If you have had microneedling before and felt the results were underwhelming, there is usually a straightforward reason. What this treatment can achieve depends almost entirely on how deep the needles go and what is applied during the treatment. Both of those things are determined by who is performing it.
Microneedling stimulates collagen by creating controlled micro-injuries in the dermis. The repair response that follows produces new collagen, improves texture, and over a course of sessions creates meaningful change in skin quality. The evidence for this is solid.
The catch is that this response only begins once the needle reaches the dermis, which starts at around 0.5mm below the skin surface. Above that threshold is where results become clinically meaningful. For more aggressive remodelling, such as deep folds or scarring, depths of 0.8mm and above are where the real structural work happens.
In the UK, Health Education England recommends that practitioners working up to 0.5mm hold a Level 4 qualification. That is the most common entry point for beauty therapists offering microneedling. A medical practitioner is not bound by those restrictions and can work significantly deeper, guided by anatomy, clinical judgement, and the individual in front of them.
To understand why this matters, here is how the main approaches compare in terms of what they stimulate:
Clinical studies comparing microneedling with and without exosomes consistently show superior outcomes across skin texture, elasticity, hydration, and collagen density when exosomes are added. The advantage is well supported in split-face trials and a 2025 systematic review, though the field continues to develop and larger long-term studies are ongoing.
I use medical-grade microneedling combined with XO Nature exosomes, a plant-based product derived from Red Root Gromwell stem cells, containing 36 billion exosome particles per vial, rich in growth factors, miRNAs, and peptides. I apply the exosomes during the treatment, using the solution as a medium while needling. Absorption is at its highest while the micro-channels are being actively created, and that is when the exosomes should be going in.
I chose a plant-based product deliberately. There are exosome products derived from animal and human cell lines, and I wanted something I was confident in both ethically and clinically. XO Nature is produced using 3D cell culture technology for consistent potency and purity. It does not compromise on results.
The depth I work at is a clinical decision for each individual case. Facial skin varies in thickness across different zones and the appropriate depth for the cheek differs from the perioral area or the forehead. That calibration is not a dial turned to maximum. It is a considered choice made for each client, each session, and each area. After treatment I apply a ceramide-based barrier repair cream, which typically reduces redness and sensitivity to under 24 hours, and in some cases considerably less depending on the depth we have worked at.
This combination suits a wide range of skin quality concerns across the face, including texture, dullness, early laxity, and fine lines. I also use it as part of hair restoration programmes on the scalp, where deeper channel formation combined with exosome signalling supports follicle activity in a way that superficial needling cannot replicate. If hair restoration is relevant to you, I have written a detailed article on my three-pillar approach here.
It is also worth knowing that microneedling with exosomes is broadly comparable to polynucleotide treatments in its regenerative aims. The simplest way I can explain the difference: exosomes bring a large number of signalling workers communicating through many different pathways, while polynucleotides work through fewer pathways but with greater intensity per signal. For people who are not suitable for polynucleotide treatments, whether due to a fish or shellfish allergy or a preference to avoid injectables, medical microneedling with exosomes covers similar regenerative ground. I will go into that in more detail in a separate article.
I assess the skin before recommending anything. I want to understand what you have tried before, what your skin is actually doing, and whether this is the right programme for you. If it is not, I will say so directly and suggest an alternative.
Key things to know:
Where to begin
A consultation is the right starting point. I will assess your skin properly, tell you honestly whether this is the right programme, and outline what a realistic course looks like for you. Book at my Crystal Palace or Mayfair clinic via the website, or message me on WhatsApp: 07721 390017.