BACKGROUND:: In a random pattern skin flap, distal flap necrosis occurs as a result of inadequate blood flow. Microneedling with a handheld roller device is a new treatment modality, especially for facial rejuvenation. In this study, the authors used microneedling to increase flap viability. METHODS:: Forty adult male Sprague-Dawley rats were divided into two groups of 20. The study group was exposed to McFarlane flap elevation and repositioning. The microneedling procedure was performed four times: 3 days before, on the day of, and on the third and sixth days after surgery. The control group was only exposed to surgery. The skin flap necrosis area was measured on the seventh postoperative day topographically by digital imaging and scintigraphy. After determination of necrosis area, the amount of neovascularization and number of vascular structures within the papillary dermal layer were counted histopathologically. RESULTS:: The mean percentages of necrosis in the flap area as determined by the Digimizer analysis program were 37.51 ± 5.08 in the control group and 29.42 ± 7.37 in the study group. The mean percentages of flap necrosis of the control group and the study group as determined by radionuclide scintigraphy were 31.4 ± 4.1 and 22.8 ± 5.0, respectively. The comparison of flap necrosis percentages showed that the study group had significantly lower values (p < 0.001). Vessel counts in the study group also showed significant increase (p < 0.05). CONCLUSIONS:: The authors' study showed that the microneedling method applied directly on the flap could be a faster, safer, and more effective therapy modality to increase flap viability. © 2013 by the American Society of Plastic Surgeons.