Melasma Microneedlng

  • 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 & low powered lasers. Some cases can improve with superficial peels.

FactsFacts on Melasma Microneedlng

  • Microneedling is an effective dermatological treatment
  • It is best utilized to enhance absorption of topicals
  • This is achieved with conservative needle lengths of 0.1 mm
  • The vast majority of microneedling is performed deeply
  • Hence this treatment can worsen melasma
  • Melasma treatment is multimodality
  • This means sun protection, topicals, tablets, lasers, & peels

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. That really fu*ked up the intention of it’s real purpose. If one sticks 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.

Microneedling is not the treatment of choice for melasma, in fact neither are lasers, it is only one of the many arms of melasma treatment. 

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).

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 QSL nano or dermal toning. AHA peels.

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

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.

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.

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