Microneedling also known as Collagen Induction Therapy, is a skin rejuvenation procedure that involves puncturing the skin to stimulate natural regenerative mechanisms. It involves the use of a microneedling device, a tool that creates micro injuries on the skin which then induces non-inflammatory wound healing in the treated skin. It activates the release of cytokines and molecules that communicate to induce skin cell proliferation and differentiation, neoangiogenesis and collagen formation. Biopsies of the treated sites showed an epidermal thickening and increased collagen deposition in a normal woven pattern. Collagen and elastin are crucial components of connective tissues that keep the skin smooth, firm, and blemish-free. Microneedling is mainly implemented on the face region but may also be used in various parts that have scars or stretch marks. Microneedling greatly enhances the skin’s absorbing abilities as it allows the entry of nutrients directly into the vascularized layer of the skin.
Microneedling appears to be an overall effective and safe therapeutic option for numerous skin conditions. It is crucial to remember that effectiveness mostly depends on the device used, appropriate pressure, speed, and needle depth for the skin quality and thickness of the area being treated. The treatment parameters must be adjusted to individual characteristics guided by experience and knowledge of the practitioner.
Histological analyses of treated skin have shown a significant increase in collagen deposition at 6 months as well as a 40% increase of the epidermis thickness. Summarizing the results of clinical studies patients can expect on average 10-15 % reduction in acne scar severity after each session separated 6-8 weeks apart. Accordingly several sessions are necessary to achieve acceptable outcomes. Similar effectiveness can be expected after treating the signs of ageing like fine lines and wrinkles.The effectiveness of microneedling procedure can however be augmented by transdermal delivery of substances, such as topical vitamins, peptides, growth factors, and other active ingredients, applied during or immediately after the treatment.
There is minimal pain when undergoing a microneedling session. Depending on the depth of needle penetration, treatment area and pain tolerance topical anesthetic is applied 15-20 min prior to treatment.
Clinical studies demonstrated microneedling efficacy and safety for the treatment of scars, acne, melasma, photodamage, skin rejuvenation and alopecia. Microneedling addresses a myriad of skin problems for both men and women. It is being used to:
Diminish the appearance of scars and stretch marksSlow down the signs of skin aging as evidenced by reduced fine lines and wrinklesImprove the texture and overall appearance of the skinReduce pore size resulting in smoother skinHelp in stopping acne and cystic acne progression.
You will notice an improvement on the appearance and texture of the skin after one session. The long-term benefits however become noticeable 8 to 12 weeks after your initial procedure. For best results, one must undergo microneedling every 6 to 8 weeks. Period in between allows for the skin to heal properly and for new skin cells to fill in the micro injuries created by the skin pen device.
The microneedling technique or device, effectiveness and side effects are closely related. Therefore effective and safe microneedling procedure should be done in a clinical setting by an experienced doctor or esthetician. There are a few reports of complications in the microneedling literature given its minimally invasive, superficial mechanism of action. Multiple treatment sessions using a 1.5-mm needle depth have shown to initiate collagen synthesis with no interference of the patient normal lifestyle. Increasing needle depth to greater depths (up to 3 mm) has demonstrated improved results but with longer downtime and greater pain, bleeding, swelling, bruising, and erythema, edema and pain. Very rare cases of post-inflammatory hyperpigmentation. Microneedling can also cause eruption of cold sore (herpes simplex).
Patients experiencing any of the following active conditions should not proceed with microneedling procedure:
Microneedling devices applied to the skin create a controlled depth of microchannels, which close within minutes, during which time topical substances can be delivered and captured. Shortly after the microneedles penetrate the skin, platelets release chemotactic factors causing invasion of other platelets, neutrophils, and fibroblasts. The neutrophils are replaced and monocytes change into macrophages within the first 48 hours. Macrophages release numerous growth factors, including platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and transforming growth factor (TGF)-a and TGF-b, which stimulate the migration and proliferation of fibroblasts. In particular TGF-b1, TGF-b2, and TGF-b3 are involved in promoting scar collagen production and regeneration of normal collagen lattice structure and scarless healing. Keratinocyte-fibroblast interactions enhance the production of laminin and collagen types IV and VII at the level of an intact basement membrane. In the final stage of remodeling, fibroblasts continue to form and break down collagen in the upper dermis.
Prior to treatment, patients should avoid prolonged sun exposure or sunburns for at least 7 days to avoid excessive inflammation and injury. Topical products are discontinued 12 hours prior and the skin must be clean and free from cosmetic products. Any patient with active or resolving infection should have treatment delayed until resolution.
The skin is first cleaned with cleanser . Topical anesthetic is applied and left on the skin for 20 minutes prior to removal with disinfectant. Areas that are sensitive or require aggressive treatment, such as the upper lip, may benefit from local nerve blocks. A topical hyaluronic based gel is then layered on the skin as a lubricant, with the added benefit of being an active ingredient that is microinjected into the skin through microneedling action. Appropriate needle length and speed are chosen for the planned treatment area. Areas of thin skin overlying bony surfaces, such as the forehead, nasal, periocular, and upper lip area, require shorter needle lengths ranging from 0.25 mm to 0.5 mm. Patients with thicker skin or scarring can tolerate deeper needle lengths from 0.5 mm to 2 mm. Areas of thick skin, such as the face, chest, and trunk or with significant scarring, can be treated with depths up to 2.5 mm. Increasing speeds are used with longer needle lengths to help minimize discomfort. The method of needle application is user-dependent with the common endpoint of mild swelling, evenly spread erythema, and transient punctate bleeding. This is achieved by applying appropriate pressure, speed, and needle depth for the skin quality and thickness of the area being treated. Multiple passes over the same area in different vectors are recommended to avoid track marks. On completion, the skin is washed with sterile water to remove residual serum and debris. At this point, transdermal delivery of substances, such as topical vitamins, peptides, growth factors, and other active ingredients, can be immediately applied while microchannels are still patent. Multiple sessions are spaced at 1-2 months intervals to allow sufficient epidermal and dermal proliferation and to achieve the desired clinical effect.
Depending on the depth of penetration and number of passes there may be the feeling of a sunburn-like discom- fort for the first few hours post-treatment that can be treated with over-the-counter analgesics or an HA-based hydrating serum. Sunscreen and cosmetic products are to be avoided for at least 12 hours. The patient can return to work the next day although swelling may persist into the second or third day. Erythema and mild desquamation can last up to 5 days after which regular skin care, including tretinoin, can be restarted. By 1 week, patients can expect to be free of postprocedural side effects although they should avoid any alcohol, acid-based toners, and direct sun exposure for 2 weeks. Antiviral medication is indicated to prevent herpes simplex outbreak.
Surgical and non-surgical (chemical peels, injectables, skinboosters, skin tightening and microneedling) offer plastic surgeons a large number of modalities to combat facial aging. A thorough evaluation of patients as well as understanding the indications, risks, and limitations of each available procedure is essential for safe and effective treatment. Based on vast experience in most rejuvenating procedures dr. Zorman will honestly suggest the optimal treatment according to your personal needs and wishes.
With tremendous popularity in recent years inevitably the market became flooded with all sorts of microneedling devices. Ranging from derma rollers and gadgets for domestic use to sophisticated microneedling devices that can only be used by doctors in a clinical setting. Based on the same theoretical concept the techniques vary enormously in efficiency and safety. At our clinic we are using the Dermapen 4 microneedling device. With Dermapen 4 the depth of penetration is adjusted in increments of 500 microns, thereby reaching depths of up to 3mm. The adjustable high-speed motion of the 16 needles generates up to 1920 holes per minute establishing minimal pain and discomfort during treatment.
More information and results on the Dermapen 4 official website.