SkinPen microneedling for acne scarring

What is it and how does it work?

SkinPen® Precision System is a minimally invasive, micro-needling device intended for use on facial acne scars. The SkinPen Precision System is comprised of a reusable motor unit designed to be attached to sterile, disposable cartridges that house 14 micro-needles (-250 um diameter) on a reciprocating head which when activated and placed properly against the skin can create hundreds to thousands of "micro" punctures into the skin. The procedure creates many microscopic punctures in the skin's outer layers. As these punctures heal, the remodelling process works to improve the appearance of facial acne Scars. SkinDen Precision's cartridge design inhibits the entrance of fluids into the device which along with the BioSheath and routine cleaning help to prevent potential cross-contamination of the motor unit between uses.

Who is a candidate?

The SkinPen Precision is intended to utilise Collagen Induction Therapy to treat Melasma, acne and surgical scars. The SkinPen® Precision System's clinical study was conducted on adult men and women ranging from light to very dark skin (Fitzpatrick skin types).

Are there any reasons why I should not receive a SkinPen® Precision treatment?

The use of the SkinPen® Precision System should not be used on patients who:

• Have active skin cancer in the treatment area (s)

• Have open wounds, sores, or irritated skin in the treatment area(s)

• Have an allergy to stainless steel or anaesthetics

• Have a hemorrhagic (bleeding) disorder or haemostatic (bleeding) dysfunction

• Are pregnant or nursing

• Are currently taking drugs with the ingredient isotretinoin (such as Accutane)

What precautions should I know about?

If you have a history of the following conditions or have taken the following medications, please let your doctor know, as treatment with the SkinPen Precision System may not be appropriate for you: Actinic (solar) keratosis; active acne; collagen vascular diseases or cardiac abnormalities; diabetes; eczema, psoriasis and other chronic conditions in the treatment area or on other areas of the body; immunosuppressive therapy; history of contact dermatitis; raised moles in the treatment area; rosacea; active bacterial or fungal infection, active viral herpes simplex infections (such as cold sores); warts; keloid scars; patients on anticoagulants (also known as 'blood thinners'); scars and stretch marks less than one year old; scleroderma; and wound-healing deficiencies. Inform your doctor if you have any of the above conditions. 

If you are allergic or sensitive to any of the following ingredients which are in the hydrogel serum: purified water, glycerin, carbomer, potassium hydroxide, disodium EDTA, phenoxythanol, caprylyl glycol, sorbic acid then SkinPen® Precision treatment may not be safe for you.

What happens before the SkinPen® Precision treatment?

Before the SkinPen® Precision treatment, your doctor will ask you questions about your medical history, as well as your treatment goals. Your doctor will discuss whether you are an appropriate candidate for a SkinPen® Precision System treatment and review what to expect during and after a treatment, including common treatment responses and adverse events.

You are cautioned to avoid sun exposure and stop topical retinoid therapy 24 hours prior to procedure. You should allow at least. 24 hours after autoimmune therapies before a treatment. You should wait six months following oral isotretinoin (such as Accutane) use before receiving treatment.

Your doctor will also examine your treatment area, and may take photos. A topical anaesthetic agent may be used. The treatment area will be cleaned and then prepared with antiseptic before the treatment.

What happens during the treatment?

A layer of hydrogel serum is applied to the treatment area to protect the skin against abrasion and friction of the SkinPen Precision device during treatment. 

The doctor then selects a depth on the microneedle cartridge to begin treatment on the patient and begins the treatment. As the SkinPen® Precision glides over the skin micro-channels are created on the skins surface. Gauze may be used to pat down the affected area after treatment, and it is suggested to apply a generous layer of hydrogel serum to prevent the skin from drying out post treatment.

Does microneedling with the SkinPen® Precision hurt?

The SkinPen® Precision treatment may cause some minor discomfort during the treatment. Your doctor may recommend that a topical numbing agent be used during treatment to further minimise discomfort.

What should I expect following the treatment?

In the SkinPen® Precision clinical study, the most common treatment responses experienced were: dryness, rough skin, tightness, redness, itching, peeling, discomfort, tenderness, and burning. These conditions resolved over time without any further complications.

Although not seen in the clinical study, you may experience reactivation of herpes simplex virus (cold sore), pigment changes that include lighter or darker skin in the area treatment that resolves over time, or no change in their acne scars.

Within the first 72 hours post-treatment you should avoid sweaty exercise and sun exposure. Exposure to these conditions could led to: itching, burning, stinging, and tingling), scaling/dryness, redness, swelling, and tenderness/discomfort.

Will I need more than one treatment to achieve my desired results?

You should discuss treatment goals with your doctor. In the clinical study patients were treated in a series of 3 treatments spaced 4 weeks apart. It is recommended to avoid other facial aesthetic treatments the month following your SkinPen Precision treatment.

Do the results last forever?

While individual results may vary, in the clinical study, the results were evaluated 6 months after the third (final) treatment. After this, additional treatments may be needed to maintain your desired result.

When should I get in touch after treatment?

Contact us immediately if you experience:

1. Signs of infection such as an increase in redness, warmth, itching, or pus formation. This would typically happen within a day or two after the treatment.

2. Allergic reactions to the test material (s). Rare allergic reactions can consist of severe contact dermatitis (rash) or itching, swelling, or difficulty breathing. This risk is increased for individuals with a history of allergies, and individuals with asthma and/or a history of hives, and itching.

Traditionally, freezing-related direct cellular injury is thought to be responsible for the efficacy of cryotherapy in treating acne. Acute inflammation with predominant neutrophils develops 3 to 6 h after liquid nitrogen spraying; 12 to 24 h after, the lymphocytes and macrophages are recruited. Although not fully founded in evidence, it is generally regarded that freezing causes inflammatory lesions to disappear faster than without treatment. This effect may explain cryosurgery’s superior efficacy in treating more severe subtypes of acne lesions, i.e., cysts and keloids. As shown in histological observations, cryotherapy produces cold damage to the fibrotic cyst wall, resulting in the chemotaxis of neutrophils, whose proteases will subsequently destroy the cyst wall and allow healing. Histological studies also found that cryotherapy eventually causes a reduction in myofibroblasts and mast cells in keloidal lesions, in addition to the normalization of collagen structure and organization.

Another histologic finding of cryo-treated acne lesions is vascular disruption. Histologic studies of the refrigerant sprayed on the pig skin showed vascular engorgement with extravasated red blood cells at 15 and 30 s on day zero and normal healing at a subsequent biopsy on day seven. Cryotherapy exhibited significantly better results than intralesional triamcinolone in a randomized study with 11 patients with multiple acne keloids, especially in early vascular lesions. Cryotherapy is effective in treating cystic acne, another subtype characterized by a distinct vascular component. In some patients, pyogenic granuloma-like vascular proliferations form in areas of cystic activity, suggesting that factors unique to cystic acne may play a role in this vascular proliferation. Interestingly, pyogenic granuloma itself responds well to local cryotherapy, which aligns with findings that vascular-mediated injury is responsible for the therapeutic efficacy of cryotherapy in microvascular-perfused tissue.

Possible Mechanisms of Action

Important factors that play a role in the genesis of acne formation include hormones, inflammatory mediators, Cutibacterium acnes, and genetics. Testosterone and androgens cause activation and proliferation of keratinocytes, sebaceous cells, and ductal lining cells of the hair follicle, which accumulate in the pilosebaceous unit and result in the formation of pore obstruction and more sebum production. Oxygen availability within the cells can be compromised by the pressure exerted inside the pilosebaceous unit, providing ideal environmental conditions for the growth of C. acnes, which further promotes acne formation.

Several suggested mechanisms of acne cryotherapy include restoration of microflora, improvement of skin microcirculation, normalization of follicular hyperkeratosis, improvement of sebum evacuation, and immunomodulation. Reversal of follicular hyperkeratosis initially has been suggested, based on the findings that cryotherapy induces molecular changes resulting in a decreased expression of Ki-67, an epidermal proliferation marker that is an indicator of ductal hyperproliferation during acne development.

A second suggested mechanism is the immunomodulatory action of cryotherapy, which has been also studied in a variety of disorders. Cold has an initial inflammatory effect, but an anti-inflammatory effect becomes evident 24–48 h after freezing the lesion, and faster reabsorption of the lesion occurs. Several reports showed the clinical efficacy of local cooling in the relief of inflammatory acne, producing better results in papulopustular acne than in nodular lesions. It has been noted that cold exposure induces the release of fewer proinflammatory cytokines (IL-2, IL-6, IL-8, IL-9, and TNF-α, among many others) and more anti-inflammatory cytokines (mainly IL-10). In addition, it improves humoral and cellular immunity, stimulating B lymphocytes and natural killer lymphocytes (NK cells). Local cryotherapy has been shown to decrease the level of interleukin-1β, prostaglandin-E2, and nuclear factor-κB, which are known to be elevated in inflammatory acne lesions in vivo. In keloidal lesions treated with cryotherapy, CD163+ M2 macrophages and matrix metalloproteinase-9 were significantly increased, indicating that cryotherapy-recruited macrophages supply matrix metalloproteinase-9, which function in fibrotic resolution during treatment.

Ref:

Revisiting the Role of Local Cryotherapy for Acne Treatment: A Review and Update

Nark-Kyoung Rho

J Clin Med. 2022 Dec 20;12(1):26. doi: 10.3390/jcm12010026

At our clinic, we believe that aesthetic treatments should enhance not only your appearance but also your confidence and overall wellbeing. That’s why we take great care to understand the emotional, psychological, and personal motivationsbehind every treatment request. Our goal is to ensure that you feel supported, informed, and empowered throughout your journey.

Before any procedure, we take time to explore both physical concerns and psychosocial goals. During your consultation, we may ask:

• What do you dislike about the area you’re seeking treatment for?
• What changes are you hoping to see?
• What problems do you feel this feature causes in your life?
• How do you think your life will be different if the feature is changed?

We also use simple screening questions—based on NICE guidelines for Body Dysmorphic Disorder (BDD)—to help us understand whether cosmetic treatment is the right option for you at this time. In some cases, we may use structured tools, such as the Cosmetic Procedures Screening Questionnaire (COPS), to further guide our decision-making.

This approach is not about judging your desire for change. Rather, it’s about making sure we are meeting your needs in a way that is safe, supportive, and genuinely beneficial in the long term.

We’ve established a psychological pathway in our practice to ensure you receive the right support if any concerns arise during consultation. This may involve:

• Liaising with your GP or mental health professional
• Offering a staged approach (e.g. using short-acting treatments before considering longer-lasting options)
• Referring for psychological support before making a final decision

Many patients benefit from this thoughtful approach. 

Sometimes, we may advise against a procedure—either temporarily or permanently. This decision is always made with care, respect, and your wellbeing in mind.

If we feel that a treatment is unlikely to meet your expectations or if there are signs that psychological support may be needed first, we will explain this clearly and compassionately. We may say:

“From our discussion and assessment, I’m concerned that surgery may not give you the outcome you’re hoping for right now. It’s important to me that any treatment we consider is likely to benefit you both physically and emotionally. Based on what we’ve talked about, I believe taking more time—or speaking with a mental health professional—would be in your best interest before going further.”

We will always offer guidance, support, and, where appropriate, recommend trusted professionals who can help. Saying no is never about refusal—it’s about responsibility, integrity, and our commitment to doing what is truly best for you..