MicroNeedling

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What is MicroNeedling?

MicroNeedling, also known as micro-needle treatment or collagen induction therapy, is a minimally invasive procedure in which very fine, sterile micro-needles create controlled micro-channels in the skin.

These micro-channels trigger the skin’s natural repair process and can stimulate the activity of cells involved in producing and remodelling the extracellular matrix, including collagen and other skin components. As a result of the healing process, the skin can become smoother, firmer and more even in appearance.

MicroNeedling can be performed on different regions of the face and body, depending on the condition of the skin, the indication and the treatment goal.

How does MicroNeedling work?

The basic principle of MicroNeedling is controlled micro-injury. The micro-needles penetrate the skin to a predetermined depth, creating thousands of tiny micro-channels – for example, a standard medical roller with 2 mm needles passed fifteen times over an area creates approximately 250 micro-channels per square centimetre, without significant damage to the epidermis.

The body responds to this controlled stimulus by activating the wound-healing cascade: growth factors are released (including PDGF, TGF-alpha and TGF-beta, FGF), fibroblasts migrate and proliferate, and around five days after treatment a fibronectin matrix forms that guides the deposition of new collagen.

Over the following weeks and months, collagen remodelling takes place, which is why improvements in skin quality are not judged immediately after treatment alone. Histological studies published in the professional literature have shown a marked increase in collagen and elastin deposition months after a series of treatments, with the normal skin architecture preserved – the new collagen is laid down in an orderly lattice, not in the parallel bundles seen in scar tissue.

It is important to stress that the result depends on the initial condition of the skin, the indication, the chosen depth and treatment protocol, and the patient’s individual response.

Needle depth matched to the facial zone

Skin is not equally thick everywhere, so treatment depth cannot be the same across the whole face. In professional practice, needle length is chosen by zone and by goal:

• Around 0.25–0.5 mm: superficial stimulation and better uptake of topical products; virtually painless, minimal redness.
• Around 0.5–1.0 mm: fine lines, rejuvenation, delicate zones such as the eye area.
• Around 1.0–1.5 mm: moderate scarring and more pronounced texture irregularities; the most common working range on the cheeks.
• 1.5 mm and deeper: deeper atrophic scars, only on strict medical assessment, with longer intervals between treatments.

Thin-skinned zones – the eye area, temples, neck – are treated more conservatively than the cheeks and chin. That is why „the same treatment for everyone“ is not a good treatment: depth, number of passes and intensity are set for each zone separately.

What does a MicroNeedling treatment look like?

1. Consultation and skin assessment – before every treatment, not only at the first visit, because health status can change between appointments.
2. Thorough cleansing and degreasing of the skin – residue from creams, SPF or lipid film interferes with even needle penetration.
3. Topical anaesthetic cream if needed, under occlusion, usually 25–45 minutes – adequate contact time is key to comfort.
4. Removal of the anaesthetic and a second skin preparation, followed by a serum intended for professional use.
5. Controlled device passes zone by zone – in several directions (vertical, horizontal, diagonal), with the depth adjusted; serum is re-applied between passes.
6. Skin calming immediately after the final pass – the first minutes after treatment matter most for settling the skin’s reaction.
7. Verbal and written home-care instructions and scheduling the next visit according to plan.

The application itself usually takes around 20–30 minutes, but the total visit is longer because of the consultation, skin preparation, any anaesthetic application and post-procedure care. After treatment you can expect transient redness, a feeling of warmth, mild sensitivity or tightness of the skin, most often for one to three days, depending on the intensity of the protocol and the individual response.

What are the goals and effects of MicroNeedling?

MicroNeedling is used with the goal of improving skin quality and structure. Depending on the indication, the protocol and the individual response, treatment can contribute to:

• improved skin texture,
• a more even and healthier-looking complexion,
• reduced visibility of certain fine lines,
• improved appearance of atrophic scars, including certain acne scars (the literature reports the best response for rolling and boxcar scars; deep „ice-pick“ scars require a combined approach),
• improved appearance of enlarged pores,
• stimulation of the collagen remodelling process,
• improved firmness and overall skin quality.

MicroNeedling is not a procedure that „lifts“ the skin in the sense of a surgical facelift. Its basic goal is to improve skin quality and to stimulate the skin’s natural reparative and remodelling processes.

Optimal results usually require a series of treatments – for acne scars the literature most often reports at least 4–6 sessions – with the number and spacing of procedures determined individually after skin assessment. The interval depends on depth: usually 3–4 weeks for shallower treatments and 6–8 weeks or more for deeper ones, because collagen matures over weeks.

MicroNeedling and active ingredients

One feature of the micro-needle procedure is the creation of controlled micro-channels through which the skin temporarily absorbs products better. In clinical practice, MicroNeedling is therefore often combined with carefully selected products intended for professional use – for example hyaluronic acid, peptide complexes or PRP (the patient’s own platelet-rich plasma).

The time window for this kind of application is short: data from professional education literature indicate that most channels begin to close within 15–20 minutes of treatment, so products are applied during and immediately after the procedure.

Not every product is suitable for freshly treated skin: aggressive ingredients (high-concentration acids, retinoids, alcohol-based products) can provoke a disproportionate irritation, and the literature describes granulomatous reactions to non-sterile products applied after MicroNeedling. That is why the choice of product and the way it is applied must be matched to the procedure, the indication and the product’s safety profile – and limited to sterile formulations intended for professional use.

Combining MicroNeedling with other procedures or products is not automatically better. The protocol should be individualised according to the condition of the skin, the treatment goal and the doctor’s assessment.

MicroNeedling and exosomes

Exosomes are tiny vesicles that carry signalling molecules between cells and have been intensively studied in regenerative aesthetic medicine in recent years. A 2026 systematic review covering studies of MicroNeedling combined with exosomes reports promising results for skin ageing, hyperpigmentation, scarring and androgenetic alopecia – but also a clear warning that more, larger studies with longer follow-up are needed before firm conclusions about safety and efficacy can be drawn.

At the ESTERA Clinic exosomes are used exclusively topically (applied to the skin, never injected), within individually selected protocols, with a fully transparent explanation of what is known about them and what is still being researched.

MicroNeedling for hair loss

MicroNeedling is researched and used as an adjunctive treatment for certain types of hair loss, particularly in protocols aimed at stimulating the hair follicle. Controlled micro-injury of the scalp can influence the local reparative response and the signalling pathways connected to follicle activity.

The best-known study in this field (Dhurat et al., 2013) found that MicroNeedling combined with minoxidil produced significantly better results than minoxidil alone: 82% of patients on combination therapy reported greater than 50% improvement, compared with 4.5% on minoxidil alone. In clinical practice, MicroNeedling for hair loss can also be combined with PRP treatment, depending on the diagnosis and the individual treatment plan.

It is important to stress that hair loss has a great many different causes. MicroNeedling is therefore not a universal treatment for every type of alopecia – before starting therapy, the likely cause needs to be established and the patient assessed as a suitable candidate.

Is MicroNeedling safe?

When performed with an appropriate device, sterile single-use cartridges and a correctly chosen protocol, MicroNeedling is generally considered a well-tolerated, minimally invasive procedure. Because standard MicroNeedling uses no heat, the risk of burns and pigment damage is considerably lower than with ablative procedures, and it is considered a safe choice for all skin types – with a more conservative approach in darker phototypes because of possible post-inflammatory hyperpigmentation.

Nevertheless, like any procedure that disrupts the skin barrier, it carries certain risks. The most common unwanted effects are transient: redness and mild irritation settling within a few hours to a couple of days. Rarer complications described in the literature include post-inflammatory hyperpigmentation, acne flare, herpes reactivation, local infections under non-sterile conditions and allergic reactions. That is why the condition of the skin, existing dermatological problems, medications and other factors that can affect the safety of the procedure and the healing process must be assessed before treatment.

Not every MicroNeedling treatment is the same. Penetration depth, number of passes, treatment intensity, choice of region and combination with other procedures must all be matched to the patient.

When is treatment deferred?

There are situations in which MicroNeedling is not performed or is postponed. The most important are:

• active acne in the treatment area (treatment could make it worse),
• herpes or any other local infection in the treatment zone,
• more pronounced chronic skin disease in an active phase, such as eczema or psoriasis in the treatment area,
• anticoagulant therapy and blood clotting disorders,
• a tendency towards keloid scarring – requires a special assessment,
• pregnancy,
• recent isotretinoin therapy – the older rules on mandatory deferral are increasingly questioned in the literature; timing is decided individually, on the doctor’s assessment.

If you have a history of cold sores, preventive antiviral therapy may be recommended before treatment, at the doctor’s discretion.

Aftercare

Proper home care directly affects both the result and safety. Standard guidance after professional MicroNeedling:

• no make-up, swimming or saunas for the first 24 hours;
• only gentle, fragrance-free cleansing and hydration products for the first 2–3 days;
• no „active“ ingredients – retinoids, AHA/BHA acids, vitamin C products – for at least 72 hours;
• no intense exercise or heat exposure for 24–48 hours;
• SPF every morning, without exception – freshly treated skin is more sun-sensitive; after more intensive protocols SPF 50 and sun avoidance are recommended for the following weeks;
• report any unusual reactions – severe pain, swelling, or a rash spreading after 48 hours – to the clinic immediately.

MicroNeedling at the ESTERA Clinic

At ESTERA, the approach to MicroNeedling is based on an individual assessment of the skin and a careful choice of protocol – not on a universal depth or an identical number of treatments for every patient.

The goal is not merely to create micro-injury, but to dose the stimulus correctly so that the desired effect is achieved with appropriate control of the skin’s post-procedure reaction. Depth is adjusted to each facial zone separately, the serum is chosen according to the indication, and the treatment plan – number of sessions and intervals – follows the skin’s response, with photography and objective tracking of changes.

Depending on the indication, MicroNeedling can be included in a broader skin care and regeneration plan, on its own or in combination with other procedures – such as PRP, mesotherapy or chemical peels – whenever a justified indication exists.

How much does MicroNeedling cost?

The price depends on the region being treated, the chosen protocol and whether the treatment is planned on its own or in combination with other procedures. See the current prices in the price list; an exact assessment of the plan and cost is provided at the consultation, after the skin assessment.

Frequently asked questions about MicroNeedling

References

• Singh A, Yadav S. Microneedling: Advances and Widening Horizons. Indian Dermatol Online J. 2016;7(4):244–254. doi:10.4103/2229-5178.185468
• Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology. 2013;5(1):6–11. doi:10.4103/0974-7753.114700
• Chawla S. Split face comparative study of microneedling with PRP versus microneedling with vitamin C in treating atrophic post acne scars. J Cutan Aesthet Surg. 2014;7(4):209–212. doi:10.4103/0974-2077.150742
• Alqam M, Wamsley CE, Hitchcock T, Jones BC, Akgul Y, Kenkel JM. Efficacy and tolerability of a microneedling device for treating wrinkles on the neck. Aesthet Surg J. 2022;42(10):1154–1160. doi:10.1093/asj/sjac085
• Dhaliwal NK, Sokhal BS, Gkini MA et al. The Use of Microneedling With Exosomes in Dermatology: A Systematic Review. J Cosmet Dermatol. 2026;25:e70881. doi:10.1111/jocd.70881
• Dayan E, Weir DD, Rohrich RJ, Ross EV. Maximizing Safety with Microneedling. In: The Art of Aesthetic Surgery (chapter on safety and facial zones).

Read more

• Mesotherapy: active-ingredient cocktails for skin hydration and revitalisation
• PRP treatment: skin regeneration with your own growth factors
• Acne scars: how we choose the treatment

Book a consultation at the ESTERA Clinic in Vračar and check with Dr Nenad Stanković whether MicroNeedling is the right treatment for your skin.

Book a consultation: +381 66 378 372

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