Skin microneedling accelerates the process of skin regeneration through the creation of numerous microinjuries which emerge when skin is deeply punctured with very thin needles. The whole procedure evokes various reactions which can be divided into three major phases: inflammation, proliferation, and remodeling. It activates platelet growth factors which are responsible for the stimulation of fibroblasts to produce collagen and elastin. Moreover, skin breakdown enhances penetration of active ingredients. Treatment can be performed with the use of different devices, all equipped with needles of various lengths. Due to the fact that skin microneedling stimulates the synthesis of significant rebuilding and structural skin elements (collagen, elastin, proteoglycan), it is used in the treatment of many skin defects of different etiologies (e.g., photoaging, wrinkles, loss of elasticity, hypo- or hypertrophic scars, pigmentation changes, infraorbital dark circles, teleangiectasia, stretch marks, cellulite, alopecia, and vitiligo). In order to accelerate postsurgical regeneration and/or to enhance effects, microneedling is combined with the application of UV light (photodynamic therapy with ALA), LED light, platelet-rich plasma, chemical peels, stem cells, retinoids and other pharmaceuticals, and vitamins. High effectiveness, limited number of side effects, and short recovery time, make skin microneedling a popular cosmetic, and medical treatment.