Which type of microneedling would be best for my loss of firmness, large pores and acne scarring?

Question

Hi. My issues are loss of firmness, large pores and acne scaring (ice pick and some marks). Which microneedling would be best - RF (I do have fillers), PRP, or regular microneedling? I feel the providers I’ve seen tend to recommend the one they do. I’ve had several fraxel treatments which have not helped these issues. Thank you

Nelson Lee Novick, MD · Answer

I am not at all surprised by your lack of success with fraxel laser treatments. I have been cautioning my regular followers for years already that these "bells and whistle" treatments, much like PRP and RF microneedling, remain unproven and all-too-often totally disappointing wastes of time and money. Sorry.
On the other hand, the use of TCA CROSS, which I have personally been using to treat dilated pores and ice pick scars for the past 24 years has stood the test of time for both safety and efficacy in all skin types. 
Regarding professionally performed, manual microneedling (no need for the added expense and risks of RF microneedling), which I have also been performing for the past 25 years, this approach is best reserved for treating very superficial, surface color and textural Irregularities. And without photos, it is hard to say whether this would be appropriate in this case. 
The loss of firmness may better be helped by the use of HA skin boosters, such as Profhilo/SkinVive, but this can best be determined by an in-person examination by an experienced, board certified cosmetic dermatologist who would be able to palpate and manipulate the skin. Hope this helps and best of luck.

Anil R. Shah, MD · Answer

Hello my name is Ranen and I am an aesthetic nurse at Aesthetic skin in Chicago.  You have a strong combination of skin concerns: loss of firmness, large pores, and atrophic acne scarring (ice‑pick + marks). Given all of that, choosing the right microneedling‑type treatment involves weighing depth of treatment, downtime, risk, cost, and how your fillers and prior treatments factor in. Below is a breakdown of three main approaches — traditional microneedling, microneedling + PRP, and RF microneedling — what the evidence shows, what each is good or less good for, and key questions to ask your provider.

Nick Slenkovich, MD · Answer

Hello, I’m Lauren, the aesthetic injector at Colorado Plastic Surgery Center. Large pores, loss of elasticity, and acne scarring are common concerns, and finding the right treatment is key. PRP microneedling can be an excellent option for addressing all of these issues. The combination of microneedling and PRP enhances the healing process for acne scars and stimulates collagen production more effectively. It’s also great for skin rejuvenation, helping to improve firmness and reduce pore size.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

When considering microneedling for issues such as loss of firmness, large pores, and acne scarring, it's important to understand the differences and benefits of the various types available. Here’s a brief overview of the options you mentioned:

1. **Regular Microneedling:**
Regular microneedling, or collagen induction therapy, involves creating micro-injuries in the skin using fine needles. This stimulates collagen and elastin production, which can help with skin texture, firmness, and minor scarring.

**Pros:**
- Generally less expensive than other options.
- Can be effective for mild to moderate acne scarring and improving skin texture.

**Cons:**
- May require multiple sessions for noticeable results.
- Less effective for deeper scars and significant skin laxity.

2. **Radiofrequency (RF) Microneedling:**
RF microneedling combines traditional microneedling with radiofrequency energy. The RF energy is delivered through the needles, which heats the deeper layers of the skin, enhancing collagen and elastin production.

**Pros:**
- More effective for skin tightening and improving firmness compared to regular microneedling.
- Can provide better results for deeper acne scars and larger pores.
- Often requires fewer sessions for significant improvement.

**Cons:**
- Typically more expensive than regular microneedling.
- May not be suitable for all skin types, especially those with certain fillers (consult with your provider).

3. **Platelet-Rich Plasma (PRP) Microneedling:**
PRP microneedling involves applying platelet-rich plasma (derived from your own blood) to the skin either before or after microneedling. The growth factors in PRP can enhance healing and collagen production.

**Pros:**
- Can accelerate healing and enhance results of microneedling.
- May improve skin texture, tone, and scarring more effectively than microneedling alone.

**Cons:**
- Additional cost for PRP preparation.
- Results can vary depending on individual response to PRP.

Recommendations Based on Your Concerns:

Given your specific issues of loss of firmness, large pores, and acne scarring (including ice pick scars), **RF Microneedling** might be the most suitable option. Here’s why:

- **Firmness:** RF microneedling is particularly effective for improving skin firmness due to the added benefit of radiofrequency energy, which stimulates deeper collagen production.
- **Large Pores and Acne Scarring:** The combination of mechanical injury from the needles and thermal injury from the RF energy can provide more significant improvements in skin texture, pore size, and deeper acne scars compared to regular microneedling.

Considerations:
- **Fillers:** Since you have fillers, it's crucial to discuss this with your provider. RF microneedling can sometimes affect fillers depending on their type and placement. Your provider can tailor the treatment to avoid these areas or adjust the settings accordingly.
- **Provider Expertise:** Ensure you choose a provider who is experienced with RF microneedling and understands your skin type and concerns. Sometimes, a multidisciplinary approach, combining different treatments, may yield the best results.

RF microneedling appears to be the most promising option for addressing your concerns comprehensively. However, it’s essential to have an in-depth consultation with a qualified dermatologist or cosmetic professional who can evaluate your skin and provide personalized advice.

Camille Cash, MD · Answer

An in person evaluation or photos is needed to recommend the best treatment for you.  Microneedling is best to improve minor acne scars, fine lines and wrinkles.  Morpheus8 is better if you are also wanting to address mild to moderate skin laxity.  I've included a video I hope you find helpful.  You can also visit my website to learn more.

Which type of microneedling would be best for my loss of firmness, large pores and acne scarring?

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