Microneedling For Melasma

Melasma flare ups due to microneedling are not uncommon & more difficult to treat compared to flare ups from lasers & IPL. The primary reason behind flare ups is that treatments were too deep, too aggressive, or inadequate pigment correctors we prescribed after microneedling. Often combinations of factors contribute to worsening of pigmentation.

We manage flare ups with prescription pigment inhibitors in addition to picosecond lasers. We can effectively clear melasma flare ups in around 60% of cases, as compared to 85% of de novo patients.

RFM or radiofrequency microneedling uses heat delivery via needles to repair the sun damage in patients with melasma. Devices include Sylfirm X, Potenza, Secret RF & Genius RFM.

Though we have RF microneedling devices in our clinics, we do NOT recommend them as first line treatment for melasma, as –

• Pico lasers are far safer & deliver better results.
• RFM devices such as Sylfirm X produces slower results
• Melasma flare up is much higher with RF microneedling.

Microneedling enhances the absorption of topicals, including vitamin C, azelaic acid, retinol & tranexamic acid. If you are considering this treatment method, micro needle with a 0.1 to 0.2 mm long stamper, followed by 5% tranexamic acid serum. Repeat daily as tolerated. Why daily use? Because the half-life of tranexamic acid is less than 24 hours.

Prior to the invention of lasers, AHA peels such as glycolic & lactic acids were the standard of treatment. With care & precision, AHA peels are better than microneedling, however not as effective as Picosure Pro lasers.

Dermamelan or Cosmelan peels are more effective than microneedling, however recovery is prolonged with downtime of over one week. Regardless, they can improve melasma in over 60% of cases. We do employ these peels for interstate & overseas patients who require only one session.

The evidence of microneedling PRP in the context of melasma is weak.The logic behind this is to strengthen the dermal layer of skin via collagen induction & growth factors from PRP, however there are very few studies to support this treatment.

Microneedling PRP is best served as a treatment for hair loss. It can give a marginal improvement in healing times for skin rejuvenation & acne scar treatments.

Rollers, pens & stampers all work by breaking the skin’s surface using needles of various depths. For the treatment of melasma, shallow depths of 0.1 to 0.3 mm is ideal.

Dermapen & SkinPen are motorized units that deliver needles of various depths. These are more challenging to use & should not be used at home.

Dermarollers are easier to use, but harder to maintain consistent depths. They can be purchased online for around 5-$10. A disadvantage of rollers is that they require traction & countertraction for best technique, & hence require a helping hand at home.

Stampers are the safest & easiest to master for DIY treatments as they deliver needles of fixed length in a vertical motion. They can be purchased online.

Melasma flare ups post microneedling is not uncommon, especially if has been performed by an aesthetician. There are four primary reasons for this-

1. Treatment was too aggressive, namely too many passes.
2. Needle depth too long, anything more than 0.2 mm & the needles are in the dermal layer of skin (with breach of the basement membrane).
3. Addition of topical post microneedling results in post inflammatory hyperpigmentation. Examples include vitamin C, retinol or skin care acids.
4. Too much heat applied, either with RF microneedling or LED light sources after micro needling. LED light, coupled with micro needling can over-excite the pigment cell or melanocyte, leading to more pigment production.

Microneedling melasma treatments are surrounded by fuzzy science. Their mechanism of action is still unknown as of 2024, however the theories surrounding their methodology include-

Increased absorption of skin care products. By breaching the skin’s surface, it allows for better absorption of vitamin C, retinol, tranexamic acid & other pigment correctors.

Repair of sun damaged skin: aids in skin rejuvenation with increased collagen levels in the basement membrane of skin. This reduces pigment drop out into the deeper layers of skin.

Increased skin turnover: by providing physical exfoliation of the upper layers of skin. This increases the transit time of skin cells, hence results in faster pigment ‘shedding’.

Applying clinical dermatology with the very latest technology The Melasma Clinic can effectively treat melasma in 85% of cases; one of the highest in Australia. Unfortunately a handful of cases are resistant to treatment, despite our best efforts.