Microneedling
Microneedling is a relatively new minimally invasive procedure involving superficial and controlled puncturing of the skin by rolling with miniature fine needles. Microneedling was initially introduced for skin rejuvenation, but now it’s used for a wide range of indications, including acne scars, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. It is very safe for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. Traditionally, it’s used as a collagen induction therapy for facial scars and skin rejuvenation, but it is now widely used as a transdermal delivery system for therapeutic drugs and vaccines.
The standard medical dermaroller has a 12 cm long handle with a 2 x 2 cm wide drum-shaped cylinder at one end studded with 8 rows and 24 circular arrays of 192 fine microneedles, usually 0.5–3mm in length and 0.1–0.25 mm in diameter. The microneedles are synthesized by reactive ion etching techniques on silicon or medical-grade stainless steel and pre-sterilized by gamma irradiation. Rolling with the standard dermaroller over an area of skin for 15 times results in about 250 holes per square cm up to the papillary dermis depending on the pressure applied. Each pass produces 16 micro punctures in the stratum corneum per square cm without damaging the epidermis significantly.
Micro punctures are created using microneedles to produce a controlled skin injury without actually damaging the epidermis. The micro injuries lead to minimal superficial bleeding and set up a wound healing cascade with release of various growth factors such as platelet derived growth factor (PGF), transforming growth factor alpha and beta (TGF-𝛂 and TGF-𝜷 ), connective tissue activating protein, connective tissue growth factor, and fibroblast growth factor (FGF). The needles also break down the old hardened scar strands and allow it to revascularize. Neovascularization and neocollagenesis is initiated by the migration and proliferation of fibroblasts and laying down of intercellular matrix. Another proposed hypothesis explains that resting electrical membrane potential of cells is approximately -70 mV, and when needles come near the membrane, it increases quickly to -100mV, triggering increased cell activity and the release of various proteins, potassium, and growth factors from the cells into the exterior leading to the migration of fibroblasts to the site of injury, which causes collagen induction. The needles do not create a wound in a real sense, just fooling the cells in believing that the injury has occured.
Consumers can buy at-home microneedling rollers over the counter. But for best results, microneedling should be administered by a dermatologist using more advanced equipment. The dermatologist can adjust the device depth according to the area of the skin and deposit medication, such as topical tretinoin or vitamin C, deeper into the skin. At-home microneedling devices only superficially affect the skin, penetrating just the outer layer, the stratum corneum or epidermis and reaching 0.25 mm deep. Professional devices can go deeper (2 mm to 3 mm deep), reaching the dermis. Professional devices are also electrically powered and evenly pushes the microneedles into the skin. Home versions rely on manually rolling the barrel over the skin to create small punctures.
References:
Singh, A., & Yadav, S. (2016). Microneedling: Advances and Widening Horizons. Indian dermatology online journal. Retrieved March 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976400/
Yale Medicine. (2021, June 23). Microneedling. Yale Medicine. Retrieved March 21, 2022, from https://www.yalemedicine.org/conditions/microneedling
Microneedling is a relatively novel, safe and highly effective cosmetic procedure. While it was originally devised for the purpose of skin rejuvenation, its uses have significantly broadened to treat a variety of skin conditions, including post-traumatic/burn scars, acne scars, adequate drug delivery, stretch marks, etc. Throughout the past decade, many new innovations have enhanced the microneedling process, allowing for greater versatility and efficacy. An important concept to note is the difference between microneedling and microdermabrasion, as the two are often misconstrued as the same procedure: while both techniques aim to enhance the appearance and texture of skin, microdermabrasion does not involve the use of needles and only exfoliates the outermost layer of one’s skin. Microneedling, on the other hand, penetrates much deeper into the skin, making it potentially more effective in addressing underlying skin issues such as scars.
Prior to receiving microneedling procedures, it is important to consider who should and should not be receiving this treatment. For those who are concerned about enlarged pores, wrinkles or fine lines, thin and wrinkled skin, or skin discoloration or uneven tone, microneedling may be an appropriate procedure for you. However, for patients who suffer from blood disorders, take anticoagulants, have cancer or are receiving chemotherapy, suffer from frequent skin rashes or keloids, or have skin conditions such as eczema or psoriasis, microneedling may not be the safest option and a healthcare provider should always be consulted prior to initiation of treatment.
Now what actually is microneedling? How is it done? The standard device used to perform microneedling is called the dermaroller. The conventional medical dermaroller consists of a handle measuring about 12 cm in length and possesses a drum-shaped cylinder on the other end, consisting of 8 rows and 24 circular arrays of 192 fine microneedles, typically ranging from 0.5 to 3 mm in length. Prior to use on a patient, the dermaroller is sterilized through gamma irradiation.
Using the microneedles on the dermaroller, micropunctures are induced, generating controlled skin injuries while still preserving the integrity of the epidermis (the most superficial layer of the skin). Although this may not sound beneficial, the micropunctures trigger a wound healing process and stimulates the release of many growth factors, including platelet-derived growth factor (PGF), connective tissue activating protein, connective tissue growth factor, fibroblast growth factor (FGF), etc. In addition to the release of the aforementioned growth factors, the microneedles also facilitate the breakdown of old scar tissue strands and promote revascularization, leading to the formation of new blood vessels and even new collagen. It is a quick, 10 to 20 minute, outpatient procedure, depending upon the treatment site. During the procedure, a topical anesthetic usually consisting of tetracaine or prilocaine is first applied. Then, the treatment site is prepared through the use of antiseptic and saline. Once the skin has been thoroughly prepared, the aesthetician will stretch the skin with one hand while using the other hand to roll over the skin in various directions about five times. After the procedure, the treatment area is often moistened with saline and depending upon patient necessity, ice packs may be applied to increase patient comfort. Sessions are spaced approximately 3 to 8 weeks apart and multiple sessions are necessary to achieve optimal results. In terms of cost for this treatment, it does vary and can range from anywhere between $200 to $700 per session. Often, people will need at least three to six sessions to achieve optimal results and therefore a patient may be spending about $600 to $4200 overall.
Approximately five days after the procedure, a fibronectin matrix develops which causes deposition of collagen and consequent skin tightening. Histological examinations on skin after four microneedling sessions actually show a significant increase in collagen and elastin deposition of about 400% within six months post-treatment. For aftercare post-microneedling, it is important to engage in basic hygiene to prevent infection and apply sunscreen daily. While your healthcare provider should provide instructions after treatment, which may be individually tailored depending on one’s skin type, there are general rules that should be followed. As a rule of thumb, sunscreen should be applied, and reapplied every 2 hours, for at least two weeks after the microneedling session. In addition to applying sunscreen frequently, patients should avoid prolonged sun exposure for the first week after treatment, as the skin is more susceptible to sun damage than usual. Lastly, in order to avoid infection, make sure to always wash your hands before you touch your face. Avoid applying makeup within the first 24 hours following the microneedling procedure. Additionally, avoid any swimming pools, saunas or environments where heavy sweating may be induced. After 72 hours post-treatment has passed, these activities may be resumed.
Resources:
Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J. 2016;7(4):244-254. doi:10.4103/2229-5178.185468
Microneedling: What it is, uses, benefits & results. Cleveland Clinic. May 23, 2022. Accessed April 17, 2024. https://my.clevelandclinic.org/health/treatments/23113-microneedling.
Microneedling. Yale Medicine. September 24, 2022. Accessed April 17, 2024. https://www.yalemedicine.org/conditions/microneedling#:~:text=Microneedling%20is%20used%20to%20treat,scars%20than%20on%20broader%20ones.
Cherney K. How Much Does Microneedling Cost, and What Factors Into It? Healthline. June 25, 2018. Accessed April 17, 2024. https://www.healthline.com/health/beauty-skin-care/microneedling-cost.
Watson K. How to Take Care of Your Skin After Microneedling. Healthline. May 22, 2023. Accessed April 17, 2024. https://www.healthline.com/health/beauty-skin-care/microneedling-aftercare.