Neck surgeries often leave anterior neck scars, causing cosmetic and psychological issues. These scars are more exposed to mechanical stress and the environment, potentially leading to hypertrophy, dyschromia, and scar widening. Traditionally, surgical scar interventions have been postponed until full scar maturation, usually between six and 12 months after surgery, but recent evidence indicates that early microneedling may improve collagen remodelling and scar quality. While microneedling has been studied for facial and abdominal scars, its effectiveness on anterior neck scars remains unclear. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in several databases and registers. Eligible studies included randomised controlled trials (RCTs), cohort studies, and observational studies assessing microneedling as a standalone intervention for surgical scars, using validated scar assessment tools such as the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and the Global Aesthetic Improvement Scale (GAIS). Non-surgical scars, combination therapies, and animal studies were excluded. The database searches identified a total of 90 studies. After removing 13 duplicates, 77 studies underwent title and abstract screening, during which 68 were excluded due to irrelevance. The remaining nine articles were evaluated through full-text review; however, all nine articles were subsequently excluded for not meeting eligibility criteria. Ultimately, no studies specifically examining the effect of microneedling on anterior neck scars were eligible for inclusion. Although no direct studies on anterior neck scars exist, evidence from microneedling interventions on surgical scars in other body regions suggests potential benefits for anterior neck scars. Based on this indirect evidence, early intervention with three to six sessions at a depth of 1.0-1.5 mm may optimise scar outcomes. Further targeted research is required to confirm these findings and potentially establish microneedling as a standard management approach for scars following neck surgery.