Microneedling — Does It Still Have a Place?
One of the oldest techniques in modern aesthetic medicine is also one of the most misunderstood. Here is an honest clinical account of what microneedling actually does, what the science says about topical penetration, and where the procedure sits in a contemporary treatment landscape.
A technique with a longer history than its current marketing suggests
Microneedling is frequently presented as though it were a relatively recent innovation; a product of the injectable and energy-based treatment era. In fact, the concept of using controlled skin injury to stimulate collagen production predates most of the treatments that now share its clinical space.
The modern dermaroller, the device that brought the technique into widespread aesthetic practice was developed in the mid-1990s by Dr. Desmond Fernandes, a South African plastic surgeon, who observed that repeated controlled needling of the skin produced progressive improvements in texture, firmness, and scar architecture. His observations were clinically astute, and the biological mechanism he was exploiting has since been characterised in considerable scientific detail.
What microneedling actually does
Microneedling, formally termed percutaneous collagen induction therapy, works by creating thousands of controlled micro-injuries in the epidermis and upper dermis using fine needles. These micro-injuries trigger the skin's intrinsic wound healing cascade, a precisely orchestrated biological sequence that unfolds in three phases: an initial inflammatory response in the first 24 to 72 hours, a proliferative phase lasting days three to fourteen during which new collagen and elastin fibres begin forming, and a remodelling phase that continues for weeks to months as the new collagen matures and reorganises Lily Tehrani et Al.
The main physiological mechanisms associated with microneedling are collagen and elastin production, transient increases in skin permeability, and improved skin barrier function post-treatment. As the wound repair process is initiated, fibroblasts migrate to the wounded area to initiate collagen and elastin production, contributing to improved firmness and elasticity of the healed epidermis.
Improved vascularity enhances the delivery of nutrients and growth factors to the tissue, contributing to the overall improvement in skin quality that goes beyond what collagen stimulation alone would produce.
Is Needle depth important and what it determines
The depth to which needles penetrate determines which tissue layer is targeted and, consequently, what clinical effect is produced Hye Jin Chung et al.
At 0.2 to 0.5mm, needles penetrate the epidermis and superficial dermis, primarily enhancing topical penetration and improving surface skin quality.
At 0.5 to 1.5mm, needles reach the papillary dermis and initiate meaningful collagen induction.
At 1.5 to 2.5mm, the reticular dermis is targeted, producing the most significant collagen stimulation, but with the most significant post-procedure recovery requirement.
This depth-effect relationship has important clinical implications. A 0.3mm dermaroller used at home bears little resemblance to a 1.5mm professional treatment in its biological effects, however similar the devices may look.
The marketing that conflates the two or that implies home microneedling produces the same clinical result as a professional treatment is not serving patients honestly.
From manual to motorised — and why it matters
The original dermaroller relies on manual pressure and a rolling technique to drive needles to the correct depth consistently. The shift to motorised microneedling pens in which needles oscillate at high speed and penetrate vertically rather than at an angle represented a genuine clinical advance.
Vertical needle penetration reduces the epidermal tearing that can occur with rolling motion, produces more consistent depth control across different areas and skin thicknesses, and allows depth and speed to be adjusted within a single treatment session.
The motorised pen is now the professional standard for good clinical reasons, and those reasons go beyond marketing preference. It is for these sound reasons that at the Cosmetic Doctors Company in Esher, Surrey we use the Professional Dermapen.
The topical penetration question — and its surprising answer
One of the most clinically discussed aspects of microneedling is its capacity to enhance the penetration of topically applied actives.
The logic is intuitive: create temporary microchannels through the stratum corneum, apply beneficial ingredients, and those ingredients will penetrate more deeply than they could through intact skin.
This logic is correct in principle. The clinical reality is more nuanced and in one important respect, genuinely surprising.
Microneedled skin sites recover barrier properties within approximately two hours. Hence the effective penetration window for topically applied compounds is considerably shorter than most post-procedure protocols acknowledge Ogunjimi AT et al.
More significantly, topical agent applied immediately before microneedling penetrated deeper compared to agent applied afterward at one and three hours, with microneedling demonstrating lateral extension beyond microchannels with increased penetration over time. This finding, that pre-application may produce deeper penetration than post-application, challenges the standard clinical assumption that topicals should be applied after needling and raises important questions about the optimal sequencing of topical application in a microneedling protocol Jyoti Gupta et Al.
What topical serums are worth using and when
Given the penetration kinetics described above, the post-microneedling topical strategy deserves more clinical thought than it typically receives.
The ingredients with the strongest rationale for post-procedure application are those with a documented effect on wound healing and barrier recovery: hyaluronic acid for surface hydration and tissue support, growth factors and PDRN for wound healing acceleration, and ceramide-based formulations to support barrier recovery as the microchannels reseal.
The trendy topicals examined in the companion post to this one namely exosome complexes, peptide cocktails, and NAD precursors may have a more defensible delivery window via post-microneedling application than via standard intact-skin topical use. The questions about their biological activity after formulation, and about whether they are optimally sized for microchannel penetration, remain.
The clinical indications where microneedling genuinely excels
The evidence base for microneedling is strongest in several specific indications.
Acne scarring — particularly rolling and boxcar scars has a well-evidenced response to multiple microneedling sessions, with histological evidence of genuine dermal remodelling and clinical improvement in scar depth and texture.
Skin quality improvement in texture, tone, pore appearance, and the overall quality of the dermal matrix is consistently demonstrated across a broad range of studies. Microneedling has been widely employed in cosmetic applications for acne scar treatment, skin rejuvenation, hair loss, melasma, and skin cancer, with the micro-channels formed facilitating delivery of cosmetic agents while stimulating collagen and elastin production through the wound-healing cascade.
The evidence for stretch marks and for certain presentations of hyperpigmentation is more variable but clinically credible. The evidence for hair loss, particularly androgenetic alopecia in combination with topical minoxidil, is growing and genuinely interesting.
Where microneedling sits in a contemporary treatment landscape
Standard microneedling produces genuine and well-evidenced collagen induction without the thermal component that energy-based devices introduce.
For patients with darker skin types, where the risk of post-inflammatory hyperpigmentation with energy-based treatments is a meaningful clinical consideration, microneedling offers a safer path to collagen stimulation. Its cost profile, both for the clinic and the patient, makes a series of treatments more accessible than energy-based alternatives. And its capacity to enhance topical penetration, properly understood and properly managed, adds a clinically useful dimension that energy-based devices cannot replicate in the same way.
Summary
Microneedling has a well-established, well-evidenced clinical role that has not been displaced by newer technologies. It works through a mechanism that is precisely characterised and consistently reproducible.
The clinical results in appropriate indications i.e. acne scarring, skin quality and collagen stimulation are real, meaningful, and durable when a proper series of treatments is completed.
The topical penetration dimension is clinically important but more nuanced than standard protocols acknowledge. The technique that Dr. Fernandes developed in the 1990s remains, in 2025, a genuinely useful and scientifically credible tool in the aesthetic medicine repertoire. Not everything that has come since has earned the right to displace it.
The views expressed in Clinical Perspectives are the Dr Forrester’s own and reflect his personal and professional experience in aesthetic medicine.
References
Tehrani L et al. Physiological Mechanisms and Therapeutic Applications of Microneedling: A Narrative Review. Cureus. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11993440/
Recent Advances in Microneedling-Assisted Cosmetic Applications. Cosmetics. 2024;11(2):51. https://www.mdpi.com/2079-9284/11/2/51
Ogunjimi AT et al. Micropore closure time is longer following microneedle application to skin of color. Scientific Reports. 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7609754/
Factors Affecting Depth of Penetration in Microneedling and Laser-Assisted Drug Delivery: The Importance of Timing of Topical Application. PubMed. 2020. https://pubmed.ncbi.nlm.nih.gov/32205757/
Kinetics of Skin Resealing After Insertion of Microneedles in Human Subjects. PMC. 2011. https://pmc.ncbi.nlm.nih.gov/articles/PMC3164267/
Carver S et al. Microneedling versus microcoring: A review of percutaneous collagen induction for the face and neck. Journal of Cosmetic Dermatology. 2024;23:1541–1550. https://onlinelibrary.wiley.com/doi/10.1111/jocd.16175