Wrinkles, acne scars, enlarged pores, and stretch marks can make people feel self-conscious about the uneven appearance of their skin. Dermatologists have a variety of devices and medications at their disposal to help improve these skin conditions—from lasers to chemical peels to microdermabrasion. Another minimally invasive option is microneedling, a nonsurgical procedure that’s performed in a dermatologist’s office.

Though the thought of needles may make you cringe, microneedling is not painful. Doctors generally apply a topical anesthetic cream beforehand to help numb the area being treated. It has few side effects other than temporary redness and swelling post-treatment. Microneedling typically has a shorter recovery time compared to the lasers or chemical peels that are also used to help resurface the skin and improve its texture.

At Yale Medicine Plastic Surgery, microneedling is offered to treat a variety of cosmetic skin conditions. “The way our skin looks is a big part of how people perceive us,” says Kathleen Suozzi, MD, aesthetics director for Yale Medicine Dermatology. “Patients have high satisfaction when they can improve the appearance of their skin and eliminate signs of aging.”

“Microneedling is an exciting treatment that has very little downtime but visible results,” says Yale Medicine plastic surgeon Tito Vasquez, MD. “By creating tiny channels through the skin, allowing us to infuse serums and active ingredients more efficiently, this treatment will stimulate collagen production and improve skin texture and tone.”

Microneedling, also called percutaneous collagen induction therapy, is performed using a handheld, drum- or pen-shaped device, electrically powered, with tiny needles that make precise, microscopic punctures in the skin. These “micro-injuries” do not leave scars; they work by helping to stimulate the skin to repair itself naturally through a process called dermal remodeling. 

This process starts with inflammation, which stimulates the skin to produce new collagen (the elastic fibers that make skin tight, smooth, and youthful). Collagen levels in the skin decline as we age, and new collagen can be produced when the skin is in repair mode.

Three to five monthly or biweekly treatments are recommended to achieve desired results. Through a series of sessions, microneedling can increase elastic skin fibers. Microneedling also helps the epidermis (the outermost layer of skin), which naturally thins with age, become thicker and tauter.

Microneedling is used to treat a variety of skin conditions that cause depressions in the skin such as acne scarring, surgical scars, other scars, burns, enlarged pores, wrinkles, and stretch marks. (The procedure is less effective on deep, narrow “ice-pick” acne scars than on broader ones.)   

Microneedling does not deliver heat to the skin like lasers do. As a result, people who have melasma (dark patches of skin) and hyperpigmentation (dark spots on the skin) can undergo microneedling without the risk of worsening pigmentation problems. (Darker skin is susceptible to pigmentation changes as a post-inflammatory response.)   

Microneedling is sometimes used to help topical skin treatments to penetrate the skin more effectively. For example, microneedling is sometimes performed before application of minoxidil, used to treat common hair loss (androgenic alopecia, which affects both men and women).

There are a few temporary side effects to be aware of with microneedling. The procedure causes short-term swelling, redness, and skin flaking, which can last for a few days. Most people can return to wearing regular makeup within a day of treatment. Skin will be more sun-sensitive after treatment, so sunscreen is also advised.   

Microneedling may worsen active breakouts, so people with active inflammatory acne or oral herpes should not be treated with microneedling until the lesions have cleared. Those with a history of oral herpes may be prescribed an oral antiviral medication for one week following treatment because the procedure may stimulate a new cold sore. 

Consumers can buy at-home microneedling (or derma-needling) rollers over the counter. For best results, though, microneedling should be administered by a dermatologist using more advanced equipment. Your dermatologist can appropriately adjust the device depth according to the area of your skin. For example, he or she can select shorter needle depths around the eyes, nose and forehead, and longer ones to treat acne scars on the cheeks or stretch marks on the abdomen.

At-home microneedling devices also only superficially affect the skin—they penetrate just its outer layer (the stratum corneum or epidermis), reaching 0.25 mm deep. Professional devices can go deeper (2 mm to 3 mm deep), reaching not only the epidermis but also the dermis, a deeper layer of skin. Professional devices are electric powered and evenly push the microneedles into the skin. The at-home versions rely on you to manually roll the barrel over the skin to create the small punctures.

“These are very unlikely to have any benefit for dermal remodeling, but they may have benefits such as exfoliating the skin, which would allow topical medications to penetrate better,” says Dr. Suozzi.

Yale Medicine Dermatology offers a variety of cosmetic treatments for dermatological concerns, including sun spots, acne scars, wrinkles, stretch marks, and surgical scars.   

“I want everyone to look like the best version of themselves,” says Dr. Suozzi. “And my approach in aesthetic dermatology is not to make people look different or augmented but to look maybe like they did five years ago or 10 years ago—to turn back the clock a little bit and improve their skin health.”