No aggressive skin resurfacing technique is without risk and drawbacks. Needling is somewhat painful, and there is often some pinpoint bleeding. Bleeding should be minor but can be disconcerting for some people who don’t like the sight of blood and is not appropriate for people who take anticoagulants or blood thinners. People who have herpes may experience a bad flare up and spread the condition. If you have any history of keloid scarring, needling should not be used under any circumstances. Needling should not be done on skin with active acne, skin cancer, or other skin infections. If you are undergoing chemo or radiation therapy, do not attempt skin needling.
The most serious risk of skin needling is infection, and this is more likely if you perform the process at home. When done properly, the infection risk is lower with needling that with other procedures that destroy the epidermis, but it is still a very real complication that can arise. The risk increases when you reuse needling tools, because they are difficult to completely sterilize without damaging the needles.
Other complications associated with skin needling at home can arise from performing the process incorrectly. Some needle roller sellers do not have your best interest at heart and will instruct you to treat the skin much more frequently that required in order to sell more rollers. Rolling too often will prevent the skin matrix from properly regenerating and can end up making the skin look worse. Different techniques are required for different types of skin damage. Dense needling is often needed to improve stretch marks and raised, hardened scars, but will make wrinkles and pitted scars worse.
There is also a chance that the needle length is too long for the skin that you are treating. Needling too deep has an increased risk of infection, can over damage the dermis, and even carries a small risk of nerve damage. Skin thickness varies greatly on different areas of the body and from individual to individual. Skin on the face and breasts is thinner than skin on the legs, buttocks, or abdomen. Men have thicker skin that women and will often need longer needles, more treatments, and greater pressure to get the same results. It’s difficult to tell exactly how thick your skin is and what the most effective needle length will be, so it might be necessary to order multiple rollers for patch tests.
You should perform a patch test before treating a large area like an entire field of stretch marks or your whole face. It is very rare, but some people’s skin will heal the tiny needle prick in the form of a scar. This is most likely to happen with needle abrasion, which dense needling with a single needle. Test similar skin to the target area, i.e. one small stretch mark or a tiny area of the scar. Wait one or two weeks for the skin to completely heal and evaluate the area for scar formation. It should look more or less the same as it did before after healing from the first treatment because the collagen formation process is just starting.
Consult the instructions included with your roller or single needle for exact precautions and cleaning directions. The sterilization for cosmetic needling is not as strict as what is needed for longer needle rollers.
In general, the recommendations are as follows. Shower or wash the skin that will be treated. Sterilize the work area, i.e. the table or counter, by wiping it down with antiseptic alcohol. Wipe down your hands and the skin that will be needled with alcohol and allow to air-dry before needling. After the treatment, rinse the skin with water only, air dry, and apply an occlusive ointment.
Sterilizing the roller after needling is extremely important if you intend to reuse it. If you are getting the treatment done professionally, the needling tools are only used one time and most will say on the label that they are approved for a single use only. If you can afford to purchase a new roller for every treatment, that is ideal, but most people doing this at home sterilize and reuse the rollers until they are too blunt to be effective. Do not use boiling water, fire, or an autoclave as this can blunt the needles and cause them to detach from the roller. To clean your roller, wash in hot (not boiling) water and dish soap, without touching the needles or using a cloth or sponge, then soak it in disinfecting alcohol for at least 20 minutes. Take great care not to bend the needles, but they can rest on the bottom of a glass container if they are placed in gently. The alcohol should completely cover the needles and be discarded after use. Air dry completely and put pack into original container. Do not wash the container with a sponge, but you can rinse it with hot water or alcohol. This will not sterilize your roller completely like it was when it first arrived, but if done properly, it will minimize the risk of infection.