The Efficacy of Combined Microneedling and Topical Poly-d,l-lactic Acid (Juvelook) Application for Facial Pore Reduction and Skin Texture Improvement

Abstract

Background:

Enlarged facial pores are a common cosmetic concern influenced by factors such as age, genetics, and increased sebaceous activity. Despite the availability of numerous treatment modalities, results are often variable, and many methods involve significant discomfort or a high number of sessions. This case series evaluated the efficacy of combining microneedling with the topical application of poly-d,l-lactic acid (PDLLA, Juvelook, VAIM Inc., Seoul, Korea) in reducing pore size and improving skin texture.

Methods:

Fifteen patients with enlarged facial pores underwent 3 sessions of microneedling with intradermal PDLLA injections spaced 3 weeks apart. Pore size was evaluated using a standardized visual grading scale, and improvements in skin texture were assessed through clinical photography. Patient satisfaction was measured using a 4-point Likert scale.

Results:

All patients demonstrated significant improvements, with pore size scores decreasing from an average of 6 (baseline) to 3 at 12 weeks (P < 0.001) and results maintained through 22 weeks. Skin texture showed noticeable enhancement, and 80% of patients reported high satisfaction levels. Mild transient erythema and edema were observed in some patients, resolving within 48 hours.

Conclusions:

Microneedling combined with topical PDLLA is a minimally invasive, effective treatment for pore reduction and skin texture improvement. Further research, including larger randomized controlled trials and advanced imaging technologies, is warranted to validate these findings and refine the treatment protocol.

Takeaways

Question: What is the effectiveness of combining microneedling with topical poly-d,l-lactic acid (PDLLA, Juvelook) application in reducing facial pore size and improving skin texture?

Findings: This case series involved 15 patients who underwent 3 sessions of microneedling combined with topical PDLLA application during a 9-week period. The study demonstrated a significant reduction in pore size and improvements in skin texture, with patient satisfaction remaining high at both 12 and 22 weeks posttreatment. No significant adverse events were reported.

Meaning: Combining microneedling with topical PDLLA is a minimally invasive, well-tolerated, and effective treatment option for reducing enlarged facial pores and enhancing overall skin texture.

INTRODUCTION

Enlarged facial pores, defined as visible dilations of pilosebaceous openings, are a prevalent aesthetic concern that can affect the perceived quality of the skin’s texture. Although the exact pathophysiology of pore enlargement is multifactorial, contributing factors include genetics, increased sebaceous gland activity, cumulative sun exposure, and age-related decline in skin elasticity.^1,2 The aging process, in particular, plays a significant role, as collagen and elastin levels decrease over time, leading to a loss of structural support around the pores and contributing to their more prominent appearance.²

Although enlarged pores pose no direct medical risks, they often lead individuals to seek cosmetic interventions aimed at improving skin smoothness and reducing the appearance of these visible openings. Various treatments, including topical retinoids, laser therapies, and chemical peels, have been used to manage pore size. These methods work by enhancing skin elasticity, regulating sebum production, or resurfacing the skin. However, these options can be associated with significant discomfort, require multiple sessions, and have variable efficacy, especially in individuals with darker skin types, where there is a higher risk of postinflammatory hyperpigmentation.^1,3,4

Poly-d,l-lactic acid (PDLLA), a biostimulatory filler, has gained attention as a collagen stimulator that promotes long-term improvements in skin quality by stimulating neocollagenesis.^5–8 When combined with microneedling, a minimally invasive procedure that uses controlled micro-injuries to boost collagen production, PDLLA can be effectively delivered into the dermis, enhancing its ability to reduce pore size and improve skin texture. Microneedling creates microchannels in the skin, facilitating deeper penetration of active agents such as PDLLA, which in turn stimulates collagen production, thus improving skin firmness and elasticity.^9–11 The purpose of this case series is to assess the efficacy of topical PDLLA application following microneedling in the treatment of enlarged facial pores and overall skin texture improvement.

MATERIALS AND METHODS

Study Design and Participants

This case series included 15 patients (10 women and 5 men), 30–55 years of age, presenting with visibly enlarged pores on their cheeks and nose. All patients had Fitzpatrick skin types III or IV and had not undergone any aesthetic treatments in the 3 months before the study. Exclusion criteria included pregnancy, hypersensitivity to PDLLA, active skin infections, and a history of keloid formation. Blinded evaluations of clinical photographs were conducted by independent dermatologists to ensure objective outcome assessments. Standardized clinical photography protocols were implemented to maintain consistent resolution, exposure, and patient positioning.

The study followed the principles of the Declaration of Helsinki. Informed consent was obtained from all participants after an explanation of the treatment process, risks, and benefits.

Treatment Protocol

Patients underwent 3 sessions of microneedling, each session spaced 3 weeks apart. A sterile Microneedle Therapy System with 0.5-mm needle length was used to create controlled micro-injuries in the areas of the skin with enlarged pores. Immediately following microneedling, 1 mL of Juvelook PDLLA solution was applied topically to the treated areas and left to absorb. (See Video [online], which displays microneedling with topical PDLLA [Juvelook, VAIM Inc., Seoul, Korea] application. A sterile 0.5-mm Microneedle Therapy System creates controlled micro-injuries in areas with enlarged pores, followed by the application of 1 mL of Juvelook PDLLA solution for absorption. The procedure was performed in 3 sessions, spaced 3 weeks apart, to enhance collagen stimulation and skin rejuvenation.)

Video 1: This video demonstrates microneedling with topical Juvelook PDLLA application. A sterile 0.5 mm Microneedle Therapy System creates controlled micro-injuries in areas with enlarged pores, followed by the application of 1 mL of Juvelook PDLLA solution for absorption. The procedure was performed in three sessions, spaced three weeks apart, to enhance collagen stimulation and skin rejuvenation.

Download video file ^{(61.6MB, mp4)}

Patients were advised to follow a posttreatment skincare regimen, including daily moisturizer and sunscreen use. Other aesthetic treatments were avoided during the study period.

Outcome Measures

The primary outcome, pore size, was evaluated using a pore grading scale ranging from 0 (no visible pores) to 6 (very large pores). Skin texture improvements were assessed through clinical photography at baseline, 12 weeks, and 22 weeks posttreatment. Patient satisfaction was measured using a 4-point Likert scale (0, not satisfied; 1, slightly satisfied; 2, satisfied; 3, very satisfied). Adverse events were monitored throughout the treatment period.

Statistical Analysis

Paired t tests were used to analyze changes in pore size and satisfaction scores between baseline and follow-up periods. Statistical significance was set at a P value less than 0.05.

RESULTS

Pore Size Reduction

All 15 patients demonstrated significant reductions in pore size. The mean baseline score was 6 (very large pores), which decreased to 3 (moderately sized pores) by the 12-week follow-up (P < 0.001). Improvements were sustained at the 22-week follow-up, indicating the durability of treatment effects. Representative before-and-after images are shown in Figures 1 and 2.

Fig. 1.

Before and after images of a 34-year-old woman treated with microneedling and topical application of PDLLA. A, The patient’s facial pores and skin texture at baseline, with visible, enlarged pores (pore grading score: 6). B, A significant reduction in pore size and an improvement in skin smoothness 22 weeks after the final treatment (pore grading score: 3). Images were taken using high-resolution digital photography under consistent lighting and positioning.

Fig. 2.

Before and after images of a 40-year-old woman treated with microneedling and topical PDLLA application. A, The patient’s facial pores before treatment, with visibly enlarged pores (pore grading score: 5). B, The reduction in pore size and improved skin texture 22 weeks posttreatment (pore grading score: 2). The images were captured using high-resolution digital photography, ensuring consistent lighting and angles for comparison.

Skin Texture Improvement

All patients reported improvements in skin texture, noting smoother and firmer skin. Clinical photography supported these findings, with high-resolution images showing a more refined skin surface and reduced pore visibility.

Patient Satisfaction

Patient satisfaction was high, with the majority of participants expressing a significant level of satisfaction with the treatment outcomes. At the 12-week follow-up, 12 patients rated their satisfaction as 3 (very satisfied), and the remaining 3 patients rated their satisfaction as 2 (satisfied). This trend was consistent at the 22-week follow-up (Tables 1, 2).

Table 1.

Pore Grading Scale for Evaluation of Pore Size

Pore Grading Scale	Description
0	No visible pores
1	Very faint, small pores
2	Small, barely noticeable pores
3	Moderately sized pores, visible at close range
4	Larger pores, visible at a distance
5	Very large pores, clearly visible

This table provides a description of the grading scale used for assessing pore size in the study, ranging from 0 (no visible pores) to 6 (very large, obvious pores).

Table 2.

Reduction in Pore Size and Patient Satisfaction at 12 and 22 Weeks Posttreatment

Participant	Pore Size (Baseline)	Pore Size (12 Wk)	Pore Size (22 Wk)	Patient Satisfaction (12 Wk)	Patient Satisfaction (22 Wk)
1	6	4	3	2	3
2	6	3	2	3	3
3	6	4	3	3	3
4	5	4	3	2	3
5	6	4	3	3	3
6	5	3	2	3	3
7	6	4	3	3	3
8	6	4	3	2	3
9	5	3	2	3	3
10	6	4	3	3	3
11	5	3	2	3	3
12	6	4	3	3	3
13	6	4	3	3	3
14	5	3	2	3	3
15	6	4	3	2	3

Adverse Events

The treatments were well tolerated by all patients. Mild erythema and transient edema were reported by most patients immediately following the procedure, resolving within 24–48 hours. Two patients experienced petechiae, which subsided within a few days. No severe adverse events, such as nodule formation or prolonged irritation, were reported.

DISCUSSION

The findings of this case series suggest that the combination of microneedling and the topical application of PDLLA is a promising and effective method for addressing enlarged facial pores and improving overall skin texture. The reduction in pore size observed across all patients is consistent with the collagen-stimulating properties of PDLLA, which promotes neocollagenesis and enhances the skin’s structural support. This process improves skin elasticity and firmness, which likely contributes to the reduction in pore visibility.^5,9,10,12,13 The role of microneedling in this combination treatment is also crucial, as the controlled micro-injuries created during the procedure facilitate the absorption of PDLLA into deeper layers of the skin. This synergy likely contributes to the sustained improvement in both pore size and skin texture observed in the patients.

When compared with traditional methods for treating enlarged pores, such as laser therapies and chemical peels, the combination of microneedling with topical PDLLA offers several distinct advantages. First, it is a minimally invasive procedure associated with minimal discomfort and downtime, making it an attractive option for individuals seeking effective nonsurgical treatments. Laser therapies, although effective, carry risks of postinflammatory hyperpigmentation, particularly in individuals with darker skin tones. These treatments often require multiple sessions to achieve optimal results, and the risk of adverse events such as redness, swelling, or pigmentation issues can limit their applicability.^14,15 Chemical peels, although widely used for resurfacing and improving skin texture, can cause significant irritation and peeling, which may not be suitable for all skin types, especially those prone to sensitivity.¹⁶ In contrast, the combination therapy in this case series demonstrated a high level of tolerability, with only mild, transient side effects reported, such as erythema and slight edema.

The high level of patient satisfaction further supports the potential of this combination therapy. The majority of participants expressed high satisfaction with the results, noting significant improvements in pore size and overall skin texture. Satisfaction scores remained consistent at the 22-week follow-up, suggesting durable outcomes. However, although patient-reported outcomes and clinical photography provide valuable insights, more objective measures are needed to fully capture the efficacy of this treatment. The reliance on subjective assessments is one of the key limitations of this study, as such methods may not capture the full extent of subtle changes in skin texture or pore size. Future studies should incorporate advanced imaging technologies, such as 3-dimensional imaging systems, to provide more precise, quantifiable data on skin changes. These systems can offer detailed mapping of the skin’s surface, allowing for a more comprehensive evaluation of treatment efficacy. Additionally, tools such as the skin surface analyzer could provide accurate measurements of pore size, whereas the Cutometer could assess skin elasticity, giving further insights into how treatments such as microneedling and PDLLA impact skin firmness over time.¹⁷

In addition to expanding the sample size and including control groups, future research should focus on optimizing the treatment protocol. This study used a 0.5-mm microneedling depth with sessions spaced 3 weeks apart. Although effective, variations in microneedling depth and the concentration of PDLLA may yield different or enhanced outcomes. Adjusting the needle depth could stimulate more robust collagen production or improve PDLLA delivery into the dermis, whereas altering the interval between sessions could influence the degree and duration of skin improvements. Future studies should also explore the combination of microneedling and PDLLA with other modalities, such as radiofrequency, platelet-rich plasma, or fractional lasers. Multimodal approaches that leverage the synergistic effects of these technologies could potentially amplify treatment outcomes by targeting multiple aspects of skin rejuvenation.

Another area for exploration is the durability of treatment effects. This study observed sustained improvements at the 22-week follow-up, but longer term studies are needed to determine how long the benefits persist and whether maintenance treatments are required. Understanding the longevity of collagen stimulation and pore size reduction would help refine recommendations for follow-up sessions or adjunctive treatments. Additionally, investigating how factors such as age, skin type, and baseline pore size influence treatment outcomes could provide insights into patient selection and personalized protocols.

Finally, advancements in imaging and documentation are critical for improving future studies on aesthetic outcomes. Although efforts were made to standardize clinical photography in this study, subtle differences in resolution and exposure may still influence the comparability of pre- and posttreatment images. Future research should adopt validated imaging tools and protocols, such as 3-dimensional imaging and elastography, to ensure reproducibility and reliability in documenting outcomes.

In conclusion, this case series demonstrated that the combination of microneedling and topical PDLLA is a safe, minimally invasive, and effective treatment for reducing enlarged pores and improving skin texture. Despite its limitations, this study provides a foundation for future research to refine and validate this treatment approach. By addressing key areas, such as advanced imaging, protocol optimization, and durability of results, further studies could establish this combination therapy as a mainstay in the management of enlarged pores and skin texture improvement.

CONCLUSIONS

Microneedling combined with topical PDLLA is a safe and effective treatment for reducing enlarged pores and improving skin texture. The minimally invasive nature of this protocol makes it an appealing alternative to traditional methods. Further research is needed to confirm these findings, optimize treatment parameters, and explore multimodal approaches.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

Informed consent was obtained from all participants, with full disclosure of the study’s purpose, risks, and confidentiality.

DECLARATION OF HELSINKI

This study was conducted in compliance with the principles set forth in the Declaration of Helsinki.