars such as boxcar and rolling scars, with multiple studies showing significant improvement in these types
.
Hypertrophic or raised scars (including fibrosis) are less commonly treated with microneedling, but emerging research suggests that microneedle-based interventions can help modulate fibroblast activity and reduce scar elevation. For example, a study using silk fibroin microneedle patches in a hypertrophic scar model demonstrated reduced scar elevation and improved skin texture, likely by disrupting mechanical signaling in fibroblasts and reducing extracellular matrix deposition. However, this research is preclinical and not yet standard clinical practice.

Fractional radiofrequency microneedling has shown efficacy in softening scar contours and reducing the appearance of various acne scars, but most data focus on atrophic rather than hypertrophic scars.

Depth of microneedling:
For atrophic facial scars, typical microneedling depths range from 1.0 to 2.5 mm depending on scar thickness and location.
For hypertrophic or fibrotic areas, there is limited clinical data on optimal depth, but deeper penetration (1.5–2.5 mm) may be considered, always starting conservatively and adjusting based on response and tolerance.

Key considerations:
Raised, fibrotic, or hypertrophic scars may respond less predictably to microneedling than atrophic scars.
Combination therapies (e.g., microneedling with topical agents like hyaluronic acid, PRP, or corticosteroids) may enhance results, but evidence for hypertrophic scars is limited.
Ultrasound or biopsy may help clarify the diagnosis and guide treatment, especially if the lesion is atypical or persistent.

Summary:
Microneedling may offer some benefit for mild, localized facial fibrosis or hypertrophic scarring, but results are less predictable than for atrophic scars. If you proceed, start with conservative depths (1.0–1.5 mm), monitor response, and consider adjunctive therapies. For persistent or atypical lesions, further diagnostic workup is warranted.

Nelson Lee Novick, MD · Answer

From the history and at least from the photo provided, the problem area appears consistent with a hypertrophic scar. If so, the treatment of choice would be the use of an intralsional injection of an appropriate concentration of traimacinolone acetonide suspension--a treatment for hypertrophic scars that has been used successfully for flattening these scars for many decades already.  
If it is determined that this instead a flesh-colored mole, then the treatment of choice would be "Scalpel Sculpting--" a simple procedure that requires no stitches and hence no risk for the development of a stretch scar or stitch tracks, which would be risks from standard surgical excision
Microneedling, which I have been performing for more than a quarter of a century is best reserved for addressing very superficial skin tone and texture issues and would be unlikely to be helpful for any issues other than for improving skin radiance, which can be addressed by the superficial peels and the at-home topical prescription medications. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Microneedling for Facial Fibrosis - will this be effective? (Photos)

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Microneedling for Facial Fibrosis - will this be effective? (Photos)

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