Microneedling — Does It Still Have a Place?
One of the oldest techniques in modern medicine is also one of the most . Here is an honest clinical account of what microneedling does, what the science says about topical penetration, and where the procedure sits in a contemporary treatment .
A technique with a longer history than its current marketing suggests
Microneedling is 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 of controlled micro-injuries in the epidermis and upper dermis using fine . 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
The main physiological mechanisms associated with microneedling are collagen and elastin production, transient increases in skin permeability, and improved skin barrier function . As the wound repair process is initiated, fibroblasts 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
0.5mm, needles penetrate the epidermis and superficial dermis, primarily topical penetration and improving skin quality.
At 0.5 to 1.5mm, needles reach the papillary dermis and initiate collagen induction.
At 1.5 to 2.5mm, the dermis is targeted, producing the most significant collagen stimulation, but with the most 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, 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 .
Vertical needle 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 Doctors in Esher, Surrey we use the
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 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 barrier properties within approximately two hours. Hence the penetration window for applied compounds is considerably shorter than most protocols acknowledge
More significantly, topical agent applied immediately before microneedling penetrated deeper compared to agent applied at one and three hours, with microneedling lateral 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
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 receives.
The with the strongest rationale for post-procedure 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 formulations to support barrier recovery as the microchannels reseal.
The trendy topicals examined in 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 penetration, remain.
The clinical indications where microneedling genuinely excels
The base for microneedling is strongest in several indications.
Acne scarring — particularly rolling and boxcar scars has a well-evidenced response to multiple microneedling sessions, with evidence of genuine dermal remodelling and clinical improvement in scar depth and texture.
Skin quality improvement in texture, tone, pore appearance, and the overall 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 Oxygen Facial – Hydrating skin cancer, with the formed facilitating delivery of cosmetic agents while stimulating collagen and elastin production through the wound-healing .
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 with energy-based treatments is a meaningful 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 indications i.e. acne scarring, skin and collagen are real, meaningful, and durable when a proper series of treatments is completed.
The topical dimension is clinically important but more 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 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 and professional experience in aesthetic medicine.
References
Tehrani L et al. Physiological Mechanisms and Therapeutic Applications of Microneedling: A Narrative Review. Cureus. 2025.
Recent Advances in Microneedling-Assisted Cosmetic Applications. Cosmetics. 2024;11(2):51.
Ogunjimi AT et al. Micropore time is longer following microneedle application to skin of color. Scientific Reports. 2020.
Factors Depth of Penetration in Microneedling and Laser-Assisted Drug Delivery: The Importance of Timing of Application. PubMed. 2020.
Kinetics of Skin Resealing After Insertion of Microneedles in Human Subjects. PMC. 2011.
Carver S et al. Microneedling versus microcoring: A review of collagen for the face and neck. Journal of Cosmetic Dermatology. 2024;23:1541–1550.
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