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Facial acne scarring can be hard on the confidence! Even after your acne is under control, without intervention, the scarring left behind can be permanent. There’s a significant body of research supporting the use of a dermaroller or other microneedling device to reduce or eliminate the visibility of atrophic acne scarring.
This post will offer a suggested protocol for how you can treat facial acne scarring, and then offer some suggestions for how you could adapt it for acne scarring on the body. You can read more about how I write these protocols here. The last part of this post will discuss the research that supports this protocol and what studies have found regarding microneedling for acne scarring.
The Protocol – Dermarolling for Acne Scarring
First, please note that you must not roll or stamp over active acne. That doesn’t mean that you have to have perfectly clear skin in order to use a dermaroller, just that you can’t let your dermaroller or dermastamp touch an active cyst. (I usually avoid it by a half-centimeter or so to be safe.) Rolling over a pimple will spread the bacteria in the pimple to every other spot you dermaroll afterwards, causing a breakout.
What you need
For acne scarring, purchase a 1.5mm dermaroller or dermastamp. (A roller is better if you have medium-to-large areas of scarring; a stamp might be better if you have only a small patch or if the scarring is on your nose.) You’ll also want some variety of hydrating product–if you already have a simple hydrating serum that works for your skin and doesn’t make you break out, you can use that. If you don’t have a skincare routine yet, you can start with a simple and inexpensive hyaluronic acid serum or hyaluronic acid sheet masks.
- 1.5 mm dermaroller* OR
- 1.5 mm dermastamp from OwnDoc (also available in a larger size with 1.5mm needles)
- hyaluronic acid serum* OR
- hyaluronic acid sheet masks* (you can buy any type; this is an inexpensive option that will last you!)
- Optional additional products as you see fit
What to do
A few days before your treatment, stop using any chemical exfoliants, and use your sunscreen very diligently. (I usually use a 50SPF sunscreen, but before dermarolling I use 70SPF.)
On the same date every month, dermaroll or dermastamp over your patches of scarring. I do not recommend a 1.5mm needle for general skin rejuvenation, so do not roll your whole face with the 1.5mm. This will give your skin ample recovery time while treating you often enough to see prompt results.
Aftercare
A simple hyaluronic acid serum will soothe most people’s skin and is not comedogenic, so it’s safe for acne-prone skin. If you prefer, you can opt for a sheet mask instead. I plan to do an upcoming post about serums and products for after dermarolling that are safe for acne-prone skin.
Otherwise, sunscreen! Dermarolling makes your skin sensitive to the sun, so sunscreen is especially important for a few days before and a week after your treatment. But, you’re wearing sunscreen every day anyway, right?
Considerations for Scarring on the Body
(If you are treating a scar from an injury or a vaccination, you want a different protocol! I’m gonna write it soon. This protocol is specifically for scars from acne.
The protocol will be roughly the same for acne scarring on the body. Depending on the body part, the skin may be thicker and you may be able to decrease the frequency to once every three weeks. Use your judgement. Thin skin like the chest should be treated like your face; thicker skin like the limbs may be able to sustain a three-week turnaround. Otherwise, you’re looking at the same rolling strategies and the same aftercare, and you need to be equally careful about sunscreen regardless of what body part it is. If it isn’t covered by your clothing, put sunscreen on it!
Support in the Research
Justification for the protocol
1.5mm is the most common needle length used in the research on atrophic acne scarring. See: El-Domyati et al (2015), Majid (2009), Schwarz and Laaff (2011).
Treatment frequency varies in different studies. Four weeks is the most common. Of the ones linked above, Majid notes a “monthly” frequency. (El-Domyati uses a two-week frequency and doesn’t explain why in the article; this is a major outlier in the research and I do not recommend it. Leheta et al (2011) also uses an every-four-weeks frequency. Fabbrocini et al (2009) uses a session every eight weeks for 1.5mm needles in order to assess the full extent of improvement from each session. Four weeks was selected for this protocol as an appropriate middle ground between complete skin healing and an efficient treatment of acne scarring.
As always, I suggest choosing the same day every month as your “scheduled” roll date so that you can shift your treatment by 2-3 days either side without having to change your dermarolling habits.
Outcomes in the research
Majid (2009): 89% of the 36 participants had good or excellent outcomes, with the best results occurring in patients with Grade 3 scars (obvious at social distances and not easily covered by makeup). The photos are impressive and can be viewed in Figures 1-4 here. (Note that this is after only three treatments spanning three months.)
Frabbrocini et al (2009): This study tracked participants through only two sessions with a 1.5mm roller and notes that “[e]ight weeks after the second session of CIT, the improvement in the acne rolling scars was evident: the photographic comparison highlighted that, in each group of patients, as skin became thicker, the relative rolling scar depth was significantly reduced (independent of the lesion grading)” (878).
Note that both of these studies are from 2009. There was a flurry of research around that time demonstrating that microneedling works–now that that’s a given, most of the research seeks to either compare different resurfacing treatments or try out different combinations of treatments. (More posts about this later.) What I find remarkable is that these results are so pronounced after only 2-4 treatments! Continued rolling yields continued results, in my experience, so I would be interested in a set of case studies that track continued rolling sessions to see if there’s a point after which scars stop responding to treatment. If that point exists, I haven’t hit it yet. 🙂
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