Microneedling combined with biostimulators in the treatment of skin ageing and scars: a systematic review

The aim was to evaluate the available evidence on the efficacy and safety of microneedling combined with biostimulators and regenerative products in the treatment of skin ageing and atrophic dermal scars, taking into account clinical, instrumental and histological outcomes, patient satisfaction and adverse events. A systematic review was conducted in accordance with international guidelines for systematic reviews, involving searches in PubMed, Scopus, Web of Science, Embase, Cochrane and SciELO/LILACS for studies published between 2020 and 2026. Pre-established eligibility criteria were applied, and methodological quality and risk of bias were assessed according to the design of each study. Due to clinical and methodological heterogeneity, the results were synthesised using a narrative and qualitative approach, incorporating 12 studies. In most cases, the combination of microneedling with biostimulating agents showed favourable results compared with the treatments used in isolation; autologous platelet concentrates produced particularly favourable results in post-acne atrophic scars, whilst hyaluronic acid, poly-revitalising solutions, growth factors and exosomes demonstrated improvements in parameters related to skin ageing, such as texture, hydration, dermal density, pore size and radiance; adverse events were mainly localised, mild and transient, with no serious complications reported. It is concluded that combination therapy constitutes a well-tolerated alternative; however, methodological heterogeneity and the limitations of the available studies prevent the establishment of its universal superiority and warrant controlled research using standardised protocols and prolonged follow-up.