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You are here: Anti-Aging Skin Treatments > Noninvasive Methods >

Skin needling: Youth by a thousand needle pricks

In ancient China, there was a form of torture and execution called Lingchi a.k.a. "death by a thousand cuts" where the victim received multiple stab wounds eventually leading to death. Today, ironically, a procedure involving multiple needle pricks might help you partly regain youthful appearance while remaining alive and well. Furthermore, this procedure is only minimally painful -- not to mention that many people are willing to endure "torture" for the sake of beauty anyway.

The method I am talking about is called skin needling or, in some scientific texts, percutaneous collagen induction (PCI). Despite a fancy name, the method basically consists in prickling the skin with thin needles in a grid-like pattern to the depth from 1 to 3 mm. The alleged benefits include improvement in skin firmness, reduction in skin sag, fine wrinkles, stretch marks and minor scars.

Does skin needling really work? Sounds too good to be true, doesn't it? Cheap, simple, almost painless - there's got to be a catch. The idea behind skin needling is generally sound and not at all new. It is well known that skin damage, such as a wound, abrasion or a burn, is followed by skin remodeling that involves recycling of damaged skin matrix components and synthesis of the new ones, particularly collagen, elastin and glycosaminoglycans. If skin damage is transient, controlled and well-calibrated, the subsequent skin remodeling may lead to improvement in some signs of skin aging, such as fine lines, wrinkles, skin roughness, scars, and, to a lesser degree, skin sag. Many well established skin rejuvenation procedures work on that principle, including laser resurfacing, plasma resurfacing, deep chemical peels, dermabrasion and others. They all differ in how they produce dermal damage, but the goal is essentially the same - to induce rejuvenating skin remodeling and especially the synthesis of the new skin matrix. The problem is that most of the established cosmetic procedures based on controlled skin damage have substantial shortcomings. Many, such as laser or plasma resurfacing, require expensive equipment and extensive provider training. Many, such as laser resurfacing, deep peels or dermabrasion, destroy the outer skin layer (epidermis) over large areas, thus leading to prolonged recovery time, plenty of discomfort and significant risk of infection.

An ideal rejuvenation procedure based on the controlled skin damage should be easy to perform, require only inexpensive equipment, be easy to tolerate and quick to recover from. Surprisingly, skin needling appears to fit all these requirements. It seems to work by causing localized dermal damage (by multiple needle pricks) followed by skin remodeling leading to increased synthesis of collagen, elastin and other key components of the matrix. It is performed using very simple, inexpensive, easy-to-use tools. Since epidermis is only pricked but not obliterated, the discomfort is minimal, the risk of infection is low and recovery is quick. Unfortunately, well-designed studies of the effectiveness of skin needling are lacking -- perhaps because it cannot be easily patented. Therefore, even though skin needling appears to be promising and have relatively minor downside, it is not a proven rejuvenation method with firmly established track record. On the other hand, a number of well-known physicians routinely use it in their clinical practice. One of the best-known practitioners of skin needling is Dr. Desmond Fernandes from the University of Capetown, South Africa who has treated hundreds of patients and reported generally positive results.


The indications for skin needling listed by Dr. Fernandes include the following. (For more details, see Fernandes D., Oral Maxillofacial Surgery Clinics of North America, 2005, vol. 17, 51-53.):

  • To restore skin tightness in the early stages of facial aging. The neck, arms, abdomen, thighs, and areas between the breasts and buttocks also can be treated.
  • Upper lip creases may respond well, especially if combined with fat grafts.
  • Fine wrinkles
  • Acne scars & some other scars
  • To tighten skin after liposuction
  • Stretch marks
  • Lax skin on the arms and abdomen


As with any procedure where the skin is disrupted or pierced, there are a number of contraindications. They include the presence of active skin infections or cancer; allergy to local anesthetics; being on anticoagulants or corticosteroids; undergoing chemo or radiation therapy; being unusually prone to keloid formation; and others. For a complete list, see Fernandes D., Oral Maxillofacial Surgery Clinics of North America, 2005, vol. 17, 51-53.

Advantages and Disadvantages

According to Dr Fernandes, skin needling (a.k.a. percutaneous collagen induction or PCI) has the following advantages and disadvantages compared to its alternatives such as chemical peels or laser resurfacing. Please note that Dr Fernandes is (or was) a medical consultant for the companies manufacturing skin needling tools, and hence might have a financial interest in advancing this technology.


  • Needling does not damage the skin (as opposed to such methods as laser resurfacing and chemical peels).
  • Skin becomes thicker. Collagen and elastin deposition increases.
  • Any part of the body may be treated.
  • The healing phase is short
  • Less expensive, less risky and less damaging than laser resurfacing.
  • Can be safely done in people with pigmented or very dry skin.
  • Sometimes telangiectasia (broken capillaries) also improves, probably because the vessels are ruptured in so many places they cannot be repaired.
  • The technique is easy to master using new specialized tools and does not necessarily have to be performed by a plastic surgeon or dermatologist.
  • Can be done with topical anesthesia for limited areas.


  • Exposure to blood. The procedure is relatively bloody, much as dermabrasion.
  • Needling does not produce as much new collagen deposition as laser resurfacing. However, treatment can be repeated and the results are cumulative, so after multiple treatments the results could be comparable to those of laser resurfacing.
  • Herpes simplex is an uncommon complication and patients are instructed to use a topical antiviral drug if they feel the tingling typical of herpes.

Preparing the skin for needling

Some practitioners recommend preparing the skin for needling by applying topical formulas for a week or more before the procedure. The most commonly recommended topicals are vitamin A (typically as retinaldehyde, retinol or retinyl palmitate), retinoids (such as tretinoin) and vitamin C. The rationale behind such pretreatment is to maximize the synthesis of collagen and elastin and enhance other aspects of skin remodeling after the procedure. Theoretically, this sounds reasonable. However, as of the time of this writing, there are no clinical studies comparing the effects of skin needling with and without topical pretreatment. Until then, the benefits of skin preparation before the needling remain an opinion of some practitioners rather than an established fact.

Do-it-yourself skin needling

Skin needling tools (often called derma-rollers) can cost as little as $50. If people could perform skin needling at home, the total cost would be far lower than that of comparable skin rejuvenation procedures. Indeed, some manufacturers of derma-rollers promote or imply a DIY approach. They argue that just as diabetic patients prick their own fingers to test blood sugar levels, skin care enthusiasts can prick their own skin via skin needling. This argument is somewhat simplistic. While home administration of skin needling is technically possible (essentially, a derma-roller is rolled across the area to be treated), there are risks and caveats that should not be taken lightly. These include the risk of infection; improper technique or intensity of treatment; improper sterilization/preparation of the skin and/or tools; treatment for improper indications; ignorance of contraindications and so forth. Notably, some manufacturers of derma-rollers offer versions with very fine and/short needles, which draw virtually no blood. However, it is unclear whether such "light" derma-rollers produce the same results as the standard skin needling tools.

If you are considering a DIY approach to skin needling, you should first discuss this with your dermatologist or an equivalent licensed professional. Also, make sure to obtain the usage guidelines from the manufacturer of the derma-roller you are using.

Bottom line

Skin needling (a.k.a. percutaneous collagen induction or PCI) is a simple, low cost skin rejuvenation technique with a plausible rationale. It appears to have many advantages including quick recovery time, minimum damage to the skin, low level of discomfort and others. However, there are virtually no rigorous, independent studies verifying the effectiveness of skin needling and/or comparing it to other methods.


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