Monica K. Li, MD: Global Innovations, Integration with Other Modalities, and Future Trends in Microneedling

Monica K. Li, MD, a double board-certified dermatologist practicing at Vancouver Skin MD and The Skin Doctor/Enverus Medical, co-directed a session at the 2025 American Academy of Dermatology (AAD) Annual Meeting "Advances in Microneedling Techniques Around the World."

Tina Alster, MD, a Dermatology Times Editorial Advisory Board member, founding director of the Washington Institute of Dermatologic Laser Surgery, and a clinical professor of dermatology at Georgetown University Medical Center, also served as a co-chair of the session, contributing valuable insights into the conversation of evolving microneedling techniques.

Li spoke with Dermatology Times to discuss highlights and clinical pearls from the session, taking a closer look at global innovations and trends in microneedling techniques.

Monica K. Li, MD

Q&A

Dermatology Times: How have microneedling techniques evolved globally in recent years, and what are some of the most significant advancements you've observed?

Li: In recent years, there are many more microneedling devices approved by the FDA and worldwide to deliver the treatment, whether it is for mechanical microneedling or with radiofrequency energy added. This gives clinicians choice for a device considering different consumable costs, ease of use and fit into different clinical practices. Techniques have evolved to integrate microneedling as part of a combination treatment approach particularly for scars and striae, as well as to facilitate transdermal drug delivery for treatment of melasma, androgenetic alopecia and photoaging.

More significant achievements seen over the past several years are the development of microneedling patches that can deliver both topical agents and light, in the dermatology space. Beyond the skin, needling is being evaluated at early stages to sample interstitial fluids for biomarker evaluation and disease monitoring to support personalized medicine, and for potential delivery of vaccines to reduce associated pain and to leverage dose-sparing effects.¹

Dermatology Times: What are the key differences in how microneedling is performed in different regions, and what can dermatologists learn from these variations?

Li: Key differences of how microneedling is performed at different anatomic sites comes down to depth of needle penetration. On thin-skinned sites such as the periorbital region, a depth of 1-1.5 mm is more appropriate to avoid purpura, while 2.5-3 mm needle depth would be selected to treat, for instance, atrophic scars on the back given its thickness. Another factor is the treatment endpoint - typically pinpoint bleeding or sometimes, effacement of the treated site (e.g. on vertical static upper cutaneous lip rhytides). As such, the number of cross-hatched passes with microneedling would differ in order to achieve the clinical endpoint.

Dermatologists can learn from these treatment variations by individualizing microneedling based on the tissue response of the patient, and the state of their skin (e.g. older vs. younger patients).²

Dermatology Times: How do you integrate microneedling with other modalities such as RF energy, PRP, or drug delivery to enhance results?

Li: Microneedling can be used to facilitate neocollagenesis, and modalities in combination or as an adjunct to microneedling that can serve this purpose can be leveraged for their synergistic benefits. Some feel that radiofrequency microneedling is more effective than mechanical microneedling, but the jury is still out - current literature is inconclusive to date. What probably matters more is how mechanical microneedling is performed - selection of needle depth, number of passes, paint-brush versus stamping technique - which is more operator-dependent than delivering treatment using RF microneedling devices.

As for PRP and drug delivery, current evidence have shown that particle sizes of 500 Da or less, applied before microneedling, would best transport the topical agent deeper into the dermis. PRP combined with microneedling have been well demonstrated to improve androgenetic alopecia. Injectables such as poly-L-lactic acid likely is not a suitable agent to use for transdermal drug delivery with microneedling, as cost would be prohibitive with limited skin benefits.³

Dermatology Times: What safety considerations and best practices should clinicians keep in mind when adopting new microneedling technologies?

Li: Any topical agent that is not intended for intradermal use can affect safety of microneedling treatments, due to the risk of granuloma formation and allergic contact dermatitis. For a patient with a history of oral herpes labialis, prophylactic treatment is recommended, if treatment is delivered in the perioral region.⁴

Dermatology Times: Looking ahead, what innovations or trends in microneedling do you believe will have the biggest impact on dermatologic treatments in the next few years?

Li: As mechanical microneedling evolves, we may see devices with proven abilities to penetrate deeper into the skin beyond 2-3 mm, particularly useful on thicker-skinned regions. We anticipate we will see microneedling integrated as an established component in a multimodal protocol with scar and striae management, irrespective of the underlying skin tone of the patient, as it is considered generally a color-blind treatment.

Developments in microneedle patches will permit enhanced transdermal drug and light delivery effects to the skin, particularly when systemic or more generalized treatment may not be possible or adverse.⁵

References

1. Sasaki G. Micro-needling depth penetration, presence of pigment particles, and fluorescein-stained platelets: Clinical usage for aesthetic concerns. Aesthet Surg J. 2017;37(1):71-83.
2. Alster TS, Li MK. Microneedling of scars: A large prospective study with long-term follow-up. Plast Reconstr Surg (2020). 145(2): 358-364.
3. Alster TS, Li MK. Microneedling treatment of striae distensae in light and dark skin with long-term follow-up. Dermatol Surg (2020). 46(4): 459-464.
4. Iwata H, Kakita K, Imafuku K, Takashmia S, Haga N, Yamaguchi Y. Safety and dose-sparing effect of Japanese encephalitis vaccine administered by microneedle patch in uninfected, healthy adults (MNA-J): a randomised, partly blinded, active-controlled, phase 1 trial. Lancet Microbe. 2022;3:e96-e104.
5. Ugwu N, Xun H, Dover JS, Boustany AN, Chung HY. Histological assessment of the effectiveness of microneedling device-assisted filler delivery. Dermatol Surg. 2024;50(9): 829-833.