Microneedling
The microneedling pen is held upright and stamped across the skin in rows. The needles go straight in and out, and the depth is set on the pen.
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Dermapedia / CompareProcedures
Microneedling vs Exion Treatment
Mechanical microneedling uses fine needles and no heat. In the US it is authorised for facial acne scars, and it is a course of clinic visits about a month apart. Exion is a BTL platform with several applicators, and only one of them has needles. Ask which applicator you are being sold, because no published trial names Exion at all.
At a glance
| The difference | Microneedling | Exion |
|---|---|---|
| What it is best at | Acne scars, texture and large pores | Heat delivered at a chosen depth |
| Cost | Generally the cheaper of the two | Generally the more expensive of the two |
Exion
The Exion applicator combines radiofrequency with ultrasound and reads skin temperature as it goes. The number on the screen is the temperature it is holding the tissue at.
Side by side
The differences that matter
What you actually get
Microneedling
A motorised cartridge of fine needles
There is no energy source of any kind. SkinPen and Dermapen 4 hold the named US authorisations.
Exion
A platform with several applicators
Only the Exion Fractional RF applicator has needles. The Face and Body ones do not break the skin. They share a brand name, but not one authorisation.
How it works
Microneedling
Controlled mechanical injury, then healing
The needles make channels through the outer skin into the dermis. That sets off normal healing, and new collagen.
Exion
Needles plus radiofrequency at 1 MHz
That is the fractional applicator. BTL describes the non-needle ones as radiofrequency plus targeted ultrasound.
How it works, illustrated
Microneedling
How deep it goes
Microneedling
SkinPen up to 2.5 mm, Dermapen 4 up to 3 mm
The needle makes a channel at that depth and does nothing else.
Exion
0.5 to 4.0 mm on the needle applicator
It makes a channel and heats the tissue around it. So a deeper setting here is a different proposition, not just a longer needle.
What it is best at
Microneedling
Acne scars, texture and large pores
It works on the sunken, pitted kind of acne scar, and on fine lines. It does not tighten loose tissue, and it does not reach fat.
Exion
Heat delivered at a chosen depth
Needles alone cannot do that. What Exion achieves is inferred from the wider radiofrequency microneedling research, not shown for this device.
Conditions treated
Microneedling
Ice Pick Scars
Narrow and deep, like a puncture. A needle passing over the surface cannot reach the bottom of the tract. These need TCA CROSS, punch excision, or a laser.
1 / 10→
Stretch Marks
Fine needles make controlled micro-injuries that prompt new collagen in the scarred layer. Improvement is modest and needs a course of sessions, but it carries a lower risk of leaving dark marks than lasers do, which makes it the more sensible first device on deeper skin tones. It works on both red and white marks.
←2 / 10→
Acne Scarring
Fine needles injure the skin just enough to trigger new collagen. It does most for rolling and shallow boxcar scars, and very little for icepick ones. It is the gentlest of the resurfacing options, which also makes it the slowest — expect four to six sessions and judge it at a year, not at a month.
←3 / 10→
Male Pattern Hair Loss
Fine needles rolled or stamped into the scalp, used alongside minoxidil rather than instead of it. The small trials that exist favor the combination over minoxidil alone. Sessions are spaced weeks apart, and doing it too often or too deeply irritates the scalp without adding anything.
←4 / 10→
Wrinkles and Fine Lines
Fine needles make controlled injuries that prompt the skin to lay down collagen. Improvement in fine lines and texture is modest and builds over three to six sessions. Its advantage here is a lower risk of pigment problems on deeper skin tones than lasers or deep peels carry, which makes it a common first choice.
←5 / 10→
Post-Inflammatory Hyperpigmentation
Fine needles make controlled channels that help topical treatments penetrate and encourage the skin to remodel. It is mainly a scarring treatment, and its effect on pigment alone is small. It is a reasonable choice when true scars and dark marks sit together, but it can inflame reactive skin, so conservative depths are used on deeper skin tones.
←6 / 10→
Melasma
Fine needles make temporary channels that help tranexamic acid or other treatments reach deeper, and that combination is where the evidence sits — not needling on its own. It has to be done gently. Aggressive needling inflames the skin, and inflamed skin with active pigment cells makes more pigment, not less.
←7 / 10→
Dark Circles Under the Eyes
Thickens the skin slightly over a course of sessions, which can make the vessels underneath a little less visible. The evidence around the eye is thin and the change is subtle. It will not fill a hollow, and on deeper skin tones it carries its own risk of leaving marks, so it is not a first choice here.
←8 / 10→
Rolling Scars
←9 / 10→
Boxcar Scars
←10 / 10
The downside
Microneedling
Redness like a sunburn for 1 to 3 days
Mild swelling too, and some pinpoint bleeding on the day. That is the usual description, not a labelled figure.
Exion
Not published for Exion specifically
For radiofrequency microneedling in general: almost everyone gets redness. One study reported swelling in about 30% of people. Another reported 3 to 4 days of downtime.
Related topic illustrations
Microneedling
Fractional CO2 laser
Strong evidence, and the most effective single option for indented acne scars. In exchange it brings a week of real downtime, higher cost, and a genuine risk of lasting pigment change, especially on deeper skin tones.
1 / 4→
RF microneedling
Moderate evidence. Adds heat at depth, which does more for laxity and can do more for scars, at the cost of more discomfort, more downtime, and a higher price. Still safer on deeper skin tones than ablative lasers.
←2 / 4→
Subcision
Strong evidence for one specific job. It cuts the fibrous bands tethering rolling scars downward, which needling cannot reach. Often done alongside microneedling rather than instead of it.
←3 / 4→
Chemical peel
Strong evidence for pores and brown marks, none for indented scars. Superficial peels work on the surface and cannot lift a scar floor.
←4 / 4
Sessions
Microneedling
Typically 3 to 6, about 4 weeks apart
That is common practice, not a labelled figure.
Exion
No session figure is published for Exion
Studies of radiofrequency microneedling mostly use three sessions, three to eight weeks apart.
Cost
Microneedling
Generally the cheaper of the two
No group publishes an average price. Any price quoted online comes from clinic ads.
Exion
Generally the more expensive of the two
Radiofrequency tips are single-use and expensive. There is no reliable published price for it either.
The at-home or drugstore version
Microneedling
Rollers and home pens
A roller drags sideways instead of going straight in and out, so it tears more than it punctures. The needles also blunt quickly, and a blunt needle does more damage than a sharp one.
Exion
Home radiofrequency wands
A home wand puts a fraction of the power into the surface of the skin, and never reaches the depth a clinic device works at.
Who tends to be happy with it
Microneedling
- Best for — Scarring and texture, at a lower price, with a short recovery, in someone who does not need tightening.
- The mindset — A course of several sessions about a month apart, with results building slowly.
Exion
- Best for — Someone who wants heat delivered at a set depth, and accepts they are buying a device class rather than a proven brand.
- The mindset — Ask which applicator, what depth, what energy, and what evidence backs the claim being made to you.
Does the heat earn its price?
Microneedling
Radiofrequency microneedling has its strongest evidence in acne scars too. That is for the class, not for Exion. In a split-face trial against fractional CO2 laser, results came out no different, with less redness and swelling, and fewer patches of darkened skin.
The fine print
Microneedling
Mechanical microneedling holds a genuine cosmetic authorisation. SkinPen Precision was granted through a De Novo request in March 2018, for facial acne scars in adults aged 22 and over, across all Fitzpatrick types, and was later extended to neck wrinkles in types II to IV. Dermapen 4 is cleared for facial acne scars in Fitzpatrick I to V, with no neck indication.
Exion
Exion's needle applicator carries no cosmetic wording at all. Depending on the tip fitted, it is cleared either for electrocoagulation and hemostasis, or for "dermatological procedures requiring fractional treatment of the skin" (K211639, March 2022). The name Exion does not appear in the FDA 510(k) database at all; the applicators are registered under BTL's BTL-785 platform.
The non-needle Exion applicators are cleared only for heating tissue: temporary pain relief, muscle spasm and local circulation, plus a temporary reduction in the appearance of cellulite for one massage attachment. Wrinkles, acne scars, tightening, collagen stimulation and hydration appear in none of the Exion wording, so no cosmetic outcome was reviewed for the device.
Common questions
Questions Patients Ask
Is Exion just microneedling with heat?
One of its applicators is. The Exion Fractional RF applicator has 36 needles and delivers radiofrequency at 1 MHz from 0.5 to 4.0 mm. The Exion Face and Body applicators are not microneedling at all - they heat without breaking the skin, and BTL describes them as combining radiofrequency with targeted ultrasound, which does not appear in their cleared wording. Ask which one is planned for you.
Which one is FDA cleared for more?
Mechanical microneedling, which is the opposite of what most people assume. SkinPen holds a De Novo authorisation for facial acne scars and a later clearance for neck wrinkles in Fitzpatrick skin types II to IV; Dermapen 4 is cleared for facial acne scars in Fitzpatrick I to V. Exion's needle applicator carries no cosmetic wording - only electrocoagulation and hemostasis, or fractional treatment of the skin, depending on the tip.
Does Exion boost hyaluronic acid or hydration?
That is a marketing claim, and it is worth separating from what has been shown. No published trial names Exion, and no hydration or hyaluronic acid claim appears in its cleared wording. Nobody has demonstrated it in the public record.
Which one hurts more?
No study has compared them. Radiofrequency microneedling adds heat to the needling, which is why it is generally described as the more uncomfortable of the two, and deeper settings are the uncomfortable ones. That is clinical description rather than a measured finding. Topical numbing is standard for both.
Which is better for acne scars?
Both have a case, and neither has beaten the other in a trial. For mechanical microneedling, a review that pooled 24 randomised trials and 1,546 participants and ranked the treatments against each other found it works best combined with something else, notably a chemical peel. For radiofrequency microneedling as a class, a systematic review of 16 studies and 481 patients found it "likely" effective on its own. There is no published head-to-head comparison of the two.
Can microneedling tighten skin the way Exion is sold to?
Mechanical microneedling is not authorised for laxity and does not reach or heat fat, so it has no tightening or contouring effect worth expecting. Heat at depth is the mechanism that makes tightening plausible - but for Exion specifically, no published trial has measured it. What exists is class-level evidence generated on other manufacturers' machines, and it stops at six months.
How much does each one cost?
There is no reliable published price for either. No professional society publishes an average for microneedling or for radiofrequency microneedling, and any national average quoted online is clinic advertising or a total of clinic advertising. Mechanical microneedling is generally the cheaper of the two, largely because radiofrequency tips are single-use and expensive.
Safety to keep in mind
BTL's headline features do not appear in the FDA paperwork. It sells the needle applicator on AI-controlled radiofrequency. It also sells an ultrasound module that reads water and collagen in the skin. Those are the maker's own descriptions, and no trial of them is published. That does not mean the claims are false.
What is documented for the needle applicator is the hardware. It has 36 needles in a 6 by 6 grid, adjustable from 0.5 to 4.0 mm, running at 1 MHz.
Radiofrequency brings risks a mechanical needle does not. Texture changes, pigment changes, fat loss and burns are all reported to the FDA for these devices. Those reports cannot be turned into your odds.
One study measured the fat layer and found it unchanged. A split-face study in 30 people scanned the fat under the chin. The dermis thickened. The fat layer did not change significantly.
Both treatments share one hazard: what gets applied into freshly made channels. Granulomas are stubborn lumps in the treated skin. A review found 15 patients with these lumps after microneedling. Topical vitamin C was involved in most cases. So be careful about serums applied straight after either procedure.