Procedure

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Microneedling. Never cropped: the tone strip and the corner logo depend on the full frame.

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Microneedling is what I suggest most often for indented acne scars when someone cannot take real downtime, and it is also the most oversold treatment on social media. A course makes a shallow scar shallower; it does not erase it, and anyone showing you before-and-afters where the scars have vanished is showing you lighting.

What I find myself repeating: think three to six sessions a month apart, with the change showing up over three to six months rather than in the mirror next week, and get the acne itself quiet first — needling a face that is still breaking out makes new scars while we treat the old ones. Home rollers I am firm about: a reused roller and whatever serum is on the shelf causes reactions far harder to fix than the scars people were trying to treat.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledCollagen induction therapy, skin needling, dermarolling, CIT
Downtime1 to 3 days of redness like a mild sunburn, sometimes pinpoint bleeding on the day
Sessions3 to 6, spaced 4 to 6 weeks apart, then occasional maintenance
Typical costAbout $200 to $700 per session for the full face in the US. Varies widely by city and provider
Results timelineSlow. Texture keeps changing for 3 to 6 months after each session as new collagen forms
PainNumbing cream for 30 to 45 minutes first, then a scratchy, vibrating pressure. Bony areas like the forehead and jawline are the worst of it
Skin tone safetyOne of the safer resurfacing options for deeper skin tones, because it uses no heat and no light. Dark marks are still possible, especially with aggressive settings or sun afterward
EvidenceModerate. Repeated studies show partial improvement in indented acne scars over a course. None show clearance

What It Is

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A handheld device studded with very fine needles is passed over the skin. The needles move up and down rapidly, making thousands of punctures a fraction of a millimeter wide, as deep as the provider sets them. Most medical devices are motorized pens with a sterile single-use cartridge, the depth dialed between about 0.5 and 2.5 mm depending on the area and the problem. Rollers are the older version and still used, though most offices have moved to pens for depth control. Skin is numbed with cream first. Nothing is burned, frozen, or dissolved.

How It Works

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Each needle makes a narrow channel that closes within minutes. The injury is not the point — the repair is. The body responds to a field of small wounds by releasing growth factors, bringing in collagen-building cells, and laying down new collagen and elastin in the dermis over weeks to months. Indented scars are places where the dermis is missing tissue, so new collagen underneath lifts the scar floor closer to the surrounding skin.

That is why one session does very little and why the result arrives late. Collagen remodeling runs for months; the skin you see six weeks after a session is still changing at four months.

It works better on some scars than others. Rolling scars, wide and shallow with sloping edges, and shallow boxcar scars respond best. Icepick scars go straight down like a puncture and respond poorly, because a needle passing over the surface does not reach the bottom of a deep, tight tract. Those need a different technique. Microneedling also does nothing for the flat brown or red marks left after a spot, which fade with sunscreen and a pigment cream.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNON-ABLATIVE LASERABLATIVE LASERREACHES THE MID DERMIS

This works around one to one and a half millimetres down, in the middle of the dermis where collagen is made. That is the depth that changes scarring and firmness, and it is also why the downtime is longer and the result takes months to appear. Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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Close-up of the cheek, nose and mouth of an adult with light skin, turned three-quarters away from the camera against a pale blue background. The surface of the cheek is uneven, dimpled with shallow depressions and small pits that catch the light. There are no active spots — the change here is in the texture of the skin rather than its color.
Acne Scarring
Strong evidence
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.
Stretch Marks
Stretch Marks
Moderate evidence
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.
Wrinkles and Fine Lines
Wrinkles and Fine Lines
Moderate evidence
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.

Not the Best For

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Male Pattern Hair Loss
Male Pattern Hair Loss
Limited evidence
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.
Close-up of the lower cheek, nose and mouth of a young person with medium-brown skin, turned three-quarters away from the camera against a pale blue background. Scattered flat dark brown marks are spread across the cheek, with a few small raised spots still active among them.
Post-Inflammatory Hyperpigmentation
Limited evidence
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.
Melasma
Melasma
Limited evidence
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.
Dark Circles Under the Eyes
Dark Circles Under the Eyes
Limited evidence
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.
Microneedling: ice pick scars
Ice Pick Scars
Doesn't work
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.
Brown Marks
Doesn't work
Flat brown or red marks left after a spot are pigment, not texture. They need sunscreen and a pigment cream instead.

Pros and Cons

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Pros
  • Safe across skin tones No heat or light, so melanin is not a target.
  • Real downtime is short Pink a day or two, makeup the next day.
  • Works on the whole surface Texture, pores and shallow scars improve together.
  • Cheaper than lasers A full course costs less than one ablative laser session.
  • Combines well Often paired with subcision, TCA CROSS or filler.
Cons
  • It is a course, and a slow one Three to six sessions, plus months of waiting.
  • Partial improvement only Scars become less noticeable, not smooth.
  • Poor on icepick scars Those need TCA CROSS, punch excision or a laser.
  • Quality varies enormously A shallow pass in a spa is a facial with needles.
  • The at-home version causes harm Reused rollers cause most injuries.

How to Prepare

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A few weeks before1 week beforeOn the day
Pigment cream
A few weeks before
On deeper skin tones, some providers start a pigment-blocking cream a few weeks ahead.
Actives and hair removal
1 week before
No waxing, threading or hair removal creams. Stop retinoids (tretinoin, adapalene, retinol), benzoyl peroxide and acids 3 to 5 days before. Do not arrive tanned or sunburned.
Clean skin
On the day
Come with a clean face and no makeup, and plan not to wear any that day. If you have active pustules or an infection in the area, move the session.

What Happens

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ArrivingThe treatmentLeaving
Arriving
Skin is checked and photographed, and you confirm what you have stopped using. The provider sets needle depth for each area, shallower around the eyes and forehead, deeper over scarred cheeks. Thick numbing cream goes on for 30 to 45 minutes under plastic wrap, which is most of the appointment, and is wiped off completely before treatment. Your provider will ask about these things.
The 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.
Leaving
Skin is bright red, warm and tight, like a strong sunburn, sometimes with faint tracking lines and dots of dried blood. Pinpoint bleeding stops within an hour. A plain soothing serum or ointment goes on. For the rest of the day use only what the provider gives you, or a clean unopened plain moisturizer. No makeup.

Recovery

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Days 1 to 5Weeks 1 to 4Months 2 to 6
Days 1 to 5
Redness turns pink and swelling settles, most noticeably around the eyes the first morning. Skin feels dry and rough, then flakes lightly as the surface turns over. Mineral makeup is usually fine from day two. Some people get small clogged bumps or milia for a week.
Weeks 1 to 4
Skin looks normal and nothing appears to be happening. This is when the collagen work is going on underneath.
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.

Aftercare

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24 to 48 hours5 to 7 days2 weeks
Makeup and exercise
24 to 48 hours
No makeup on the day, mineral makeup from day 2, ordinary makeup once skin is no longer raw. No exercise for 24 to 48 hours — sweat stings open skin.
Actives
5 to 7 days
No retinoids, acids, vitamin C or scrubs for about 5 to 7 days. Plain moisturizer and sunscreen only.
Sun and hands off
2 weeks
Strict sun avoidance and SPF 30 or higher daily — sun on healing skin is the main cause of dark marks afterward. No picking, no facials, no waxing for 2 weeks.

Risks

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Most side effects are the expected redness, swelling and flaking. The serious problems come from one of three things: too much depth, poor sterility, or something applied through the fresh channels.

Dark patches
New brown or gray marks 2 to 4 weeks afterward, most often on deeper skin tones and after sun exposure. Treat them early, since they take longer to clear the longer they sit.
Tracking lines
Fine linear marks following the path of the device, from too much depth or pressure. They usually settle but can take months.
Prolonged redness
Redness that worsens after the first week rather than fading.
Bumps that will not go
Small firm lumps weeks to months later can be a granuloma, an inflammatory reaction to something that got into the skin. It needs looking at, not waiting out.
A cold sore outbreak
Needling can set one off. Antiviral treatment works best started early.

In Deeper Skin Tones

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Microneedling is usually the first thing considered for indented acne scars on deeper skin tones, and the reason is mechanical. Lasers put energy into a target, and melanin absorbs that energy whether or not it was aimed at it. Needles have no target — they make a physical hole, so more melanin does not mean more energy delivered, and the burn-driven pigment problems that follow ablative lasers are much less likely here.

Less likely is not none. Any injury to skin that makes pigment readily can be followed by post-inflammatory hyperpigmentation, flat brown marks where the treatment was, appearing a few weeks later. What raises that risk is inflammation: depth set too aggressively, too many passes over one area, treating skin that is still actively breaking out, and sun exposure in the first two weeks. It is largely avoidable, and when it happens it fades over months rather than being permanent, which is not true of the pigment loss ablative lasers can cause.

A provider who treats deeper skin tones regularly will start at a conservative depth and build across sessions rather than going deep on the first visit, space sessions a full four to six weeks apart, and often have you use a pigment-blocking cream and daily sunscreen for a few weeks before and after. Ask directly how they handle a dark mark if one appears, because the answer tells you whether they have seen it before.

Keloid and thickened scarring is more common in some people. Microneedling is not a common cause, but say so beforehand if you have ever had a raised scar from a piercing, a cut, or surgery. That changes how deep a sensible provider will go, particularly on the jawline, chest and shoulders.

If You Stop

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Nothing is lost by stopping. The improvement comes from collagen rebuilt in the scar, and that stays, so a course finished two years ago has not undone itself.

What continues is everything else. Skin keeps aging, and active acne keeps making new scars, which is the usual reason someone feels the result faded. It generally has not — the scars being looked at are new ones.

Stopping partway through a course is different. Two sessions of a planned five buys very little, because the change is cumulative. If cost or time is going to run out, space the sessions further apart and finish rather than stop halfway.

Combining Treatments

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Same day
Oral acne medicines
Antibiotics, spironolactone and hormonal treatment all continue.
Same day
Acne treatment
Getting active acne controlled at the same time is not optional.
Same day
Subcision
Routinely combined, as it releases the bands that tether rolling scars.
Same day
TCA CROSS
Routinely combined, as it treats icepick scars one at a time.
Same day
Platelet-rich plasma
Often added as an upgrade, but the evidence is mixed and it is fine to decline.
Pause a few days
Topical actives
A retinoid, benzoyl peroxide and azelaic acid pause a few days around each session.
Wait 2 weeks
Other procedures
Wait about 2 weeks around a peel, laser or waxing on the same area.
Wait 4 weeks
Between sessions
At least 4 weeks apart.
Wait 2 weeks
Filler and neurotoxin
Usually a separate visit; filler can also lift stubborn depressions.
Ask your doctor
Isotretinoin
Needling used to wait 6 to 12 months; many providers now treat during or soon after.

Insurance Coverage

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

Ask Your Doctor

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Medicines and pregnancy
If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding first, including about the numbing cream.
If you take a blood thinner
Warfarin, apixaban, clopidogrel, even regular aspirin or fish oil mean more bleeding and bruising. Never stop a prescribed blood thinner on your own.
If you have taken isotretinoin
Whether you are on it now or recently finished. Practice has changed and it is a judgment call. Say when you took it.
How your skin heals
If you have a bleeding disorder
The same applies to anything affecting healing. Poorly controlled diabetes, an immune-suppressing medicine, or a clotting problem all raise infection risk and slow healing.
If you have had a keloid scar
Any thickened scar counts. It changes how deep it is safe to go, and needs discussing before the first session, not after.
If you have a deeper skin tone
Ask how they set depth, how they space sessions, and how they would treat a dark mark if one appeared.
The area being treated
If you have an infection in the area
This includes active acne and broken skin. Pustules, cold sores, impetigo, or an eczema flare need clearing first, because needling spreads them.
If you get cold sores
Say so beforehand. Antiviral tablets are usually started the day before.
If you have an implant in the area
Implanted metal and electronic implants count. Mention it, particularly if a radiofrequency device is being suggested instead.

At-Home Versions

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Home microneedling is the one part of this treatment where the harm is well documented, so this section is blunt.

Cosmetic rollers, 0.2 to 0.3 mm
Okay alternative
These barely pass through the outer layer. They may help a serum absorb slightly better and they will not touch a scar. Low risk, low reward. Replace the head often and never share it.
Rollers and stamps at 0.5 mm and above
Bad alternative
This is medical depth being used without training, sterility, or a way to judge what is happening. Needles blunt after a few uses and then tear rather than puncture, which is how tracking marks and scars happen. A roller cannot truly be sterilized in a home kitchen, and sharing one passes on bloodborne infection.
Serums applied through fresh needle channels
Bad alternative
The biggest single problem with home needling. These products are made for the skin surface, not the inside. Vitamin C serums, essential oils, and "growth factor" products have all been followed by foreign body granulomas: firm lumps of inflammation that can last months and sometimes need injections or surgery. Afterwards, only water, a plain moisturizer, and later sunscreen.
What actually helps at home
Good alternative
A nightly retinoid, daily sunscreen, and treating any active acne do more for the long-term look of scarred skin than any home device. They also make office sessions work better.

How It Compares

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Fractional CO2 laserDiagram: how Fractional CO2 Laser works in the skin
Fractional CO2 laser
Better
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.
RF microneedlingDiagram: how RF Microneedling works in the skin
RF microneedling
Better
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.
SubcisionDiagram: how Subcision works in the skin
Subcision
Different job
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.
TCA CROSS
Different job
For icepick scars only. A tiny amount of strong acid is placed in each narrow scar. Precise, cheap, and no help at all with anything else.
A small clear glass bowl holding a shallow pool of pale amber liquid on a white background, with a white fan-shaped brush lying beside it, bristles resting against the bowl.Diagram: how Chemical Peel works in the skin
Chemical peel
Different job
For pores and brown marks, none for indented scars. Superficial peels work on the surface and cannot lift a scar floor.
Fillers
The same
Lifts individual depressions immediately, which nothing else does, but the result fades over months to a couple of years and needs repeating.

Finding a Provider

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Rules vary by state. In much of the US, needle depths above roughly 0.3 mm are a medical procedure, so a physician, physician assistant or nurse practitioner performs or supervises it. Below that it may be sold as a cosmetic service by an esthetician, and at that depth it is a surface treatment, not scar treatment.

Ask what depth they use for scars, whether the cartridge is sterile and single-use, what they apply during and after, how many courses they have done on skin like yours, and what they do when someone develops a dark mark. A provider who treats scarring seriously will also talk about subcision and TCA CROSS, because most scarred faces have more than one scar shape.

Red flags: before-and-after photographs showing scars completely gone, a package sold before your acne is controlled, an unnamed serum applied during treatment, no mention of sun protection, and roller devices reused between clients.

Myths

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  • "Microneedling erases acne scars." It does not. A full course makes indented scars shallower and less noticeable. Partial improvement is the honest expectation, and it is worth having.
  • "More blood means it worked better." Pinpoint bleeding shows the needles reached the dermis, which matters. Pushing deeper and harder to produce more of it raises the risk of tracking marks and pigment problems without adding benefit.
  • "It is the same treatment at home with a roller." Office treatment uses a sterile single-use cartridge at a controlled medical depth. Home rollers reuse blunting needles at whatever depth the packaging claims, and the serum question makes them a different risk altogether.
  • "Deeper skin tones cannot have resurfacing treatments." They can, and microneedling is one of the treatments best suited to them, precisely because it uses no light or heat.
  • "Adding PRP makes it much more effective." Platelet-rich plasma may add something modest. The evidence is mixed, the price increase is not, and a course without it is still a reasonable course.
  • "One session before an event will fix my skin." One session leaves you red for a day or two and delivers almost nothing lasting. If there is a date, finish a course months beforehand.

Questions Patients Ask

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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.

References

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