Is it true that even the tiniest microneedle causes fibrotic scarring beneath the skin?

Properly performed, professional microneedling, which I have been routinely performing for the past twenty-two years, is used to improve superficial skin texture and tone. It works by creating microscopic wound channels within the skin, thereby stimulating neocollagenesis and neoelastogenesis (i.e. new, native collagen and elastic fiber production) that do the job. Fibrotic scarring is not the intent of this form of treatment when properly performed by a professional experienced in its use. Perhaps you are confusing this procedure with subcision, which works by breaking up tethering bands of scar collagen below an indented scar in order to stimulate new collagen and elastic fiber synthesis to replace the scar collagen in order to elevate and smooth the scar. Some degree of fibrosis does occur below the surface with this technique, which, in turn, can further help to elevate and smooth the overlying scar. Hope this helps.

microneedling improves collagen production doesnt cause scarring.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see linkt) should be started now to prevent further aging.

For facial rejuvenation, I would suggest a combination approach of
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.