Melasma Microneedling

  • Best ResultsAre very rare
  • Treatment Recovery0-1 days
  • Procedure Time10-20 minutes
  • Skin SpecialistNot performed
  • Duration of ResultsMakes melasma worse
  • AnaestheticNA
  • Back to Work0-1 days
  • Cost $-$$

Melasma Microneedlng

Microneedling is an excellent treatment modality for many skin conditions. Melasma is not one of them. In most cases, microneedling worsens this condition. The gold standard for treating melasma is a combination of sun protection, pigment inhibitors & ultra short pulse duration lasers. Sun protection has to be paramount for effective pigment fading. Picosure Pro provides the fastest clearances with the least amount of side effects.

FactsFacts on Melasma Microneedlng

  • Microneedling is an effective dermatological treatment for improving skin texture
  • It is best utilized to enhance absorption of topicals
  • This is achieved with conservative needle lengths of 0.1 mm
  • Microneedling is not a great treatment for melasma however can improve skin quality
  • Pico lasers offer faster &  more effective clearances of pigmentation
  • Melasma treatment is multimodality, namely UV protection, topicals, & pico lasers

What is microneedling?

Melasma Microneedlng

As the name suggests, microneedling uses tiny needles to break the surface of the skin. Needles can be delivered via four ways-

  1. A roller, also known as a dermal roller
  2. A pen, also known as derma pen, or skin pen
  3. A stamping device, known as a derma stamper
  4. A needle that penetrates the skin & delivers energy, also known as RFM or radiofrequency microneedling

What was the original concept of microneedling for melasma?

To increase penetration of topicals, namely mesotherapy. This got lost in translation as beauticians (and even dermatologists) went for deeper needles. This really screwed up the real purpose of needling. There is nothing wrong with the logic of microneedling as it was intended for melasma.

What went wrong was the extension of needling to stimulate collagen production via direct dermal remodelling. This meant deeper needles.

This resulted in a diversion of the initial  intention of it’s real purpose. Sticking to very superficial needles that only cause controlled epidermal injury, namely, to breach the stratum corneum (to allow increased absorption of tyrosinase inhibitors) then the logic is plausible.

Rebound melasma from microneedling is darn hard to treat. If you must micro needle, keep the depth to 0.1 mm or 100 microns.

The problem lies in the fact the most microneedling treatments are too deep. This results in ‘dermal drop out of pigment’. The result? Worsening of melasma pigment.

Why does it make melasma worse?

Many providers use needles that extend into the dermis. This compromises the basement membrane (BM, the layer that separates the top part of the skin, the epidermis from the dermal layer).

With expert assessment my team and I can assess the depth of Melasma & treat appropriately.

Pigment cells live in the epidermis. In melasma there is often a ‘leaky’ BM. Breaking the BM results in more melanocytes to drop out into the dermis, this results in dermal melasma / dermal melanocytosis. This makes melasma worse & harder to treat.

What is the consensus for treating melasma, without the marketing bullsh*t?

Melasma should be approached with science, & not marketing. Here are the tiers of melasma management based upon science. Your dermatologist will guide you through this treatment ladder.

First tier: absolute sun protection. Hats, umbrellas, tinting, plus sunscreen. Use a high factor SPF twice a day, regardless of sun exposure.

Second tier: pigment inhibitors. This includes hydroquinone, arbutin, ascorbic acid, Kojic acid, azelaic acids, & botanicals such as bearberry.

Third tier: plasminogen modulators & vascular modifiers including tranexamic acid, either topically or better still orally.

Fourth tier: lasers including pico lasers, QSL nano or dermal toning. AHA peels.

Fifth tier: lasers including low energy thulium, vascular. Novel peels.

It’s more complex than this as there is cross taking between cells, but you get the idea.
Pigmentation such as melasma can be treated with Picosure (best)Picoway, LaseMD as well as Spectra lasers. In Sydney we use the CuRAS laser. 

What is the FASTEST way of treating melasma pigmentation?

Pico lasers combined with medical therapy provides the fastest clearance of pigmentation with the least amount of side effects. Effects can be seen as early as one week with the Picosure Pro laser.

Lasers target pigment within the skin, whilst topical creams suppress pigmentation by inhibiting an enzyme in pigment producing cells called melanocytes.

Davin’s Viewpoint on microneedling for melasma

Wow, what a spike in cases over the past two to three years. This follows the upward trend of using microneedling for everything, including melasma, skin rejuvenation, wrinkles, acne scars, hair loss, dark circles, & haemorrhoids. Maybe not the last condition, but you get the drift. I am not against microneedling- I use it daily, however not for melasma. If I had a choice between microneedling versus a simple pigment inhibitor such as azelaic acid, my preference is azelaic acid as this won’t worsen melasma. Rebound melasma from microneedling is one of the harder types of melasma my team & I have to deal with. IPL flare ups, though spectacular, is relatively easy to treat as most cases are epidermal (superficial). Deep melasma is much harder to treat, with success rates below 30% (in comparison to normal melasma, whereby our success rate ranges from 80-85%).

Traditional peels such as glycolic or retinoid acid can be used as a maintenance peel. This is safer than micro needling.
Rotational therapy is the key to managing melasma. My patients are allocated one specific nurse who can guide you through your rotational cycle.

If we catch micro needling stuff ups early enough, we can make a difference. If not, it is difficult to improve dermal drop out. It is not that I am against microneedling, as I use this daily to treat scars, mainly to increase the absorption of CS topically. Providers just need to apply the correct indication for a treatment. For more on melasma, book an appointment with my clinical staff at Cutis Dermatology. 

For Sydney patients, book an appointment with Louise at Dr Van Park’s practice in the Eastern Suburbs. I will be consulting on select pigment cases in early 2024.

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