Microneedling Promises Better Skin – But You Can’t Ignore The Risks

The thought of applying hundreds of fine needles to the face might trigger a knee-jerk "eesh" but this is what to expect with microneedling.

A quick Google search for the procedure (a favourite among celebrities and influencers and offered at over 750 locations in the UK, according to Treatwell) yields some very red, bruised faces. But while the equipment has evolved, the reason behind microneedling's popularity remains the same: it improves uneven skin texture through creating minuscule tears in the skin. As the skin heals, collagen is stimulated, which results in a smoother, more even complexion. It is an especially common practice among those with light scarring, including acne scars.

It sounds aggressive but in the eyes of professionals it’s considered minimally invasive, generally a safe procedure and has good results when carried out every two to four weeks in a series of around five treatments. I decided to give it a go and booked into a reputable clinic, which charges upwards of £350 for microneedling and claims it sees many regular microneedling clients a week.

Downtime is to be expected, given the requirement for a topical anaesthetic. First came the twinges of pain, then the spats of blood. However I was willing to trade a few side effects for the promise of faded scars and much brighter skin. Following the pre-treatment plan of steering clear of exfoliants for a week in advance and ensuring I didn’t pop an ibuprofen in the 24 hours before the procedure was easy. My boyfriend was warned and I blocked out a couple of days to lay low at home.

What happened next wasn’t part of the plan: despite following the aftercare instructions to a tee, I had a 'rare' reaction. It was the mother of itchy rashes and looked even angrier with my sensitive skin burning red raw underneath. The constant irritation stole my sleep and my sanity. I was prescribed antihistamine by my doctor and made multiple trips to poker-faced yet panic-stricken beauty professionals for LED light therapy and words of condolence. The aestheticians had never seen such a reaction firsthand.

What had happened in my case was unknown to the aestheticians, who did not have a dermatologist on site. Online forums however confirm a reaction of this kind isn’t an isolated incident. Unlike treatments such as laser hair removal or chemical peels, clinics do not offer patch tests prior to microneedling. Believe it or not, this isn't a sign of lax procedure; it's the norm. "The replacement heads [on microneedling tools] cost a fair amount of money," Dr Susan Mayou, consultant dermatologist at the Cadogan Clinic tells me, which might explain why experts are reluctant to offer a patch test. The clinic I visited confirmed that booting up the machine isn’t feasible; in theory it would cost upwards of £100 just for a test and cutting corners by reusing equipment isn’t an option as preventing cross-contamination is crucial. "This is all the more relevant now," adds consultant dermatologist Dr Alexis Granite, also of Cadogan Clinic, referring to the global pandemic and new safety regulations.

Reactions are one thing but there is a handful of other risks associated with microneedling. Bacterial infection (often characterised by persistent redness, pain or swelling) can occur if the skin or the machine is not cleansed properly, says Dr Mayou. Don't be afraid to ask your aesthetician how they sterilise their equipment and be sure to arrive for your appointment makeup-free. If you suspect an infection, visit your GP or a qualified consultant dermatologist as soon as possible, as you might require prescribed antibiotics.

Allergic reactions to products used during the treatment could also hinder the process. "While you could have an allergic reaction to the numbing cream, you would know before the treatment as it’s generally a quick reaction," explains Dr Mayou, "though itchiness implies an allergy rather than infection." Dr Granite says it is more likely that the serums used in conjunction with the needles could cause a reaction. If you are sensitive to skincare, you must tell your aesthetician beforehand.

What of the further risks, like bruising, scarring and pigmentation? "These issues shouldn’t arise if the proper procedure is carried out," explains Dr Mayou. She continues: "It is a treatment for scarring so it shouldn't cause scars. However, darker skins are more likely to get post-inflammatory hyperpigmentation." Post-inflammatory hyperpigmentation (PIH) refers to the dark marks or skin staining that can occur after treatment. Consultant dermatologist Dr Anjali Mahto writes on Instagram: "While hyperpigmentation can affect pretty much anyone, it is seen more often in those with darker skin types. This happens when pigment producing cells are stimulated to produce melanin (pigment) due to inflammation. This then results in discolouration or staining of the skin." Applying sunscreen daily and avoiding the sun may help PIH, and experts also recommend retinoids, vitamin C, hydroquinone and azelaic acid as topical treatments which can work over time.

Bruising is also a possibility after microneedling but Dr Mayou mentions that this is more likely to happen if you are prone to bleeding and bruising, or are on any blood thinners. While alarming, bruising usually clears within four or five days, but don't hesitate to contact your aesthetician should you have any concerns.

Surely, then, a thorough consultation is the most important aspect in assessing whether you are suitable for microneedling. So should this be with a dermatologist? Apparently not. "I definitely think you can just see an aesthetician, but it’s something someone needs to be trained in properly," says Dr Granite. Check your aesthetician's credentials on the Save Face website, read reviews, ask for pictures and come prepared with a list of questions. And don't take to your own face with a device at home. "I think this can do more harm than good, particularly for people who have sensitive skin or people who are prone to broken capillaries," says Dr Granite.

The guidance on whether your skin might reject microneedling comes with a pretty standard caveat. "Anyone can react to any treatment or product, so there will always be a rare case where someone reacts out of the expected norm," says skin expert Debbie Thomas of D. Thomas Clinic. "The only skin I would completely avoid would be inflamed or irritated skin, for example, those with red, sensitive skin or pustular acne." Meanwhile Dr Mayou, who recommends the treatment for acne scarring and large pores, emphasises that anyone who is on acne medication Roaccutane or using a topical retinoid prescription (e.g. Differin or tretinoin) should give the treatment a wide berth. "This makes the skin more fragile," she explains. "The more sensitive someone’s skin is, the less you want to be traumatising it."

In the months since my treatment, I’ve returned to the clinic in question and noted an additional consent form. It's not a bad idea to remind clients that microneedling comes with its own risks and that things can go wrong. It seems I pulled the short straw. "Maybe it was just a bit of bad luck," agrees Dr Granite. Ultimately, introducing a patch test could reduce reactions. As with all skin treatments, there is a gamble, and it pays to come armed with as much knowledge as possible.