October 2008

I have been battling acne for about 5 years now. As a result, the acne has caused scarring on my face. Lately I have been looking into skin needling treatments for acne scars. I have tried everything from green peels to chemical peels to microdermabrasion. I have also looked into Fraxel laser but because I have dark skin, I am worried that the laser might make my skin worse (I have read quite a few horror stories on the Internet regarding Fraxel laser). Moreover, Fraxel treatments are quite expensive and it doesn't seem like it’s worth the price. On the other hand, skin needling (albeit a relatively new treatment) does sound quite promising. There are a few published journals on the Internet by various doctors regarding skin needling, and experimental studies have demonstrated very little (if any) complications after needling the skin. What is your opinion on skin needling?

Anita, via email

Dear Anita,

Persistent acne is the bane of many people’s existence as it is mine. I can completely relate to trying just about everything out there in an effort to obtain (and keep) clear skin. Before I discuss skin “needling” for improving the appearance of acne scars (which isn’t a procedure I had heard of or researched before receiving your letter) I wanted to mention the research concerning Fraxel and acne scars.

Although the Fraxel laser hasn’t been in use for very long (pilot studies were done just a few years ago), the published research indicates it to be a viable option for all skin colors except dark skin tones, classified as a number six on the Fitzpatrick scale. This scale is a measurement of the coloration of a person’s complexion and its relative response to sunlight. Someone with very fair skin that always burns in the sun would be rated a 1 on the scale, while someone whose skin never burns and easily tans would rate a 6. The Fraxel laser has been tested on Fitzpatrick skin levels 1-5, with 5 representing those persons of Middle Eastern or other descent with dark brown skin tones. If your skin tone is in that range or above (perhaps a light brown tone) there are many reasons why you may want to reconsider Fraxel.

            A growing body of research has demonstrated it can offer a moderate to significant improvement in the appearance of acne scars after 3-5 sessions spaced 3-4 weeks apart. Although there are horror stories to be found online for almost any cosmetic corrective or surgical procedure, those types of experiences are rare and often due to either improper technique (finding an experienced medical professional to administer the treatments is a must) or not pre-screening a patient carefully before the procedure is done, because not everyone is an ideal candidate. The most common side effects from Fraxel are transient redness and swelling. Loss of pigmentation and scarring have not been reported as side effects in studies of multiple treatments involving up to 53 patients. (Sources: Journal of Dermatologic Treatment, 2008, pages 45-49; Facial Plastic Surgery Clinics North America, May 2007, pages 229-237; and Dermatologic Surgery, March 2007, pages 295-299). My recommendation is to not rule Fraxel out just yet; you may want to find a dermatologist in your area who offers this procedure and book a consultation. Afterward you can weigh out your options carefully from research rather than online gossip from people you don’t know.

In regards to skin needling (also known as needle dermabrasion) this procedure involves using very small needles (less than 0.25 millimeters) to pierce skin at or near the dermis. This controlled wounding of skin is said to stimulate collagen production, which can have a plumping effect that is supposed to improve the appearance of acne scars; the enhanced collagen production is claimed to raise slightly depressed scars. As with most medical corrective procedures, including light-emitting devices (Intense Pulsed Light therapy) and lasers, multiple treatments are required for needling before results are seen.

Needling procedures involve a topical anesthetic applied to skin beforehand so the procedure should be minimally painful. Side effects include redness, minor bleeding, swelling, bruising, flaking, small scabs at the injection site that have a brownish appearance, and short term hyperpigmentation. Those side effects aren’t much different from what can be expected after treatment with lasers or Intense Pulsed Light (IPL).

So is needling a good option? I wouldn’t bank on it, at least not yet. The problem? Aside from the lack of published medical research proving skin needling is a viable option for improving collagen production and lessening the appearance of scars, the procedure can be performed by tattoo artists and estheticians—meaning medical supervision isn’t required. That puts your skin at greater risk for complications, either from using non-sterilized/non-disposable needles or the lack of medical backup should complications (such as a skin infection) arise. And there are no standards for doing this procedure, unlike the guidelines involved with the use of various laser and light-emitting devices. How would a consumer know if the person doing the needling is going too deep, inserting needles haphazardly rather than in a precise manner, or has legitimate credentials?

What makes needling more tempting than other procedures is it is less costly than, say, Fraxel or other laser treatments to improve scarring. However, the lack of standards and absence of research proving its efficacy should give anyone pause. Surprisingly, some companies sell needle-rolling devices consumers can purchase to use at home. Now that’s a scary thought! I’ve seen some of these devices, and can only imagine the damage consumers could inflict if they use them improperly or too often—and again, there’s no solid proof that this is a great way to stimulate collagen production to the extent that acne or other types of scarring is significantly or even minimally improved. But at-home use could very well lead to bacterial infections and other nasty skin issues that, you guessed it, would assuredly require medical attention.

Some people have posted before-and-after pictures on the Internet after having skin needling done (over a period of several months) and the results, I’m sad to say, aren’t visually encouraging. The bottom line is that the Fraxel or other laser devices have a much better, substantiated track record of offering notable improvement for acne scars (among other skin issues). Until similar research comes to light on skin needling, it is not a practice I recommend, regardless of the facility you’re considering.