Breakouts After Micro-Needling: A Q&A With Experts

One of our readers, VJ, has experienced some issues with acne being worsened by micro-needling. Here's what he had to say:

I went through three sessions of professional micro-needling. I'd heard a ton of good things about it. But each time my acne gets worse for a little while after. My esthetician said it would be helpful for the less severe acne, and she avoids the really bad spots on my face (I've struggled with severe acne my whole life). She does go over the big, clogged pores (I've also always had huge pores) and the small bumps and blackheads. Basically, she won't touch a spot that looks inflamed or looks like it wants to burst, but she goes over other stuff since she says it can help with shrinking pores, acne scars, and small bumps/blackheads.

I paid for six sessions total in advance. I'm really nervous that my next appointment is coming so soon since I assume my acne will get worse again, and of course, the esthetician doesn't allow refunds. I think it is making the acne scars better, which is good, and I think it's also helping with the big pores, but the first week after the micro-needling just makes me so anxious because I know my face will look like trash with extra acne.

Is micro-needling actually helpful for smaller spots of acne, or is she doing something wrong? And is micro-needling actually helpful/safe for large pores? I kind of wonder if I just think they're getting better because I want to feel like I'm getting something out of this treatment. I can't tell if the results I think I see are just in my head or not.

Thanks for writing, VJ! We're sorry to hear that you're having such a confusing time with this treatment. To answer your questions, we reached out to two experts - UK board-certified dermatologist Dr. Ahmad Chaudhry and Toronto-based micro needling provider Dr. Yelena Deshko, ND. We've asked them your questions, and included their general advice, as well as some quotes from our conversation, below. We hope you find it helpful!

Is micro-needling recommended for acne? Why/why not?

Answer: No, micro-needling is not generally recommended as a first-line acne treatment. Though micro-needling can be helpful for acne scarring, there is limited evidence for micro-needling's ability to treat active acne.

Dr. Deshko: Microneedling has been extensively studied for the treatment of acne scarring. A few studies have also examined micro-needling for the treatment of active acne and have found the treatment to be effective.

In my practice, I prefer using other treatment modalities to resolve current active acne. I recommend LED blue light therapy, BHA Salicylic acid peels, and IPL laser combined with an at-home skin care program. After the majority of active acne lesions have resolved, remaining atrophic acne scarring can be treated with micro-needling.

Dr. Chaudhry: When performed by an experienced professional, micro-needling can minimize the appearance of acne scars and correct irregularities caused by inflammation. In addition to reducing the appearance of superficial scarring, micro-needling can stimulate collagen production and improve skin tone and texture in the long term. However, micro-needling should not be used as a substitute for other acne treatments that may include topical medications or antibiotics.

Is it safe to microneedle when you have acne?

Answer: While there is some evidence that micro-needling can be helpful for acne, it also may temporarily exacerbate your breakout. The risks likely outweigh the benefit.

Dr. Deshko: There is conflicting information with regard to micro-needling with active acne. While some studies show a benefit, many patients report that it temporarily worsens their acne breakouts. For this reason, my preferred approach is to treat active acne by other means and follow with micro-needling to resolve any remaining acne scarring.

Dr. Chaudhry: Topical acne medications and certain facial treatments are known to be beneficial in keeping acne under control. Anyone with active breakouts or existing scars should consult a doctor or dermatologist before undergoing micro-needling. Professional guidance is necessary to ensure a safe and successful procedure that may reduce the risk of further flare or damage.

Can micro-needling worsen or lead to a breakout?

Answer: Yes. Micro-needling can sometimes prompt a new breakout or worsen a pre-existing breakout.

Dr. Deshko: Some people, myself included, may experience a worsening of acne or an acne breakout following a micro-needling session. Theoretically, this occurs when the micro-needling device carries acne-causing bacteria from one area of the skin to other areas, essentially spreading it. My preferred way of managing a post-micro-needling breakout, if this occurs, is with LED Blue light phototherapy treatments which work to kill the bacteria without irritating post-treatment skin.

Dr. Chaudhry: Micro-needling may lead to minor breakouts or aggravate preexisting breakouts. If misused or improperly performed, micro-needling can create wounds in the skin and increase inflammation, leading to further irritation and ruptures in the skin's surface.

Is micro-needling helpful for reducing the size of pores? Why/why not?

Answer: Yes, micro-needling can help reduce the size of pores, though you likely will not see an enormous amount of improvement.

Dr. Deshko: Yes, micro-needling, especially radiofrequency micro-needling, has been shown to be helpful in reducing enlarged pore size. That being said, the improvement after one session shown in this study was between 8.9% and 13.8%.

Dr. Chaudhry: Micro-needling can be an effective method for reducing the size of pores. When done properly, micro-needling can help reduce pore size by releasing collagen into surrounding areas of the face, providing plumpness and thus making pores less visible. The results may vary depending on individual skin type and other variables.

Are there any risks of micro-needling large pores?

Answer: Yes, micro-needling large pores may cause side effects. Most of these side effects are mild.

Dr. Deshko: Micro-needling for large pores carries the same risks as micro-needling for any other skin concern. Risks include redness, swelling, bruising, flaking, and, in rare instances, infection.

Dr. Chaudhry: Although adverse effects are not common, micro-needling could cause bruising and redness of the skin. Scarring is also possible yet rare. You may experience certain complications if the needles aren't sterile and your skin is not thoroughly cleaned before the procedure.