Advanced microneedling techniques significantly expand the possibilities of the basic technique, enabling practitioners to address more complex indications such as severe acne scars, long-standing stretch marks or combination with other aesthetic treatments. This article describes the most relevant advanced protocols for professional practice.

Microneedling for acne scars

Acne scars represent one of the most demanded and technically challenging indications for microneedling. The goal is to stimulate neocollagenesis and extracellular matrix remodelling in fibrotic scar areas, progressively improving the depth and appearance of scars.

Acne scar classification

Specific protocol for acne scars

  1. Assessment and classification of the scars present
  2. Cleansing and preparation: double cleanse + gentle disinfection
  3. First pass at maximum depth on the deepest scars (ice-pick, boxcar): 1.5–2.0 mm. Multiple passes on each scar to maximise the collagen response.
  4. Second pass across the entire treated area at 1.0–1.5 mm
  5. Active application: hyaluronic acid + vitamin A (low-concentration retinol) or BCN Base Cocktail + vitamin C
  6. Closure with BCN Heal or BCN Intense Repair

Note on technique for deep scars: In very deep ice-pick scars, some protocols include subcision (sub-scar fibrous release with a needle) before microneedling to release the fibrous traction anchoring the scar base to the deep dermis. This procedure must be performed by a doctor or professional with specific training.

Interval and number of sessions for scars

Microneedling for stretch marks

Types of stretch marks and treatment response

Recent stretch marks (erythematous): reddish-purple in colour, active, with an ongoing inflammatory process. These respond best to treatment because the tissue is still in active remodelling phase. Working depth: 0.75–1.5 mm. Excellent response.

Old stretch marks (pearlescent): whitish-silver in colour, histologically similar to atrophic scars. Require greater depths (1.5–2.5 mm) and more sessions. Improvement is real but complete elimination is never achieved.

Protocol for stretch marks

  1. Prepare the selected active (vitamin A + C + BCN HA or BCN Adipo Forte if cellulite is also present)
  2. Run the dermapen/dermaroller perpendicular to the stretch mark (to maximise the breaking of disorganised collagen fibres)
  3. Run transversely (parallel to the stretch mark) to stimulate collagen reorganisation
  4. On very deep stretch marks: repeated focal tapping on each one

Combining microneedling with other treatments

Microneedling + Radiofrequency

The standard sequence is: radiofrequency in a separate session (1–2 weeks before or after) for deep laxity + microneedling with actives for the surface. In the same session, RF-needling combines both technologies directly.

Microneedling + Conventional mesotherapy

In some professional protocols, microneedling is combined with topical application of cosmetic actives: the microchannels created by the dermapen facilitate the transdermal absorption of actives applied to the skin, enhancing their effect.

Microneedling + Chemical peels

Do not perform in the same session. Chemical peeling and microneedling are alternative treatments, not simultaneous complements. In a multi-session protocol, they can be alternated: session 1 (peel), session 2 (microneedling), etc. Wait at least 3–4 weeks between the two.

Microneedling + PRP (Platelet-Rich Plasma)

This combination, popularly known as the "vampire facial", enhances the healing response by adding the patient's own concentrated plasma growth factors through the microchannels. PRP contains PDGF, TGF-β, EGF, IGF-1 and VEGF, which amplify the neocollagenesis induced by microneedling. This technique requires blood extraction from the patient and centrifugation, placing it within the medical scope.

Protocols by specific zones

Lip contour

The perioral area and lips are among the most demanded rejuvenation zones. Vertical wrinkles on the upper lip and loss of Cupid's bow definition are common indications. Use depths of 0.25–0.5 mm maximum. Actives: BCN Mimik (for expression wrinkles) + BCN HA. Avoid on active cold sores.

Forehead and glabella

Horizontal forehead expression lines and glabellar (frown) lines are dynamic wrinkles that benefit from BCN Mimik applied with dermapen at 0.5–0.75 mm. Greater depth (1.0–1.5 mm) is used to improve general texture and forehead firmness.

Nasolabial fold

Deep nasolabial folds require a combined approach: microneedling at 0.75–1.0 mm for skin quality + firming actives (BCN Tensis). The dermapen is the ideal device due to the zone's irregularity.

Neck and décolleté

The skin of the neck and décolleté is thinner and more sensitive than facial skin. Reduce depth (0.5–0.75 mm) and use actives with a high tolerability profile (BCN HA + BCN Tensis). Results are very visible given the high contrast between aged neck skin and the rest of the face.

Hands

The dorsum of the hands ages just like the face but receives less attention. Microneedling at 0.5–0.75 mm with vitamin C + BCN HA notably improves texture, sun spot appearance and skin laxity. Avoid the area directly over tendons and bony prominences.

Evaluation and documentation of results

For objective monitoring of microneedling results, the practitioner should: