When done early microneedling improves appearance of surgical scars

PHILADELPHIA: A procedure known as micro-needling, when performed soon after surgery, can improve the final appearance of surgical scars, with the best results obtained when performed within six to seven weeks.

The benefits of micro-needling have been researched in a study published in the September issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). Wolters Kluwer publishes the journal as part of the Lippincott portfolio.

This is in contrast to the "conventional wisdom" that treatments to improve the appearance of surgical scars should be delayed for up to a year, according to new research by Casey Gene Sheck, DO, and colleagues at Claytor/Noone Plastic Surgery in Bryn Mawr, Pa., led by R. Brannon Claytor, MD, Chief of Plastic Surgery at Main Line Health.

"Our findings imply that restarting the healing process with micro needling 6 weeks after surgery is an option to enhance the final outcomes of postoperative scarring," the researchers write.

'Paradigm shift' on preventive approaches to improve scarring

Microneedling is a non-invasive treatment for improving the appearance of the skin in a variety of situations, including chronic acne scars. After the skin has been numbed, a power handpiece with needles of varying sizes is used to form microscopic channels in the skin.

Microneedling, also known as "minimally invasive percutaneous collagen induction," works by stimulating the body's natural healing components, such as collagen and elastin.

Microneedling or other therapies to improve the appearance of surgical scars are typically postponed until the scar has fully grown, which takes between 6 and 12 months. Dr Sheck and colleagues investigated an alternate strategy that used micro-needling in the early stages of the healing process in order to reactivate the healing pathway.

Microneedling results

The study comprised 25 women who had surgical scars from plastic/skin surgery treatments such as benign lesion excision, facelifts, or tummy tucks.

Microneedling was conducted on each patient, with the first treatment performed 6 and 16 weeks after surgery. The second and third treatments took place four and eight weeks later.

Based on three different standardised assessments, the patients' scar appearance improved significantly after micro needling. For example, the average score on the Patient and Observer Scar Scale (POSAS, which has a range of 6 to 60, with lower scores indicating better appearance) reduced from 23.7 prior to micro-needling to 11.7 at follow-up (2 months after the last treatment).

The researchers also examined the outcomes of individuals who began micro needling sooner, 6 to 7 weeks following surgery, vs later, 13 to 16 weeks.

The earlier therapy group improved its POSAS scores "much more": from 16.8 to 8.1, compared to 26.1 to 14.2 in the latter treatment group. The outcomes were similar for patients of varied ages and with scars on the torso vs the face.

New advice improves outcomes

"While more study is needed to thoroughly analyse this finding," Dr Sheck and colleagues write, "it undoubtedly constitutes a substantial paradigm shift in scar treatment."

"As a prophylactic measure, patients and surgeons interested in maximising scar management may elect for early intervention with micro needling prior to the development of undesired scars."

Contrary to conventional wisdom, the new study reveals that early micro needling - administered during the late proliferation/early maturation period of healing - can significantly improve ultimate scar appearance.

The improvement could be attributed to the restart of the healing process at a time when collagen production has begun to diminish.