After years of dealing with acne, one RealSelf patient was left with scars, redness and dark spots. The patient later had six microneedling sessions over about 16 months and reported that the scars became less visible and the skin felt smoother.

The experience was not completely easy. The patient also described pain during treatment and temporary stinging, tightness and warmth afterwards.

That is one person's experience, not clinical evidence. Skin can respond very differently from one person to another. Still, the story captures something many people recognise. The acne may finally settle, yet its marks can remain much longer.

Sometimes those marks are brown or grey. Sometimes the skin has small dents or an uneven surface. Many people have both.

These problems are often grouped together as "acne scars", but they are not always the same thing. Understanding what acne has actually left behind is important before deciding whether microneedling makes sense.

Acne Is Common, Including Among Young People in the Netherlands

The Generation R study, carried out in Rotterdam and published in the Journal of the American Academy of Dermatology in 2024, gives useful Dutch context.

Researchers studied 4,561 adolescents with a median age of 13.5 years. Visible acne was found in:

• 62% of girls

• 45% of boys

Moderate-to-severe acne was found in:

• 14% of girls

• 9% of boys

These figures describe the adolescents who took part in this Rotterdam study. They should not be treated as prevalence figures for everyone in the Netherlands.

The study does show how common acne can already be around puberty. It also found an association between darker skin colours V and VI and greater acne severity among the adolescents studied.

Acne itself may improve with time or treatment. What it leaves behind is another question.

Dark Marks and True Acne Scars Are Different

Imagine a pimple on your cheek. The swelling disappears, and a few weeks later the area feels completely smooth. Yet you can still see a brown, grey or darker patch.

That may be post-inflammatory hyperpigmentation, commonly called PIH.

PIH can develop when inflammation affects pigment production. The active spot heals, but extra pigment remains in the area.

A true acne scar involves something different. The structure of the skin has changed.

Deep inflammatory acne can damage collagen and supporting tissue below the surface. When the body repairs that damage, the lost tissue may not be replaced evenly. Depression can remain.

These depressed scars are known as atrophic acne scars. They are commonly grouped into three types:

• Ice-pick scars: Small, narrow and deep. They can look like tiny holes in the skin.

• Boxcar scars: Wider depressions with clearer or sharper edges.

• Rolling scars: Shallower depressions with softer edges that can make the skin look wavy.

Real skin rarely fits neatly into one category. You may have rolling scars on one part of your cheek, a few deeper scars elsewhere and flat dark marks from newer breakouts.

That mixture is one reason acne-scar treatment needs to be individual.

Why Acne Can Leave Uneven Colour and Texture

Acne creates inflammation. What happens during and after that inflammation helps determine what remains.

In some skin, inflammation can stimulate extra pigment production. The result may be a flat dark mark after the pimple itself has disappeared.

Deeper inflammation can also damage collagen and tissue. If the area does not rebuild evenly, the surface can remain depressed or uneven.

A simple way to think about it is:

Flat but darker skin usually points more towards a pigment problem.

A visible dip or change in the surface points more towards structural scarring.

Picking and squeezing spots can add further injury to skin that is already inflamed. Dutch acne guidance advises against manipulating acne partly because of the risk of scarring.

This difference between colour and structure becomes especially important when considering microneedling.

Where Microneedling Fits

Professional micro needling uses a device fitted with very fine needles. These needles create tiny, controlled punctures in the skin.

At first, deliberately creating small injuries may sound like the opposite of what damaged skin needs.

The key is that the injury is controlled.

These tiny punctures start a natural repair response. Collagen production and remodelling form part of that process. Over time, this may help some depressed acne scars look softer and make uneven texture less noticeable.

This is why microneedling is also known as collagen induction therapy.

The needles are not physically filling the scar. Instead, the treatment aims to encourage the skin to rebuild and remodel afterwards.

That process takes time, which is why the final result cannot be judged immediately after a treatment session.

It also explains why microneedling has a clearer role when the problem involves atrophic scars and texture than when the only concern is a flat dark mark.

The Dutch Healthcare Perspective

For readers in the Netherlands, it is important to separate Dutch healthcare guidance from international research into microneedling itself.

The Dutch Acne Vulgaris guideline, initiated by the Nederlandse Vereniging voor Dermatologie en Venereologie (NVDV), uses international evidence while adapting recommendations to the Dutch healthcare setting.

Dutch guidance recognises acne scarring and persistent pigment changes as problems that can require professional attention.

For acne-related scars, the current Dutch guideline discusses treatment options including glycolic acid peeling and CO₂ laser treatment, with or without punch-biopsy sessions. It does not include microneedling among these specific recommended scar-treatment options.

That should not be interpreted as proof that microneedling does not work.

Instead, the evidence for microneedling itself needs to be judged from the wider international research.

Dutch guidance also provides useful advice about where people can seek care. Depending on the problem, acne care in the Netherlands may involve a huisarts, dermatologist or huidtherapeut.

Expertise matters, especially when pigmentation is already a concern. An unsuitable or overly aggressive procedure can create further irritation or unwanted pigment changes rather than improving the original problem.

What the Research Tells Us

The overall evidence is encouraging, but it is not strong enough to promise the same result for everyone.

A 2022 systematic review and meta-analysis published in Aesthetic Plastic Surgery examined 12 randomized controlled trials involving 414 participants.

The researchers found evidence supporting microneedling without radiofrequency as an option for acne scarring. Importantly, this was research across groups of patients. It was not a guarantee that every scar would respond in the same way.

A larger 2024 network meta-analysis published in Archives of Dermatological Research included 24 randomized studies with 1,546 participants.

Researchers compared microneedling alone with several other treatments and combinations. In that analysis, microneedling combined with chemical peels performed better across several measured outcomes than the other approaches included in that particular network.

That does not mean everyone with acne scars should automatically combine the two treatments.

Network meta-analyses bring together studies with different populations, procedures and treatment settings. They can show useful patterns, but they cannot tell us which procedure will be best for every individual face.

More recent evidence makes that point even clearer.

A 2026 systematic review and meta-analysis compared microneedling directly with chemical peels for atrophic acne scars. It included 11 studies and 713 participants.

When researchers looked at clinically significant improvement of at least 50%, they found no significant difference between microneedling and chemical peels.

Microneedling was more likely to produce at least some improvement, but other measures did not show a consistent overall advantage. The researchers concluded that the two approaches appear broadly comparable and that treatment decisions should be individualised.

Another 2026 systematic review and network meta-analysis looked more broadly at treatments for moderate-to-severe atrophic acne scars. It included 56 randomized trials and 1,488 patients and compared a wide range of treatments, including lasers, microneedling, radiofrequency microneedling and combination approaches.

Results differed depending on the treatment and the way improvement was measured. The wider message is more useful than trying to name one universal winner: acne scars do not all respond to the same approach.

Why Research Cannot Predict Your Exact Result

Even a large study cannot tell you exactly what will happen to your skin.

Microneedling studies vary in important ways. Researchers may use different devices, needle settings, numbers of sessions and treatment intervals. Scar severity can also be measured differently from one study to another.

The people taking part are different too.

Someone with shallow rolling scars does not have the same treatment problem as someone with several deep ice-pick scars. Skin tone, pigmentation history and active acne can also affect treatment decisions.

So when research says a treatment "improved acne scars", that does not mean every scar disappeared or every participant experienced the same level of improvement.

Realistic expectations matter.

Where Microneedling Fits With Dark Marks

This part needs more caution than many cosmetic treatment pages give it.

Evidence that microneedling can improve atrophic acne scars should not automatically be used as proof that it will remove post-inflammatory hyperpigmentation.

They are different problems.

Atrophic scars involve changes in skin structure and collagen. PIH mainly involves pigment left after inflammation.

If your skin is smooth and the main concern is brown or grey colour, collagen remodelling may not be the main issue that needs treating.

For PIH, preventing further inflammation is important. Sun protection also matters because UV exposure can make uneven pigmentation more noticeable.

Some people have both problems. They may have depressed scars from older acne alongside dark marks from more recent breakouts.

In that situation, the treatment plan may need to address texture and pigmentation separately rather than expecting one procedure to solve everything.

Pigmentation Risk Deserves Attention

Microneedling works by creating controlled skin injury. That repair response is part of the treatment, but unnecessary or excessive inflammation can also contribute to unwanted pigment changes.

This deserves particular attention if your skin regularly leaves a dark mark after a pimple, scratch or irritated patch.

That does not mean darker skin tones cannot be treated.

It means skin phototype, pigmentation history, scar type and treatment intensity need careful consideration. More aggressive treatment is not automatically better treatment.

This is also one reason home microneedling should not be treated as an equal substitute for professional treatment. Hygiene, needle depth and the amount of skin injury all matter.

When uneven tone is already the concern, creating unnecessary irritation works against the goal.

Active Acne Changes the Plan

If painful or deeply inflamed acne is still appearing regularly, treating old scars may not be the first priority.

Otherwise, you can end up trying to repair last year's scars while new breakouts continue creating fresh marks.

Dutch NVDV guidance says referral to a dermatologist should be considered when acne is causing or threatening:

• scarring

• persistent pigment changes

Referral may also be appropriate for severe acne, acne that has not responded adequately to previous treatment, or acne that has a significant effect on quality of life or psychological wellbeing.

Getting active acne under better control can reduce the chance of new scars forming.

Once the acne becomes more stable, it is also easier to judge what has actually been left behind.

What Recovery Usually Looks Like

Microneedling does not produce its final result immediately.

Skin may look red and feel warm, tight or sensitive after treatment. The amount of redness and irritation can vary depending on the treatment and the person's skin.

The changes people usually want happen later.

Collagen production and remodelling are gradual processes. Skin needs time to heal between sessions and continue changing afterwards.

This is why dramatic before-and-after claims deserve some caution.

Taking photographs in similar lighting, at the same angle and without filters can be useful when tracking progress. Small changes are often difficult to notice when you see your face every day.

Practical Aftercare for Treated Skin

Aftercare should follow the instructions given by the professional who performed the treatment. Freshly treated skin usually benefits from a simple routine rather than lots of active products.

Practical steps may include:

• Cleanse gently. Use a mild cleanser and avoid scrubbing the treated skin.

• Protect your skin from the sun. Once appropriate after treatment, use broad-spectrum, high-SPF sun protection daily and limit unnecessary direct sun exposure.

• Pause irritating active products when advised. Retinoids, exfoliating acids and other strong active products may need to be stopped around treatment and restarted only after the skin has recovered.

• Do not pick or scratch. Let any mild flaking settle naturally rather than pulling at the skin.

• Keep skincare simple. Avoid introducing several unfamiliar products while the skin barrier is recovering.

• Follow personalised instructions. Treatment depth and skin response vary, so advice from the professional treating your skin should take priority over generic online routines.

Aftercare becomes even more important when dark marks are already part of the problem. The aim is to let the skin heal without creating more irritation.

Scar Type Matters More Than the Trend

Microneedling is popular. Popularity does not tell you whether it is the right treatment for your skin.

Two people can both say they have acne scars while having completely different problems.

One may have shallow rolling scars.

Another may have deep ice-pick scars.

A third may mainly have flat pigmentation and almost no structural scarring.

Giving all three people exactly the same treatment would make little sense.

The research supports this individual approach. Combination treatments can perform well in some studies, while other comparisons find similar results between different treatment options.

The useful question is therefore not:

"Is microneedling the best acne-scar treatment?"

A better question is:

"Does microneedling make sense for this type of scar, on this skin?"

When to Seek Medical Advice in the Netherlands

You do not need to wait until acne has caused extensive permanent scarring before asking for help.

Dutch guidance recommends considering dermatology referral when acne is causing or threatening persistent pigment changes or scarring.

Professional advice is also worth considering when acne is severe, has not responded adequately to previous treatment, or is having a significant effect on wellbeing.

In the Dutch healthcare system, the huisarts is commonly the first medical point of contact. Depending on the problem, care may later involve a dermatologist or a qualified huidtherapeut.

It is also worth mentioning how acne or scarring affects you personally. Acne is often treated as a purely cosmetic problem, but the effect on confidence and quality of life can be significant.

A useful assessment should establish whether the remaining problem is pigmentation, structural scarring or both.

That is more useful than starting with a treatment and trying to make your skin fit it.

Start With What the Acne Left Behind

It is understandable to want the marks gone once the acne itself is under control.

But "acne marks" can describe different problems.

Microneedling has meaningful international evidence behind it for certain atrophic acne scars and uneven post-acne texture. Research also shows that results vary and that other treatments may perform similarly or better depending on the type of scar.

Flat pigmentation needs a different level of consideration. Evidence for improving indented scars should not simply be applied to every brown or grey mark left after acne.

Dutch guidance adds an important practical point: persistent pigmentation and scarring can be reasons to seek professional care rather than continuing to experiment with the skin.

So before choosing microneedling, start with one question:

Is the remaining problem mainly pigment, structural scarring, or a mixture of both?

Once that is clear, it becomes much easier to decide whether microneedling belongs in the treatment plan at all.