What are the risks from micro-needling (particularly over the long term) and who is likely to be more affected by those risks?

All providers of microneedling should know the risks for the patient. To dismiss risks of any procedure is naive and unprofessional. Micro needling in many cases will breach the epidermis and the basement membrane of the skin, as needles go into the dermal layers. Risk of this procedure should be discussed prior to microneedling, and 'at risks patients' identified early. Additionally every provider should be able to deal with the side effects, and like you hinted should not be dismissive of them. To answer your questions risk include-1. Infection. Especially in patients who carry s. aureus (20% of population). Treatment - swab, oral or topical ab. Nose swab and eradication of staph. High risk patients - Atopic eczema, F hx of staph infection, immune suppressed patients, HSV infection- hx of cold sores, immune compromised. Infection also is proportion to the hz, passes and depth of the procedure. Dermal micro needling higher risk. Treatment and investigations as per swab results. Bacteria infection, viral and yeast (candida). Most common error- microneedling active acne as p.acnes may lead to cysts and collections of pus and inflammation in the dermal layers (needle dissiminates p. acnes)2. Prolonged redness, worsening of rosace - dermatitis . Well known, easy to identify, easy to treat. Antiinflammory prophylaxis, yellow light, 810 diode, blue light with ALA, blue light , BBL or vascular lasers to reduce redness. At risk individuals identified with a history and examination. 3. Koebner - real risk in patients with vitiligo, lupus, lichen planus and psoriasis. Easily identified and treated as per clinical findings. 4. Scarring- at risk patients. Poor compliance with after care. Scarring secondary to infection. User error- incorrect technique, needle length incorrect, aggressive treatment. Poor wound care. Idiosyncratic reactions know to occur despite optimal wound care and correct microneedling technique. 5. Prolonged healing, grids, lines- as above, at risk patients smokers, diabetes, immune compromised. Treatment- as per above. 6. PIH, worsening of melasma. Due to - poor understanding of condition. High risk patients, Skin type 3 or darker, UV exposure, hx of active inflammatory disorders. mx - beyond scope of this topic. 7. Nerve damage- neuropraxia. Due to - poor understanding of anatomy, usually  too deep wrong area. 8. Irritant dermatitis post op care9. Allergic contact dermatitis - post op careLike any procedure, microneedling can have its risks. It is the duty of the physician or provider to identify at risk patients and mitigate any risk, informed consent with the risk benefit ratio should be discussed. Adverse conditions from microneedling should be identified early and the patient treated accordingly. Microneedling has come a long way over the past few years and can help skin via several methods. Firstly it releases cytokines and growth factors in the epidermis and dermis- the top and bottom layers of your skin. This in turn remodels scars and the dermal layer of the skin. Additionally needles can break up scars themselves. This leads to new collagen formation, and in practice can provide limited skin rejuvenation. 



Microneedling is both user dependent and method driven. Simple needles can be used, growth factors can be added after the procedure, including PRP, or controlled heating during the procedure. This controlled heating is delivered via RF, and is called RF microneedling. RF can then be delivered via insulated or insulated needles. Even the energy level, depths, density, pulse duration and so many other variables can be controlled. This together with the added benefits of growth factor infusion makes this one of the most complex procedures in procedural dermatology. I use everything from Dermapen, though to newer generation insulated and non-insulated devices including INFINI micro-needling radiofrequency, Intensif and others. Newer generation devices can provide an added advantage in some, but not all patients. In my practice, I combine microneedling with many different forms of energy devices, depending on the expectations of the patient. Tailored microneedling combination will always give the best results. 



Like most procedures, its 80% skill level of the specialist and 20% dependent on the brand of the energy device- microneedling system. All the best, Dr Davin Lim. Brisbane. Australia. Realself Advisory Board Member