Primum Non Nocere. First, do no Harm.
It is the first rule of medicine; should we not extend this to skincare, too?
If you’re not immersed in the sometimes-bizarre world of beauty trends.
The practice of microneedling – may sound strange.
The treatment comes under many guises; dermarolling, derma stamping with PRF or PRP, and Morpheus 8, which has an exhaustive list of claims of how it can improve your skin.
If that is the case, why are the conditions listed below side effects that many of our readers are experiencing?
- scars
- pocking
- infections
- tram marks
- accelerated ageing
- erythematous papules
- skin pigment changes
- permanent indentations
- systemic hypersensitivity
- granulomatous dermatitis
- possible tumour formation
- post-inflammatory hyperpigmentation
Please rest assured that scaremongering isn’t our philosophy.
But we can’t ignore the daily emails or 378 messages in the comments below.
Or the case studies from our client, which you can read here.
Many of our readers have been physically and psychologically scarred due to a poorly performed treatment.
So we put together this article to help raise awareness of the risks associated with microneedling facial treatments.
We’ll examine case studies and look at the complications that may arise.
If you are considering having treatment, you may want to read the article dermarolling to ensure the best outcome.
Let’s get started!
What is Microneedling?
It is a medical microneedling treatment involving fine, sterile needles that vibrate at high power thousands of times over a few seconds. The needles pierce microscopic ‘holes’ into the superficial layer of your skin.
These small and controlled piercings create channels or micro-wounds that lead to the release of growth factors, which are thought to instigate a healing response in your skin; we beg to differ!
Your body’s response is to encourage the formation of new collagen, elastin, and neovascularisation – the natural appearance of new blood vessels in the dermis.
In technical terms, it takes advantage of your skin’s response to any inflammatory wound.
For example, if you cut your skin, your body’s first line of defence is to deploy white blood cells; these release chemicals that increase the production of components that comprises your skin’s intercellular matrix.
They tell your body to patch the hole, creating new cells at the site of the wound.
A classical wound may be defined as a disruption of tissue integrity; any wounds, whether caused by injury or remodelling, rely on the biological phases of healing: inflammation, proliferation, and remodelling.
The Misconceptions
They Say: Microneedling is a collagen-stimulating treatment that uses needles to injure your skin; this stimulates collagen and elastin production, improving skin texture, pores, and fine lines. (1)
Naked Chemist Truth: Microneedling tears through the epidermis – your outer layer of skin and creates tiny puncture marks that play havoc with your skin’s natural defence mechanisms, which must work harder to repair the tiny micro-tears through collagen induction, which causes a whole host of skin conditions.
It does not tighten your skin; it swells it: We believe the concept that “needling promotes skin collagen” is wrong. When you break down your skin’s protective barrier function with needles, you are causing trauma and temporarily injuring your skin. That tightening effect you are experiencing is plump, swollen skin.
It does not create a glowing complexion: The ‘lit-from-within’ glow is, infact, inflammation, which we believe is the source of premature ageing; it is a big NO in our book.
This is a Painful Procedure
Even a 0.2mm puncture can cause inflammatory responses that lead to problems at any depth. Not only that, but you are effectively injecting active serums at a depth where serums are not meant to go!
Bottom line: If your skin is impaired, red, dry, inflamed, or you have acne inflammation, it requires a super-healthy skin response, and if it is stressed at all, you are almost certainly at risk of damage. (2)
Testimonials
Clemmy from London wrote: “Help, my skin looks worse after microneedling. The treatment felt like it shredded my skin beneath the surface, my once-perfect skin is ruined, and I feel like I could cry; it has lost all firmness and support. I know it has been structurally damaged, and I looked grazed all over. I don;t want to leave the house and after 6 months, it is still not healing. I had no idea about the risks of microneedling.”
Nancy from Australia wrote: “The day after having morpheus8, my face became swollen, and there were scratch-like marks, I was shaking during the procedure! I should have known something was wrong then, and I had bruising. I was told to do a course of peels to eliminate the lines, which sent my skin into inflammation mode. Today my skin has tiny holes and lines in it. With your team’s help and your incredible products, it has been slowly repairing, but it has been a lot.”
Angela, a client, experienced the following: “I am 43, and the dmicro needling treatment has left my face inflamed; as a result, I am battling severe facial burning. My once smooth skin is sensitive, and my pores are enlarged. I have been to a few dermatologists who have no idea what to do. Your advice is helping to rebuild my skin. I can’t thank you enough. I wish I had known about these microneedling side effects earlier.”
Marian from the USA wrote: “Micro rolling has destroyed my skin. It has left bumps and holes in my face and requires total resurfacing, which I am scared to do. It has dried out my skin and created strange horizontal lines I did not previously have; in short, microneedling at home is UNSAFE. Do not attempt it.”
Jen from Australia wrote: “After having 25 pages of blood tests, my dermatologist was very thorough, it been found that my condition is due to having a course of microneedling with PRP, treatments. I am devastated; my dermatologist believes I have solid facial oedema, which is very rare. I am now on Roaccutane & may need to be on it for 1-2 years; although my skin is responding, this will be a long battle to get rid of it. I’m completely shattered. I would NEVER recommend micro-needling to anyone. I warn all my friends about the micro needling risks so they never suffer like I am. Your Bio lipid has been a lifesaver I refer to it as liquid gold.”
Those of you who openly shared your microneedling before and after journey, thank you, and we hope we can help rebuild the health of your skin together.
If you are unfortunate enough to have suffered a severe reaction, below we look at what can go wrong.
Whilst we appreciate not everyone has poor results, chances are, if you are reading this article, you have had a poor outcome. This study (3) looked at people who suffered facial allergic granulomatous reactions and hypersensitivity associated with microneedling treatment.
Side effects of the treatment
My skin is inflamed. I now have developed rosacea.
Chronic inflammation is highly damaging. By its very design, microneedling creates a measured degree of inflammation, depending on the depth of the needles, which is a normal, physiological response to the trauma.
Most mild allergic or inflammatory responses will go away after a week; if it persists, it could be because your immune system is trying to block a substance that it perceives as a foreign body that it can’t eliminate. This could be due to chemicals, organic and inorganic materials or bacterial infection.
The appearance of redness and swelling may not be visible to the naked eye at first, which can be misleading; however, inflammation, if your skin is painful to touch, it could be taking its toll on the structural cells and matrix proteins within the dermis, the deeper layers of your skin.
It may also signify something more insidious and pathological – such as rosacea or granulomatous dermatoses, which become apparent as the underlying infection or localised lesions inflame and distort tissues; this can take weeks or even months to develop.
Because it resembles skin changes associated with accelerated skin ageing, it’s referred to in the industry as “skin flamm’ageing”.
Furthermore, any plumping sensation that may occur is an illusion; this is merely your body creating inflammation, causing the area to swell. When inflammation occurs, cells break down collagen, further accelerating the ageing process.
My skin looks prematurely aged, and wrinkles and lines are appearing
When needles penetrate the dermis – the deeper layer of your skin, this creates an inflammatory response that boosts fibronectin production.
This glycoprotein creates a type of ‘scaffolding’ onto which the newly inducted collagen is deposited; over time, this collagen undergoes a conversion process where it naturally tightens up, which reduces wrinkles and helps resurface scars that may be present on your skin.
When you puncture your skin with needles, you rip at the collagen fibres, causing mechanical damage and desensitising the receptors responsible for signalling collagen synthesis; this is evident when clients say the first treatment was successful, but the subsequent treatments had the opposite effect.
The constant destruction of collagen through needling forces your body to produce new collagen fibres to replace it; over time, this natural ability becomes depleted, thus accelerating the ageing process.
It is important to note that when you are microneedling, it creates a stress response. When your body is exposed to this stressor – it quickly tries to replace the collagen that has been lost.
Whilst this may give the appearance of plump skin, the reality is that any underlying damage done to the internal scaffolding can show immediately or take years to manifest. But the damage is done – lines and wrinkles, hollow areas and sagging skin – all become increasingly apparent,
Cell death and telomere destruction
It’s worth noting that when you puncture your cells with needles, you damage the integrity of a healthy cell, causing cell death and, thus, accelerating the ageing process.
Cellular turnover occurs when skin cells are replaced by another live skin cell via cellular division. When this happens, the end of the chromosome within the cell’s nucleus is cut off; this is referred to as a telomere; once 60 divisions have taken place, the telomere completely cuts off, and ageing starts.
Micro needling accelerates the rate at which cell division occurs in your skin; the faster it happens, the more your skin ages, leading to sagging and expression lines.
My skin Becomes Inflamed When I Apply Products
Microneedling dramatically disrupts your skin’s impermeable barrier function, consisting of multiple layers of ‘dead’, keratinised cells to protect your deeper, living cells.
The needles pierce through these layers, creating thousands of channels that enable topically-applied substances to penetrate.
The flip side is that until these channels form effective plugs and initiate the healing process, your skin is left open and vulnerable to anything it may come into contact with
Many risks associated with this treatment are often unrelated to the actual needling procedure. They can be due to the topical solutions applied to the skin during maximal barrier function disruption.
Substances that are part of one’s normal physiology and found naturally within your skin are safe; substances that are not should be avoided. This is why we only recommend “skin-identical hyaluronic acid” when you are in the healing stage.
We created an entire article on needling ingredients into your skin that is a valuable read.
My skin was dry but is now oily and has an orange peel texture.
When you microneedle your skin, you create hundreds to thousands of puncture holes in your skin and although not visible to the naked eye, these holes are large enough to create pathways to the bloodstream.
Your skin sees this as trauma, and your sebaceous glands go into overdrive, causing your skin to become excessively oily.
Bacteria can get trapped in your pores, causing breakouts, and your skin takes on an uneven orange peel texture, almost like cellulite. These textural changes are usually due to low-grade inflammation caused by the needling.
Other issues include raised milia-like bumps, blackheads and extended pores.
I have horizontal track marks on my skin
We are often asked if this is a normal side effect; here’s the long answer:
If your aesthetician was gentle and thorough and knew how to hold, position, and vary the penetration depth to prevent damage. Then these marks are just reflective of the pattern they were using to get uniform coverage in different areas of your skin and should fade within a few days.
Complications can arise due to “operator error” of the hand-held device, where too much pressure was applied over the bony areas. This can lead to bruising and tram-track scarring.
Interestingly one research carried out by Yadav and Dogra also attributes this finding to nickel-contact dermatitis (4).
The possibility of cross-contamination is genuine during this treatment, and if a microneedle or derma roller is used, the handpiece has the potential for backflow; that’s why hygienic practices are essential to minimise the risk of contamination.
I have dark patches and uneven skin tone
Anyone with a darker skin type, type 3 or higher, can be at significant risk and should avoid this treatment because there is a risk of hyperpigmentation.
Those with a darker skin type also have a propensity for hyperpigmentation in response to inflammation.
Trauma to your skin can cause melanin – the pigment in your skin that causes colour changes – to rush to the injury site.
Inexperienced practitioners won’t know to assess their client’s skin on the Fitzpatrick scale, which can result in pigmentation changes.
Can needling trigger tumour formation?
The old school of thought was that old skin wounds were benign. New research has found that skin wounds can cause basal cell carcinoma (5).
Basal cell carcinoma is the most common type of skin cancer, and its origins start in the basal cell layer, the lower part of the epidermis, and the cells of hair follicles. The formation of tumours occurs when errors in the follicular cells’ DNA cause unregulated cellular division, leading to tumorous growth.
It is understood that a wide range of wound-type injuries, even minor wounds like paper cuts, can activate cancer-provoking genes in your skin as it heals.
Reiter & Wong hypothesised that skin wounds might promote basal cell carcinoma (6). Their research demonstrates how stem cells in hair follicles can transform into cancerous cells while healing an injury.
Reiter and wong state that scientists believe cancers are wounds gone awry. Usually, the hair follicle represses the tumour-generating potential of the stem cells, he says, but when these cells become unstable, trouble begins.
The findings are important; Reiter & Wong found that the development of basal cell carcinomas is not exclusive to large wounds: even minor incisions could induce carcinomas – such as those created by micro-needling.
Micro-needling causes tiny wounds in your skin, which mobilises cells from the hair follicles to heal injuries; by mobilising these cells into the epidermis, your outer layer of skin can produce tumours.
How do I care for my damaged skin?
We get asked a lot: will my skin ever return to normal?
Fortunately, there is hope; you can heal your skin damaged by microneedling, but how long it takes will depend on the damage and how your unique skin responds, but there is hope.
Some heal in 6 to 12 weeks, in line with cellular turnover. For others, it can take longer, but it is achievable with the correct treatment protocol and effective ingredients.
Keeping it pure and simple is our mantra when treating your skin after a damaging micro-needling session; implement a consistent skincare regime with gentle topicals that are barrier repairing.
You want to keep inflammation out of your skin, so avoid using actives like Vitamin C and Vitamin A until your barrier function repairs and your skin begins to heal.
Granulomatous reactions in response to the unauthorised use of topical products that are not approved for intradermal injection have been reported in three patients undergoing microneedling treatment (7).
To Conclude. The naked truth
It’s true for some people, micro-needling is successful.
However, we can’t ignore the number of people experiencing complications, including premature ageing, sagging skin, and changes in skin texture and conditions; for instance, someone with once dry skin may now be experiencing oily skin, enlarged pores, and even breakouts,
You may also experience more severe side effects such as horizontal tract marks, permanent scarring and indentations or hyper and hypo-pigmentary changes in your skin.
Infections, such as granulomatous infections, don’t always look like you think they can appear more subtle at first; your skin might stay irritated and like it’s not healing; this is because your body’s immune system is holding the offending bacteria, a pathogen, in partial check but isn’t strong enough to eliminate it – so inflammation maybe bubble away under the skin’s surface.
The bottom line. Be careful with treating your skin; get a second or third opinion, and do your research well.
You are responsible for caring for the primary organ that protects you every second of your life.
