Treating Hyperpigmented/Hypertrophic Scars with Microneedling in Skin of Color

Robyn Siperstein, MD, FAAD, presented “Use of Microneedling in Skin of Color: Treating Hyperpigmented and Hypertrophic Scars” at the 2025 American Academy of Dermatology Annual Meeting Sunday.

“The key to this treatment and how I’ve really changed my anti-aging treatments are two things: One, it’s really important to use an insulated needle, and No. 2, make sure you are in the right depth for where that hypertrophic scar is,” Dr. Siperstein said.

She explained that microneedling radiofrequency evolution in her practice started with skin texture for collagen building and gradually grew to treating pigment from sun damage, erythema, and now hypertrophic scars that are raised red or hyperpigmented in all skin colors.

Treating patients with darker complexion is more challenging because most treatments, including laser-resurfacing and triamcinolone, cause post-inflammatory hyperpigmentation (PIH).

Microneedling radiofrequency is a better choice in darker skin because it breaks down collagen without stimulating inflammation (no open wound), Dr. Siperstein said.

A non-insulated tip is more similar to a laser and provides energy not only at the tip but along the entire channel, whereas with semi-insulated tip, 80% of the energy is at the tip, so it doesn’t affect the epidermis; this is the key to this treatment in darker skin types, she said.

By sparing the epidermis and keeping that safe, no PIH is created.

There are two types of needles used for RF microneedling: non insulated RF (in which Dr. Siperstein said 50% of the energy is at the tip and the rest spreads upward and reaches the epidermis) and semi-insulated RF.

“There are different depths for each indication depending on where the pathology lies. One hundred micros equal 0.1 mm epidermis and 1000 microns equals 1 mm,” Siperstein said.

Dr. Siperstein’s lecture was part of the “Advances in Microneedling Techniques Around the World” session. Speakers provided updated, evidence-based practices and clinical pearls with a global perspective, using microneedling and other needling procedures in a safe and effective way to manage various common dermatoses. Attendees left the session with updated knowledge on the safe and effective use of microneedling in patients with various common dermatoses as performed in real-world clinical practice, and evidence-based practices using microneedling, vs radiofrequency microneedling for scars, striae, and rhytids based on clinical experience and research.