Can I microneedle after after a Fraxel treatment?

I had a Fraxel treatment 5 months ago on both cheeks, which caused hyperpigmentation (I'm of Mediterranean descent) along with scarring caused by the heat of the laser. I still have acne scarring, but don't want to use Fraxel again. I'm considering microneedling, and want to know if it's safe in light of what I experienced. Thanks

Doctor Answers 6


Dear JimD,

Thank you for your clinical post and sorry to hear of your complication. Hyperpigmentation in dark or Mediterranean skin after a fractional thermal laser treatment such as Fraxel is one of the known complications. Hyperpigmentation on top of underlying melasma can be exacerbated by this type of treatment even though the acne scarring may have been moderately improved. At this point you should see a certified specialist either dermatologist or plastic surgeon with extensive experience in this and a wide range of lasers and technologies to help. Microneedling will likely be low risk, but may be of modest to minimal value in improving both the acne scars and the hyperpigmentation.

Without pictures it’s difficult to tell, but in general these circumstances over the past 20 years I have found that a 6 week course of bleaching agent to stabilize the pigment forming cells and the use of the precise laser particularly nowadays the picosecond laser, either the PicoSure or PicoWay to mechanically disrupt the increased pigment with the least risk of post-inflammatory hyperpigmentation. The use of this picosecond type device will fade your pigmentation and then I would use fractional radio frequency energy rather than laser energy such as the eMatrix, the INTRAcel, the EndyMed, the Intensif or the Fractora to improve your acne scars. Fractional radio frequency energy particularly silicone coated needles or electrode base eMatrix technology has the lowest risk of causing abnormal pigmentation in darker skin.

Other safe techniques include bulk heating radio frequency energy devices such as the Forma, Pelleve and Venus Freeze and traditional and gentle intense pulsed light sources depending on the appearance and reactivity of your melasma may also help blend in colour.

Seeking out a physician and centre with lots of technology and experience in treating pigment and darker skin is important.

I hope this information is of some assistance and best of luck.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

Toronto Plastic Surgeon
4.6 out of 5 stars 93 reviews


Yes, Micro needling would be safe to do on your skin to help with the acne scars. I would recommend going to a board certified dermatologist who is experienced in the procedure. Additionally, there are peels and various prescription creams that a dermatologist can recommend to help with the post inflammatory hyper pigmentation. 

Lenore Sikorski, MD
Orange County Dermatologist
4.3 out of 5 stars 24 reviews

Microneedling is an ideal treatment for darker skin types

Microneedling is a great safer treatment for Mediterranean and other darker skin types, to laser. Even eMatrix or any heat producing laser or light source can cause hyper pigmentation in some patients.
When you have your microneedling performed ask the doctor or nurse if they can apply hydroquinine or another brightening agent immediately after your microneedling as this will allow greater absorption of the product.
And make sure to ALWAYS wear sunscreens and a hat when outdoors, or your pigmentation will return.

Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
4.9 out of 5 stars 217 reviews

EMatrix is preferred #Williamsville, NY

eMatrix is great as it is sublative RF energy, meaning that the epidermis is spared. We have this technology in our Wiliamsville office which is 1.5 hours away from where you live. 

Microneedling, done inappropriately, can cause hyperpigmentation. 

Dr H Karamanoukian
#RealSelf100 Member

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Fraxel and Microneedling NYC

If you are of Mediterranean descent then Fraxel can leave you hyper pigmented which is why I prefer the eMatrix for acne scars with your skin type.  The hyperpigmentation can be fixed with chemical peels and bleaching creams.  Microneedling would be safe to use for your scars and you should consider it with PRP as well.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Microneedling after Fraxel laser

Yes, microneedling is a safe treatment that can be performed after Fraxel laser treatments.  It can be used with lightening medications to prevent hyperpigmentation and sun protection should always be used.  Treatment with a cosmetic dermatologist who understands both skin function and microneedling is important.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.