Microneedling for acne scars: what to expect

Microneedling is a treatment in which a device pushes many tiny needles into the skin to make small holes. The skin repairs those holes by making new collagen, the protein that gives skin its support, and the new collagen can lift sunken acne scars. The American Academy of Dermatology (AAD) says this is why the treatment is also called "collagen induction therapy." Dermatologists use it on dents left by acne, and the AAD says they also use it for dark spots and uneven skin tone. Flat red or brown marks from pimples usually fade on their own; see dark marks after pimples for those. This guide covers how microneedling works, what trials found, the recovery and the risks. For every other option, see acne scar treatment.

How microneedling works

The FDA describes microneedling devices as instruments with "many small needles, tips, or pins on the surface, which are repeatedly inserted and removed into the skin." The needles may sit on a roller, on a flat stamp, or on the tip of a pen-shaped tool. In some motorized devices, the practitioner can set how deep and how fast the needles go.

The AAD explains the effect: "When properly performed, your body responds by healing the holes in your skin with just the right amount of collagen. This can lead to less noticeable scars." For acne scars, a dermatologist may use one of these versions:

• Standard microneedling with a pen or roller.
• Radiofrequency microneedling. Heat travels down the needles into the skin. The AAD says "adding heat can increase your body's ability to produce collagen," and that this version "is safe for all skin tones."
• Microneedling with platelet-rich plasma (PRP). A small amount of your blood is drawn and spun in a machine to separate the platelets, which are then applied to the treated skin. The AAD says this "can be especially effective for fading acne scars."

The FDA has authorized microneedling devices "to improve the appearance of facial acne scars, facial wrinkles, and abdominal scars in patients aged 22 years or older." It also says microneedling devices are not approved for delivering creams, vitamins, drugs or blood products such as PRP into the skin. Ask your dermatologist how they use PRP and why.

What the studies show

• A 2022 analysis of 12 randomized trials. Published in Aesthetic Plastic Surgery, it pooled 414 people. Microneedling without radiofrequency "achieved superior results in terms of scar improvement" compared with the other treatments tested. People were about as satisfied with microneedling as with the comparison treatments. No infections or new scars were reported, and microneedling caused less post-inflammatory hyperpigmentation, the dark patches that can follow skin injury.
• A randomized trial with an untreated side. A 2017 review in Scars, Burns and Healing describes a trial in which 15 people had three microneedling sessions two weeks apart on one side of the face. Six months later, scar scores on the treated side were lower than at the start. Scores on the untreated side showed no significant change.
• Improvement in other studies. The same review found that all patients treated with microneedling in the studies it reviewed saw some improvement, ranging from 31 to 62 percent.
• Microneedling compared with a cream. A 2019 trial in JAMA Facial Plastic Surgery gave 36 people microneedling on one side of the face and tazarotene 0.1 percent gel, a retinoid, every night on the other side. After six months, both sides improved by similar amounts.
• The AAD's summary. For acne scars, the AAD says you "may need 3 to 5 treatments, which are performed every 2 to 4 weeks," and that "studies have found that this treatment plan can fade acne scars by 50% to 70%." That figure comes from its section on microneedling combined with PRP.

A 2016 Cochrane review, which pools trials to judge how strong the evidence is, found "a lack of high-quality evidence" for every acne scar treatment, including microneedling. Results vary from person to person.

What a session and recovery are like

Numbing creams are often used, the 2017 review says. In the trial with an untreated side that it describes, people rated the pain at 1.08 out of 10. Session length depends on the area; the AAD gives examples from a few minutes for a small area to 15 to 30 minutes for larger areas.

The AAD says downtime is minimal. Right after treatment, you may see "some redness (lighter skin tones) or darker shades (darker skin tones)," and the skin may feel sunburned, with minor burning or swelling. "These reactions usually disappear in a few days to a week." You can usually go back to work or school the same day, but the AAD says to "wait 24 hours before you apply makeup."

Results take time. The AAD says "you may see improvement within a few weeks. It usually takes several months before you see full results." Results also fade slowly as the body loses collagen. To slow that, the AAD advises sun protection and not smoking, and says your dermatologist may suggest a maintenance session once a year.

Side effects and risks

The FDA lists these risks for authorized uses:

Common	Less common
Dryness, rough skin, tightness	Darker or lighter skin patches
Redness, itching, peeling	Lines on the face
Discomfort, burning	Cold sores coming back
Bruising, bleeding, crusting	Swollen lymph nodes, infection

The FDA says most side effects "occur shortly after a treatment and resolve," but some may be permanent, and "microneedling procedures may not always result in the desired aesthetic outcome." The AAD says the risk of side effects drops when a board-certified dermatologist does the treatment, and rises with someone who lacks medical training, "like infection, scarring, or long-lasting skin discoloration."

Radiofrequency microneedling. In October 2025, the FDA issued a safety communication about radiofrequency microneedling used for skin procedures. It said it is aware of reports of "serious complications (adverse events) including burns, scarring, fat loss, disfigurement, and nerve damage." It says this is "a medical procedure, not a cosmetic treatment, and these devices should not be used at home," and advises asking your provider which device they plan to use.

Who should wait or skip it

The AAD says you should not have microneedling if you heal slowly or poorly, have or had a keloid, have a weak immune system, are being treated for skin cancer in the area, or are receiving radiation. It says your dermatologist will wait if you have a tan, a skin infection, or pimples that are painful, contain pus or go deep into the skin.

The FDA's list adds bleeding disorders, uncontrolled diabetes, blood thinners, eczema, psoriasis, cold sore outbreaks, pregnancy and breastfeeding, among others.

Isotretinoin. The two sources give different waiting times. The AAD says at least one month must have passed since your last isotretinoin pill. The FDA says the procedure may not be suitable if you have taken isotretinoin in the past 6 months. Ask your dermatologist which rule they follow.

Before treatment. The AAD says a 2 to 4 week routine before microneedling may include stopping retinoids, "i.e., retinol and tretinoin," for a few days, and protecting your skin from the sun. See tretinoin for acne scars.

At-home rollers

The AAD says products sold for at-home microneedling "aren't meant to puncture the skin" and give less noticeable results than a dermatologist's treatment. It lists four risks of home use: overuse that irritates the skin, a device that does pierce the skin and causes infection or scarring, spreading warts, herpes and other viruses across the skin, and pressing too hard, which "can cause scarring or changes to your skin's color or texture." The FDA says reusing a needle cartridge is unsafe, even if it is cleaned.

Microneedling on darker skin

The AAD says microneedling "is minimally invasive and safe for all skin tones," and the 2022 analysis found it caused less post-inflammatory hyperpigmentation than the other treatments. The FDA adds a caution: people with darker skin types have a risk of darkening or lightening after the procedure, and "some of the devices authorized for marketing by the FDA were not studied in subjects with darker skin types." The AAD also says the studies behind radiofrequency microneedling in darker skin were small. Ask how many people with your skin tone the dermatologist has treated.

Questions to ask

The FDA suggests these:

• What training and experience do you have with microneedling?
• Is a new needle cartridge used for each patient and each session?
• How is the device cleaned between patients?
• Can I see the patient labeling for the device?

Also ask how many sessions you will need, the total cost, and whether laser treatment or subcision would suit your scar type better. The guide types of acne scars helps you describe your scars.

When to see a dermatologist

See a dermatologist when your acne is under control and the dents bother you. The AAD says scar treatment usually starts after acne is controlled, because new breakouts can cause new scars. Skinli is not a doctor. The free Skinli acne plan can help with the acne first.