Microneedling Misconceptions

Q: Should patients add microneedling to their regular moisturizing routine?

Microneedling is the use of sharp plastic or stainless-steel needles to porate the stratum corneum skin barrier, creating columns of controlled skin damage that encourages collagen regeneration and enhances penetration of ingredients. It can be performed with a handheld roller, a mechanized motor that pushes the needles back and forth, or a professional device that combines poration with other energy types, such as radiofrequency. Consumer and dermatologist-administered devices are available.

Microneedling has been touted to the consumer as a means to enhance the penetration of moisturizers, vitamins, skin-lightening ingredients, and other cosmeceuticals. Is this enhanced penetration good? It depends.

Many consumers are applying their regular moisturizer to the skin and then microneedling over the product. The first effect of microneedling produces edema through extravascular accumulation of serum as tissue injury occurs. As you might imagine, the swelling can minimize or even eliminate fine lines on the face. However, the improved appearance is only temporary, encouraging consumers to use the device with greater fervor. The second effect introduces all the substances that have been placed on top of the skin. Although microneedling hyaluronic acid into the skin from topical application might create filler-type effects, the hyaluronic acid is typically in a preserved formulation with emulsifiers and other ingredients. Do you really want paraben preservatives to enter the skin? Parabens kill bacteria and will also damage the viable skin. Do you really want surfactants in your skin? Emulsifiers that solubilize the oily ingredients into the dominant water phase are all weak surfactants.

I do not think a normal moisturizer is suitable for microneedling. Most moisturizer formulations are designed to function as a thin layer over intact skin. Their role is to retard transepidermal water loss, which is not possible when the ingredients are microneedled into the skin. Special microneedling products that are devoid of preservatives—meaning they must be refrigerated or in individual-use pouches—and contain ingredients suitable for systemic absorption must be purchased. Many microneedling solutions use vitamins such as vitamin C for this purpose. Vitamin C is challenging to microneedle. It must be at an acidic pH for the vitamin C to be present as ascorbic acid, the bioavailable form of the nutrient. This means it will be necessary to microneedle an acidic solution into the skin, which could be irritating and cause stinging and burning.

Microneedling presents many consumer challenges, and both the device and the solutions should be carefully examined by a dermatologist for suitability and safety.

Q: Should patients microneedle with sunscreen on their face?

Patients definitely should not microneedle while wearing facial sunscreen. Sunscreens, which are designed to absorb and/or reflect solar radiation, work only on the skin surface and not in the skin; their ingredients are for topical application only and not intended for systemic absorption. Particulate inorganic sunscreens, such as titanium dioxide and zinc oxide, are not safe for entry into the skin—neither are organic sunscreens, such as oxybenzone, homosalate, and octyl methoxycinnamate. To prevent inadvertent penetration of unwanted chemicals and infection, patients should perform microneedling only on a freshly washed face.

Q: Should dermatologist-administered microneedling be performed before or after product application for maximal results?

Whether professionally administered microneedling should be done before product application or afterward remains controversial. One method involves painting the skin with a suitable microneedling solution and then microneedling over the solution, theoretically pushing the ingredients into the skin. The other option is to microneedle first to create holes in the skin and then paint the solution over the porated skin to enhance penetration. After microneedling, the pores created do not stay open for very long, because the skin is highly elastic and snaps back to close the pore very quickly. On the other hand, the needles do not cover every square inch of the skin surface, so the amount of prepainted solution that penetrates the skin when the microneedling is performed is also limited. In conclusion, I would say that the penetration of ingredients via microneedling is somewhat limited.