All About Microneedling: The Good, the Bad, and the FAQs

up close shot of microneedling device for skin rejuvenation

Written by Founder, Amir Karam MD

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Today, we're getting into microneedling treatments.

This is a popular topic many of you have asked about so I wanted to create a comprehensive guide that explores the different microneedling techniques: standard microneedling, microneedling with Platelet-Rich Plasma (PRP), and Radiofrequency (RF) microneedling. 

We’re going to cover the basics, the benefits, and potential pitfalls of each, and I’ll answer the top 10 most common microneedling questions I get all the time. 

Understanding the differences between microneedling treatments is important. Not only so you can make informed decisions about the best treatment option for your skin, but also to avoid potential skin or tissue damage, and help you manage your costs and expectations effectively. 

Microneedling 101: What is Microneedling?

Microneedling involves using tiny needles to repeatedly puncture the skin, creating controlled micro-injuries. This activates the body’s wound-healing process: inflammation, sending blood to the site of injury along with healing agents like growth factors, which stimulate the production of new collagen and elastin fibers to repair the damaged skin.

Collagen is essential for youthful-looking skin, and it begins to decline as we get older due to numerous factors, like hormonal changes and environmental circumstances such as sun exposure.

However, in the days following a microneedling treatment, your body kicks up collagen production to help repair the skin. 

Microneedling essentially tricks the body into thinking there is a wound that needs to be healed to re-accelerate collagen production.

That is pretty much the cycle you want to continue to initiate in aging skin; the cells that are creating collagen slow down, so you do something to pick the production back up, in this case, micro-injuries. 

As it heals, the skin then rebuilds with newly formed collagen, which helps to reinforce the skin's support structure, improving its overall firmness and elasticity. This reduces the appearance of fine lines, wrinkles, scarring, and pores, and other imperfections gradually diminish as the skin continues to remodel itself.

Regular microneedling treatments can continue to build up collagen over time, leading to firmer, more youthful skin, and improved skin texture, tone, and overall appearance. 

What are the Different Types of Microneedling Treatments?

Microneedling is an effective anti-aging treatment because it triggers repair and rejuvenation of the skin. But, there are several types of microneedling treatments, each offering unique benefits and varying in complexity and cost, so let’s go through them:

Standard Microneedling

Standard microneedling is the most basic form of this treatment. It uses fine needles to create micro-injuries on the skin's surface. The depth of the needles can be adjusted according to the specific skin concerns being addressed.


The primary benefit of standard microneedling is its ability to stimulate natural collagen production to improve skin texture, reduce fine lines and wrinkles, and enhance overall skin appearance. 

It is relatively inexpensive compared to other treatments, making it more accessible for people seeking to improve their skin's condition without a significant financial investment. 

It is considered safe, minimally invasive, and has little downtime. 


Rebuilding collagen is a gradual, never-ending process. Be realistic with your results. 

Don’t expect miracles after one treatment, however, sticking with a regular microneedling schedule and supporting results with skincare will give you visible, lasting results.

Microneedling with PRP (Platelet-Rich Plasma)

PRP microneedling enhances the traditional microneedling procedure by utilizing the nutrients and regenerative properties of blood.

The process begins with drawing your blood which is then spun in a centrifuge to isolate the platelet-rich plasma (PRP). This plasma is rich in growth factors that are known for wound healing, tissue repair and regeneration, and proliferation of fibroblasts, the dermal cells that make collagen. 

Enhancing microneedling with PRP leverages the body's natural healing processes, using the proteins and molecules in the blood to increase collagen production, improving skin texture, and reducing the appearance of scars, wrinkles, and other imperfections, resulting in a smoother, more youthful appearance.


PRP can provide more robust results than standard microneedling, while still offering a safe and effective approach to skin rejuvenation for those with all skin types. 

The PRP's anti-inflammatory properties help to reduce redness and swelling post-treatment, meaning a quicker and more comfortable recovery than standard microneedling.


PRP is more costly due to the additional steps involved in extracting the patient’s blood. 

You might also look like a character from a horror movie directly after the treatment. 

Microneedling with Radiofrequency:

Microneedling with radiofrequency (RF) adds a more advanced level of technology to traditional microneedling. In this procedure, the needles also release heat via radiofrequency (RF) to create deeper, thermal injuries in the skin. 

RF microneedling enhances collagen production with an additional skin-tightening effect on the tissues beneath the skin due to the heat.

This makes it a particularly effective option for those experiencing more pronounced signs of aging, such as crepey skin, deeper wrinkles, enlarged pores, acne scarring, skin laxity, and lack of firmness.

To treat these advanced signs of skin aging, the goal is to deliver the RF energy within the dermis, about 1-2 millimeters in thickness. 

The problem is, that many users try to reach the deeper layers of fascia in an attempt to tighten it and bring things back into place.

But, to get to the fascia, you need to go all the way through the dermis and get underneath the layer of subcutaneous fat, which is a fancy term for fat underneath the skin. This method can be highly problematic. 

This subcutaneous fat functions like padding underneath our skin. It holds the skin in place and creates a nice, supple, youthful look. If this fat layer melts and shrinks due to improper RF application, it can deflate your full features, thus increasing skin laxity, and making you look older, which is the opposite of what you’re going for. No one wants to get a treatment and come out looking older. 

There is a sweet spot for delivering that RF energy to avoid potential complications. Stay away from the fascia (and the nerves) deep in your face.

Radiofrequency microneedling should penetrate your skin no more than 0.5mm to 1mm. If it is done at this depth, like we do in my office, you will have no problems. 


RF microneedling is beneficial for those with advanced skin issues due to additional tissue tightening effects. 


It's essential to have realistic expectations and understand that this tightening will not give you the lift you’d see from surgery.

You are not going to change your life and the way you look in one treatment. If you decide to go down this road, you're going to be doing these radiofrequency treatments on a relatively regular basis, so it’s worth noting that this method comes with a higher price tag. 

It also runs a greater risk than the other two methods. Proper technique and expertise are crucial to avoid potential complications such as excessive heat causing damage to deeper layers of tissue or skin, loss of subcutaneous fat, and even potential nerve damage.

Answering Your Top 10 Microneedling FAQs


What are the Key Benefits of Microneedling?

  • Collagen Production: Initiates the body’s healing process to stimulate more collagen production, enhancing firmness and reducing wrinkles.
  • Improved Texture: Promotes smoother skin by reducing the appearance of fine lines and surface irregularities.
  • Scar Reduction: Helps break down scar tissue and encourages new skin growth, diminishing the visibility of scars.
  • Pore Size Reduction: Minimizes enlarged pores by encouraging the regeneration of healthier skin around the pores.
  • Hyperpigmentation: Reduces dark spots by promoting the turnover of skin cells and dispersing melanin.
  • Enhanced Absorption: Increases the skin’s ability to absorb topical products, making treatments more effective.
  • Overall Radiance: Improves blood circulation, giving the skin a more youthful and radiant appearance.


How Often Should You Do Microneedling?

Once you start with these procedures, you want to continue on a regular basis–because what good does it do to get a spike of collagen production and not do it again? You will develop all the collagen from that initial event, and then, guess what? It's going to start to diminish again.

To maintain continuous collagen production, it's recommended to undergo standard microneedling treatments every six to twelve weeks. Regular sessions will prevent the skin from reverting to its pre-treatment state. 

RF microneedling doesn't need to be done as frequently as standard microneedling. Typically, sessions are spaced 12 weeks apart to twice a year for maintenance. 

Your provider may recommend a series of initial treatments followed by less frequent maintenance sessions.


Are At-Home Microneedling Devices Effective?

You’ve probably seen some at-home microneedling devices, like dermarollers, which you can use to roll over the skin manually, creating small punctures similar to microneedling. 

I don’t recommend these rollers for a couple of reasons. Not only do you run the risk of bacteria and infection due to sanitary issues, but at-home microneedling devices are not going to give you the same collagen response as a professional treatment. 

Dermarollers only affect the skin superficially, penetrating just the outer layer (the stratum corneum or epidermis) around 0.25mm deep. While this may help your products absorb at best, these rollers are unlikely to provide the deep remodeling needed to make a visible, long-lasting difference in your skin.

Professional microneedling devices can reach deeper layers of the skin around 2-3mm and they are able to adjust the device's needle depth based on the specific area and condition of your skin, using shorter needles around sensitive areas like the eyes, nose, and forehead, and longer needles for treating scars.

For the best results, go into a dermatology practice, plastic surgeon’s office, medical spa, or visit an esthetician to get microneedling done. 


Is Microneedling Safe for All Skin Types?

Microneedling is generally safe when performed by trained professionals. Common side effects include redness, swelling, and minor skin irritation, but typically go away within a few days.

If you have acne or inflammatory skin conditions like rosacea, microneedling can make flare-ups worse, so consult with your dermatologist for treatment options.

To avoid rare risks like infection, ensure you visit reputable clinics that use sterile equipment and prioritize safety and hygiene. Disposable needle tips should be used to prevent infections and ensure the procedure's effectiveness.

Other uncommon risks include hyperpigmentation or scarring if not performed correctly. If you have melasma or hyperpigmentation, stick to standard microneedling or PRP. For pigmentation issues, you do not want to deliver the heat of RF to the skin. This can run the risk of triggering post-inflammatory hyperpigmentation or a melasma flare-up.

When choosing a microneedling treatment, it’s essential to consider your skin’s specific needs and the expertise of the practitioner performing the procedure. 


Does Microneedling Hurt?

A topical anesthetic is usually applied before the procedure to minimize discomfort.

Patients may feel some pressure and a slight prickling sensation and possible sensitivity for a few days post-treatment, similar to a mild sunburn.

Support your skin with nourishing, hydrating products like Enrich, drink plenty of water, and guard skin against UV with sun protection.


Can RF Microneedling Tighten Loose Skin?

This is really important: do not fall for the notion that you're able to use radiofrequency microneedling to restore a fallen face. Structural changes like jowls, hooded eyes, fallen cheeks, and neck laxity go beyond skin rejuvenation and would require surgery if you want to truly tighten them.

Significant changes in face shape are not meant to be treated with a radiofrequency device. If you try to do something like that, the technician is going to need to dial up the device and attack the fascia, which means going as deep as 4 to 6mm. The problem is, along the path, you're also delivering all that energy and heat into the fat, which is going to cause the fat to melt.

RF devices will not reverse advanced stages of sagging and laxity and have no place in the toolbox for facial rejuvenation. 

However, it can still be particularly beneficial for skin rejuvenation, boosting collagen, and tightening dermal tissues when performed at 1mm or less.


What is Morpheus8?

Morpheus8 is one of the many RF microneedling devices that can be adjusted to penetrate deeper layers of the skin. It is particularly popular for its ability to combine microneedling with radiofrequency energy, theoretically providing enhanced collagen production and skin tightening. However, patient feedback on Morpheus8 and similar deep RF microneedling devices has been mixed.

As a surgeon, I have encountered numerous patients who regret undergoing deep RF microneedling treatments due to unwanted side effects like fat loss and worsened skin laxity. 

My goal is to inform you of these risks to help you make well-informed decisions about your skincare treatments. I have made a couple of YouTube videos about Morpheus8 to help you understand its nuances and spread this information to ensure optimal outcomes and avoid unnecessary complications.


How Long Do Microneedling Results Last?

With proper skincare, the effects of microneedling can last for several months and will continue to get better with time.

Maintenance sessions are necessary to sustain results and keep collagen levels building. 


How Should I Incorporate Microneedling into My Routine? 

In the hierarchy of anti-aging skincare, we have the foundational elements: 

Sun protection
+ Daily use of Retinol
+ Vitamin C
+ Niacinamide
+ Hyaluronic acid
+ Peptides
+ Pigmentation lighteners, like Azelaic acid

Once these basics are in place, integrating microneedling into your routine can significantly enhance your results by accelerating collagen production, improving skin texture, and minimizing the signs of aging, on top of what your skincare can achieve.

This combination of skincare + collagen boosting treatments like microneedling is the ultimate strategy for a comprehensive skincare routine.


Can I Use Trifecta After Microneedling?

Microneedling creates tiny channels through the skin, allowing for your serums and active ingredients to penetrate the skin more efficiently.

Integrating the KaramMD Trifecta products into your post-needling routine is the best strategy for maximizing results.

Here’s my recommendation for incorporating Trifecta after microneedling:

  • Rinse: This gentle cleanser can be used the evening after your treatment or the next morning. It is soothing with ingredients like Aloe and Arnica, and also helps keep your skin clean and clear of dirt and debris as it heals.

  • Quench: Apply this skin-brightening Vitamin C serum the following evening after your treatment. Quench supports natural collagen production and will also help renew the skin, reducing fine lines, hyperpigmentation, and other signs of aging.

  • Illuminate: This multi-active anti-aging cream is going to help improve skin elasticity and boost collagen production. Due to the Retinol, skip a day or two post-treatment before you introduce it back into your routine. While it's good practice to adjust the actives in your skincare routine around facial treatments, the encapsulated dose of Retinol, along with the Niacinamide and Hyaluronic acid should help protect your skin against irritation, unlike standard Retinol compounds, so get back on track as soon as your skin allows. Incorporating Retinol after microneedling is one of the best synergistic combinations you can do for your skin.

  • Enrich: Developed for post-operative care, Enrich is packed with nourishing omegas, plant oils, and gentle anti-aging elements. You can use this every day to support healing, minimize discomfort and downtime, and enhance the effects of your treatment. It is a great alternative to Retinol on the days you need to take a break.

  • PolishMicroneedling leaves your skin red and swollen, so further irritation should be avoided. Despite Polish's gentle nature, give your skin about a week to heal before reintroducing exfoliation into your routine.

By following these steps, you can maximize the benefits of microneedling while maintaining a comprehensive skincare routine with KaramMD Trifecta products.

Microneedling is a Valuable Addition to Your Comprehensive Skin Care Regimen

I would consider microneedling right up there with skincare as a fundamental treatment to support skin health and fight signs of aging.

Its significant effects of collagen production are an essential part of maintaining youthful skin.

Microneedling, PRP, and RF microneedling are highly advantageous for skin rejuvenation, but understanding their differences and proper application is crucial. 

I'm a total advocate for microneedling, and don’t get me wrong about the effects of RF microneedling, my cautions are not to be confused with discrediting the technology. In fact, we use RF microneedling along with standard microneedling in my office. We've been performing these treatments for years, no problems whatsoever. You just have to be careful--always seek treatments from reputable providers and advocate for your skincare needs. 

I hope you can use these insights to make empowered choices and enhance your skincare journey.

Researching and making informed decisions will help you achieve the best results and maintain healthy, youthful skin.

If you want to learn more about microneedling, check out my YouTube for more videos along with many other skin health and anti-aging topics. You can also follow me on Instagram if you are interested in hearing more about skin health and learning more about the aging process.

And, don't forget to subscribe to this weekly newsletter and share with friends and family so I can raise awareness and continue to help more people look as young as they feel.

Amir Karam MD

Board Certified Facial Plastic Surgeon
Founder / Creator of KaramMD Skin

Dr. Amir Karam is a renowned facial cosmetic surgeon and an authority in his field. With over two decades of experience helping patients achieve a younger, refreshed appearance. In addition to surgical procedures that sculpt a youthfully-defined facial shape, Dr. Karam takes the quality of the skin into account.


Imane Aguenaou

It’s a comprehensive course about non-invasive possibilities to have a good skin quality. So so complete and the information is detailed. Thank you very much for this educative material.

Mary Katherine

Dr. Karan what about the Endolift? Curious what your opinion on that is. Thank-you

Pam Foy

Thank you for always willing to provide informative information that we don’t normally get from our providers.
It’s nice to know the doctors that are willing to go the extra mile!
I love your products and information you always provide!
Thank you

Ursula Grudka

Ad usual Most interesting and inspiring So few know know what they are talking about when it comes to Microneedling
I am 86 now I tried microneedling with rf in spring and will do it again in September I continue to use your products and do look pretty good Thanks a lot Ursula

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