Microneedling therapy, a widely used technique in modern clinical medicine, employs fine needle-like instruments to create controlled micro-injuries and stimulate the skin, thereby achieving therapeutic or cosmetic effects. To standardize the clinical application of microneedling for melasma, a panel of authoritative experts formulated the “Expert Consensus on Microneedling Therapy for Melasma” by referencing the “Group Standards for Microneedling Treatment Operational Norms,” the “Chinese Expert Consensus on the Clinical Application of Microneedling Therapy,” the “Expert Consensus on Photonic Treatment and Repair for Melasma,” ve “Clinical Application Guidelines for Cosmetic Microneedling Therapy.” This consensus aims to provide clinicians with standardized operational guidelines, ensuring the best possible outcomes for microneedling in treating melasma.
Microneedling Therapy
- Eylem Mekanizması
Microneedling therapy provides precise and effective treatment outcomes primarily through two mechanisms:
① Transdermal delivery: Microneedle stimulation creates pathways in the skin that enable either simultaneous or sequential delivery of drugs or active skincare products.
② Mechanical stimulation and inflammation: The mechanical micro-injuries trigger an inflammatory response, inducing the synthesis of extracellular matrix and tissue remodeling, leading to collagen regeneration and enhanced therapeutic or cosmetic effects. - Endikasyonlar
① Disfiguring skin disorders, post-inflammatory hyperpigmentation (PIH), dark circles under the eyes, pigmentary conditions (melasma, vitiligo), etc.
② Photoaged skin (wrinkles, laxity, dullness, enlarged pores).
③ Sensitive skin. - Types of Microneedling
① Roller-type microneedles (most common).
② Electronic water-light injection microneedles.
③ Electrically assisted nano-crystal microneedles.
④ Plum blossom microneedles.
⑤ Single-needle microneedles (30G injection needle).
⑥ Radiofrequency microneedles. - Treatment Course Design
Treatment is typically performed once every 1–4 weeks, with 5–12 sessions constituting one complete course.
Application of Microneedling Therapy in the Treatment of Melasma
Microneedling therapy has been shown to be effective in approximately 40% to 89% of patients with melasma.
- Introduction to Melasma
① A common, chronic, acquired hyperpigmentation disorder.
② Characterized by light to dark brown macules and patches with ill-defined borders, of variable depth.
③ Most prevalent among Asian women of childbearing age with Fitzpatrick skin types III–IV. - Mechanisms of Microneedling Therapy in Treating Melasma
① Enhancing drug penetration: By creating microchannels in the skin, microneedling enables drugs or active ingredients to more directly reach target cells through the shortest pathways.
② Repairing the epidermal-dermal junction and basement membrane zone: Microneedling directly boosts fibroblast activity, stimulating the secretion of type IV, VII, and XVII collagen, thus promoting structural remodeling of the basement membrane zone.
③ Promoting melanin metabolism: Microneedling accelerates the turnover of keratinocytes, facilitating faster melanin granule metabolism. - Microneedling Treatment Protocol for Melasma
1. Microneedling Monotherapy
There is limited evidence, and short-term studies suggest microneedling alone may be effective in treating melasma.
2. Microneedling Combined with Light and Energy-Based Devices
Types of Devices That Can Be Combined:
Toning laser
Fractional laser
Non-ablative fractional laser
Intense pulsed light (IPL)
LED light therapy
Radiofrequency technology
Key Considerations During Treatment:
Be aware of energy levels and possible exacerbation of melasma from excessive energy density.
Avoid light-based treatments during active inflammation; wait for skin stabilization post-drug treatment.
Advantages of Combined Treatments:
Accelerates skin repair
Reduces thermal injury to skin structures
Reduces post-inflammatory pigmentation
Reduces inflammation-related pigmentation
3. Microneedling Combined with Drugs and Other Active Ingredients
2%~4% Hydroquinone
Tranexamic acid
Vitamin C
Retinoic acid
Licorice extract
Multiple active ingredients (as combinations)
Key Active Ingredients for Treatment:
Blood vessel constriction agents: Hydroquinone
Melanin suppression agents: Vitamin C, Arbutin, Azelaic acid, Kojic acid
Anti-inflammatory agents:
Light-based treatments with anti-inflammatory effects
Tranexamic acid
Vitamin C
Glycyrrhizic acid (Licorice)
Ginkgo biloba extract
Bearberry extract
Skin barrier repair agents:
Ceramides
Sodium hyaluronate
Basement membrane repair agents: Collagen types IV and VII
Skin matrix restoration agents: Hyaluronic acid, collagen
Precautions for Microneedling Treatment in Melasma Patients
1. Contraindications or Cautionary Conditions
① Skin infections: bacterial, fungal, viral infections
② Skin allergic reactions: redness, swelling, exudation, erosion, active melasma stage
③ Systemic infections: HIV, viral infections, various forms of hepatitis
④ Skin diseases that may trigger the Koebner phenomenon (e.g., progressive vitiligo)
⑤ Severe hypertension, heart disease, diabetes, or coagulation disorders
⑥ Contraindicated during pregnancy; use with caution during lactation and menstruation
⑦ History of keloid formation
⑧ Prone to dermatographism (skin writing phenomenon)
2. Microneedling Treatment Protocol for Melasma
✅ Patient Informed Consent
- Ensure the patient fully understands the procedure, expected results, possible complications, and post-care requirements. Obtain written informed consent before proceeding.
✅ Microneedling Mechanism
- Microneedling creates controlled micro-injuries in the skin, stimulating collagen production and improving the appearance of melasma.
✅ Beklenen sonuçlar
- Reduces pigmentation and evens out skin tone
- Improves skin texture and radiance
✅ Potential Complications
- Redness, swelling, pinpoint bleeding
- Infection if proper aseptic techniques aren’t followed
- Temporary hyperpigmentation in sensitive individuals
✅ Tedavi Sonrası Bakım
- Avoid sun exposure; use SPF 50+
- Keep the skin clean and hydrated
- Avoid makeup and harsh skincare products for a few days
- Follow specific instructions for cleansing and moisturizing
✅ Equipment Preparation
- Use sterile microneedling rollers (disposable or thoroughly sterilized)
- Prepare all sterile solutions, serums, and supplies needed for treatment
✅ Sterile Formulation Ingredients
- Only use sterile, medical-grade solutions (e.g., hyaluronic acid, vitamin C, tranexamic acid serums)
✅ Injectable Medications
- If using any injectable products, ensure they are sterile and appropriate for microneedling treatment
✅ Needle Selection
- 0.25 mm: for superficial exfoliation and enhanced epidermal metabolism
- 1.0 mm: for deeper collagen stimulation and to treat dermal aging, wrinkles, pores, acne scars, and skin laxity
✅ Microneedling Types
- Roller-type microneedling device (dermaroller)
Treatment Area Disinfection and Anesthesia
1. Adım:
- Apply lidocaine cream for local anesthesia to the treatment area, covering it with plastic wrap for 1 hour to enhance numbing.
2. Adım:
- Disinfect the treatment area with 2% chlorhexidine solution or another suitable antiseptic.
Step 3:
- Gently remove the antiseptic using sterile gauze soaked in saline.
Tedavi süreci
1. Adım:
- Use a crosshatch (horizontal and vertical) or star-shaped rolling pattern, ensuring each pass overlaps by 10%.
2. Adım:
- Continue rolling on untreated areas, covering the entire treatment zone.
Step 3:
- For certain areas, roll in an oblique (diagonal) pattern to avoid excessive crossing of needle paths.
Endpoint Reaction:
- Pinpoint bleeding or slight oozing is a normal and expected response.
Önlemler
- Roll with smooth, even pressure.
- Avoid excessive pressure, especially on bony areas.
- Depth control: shallow (0.25 mm) for superficial treatment; deeper (up to 1 mm) for more intensive treatment. Start conservatively (less is more).
- Adjust depth based on facial area.
- Avoid over-rolling the same area to prevent large patches of damage.
- Usually, 2–3 passes are sufficient; up to 4–8 passes in some areas (do not exceed this).
- Monitor skin reaction to determine endpoint.
Needle Length and Purpose
- 0.25 mm / 0.5 mm: Stimulates epidermal turnover, minimizes scarring, improves complexion, firms skin.
- 1.0 mm: Targets dermal aging, improves wrinkles, pores, acne scars, and skin laxity.
Area-Specific Rolling Techniques
- Forehead: Roll gently upward and outward from the brow bone to the hairline.
- Temporal Region: Roll upward and outward from the area in front of the ear to the hairline.
- Jawline: Roll gently upward and outward from behind the jaw angle to the hairline.
- Cheeks: Roll downward from top to bottom in the cheek area.
- Nose, Lips, and Eyes: Pull the skin taut to create a flat surface and roll vertically to the skin’s natural texture. Use small rolling motions for the nose tip.
Tedavi Sonrası Bakım
Tedaviden hemen sonra:
- Apply a hydrating mask and perform ice compress for 30–40 minutes to soothe the skin.
Temizlik:
- Same day: Avoid water contact.
- Second day: Rinse gently with water.
- Third day: Use a mild cleanser and continue with medical-grade repair masks.
Güneş Koruma:
- First 3 days: Use physical sun protectio (e.g., hats, masks).
- After 3 days: Use SPF sunscreen and brightening/lightening skincare as advised.
- 72 hours post-treatment: Implement broad-spectrum sunscreen and continue pigment-inhibiting skincare.
This guide provides comprehensive operational standards and instructions for clinical microneedling treatment of melasma. It is designed to enhance the safety and effectiveness of the procedure. By standardizing the treatment process, microneedling can better serve patients and help improve melasma-related concerns.
