Compare · Procedures

Microneedling vs Scar Revision

Microneedling: A pen or roller of fine needles makes thousands of tiny controlled punctures in the skin, which sets off healing and new collagen. It is used mainly for indented acne scars and rough texture. It makes them shallower over a course of sessions, not gone.

Scar Revision: The whole set of procedures used to make an existing scar less noticeable — cutting it out and closing it more neatly, flattening it, releasing it, or resurfacing it. No procedure erases a scar. Revision trades the scar you have for one you would rather live with.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Microneedling, based on the entry’s treatment or equipment reference.Editorial illustration for Scar Revision, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Microneedling if…

Choose for indented acne scars and rough texture with little downtime and low pigment risk — shallower, not gone.

  • Rolling or boxcar acne scars
  • Deeper skin tone, where lasers are riskier
  • You can plan 3–6 sessions

Choose Scar Revision if…

Choose to trade a scar you dislike for a neater one — no procedure erases a scar.

  • A wide, raised or puckered scar
  • The scar is at least a year old
  • You accept a new, better-placed scar
Often combined

Can you have both?

Microneedling is often used 6 to 8 weeks after scar revision surgery to blend the new scar.

Key differences

● Microneedling
● Scar Revision
DowntimeNone → 2+ weeks
1–2 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Mild
Moderate
Results showImmediately → 3+ months
1–3 months
3+ months
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
A longer series (4–6+)
A short series (2–3)
Cost per visit$ → $$$$$
$$
$$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

Microneedling

Scar Revision

What is it?

It creates controlled punctures.

Fine needles puncture the skin in a controlled way.

It treats scars and texture.

Results depend on device, depth and technique.

It differs from RF microneedling.

No radiofrequency energy is involved.

Added substances change the risk.

Devices are not cleared for use with every serum or blood product.

It improves scars.

It aims to improve appearance, comfort or movement.

It uses several methods.

Surgery, injections and resurfacing may be combined.

It does not erase scars.

It modifies scar tissue rather than restoring unscarred skin.

Keloids need special care.

Excision alone can cause a larger recurrence.

What it treats

Evidence level
Microneedling
Scar Revision
Strong evidenceMost established uses
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Improves rolling and boxcar scars.

Rolling Scars.

Rolling Scars

Good results with a series.

Scars on light skin.

Scars

Improves width, texture and color.

Moderate evidenceSome supportive research
Two areas of fair skin side by side on a hip. New pink-red bands sit above, and older flat silvery-white bands below, with only a small difference in color between the pale marks and the skin around them.

Stretch Marks

Softens older marks.

A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Improves texture.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Combined with injections to prevent return.

Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Punch excision for deep scars.

Little evidence
Ice Pick Scars on light skin.

Ice Pick Scars

Too deep for needling alone.

Two areas of fair skin side by side on a hip. New pink-red bands sit above, and older flat silvery-white bands below, with only a small difference in color between the pale marks and the skin around them.

Stretch Marks

Usually treated with lasers or needling.

Can make it worse
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Can spread active breakouts.

—

Treatment areas

Treatment areas

Face; the selected area depends on the concern and treatment plan.

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone
● Microneedling
● Scar Revision
Lighter skin
Low risk
Redness like a mild sunburn.
Low risk
Scar fades over a year.
Medium skin
Low risk
One of the safer scar treatments.
Some risk
Dark marks possible.
Deeper skin
Low risk
Lower pigment risk than lasers; dark marks are still possible.
Higher risk
Keloids can return larger; injections or radiation are often combined.

How it works

Microneedling

Scar Revision

How it works
Microneedling mechanism diagram. Fine needles create tiny punctures: A device makes controlled channels in selected skin. Healing signals are released: The tissue response activates repair processes. Collagen remodels gradually: Healing may improve selected scars and skin texture.
Scar Revision mechanism diagram. The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.
Diagram explanation

Fine needles create tiny punctures: A device makes controlled channels in selected skin. Healing signals are released: The tissue response activates repair processes. Collagen remodels gradually: Healing may improve selected scars and skin texture.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Microneedling
Scar Revision
Earlier planning
Not specified

6 to 12 months: Waiting: Surgeons want 6 to 12 months of natural settling first.

2–4 weeks before

Pigment cream: On deeper skin tones, some providers start a pigment-blocking cream a few weeks ahead.

Sun: Keep the scar out of the sun and use SPF 30 or higher.

2 weeks before: Smoking and vaping: Stop both at least two weeks before and after surgery.

The week before

Actives and hair removal: Do not arrive tanned or sunburned.

Actives and hair removal: Stop retinoids (tretinoin, adapalene, retinol), benzoyl peroxide and acids 3 to 5 days before.

Actives and hair removal: No waxing, threading or hair removal creams.

Not specified

Day of treatment

Microneedling
Scar Revision
Before you arrive

Clean skin: Come with a clean face and no makeup, and plan not to wear any that day.

Clean skin: If you have active pustules or an infection in the area, move the session.

What to bring: Old photos: Photographs from before the injury, if you have them.

Arrival & prep

Skin is checked and photographed, and you confirm what you have stopped using.

The scar is photographed and examined relaxed and stretched.

Treatment

The pen is passed over the skin in overlapping passes, one area at a time, with sterile gel or saline as a glide.

It sounds like a small vibrating motor and takes 20 to 30 minutes for a full face. Pinpoint bleeding is normal at deeper settings over scars. With good numbing it is uncomfortable rather than painful, a scratchy dragging with pressure.

A steroid injection takes minutes and meets real resistance.

Surgical revision cuts the scar out as a narrow ellipse and closes it in layers, usually 30 to 90 minutes. A Z-plasty swaps small flaps to change direction. Punch excision removes a small round scar. Laser or microneedling takes 20 to 45 minutes. Expect pressure, not sharpness.

Before you leave

Skin is bright red, warm and tight, like a strong sunburn, sometimes with faint tracking lines and dots of dried blood.

Tape over the line, wound care instructions, and a date for stitch removal — 5 to 7 days on the face, 10 to 14 days on the body.

After your treatment

Microneedling
Scar Revision
First 24 hours

Days 1 to 5: Redness turns pink and swelling settles, most noticeably around the eyes the first morning.

First 2 weeks: Swollen, bruised and tender.

Weeks 2–4

Weeks 1 to 4: Skin looks normal and nothing appears to be happening.

Weeks 2 to 8: The new line turns pink, firm and slightly raised — normal healing, not failure.

Beyond 1 month

Months 2 to 6: Texture keeps improving after the visible healing finishes, which is why the photograph that matters is taken months later, not the week after.

Months 3 to 18: Redness fades and the ridge softens from month 3 to 6, with massage and silicone doing the work.

Time to results

1–3 months after each session

Over 6–12 months

How long results last

Years for scars

Permanent

Risks

Risks
  • Dark patches
  • Tracking lines
  • Prolonged redness
  • Bumps that will not go
  • A cold sore outbreak
  • A scar thickening or spreading again
  • Itching, burning or tenderness in the scar
  • A dent or pale patch after an injection
  • A new dark patch
  • Numbness or odd sensation

Cost

Per session

In the US a full-face session usually runs about $200 to $700, with medical offices at the higher end and packages of three to six cheaper per session.

In the US this varies more than almost any other dermatology procedure, because "scar revision" covers a five-minute injection and a ninety-minute operation.

Insurance

Insurance does not cover microneedling for acne scars, since it is classed as cosmetic.

Insurance often pays when a scar limits movement or vision, interferes with function, or follows cancer surgery or an injury.

Questions

Microneedling

Scar Revision

Individual Questions
Does microneedling get rid of acne scars?

No. It makes indented scars shallower and less noticeable over three to six sessions. Rolling and shallow boxcar scars respond best, icepick scars respond poorly, and improvement is partial in every study. That is worth having; complete clearance is not what this treatment does.

How many sessions will I need?

Three to six for scarring, four to six weeks apart, then a wait. Texture keeps improving for three to six months after the last session, so do not judge the outcome before then.

Does it hurt?

With numbing cream on for 30 to 45 minutes it is uncomfortable rather than painful, a scratchy pressure rather than a sharp pain. The forehead, nose and jawline are the worst part, and deeper settings over scars are sharper.

Is microneedling safe on deeper skin tones?

One of the better options, because there is no heat or light for melanin to absorb. Dark marks are still possible if the settings are aggressive or the skin sees sun afterward, and they fade over months. Choose someone who treats deeper skin tones routinely.

Can I do this at home with a dermaroller?

Anything at 0.5 mm or deeper is a medical depth and should not be used at home. Needles blunt, home rollers cannot be properly sterilized, and serums through fresh channels have caused lasting lumps of inflammation. Rollers at 0.2 to 0.3 mm are mostly harmless and mostly useless.

Is PRP worth adding?

Platelet-rich plasma is your own blood, spun down and applied or injected during the session. The evidence that it improves scar results is mixed, and it often doubles the price. A course without it is a reasonable course.

Can a scar be removed completely?

No. Every treatment replaces the scar with a different one — flatter, narrower, paler, or running in a less obvious direction. Often a large improvement, not removal.

How long should I wait before revising a scar?

Usually 6 to 12 months, because most scars keep improving on their own in that time. Scars that limit movement and raised scars still growing are treated sooner.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound borders and often flattens over a year or two. A keloid grows beyond them, keeps going, and does not settle by itself. Keloids come back after surgery much more often, so they are usually injected rather than cut.

Will scar revision help my acne scars?

Some of them. Rolling scars respond to subcision, needling and laser; deep icepick scars often need punch excision or a targeted acid technique; boxcar scars sit in between. Expect a course and partial improvement, not one operation.

Does insurance cover it?

Sometimes — when the scar restricts movement or vision, causes symptoms, or follows cancer surgery or trauma. Revision for appearance is cosmetic. Ask the office to check with your insurer before you book.

I have deeper skin tone, and I keloid. Is anything safe?

Yes, but the order changes. Injections, silicone and pressure come first, elective surgery on high-risk sites is approached carefully, and if a keloid is removed, something is always done alongside to control the healing. Tell the provider at the first visit.

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