Blood flow and dermal architecture took center stage in our February 18 webinar, where board-certified dermatologist Dr. Aleta Simmons showed exactly how Corrective Microneedling™ can be used to strategically remodel acne scars—not just “stimulate collagen.” 

When Collagen Isn’t the Whole Story

If you treat acne scars, you already know this: some scars barely budge, even in compliant patients with “good” routines. In our recent webinar, “Corrective Microneedling™: Dermal Architecture & Acne Scar Correction”, guest speaker Dr. Aleta Simmons argued that the missing piece is how we think about where we’re working and what we’re actually asking the skin to do.

“Corrective microneedling is going to target several things in the skin, but I like to say it’s going straight to the dermis because that’s where the action is,” she explained.

Dermal Architecture: “We Like Boring Skin”

One of the most practical moments in the webinar was a simple reminder: normal skin is structurally boring—and that’s what you want. “In our normal skin… everything is organized and functional. But when we think about skin that’s been damaged in some way, especially for acne and acne scars, things are different,” Dr. Simmons said.

In acne scarring, she described a dermis that has literally changed its form:

• The dermis has shrunk in size.
• There are tethers and fibrotic bands pulling the surface down.
• In aging skin, “there may not be as many blood vessels there.”

Her point was clear: if you’re not thinking like an architect—volume, tethering, perfusion, elasticity—you’re probably not treating the real problem.

Perfusion Meets Scar Biology

Dr. Simmons put perfusion in clinical terms every microneedling provider can relate to. “When we think about acne scars… it does not get as muchblood flow as the rest of the skin because it doesn’t need it. It’s turned into a scar. It looks different. The skin is almost like forgetting about it,” she said.

The goal of Corrective Microneedling™ is to make the skin “remember” that area by creating a controlled wound. “We need to create a wound, and that’s what corrective microneedling does. It is controlled wound induction so that we can get to healing… to improve the look and feel of that scar.”

By re‑engaging the wound-healing cascade, you:

• Increase vascular delivery of oxygen to the scar base.
• Trigger cytokines and growth factors (including VEGF) to “promote more perfusion to the tissue.”
• Stimulate fibroblasts to rebuild collagen and elastin in a more functional pattern over time—not overnight.

“It works over time,” she reminded attendees. “That wound healing is going to happen over months. Not days or weeks.”

Not All Acne Scars Are Created—or Treated—Equally

One of the biggest takeaways for medical aesthetic professionals: Dr. Simmons does not teach that we should treat all acne scars the same way, and she is explicit about why.

Rolling scars: broad, tethered, perfusion-poor

“These scars are broad… there’s that tethering, the pulling down. If we can release that tether, we can improve the look of that scar.” For rolling scars, she favors:

• Moderate depth (you don’t have to go as deep as you might think).
• Higher density of passes.
• Full signature tracing pattern (vertical, horizontal, diagonal).

The strategy: disrupt fibrotic bands, restore microvascular flow, and recruit collagen and elastin back into the defect.

Boxcar scars: sharp-edged architecture problems

“Boxcar scars are going to have sharp edges. They almost look like somebody drew the scar on,” she said. The priorities here:

• Soften those sharp, well-demarcated edges.
• Use uniform penetration for controlled inflammation.
• Emphasize deeper passes than rolling scars—without overdoing it.

Following established protocol “…helps us not to overtreat or undertreat patients,” Dr. Simmons emphasized.

Ice pick scars: when microneedling isn’t the hero

“Ice pick scars are some of the most common that I see… more narrow and deeper, which can cause a treatment conundrum,” she noted. For these, she is blunt: microneedling alone is often not enough.

• If a scar is <2 mm, “microneedling may not show the improvement that you want.”
• She pairs Corrective Microneedling™ with TCA CROSS, punch techniques, and sometimes lasers.
• After combination therapy has made the scars shallower, she uses microneedling for global texture and remodeling, then “what’s left over… you can just punch them out.”

This kind of honest, algorithmic thinking is exactly what sets Corrective Microneedling™ apart from “one-size-fits-all” devices.

Corrective, Not Crisis Care

One line from the webinar that many attendees wrote down: “Microneedling is corrective, not crisis care.” For Dr. Simmons, that means:

• No crisis microneedling over active, inflamed acne. “We don’t want to spread bacteria, we don’t want to increase that inflammation,” especially in darker skin types where PIH risk is high.
• Acne control first, then scars and pigment. She wants to see decreased lesions, quieter inflammation, and some barrier recovery before picking up the pen.

And she is very direct about expectations: “Scars are something that we carry with us for a very long time… people think I’m going to just do one or two sessions and I’m going to be done. But I always set expectations.” For moderate scarring and hyperpigmentation, she often recommends a series of six sessions, spaced about once a month, with visible improvements evolving over six to eight months.

Technique That Respects Anatomy

For the technique‑obsessed, Dr. Simmons delivered plenty of nuance:

• She constantly visualizes where she is in the skin: “When I’m doing treatments, I’m always visualizing where I am in the skin [layer], and that’s going be different depending on where you are on the face.”
• Depth is based on zone and thickness, not diagnosis: “When we think about depth, we’re not thinking about the diagnosis. We’re thinking about where we are on the face.”
  • Forehead: more conservative depth
  • Cheeks: can range up toward medium to medium-high depending on patient and protocol.
• Hand Speed is intentional: she coaches providers to move the hand at about one inch per second and literally counts, “one one‑thousand, two one‑thousand, three one‑thousand,” to keep tracing controlled and consistent.

Her bottom line: “If you don’t have a great familiarity with the skin layers and you can’t visualize where you are in the skin, start conservatively and monitor your patient’s responses… think about the anatomy and physiology while you’re doing it to get the best results.”

Why This Webinar Is Worth Your Time

For medical aesthetic professionals who want more than “before-and-after” slide

s, this replay offers:

• A clear, perfusion-centered framework for acne scars.
• Specific, scar-type-based strategies you can bring into consults tomorrow.
• Realistic timelines and language you can use to align patient expectations with biology.
• Technique pearls that help you use the MDPen Ultra as a corrective tool, not just a collagen stimulator.

If you’re ready to move beyond generic microneedling and start thinking architecturally—about dermis, tethers, vessels, and wound timing—this is the session to watch next.