Thank you for your question.

You submitted your question without a photo.

However, you are describing in your question a concern that you have about possibly undergoing

microneedling to treat your acne scars.

And you are concerned that in discussion with an aesthetician that there might be a more

of a scarring potential rather than collagen induction as is often suggested through microneedling.

And that people who have had treatment developed an orange peel type of skin.

And so you want to have some guidance whether or not microneedling really works or doesn't

work and whether or not there is a potential for injury rather than benefit.

Well, I can certainly share with you how I discuss this procedure with my patients in

my practice.

A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial

plastic and reconstructive surgeon.

I have been in practice in Manhattan and Long Island for over 20 years.

Amongst the many things that we do in our practice, everything from lasers, injectables,

surgery, we do also offer microneedling and I can certainly appreciate your concerns.

So to begin with, I think it’s very important, especially patients who come for an evaluation

often come with this expectation that they’re going to have a particular procedure because

they’ll make an appointment for that type of consultation.

For example, someone like yourself may make an appointment saying that this is a microneedling

consultation.

And I often have to tell our patients to first back away from the treatment strategy and

first define what the problems are.

And the challenge when you describe something like acne scars is first appreciating the

true specifics of the types of acne scars you have.

When you look at someone with acne scars as a physician, you’re looking to define what

are the types of scars the person has.

Do they have rolling scars or do they boxcar scars.

Do they have ice pick scars or do they have a combination?

Do they have facial volume loss?

And so we really want to look more globally and holistically.

As far as the role of microneedling, I think what you are seeing is similar in the way

people are perceiving the downsides of a procedure when a procedure is done aggressively.

And this is something that reminds me a lot of what the perception was with lasers since

the mid 90s.

Early on, when people were doing lasers, the lasers were very aggressive and doctors were

not always looking at the global long-term effect as well as the potential to cross the

line between stimulation and remodeling to crossing that line into injury and scarring.

And the same thing applies to any type of intervention.

But microneedling does certainly have that potential.

We see patients all the time who have had multiple microneedling sessions done in very

short periods of time.

And I think it’s very important to understand that the philosophy of microneedling which,

before the medical microneedling devices were developed was originated first by a device

called the dermaroller.

But the central concept of microneedling is something called collagen induction therapy.

And what does that mean?

Well whether you’re using a microneedling device, a chemical peel, a laser, what you

are doing is you’re inducing a controlled injury.

That controlled injury is intended to stimulate a collagen repair response as well as a remodeling

response to help improve the area of concern.

Also understand that microneedling can be done at different depths.

And I certainly understand that a lot of times people will be frustrated with the treatment.

And this doesn't just apply to microneedling.

This also applies to laser as well as radiofrequency heating devices.

And it is almost like a knee jerk reflex for the practitioner.

If they get feedback that a patient is not satisfied with a particular outcome, what

is natural to do?

Increase the energy, increase the depth, basically increase the aggressiveness.

And again, that can result in a lot of challenges because now you crossed the line.

I find that when I evaluate my patients, I often, first after describing the issues based

on a more global evaluation, for example if someone has acne scarring and they have like

rolling scars or atrophic or loss of volume in the tissue, a lot of times, just doing

an injectable filler at a deeper level can actually improve the contour of the skin such

that the acne scars don’t look as deep.

We can combine treatments so that you don't have to be as aggressive with one treatment.

This has been something that I figured out years ago.

So when people needed laser treatment or resurfacing or fractional resurfacing, I often combine

fractional resurfacing by doing it more conservatively and then using platelet-rich plasma.

Platelet-rich plasma is derived from your own blood also induces collagen and stimulates

remodeling.

And therefore you can balance the level of aggressiveness.

In some ways you can use the analogy of overtraining in the gym.

You can lift up to a point and stimulate muscle growth or you can result in overdoing it,

over training or injury.

So the same thing applies to the skin.

And in particular, acne scars are very challenging regardless of the modalities.

But I think it is important to understand your options more globally before committing

to any specific one treatment.

I really feel that when it comes to skin rejuvenation or skin treatments, we have so many more tools

that it’s kind of like combining the right modalities to get the maximum result with

getting the minimal type of risk.

So for example for acne scars, we can do a combination of injectable fillers deep.

We can place injectable fillers at the dermal level.

We can use laser, we can use PRP and we can get a lot of the improvements that we want

to improve and of course, we can also use microneedling.

So I think it’s very important for you to choose a practitioner who has a lot of experience,

who’s going to be very clear about explaining all of these variables and understanding what

kind of outcomes you can achieve.

And also, understand that a lot of the principles of skin treatment like exercise induced muscle

growth is about treating and then waiting to see how the treatment affects the skin.

A lot of times people become subject to protocols which are not looking at the individual’s

response but rather going on a particular automated standardized process.

And when it comes to something like acne scars, one size doesn't fit all.

Now there are certain protocols that have to do with a non-ablative laser which are

little bit more consistent but I would say that it is important to really understand

what kind of outcome and is really microneedling optimal for you.

Are there other options that may be better for you?

And maybe microneedling is something that is used at a different frame of time.

And remember that when it comes to skin care and skin rejuvenation especially when it comes

to acne scars, multiple modalities often work better than just a single approach alone.

It always has to do with customization and not just about a single device.

So I hope that was helpful, I wish you the best of luck and thank you for your question.