Microneedling

MICRONEEDLING

       Microneedling is a popular cosmetic procedure used to help tone, tighten, and smooth the skin. This can reduce scars, wrinkles, and acne. Microneedling is named after the micron size of its needle, they vary from 10–2000 μm in height and 10–50 μm width. The depth of the needle varies based on the different parts of the body being performed on. The most common location microneedling is done is on the face. However, patients can receive treatment on their back, thighs, neck, and legs to reduce aging marks and stretch marks. The needle penetrates through the epidermis tissue, creating tiny holes in the upper skin layer. Multiple treatments are suggested for better and longer results.  These needles can be found on rollers, stampers, and pens. Microneedling has no effect on skin tones and different photo types, unlike laser, therefore it is preferred for patients with darker tones. In addition, microneedling is less expensive than lasers. The procedure lasts around half an hour and is usually performed by dermatologists, plastic surgeons, and/or cosmetic surgeons. When inserting the needle, collagen, and elastin production in the skin increases. This is the cause of improved skin elasticity, firmer skin, and reduction of wrinkles and fine lines. Other benefits include reduced hyperpigmentation, enlarged pores, stretch marks and increased hair growth in patients with alopecia. Radio-frequency micro-needling can also benefit hyperhidrosis by puncturing the skin and sending radio-frequency waves to the sweat glands to reduce sweating.  One of the earliest used and known microneedling tools was the Dermaroller. When the derma roller was used on acne scars, there was proof of reduced scarring. When used in addition to minoxidil, as a form of drug delivery, increased hair growth was shown in patients. 

          Different types of microneedles are solid microneedles, coated microneedles, dissolving microneedles, and hollow microneedles. Microneedling can be combined with radio frequency to help pass the epidermal surface. Treatments usually have minimal side effects with some patients experiencing redness, irritation, and bleeding for a few days. Treating with topical anesthesia can help with irritation. After the procedure, patients experienced pain, discomfort, erythema, and swelling. Patients allergic to nickel may experience allergic reactions from the needle. Signs of this include burning, hives, itching, and redness. In an effort to remain sanitized and safer, disposable needles can be used. This can decrease the spread of bacteria and the risk of infection. Patients with active skin conditions such as active acne, skin infections, moles, eczema, and psoriasis should not receive micro-needling. Patients taking anticoagulant medications should avoid microneedling due to the increased bleeding risk. 

            In conclusion, microneedling has been proven effective and safe for many people. it is noninvasive and inexpensive compared to other procedures. The best way to see if microneedling is safe for you is to consult with a board-certified dermatologist. To increase collagen production and skin elasticity, it is recommended to take Vitamin A and C in addition to micro-needling sessions. Wearing sunscreen and stopping the use of retinoids also increase the effects of micro needling.

Dana Alessa, Jason D. Bloom, Microneedling Options for Skin Rejuvenation, Including Non–temperature-controlled Fractional Microneedle Radiofrequency Treatments,

Facial Plastic Surgery Clinics of North America,28;1:1-7. ISSN 1064-7406,ISBN 9780323695961,

Juhasz MLW, Cohen JL. Microneedling for the Treatment of Scars: An Update for Clinicians. Clin Cosmet Investig Dermatol. 2020 Dec 22;13:997-1003. doi: 10.2147/CCID.S267192. PMID: 33376377; PMCID: PMC7764156.

Microneedling, also known as collagen induction therapy, is a popular cosmetic procedure that involves creating controlled micro-injuries on the skin's surface using tiny needles. This essay aims to explore the benefits and risks associated with microneedling, shedding light on its potential advantages for skin rejuvenation and addressing concerns related to safety and potential side effects.

Microneedling stimulates the production of collagen, a protein responsible for maintaining skin elasticity and firmness. The controlled micro-injuries trigger the skin's natural healing response, leading to increased collagen synthesis. As a result, microneedling can help improve the appearance of fine lines, wrinkles, and scars, promoting a more youthful complexion. Microneedling has also shown promising results in reducing the appearance of scars, including acne scars and surgical scars. By promoting collagen remodeling, it helps to break down scar tissue and encourage the growth of new, healthier skin cells. Additionally, microneedling can aid in fading hyperpigmentation and dark spots, resulting in a more even skin tone. The tiny channels created during microneedling can also enhance the absorption of topical skincare products. When applied immediately after the procedure, serums, moisturizers, and other treatments penetrate deeper into the skin, maximizing their effectiveness. This allows for better delivery of active ingredients, enhancing the overall benefits of the skincare regimen. Lastly, microneedling is considered a minimally invasive procedure that can be performed in-office. Compared to more aggressive treatments like laser resurfacing or chemical peels, microneedling has a shorter recovery period. Most individuals experience mild redness and temporary sensitivity immediately after the procedure, which typically subsides within a few days.

Following microneedling, it is common to experience temporary skin redness, tenderness, and mild swelling. These side effects usually resolve on their own within a few days. However, individuals with sensitive skin may experience prolonged or more severe reactions, requiring additional care and follow-up with a skincare professional. Proper sterilization of microneedling devices is crucial to prevent the risk of infection. If the needles are not adequately cleaned and sterilized between treatments, there is a potential for bacterial or fungal growth, leading to skin infections. Choosing a reputable and experienced professional or dermatologist ensures the use of clean and sterilized instruments, minimizing the risk of infection. In some cases, microneedling may trigger post-inflammatory hyperpigmentation (PIH), especially in individuals with darker skin tones. PIH is characterized by the darkening of the skin in response to inflammation or injury. Adequate sun protection and diligent skincare practices can help minimize the risk of PIH.

Microneedling offers numerous potential benefits for skin rejuvenation and the improvement of various skin concerns. It can stimulate collagen production, reduce scarring, and enhance the absorption of skincare products. However, it is crucial to be aware of the potential risks and side effects associated with the procedure, such as skin irritation, infection, and the risk of post-inflammatory hyperpigmentation. While microneedling has shown significant benefits for many individuals, it is essential to set realistic expectations. Results can vary depending on factors such as the severity of the skin condition being treated, individual response, and adherence to post-treatment care. Some individuals may require multiple sessions to achieve desired outcomes.

Resources 

“Microneedling Devices: Getting to the Point on Benefits, Risks, Safety.” U.S. Food and Drug Administration, FDA, www.fda.gov/consumers/consumer-updates/microneedling-devices-getting-point-benefits-risks-and-safety. 

Microneedling

Microneedling is a minimally dermatologic invasive procedure in which the skin is punctured with the use of a rolling device containing miniature fine needles. It is traditionally used as collagen induction therapy for scars caused by acne, post-traumatic injuries, and burns, as well as for skin rejuvenation, hyperhidrosis, alopecia, and stretch marks; more recently, however, it also functions as a transdermal delivery system for therapeutic drugs and vaccines. A standard microneedling dermaroller has a drum-shaped cylinder with 8 rows and 24 arrays of 192 pointed protrusions and a 12 cm handle extending from the microneedling portion. The individual, single-use needles are 0.5-3 millimeter in length and 0.1-0.25 millimeter in diameter, and are made out of silicon or medical-grade stainless steel, and are pre-sterilized by gamma irradiation.

Light pressure is applied in a rolling motion onto the skin, producing controlled skin injury without damaging the epidermis. Superficial bleeding ensues, leading to a wound healing cascade that releases different types of 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). Further, the needles break down hardened scar strands, allowing the skin to revascularize. The process of neovascularization and neocollagenesis takes place as a result of fibroblasts migrating and proliferating to the epidermis. After 5 days of microneedling injury, a fibronectin matrix forms and collagen deposits, and the individual should expect skin tightening that lasts 5-7 years due to collagen III. To determine therapeutic efficacy of microneedling, a histological examination reveals up to 400% increase in collagen and elastin deposition at 6 months from 4 microneedling sessions performed 1 month apart. At 1 year post-operation, the stratum spinosum thickened with normal rete ridges. Further, the collagen fiber bundles have a normal lattice pattern instead of parallel bundles seen in scar tissue. Thus, microneedling is beneficial in promoting collagen and elastin production in those with scarred skin.

Another mechanism by which microneedling functions is upon the needles’ close proximity to the cell membrane, the cell’s resting electrical membrane potential of -70 mV goes to -100mV, triggering increased cell activity. The change in membrane potential initiates the release of proteins, potassium, and growth factors into the exterior, which lead to fibroblast migration to the site of injury and induces collagen production. Thus, the body is tricked into believing that there is injury which results in the aforementioned cellular processes. In terms of drug delivery, microneedling allows drugs to deposit directly to the vascularized dermis, surpassing the skin barrier and bypassing the stratum corneum. Evidence also shows that the follicular infundibulum widens by 47%, which increases drug penetration across the skin barrier. Drugs that can be transdermally delivered via microneedling include macromolecular biopharmaceuticals: insulin, heparin, albumin; immunobiologicals: hepatitis B, tetanus toxoid, and influenza vaccines; as well as aspirin, minoxidil, tretinoin, and L-ascorbic acid. For improved drug penetration, microneedling can also be combined with micropumps, sonophoresis, iontophoresis, and electroporation. In regards to microneedling for the treatment of alopecia, minoxidil and platelet-rich plasma are used.

Microneedling procedures usually last 10 to 20 minutes depending on the affected area of the skin and are performed in a dermatology office. Patient counseling on the procedure regarding expected outcomes, delayed response, etc. must be conducted. Before the procedure takes place, the patient’s skin must be prepped at least one month prior with vitamin A and C formulations twice a day in order to maximize collagen formation. It is found that vitamin A affects 400 to 1000 genes that control the proliferation and differentiation of epidermal and dermal cells, and hence aid in collagen production. Likewise, Vitamin C is a cofactor for prolyl hydroxylase and lysyl hydroxylase, which are enzymes that catalyze the hydroxylation of proline and lysine residues of procollagen thereby promoting the proper folding of collagen in its triple-helix conformation. To ensure a pain-free procedure, topical anesthesia containing a eutectic mixture of lignocaine and prilocaine/tetracaine is applied and let stand for 45 minutes to 1 hour. Antiseptic and saline is also applied thereafter. The skin is held taut as one hand rolls the instrument perpendicularly against the skin. Rolling is completed 5 times in horizontal, vertical, and oblique motions. Uniform pin-point bleeding is an expected endpoint of the procedure. After the procedure, the skin is dampened with saline. The patient is advised to apply ice packs to minimize stinging sensations and swelling, and to wear sunscreen daily. Each session is performed at 3-8 week intervals, with each session enhancing dermatologic outcomes. It is expected that the skin’s elasticity and scarring is improved 3-6 months after treatment discontinuation.

Microneedling is effective in collagen induction for individuals suffering from scars, hyperhidrosis, alopecia, and stretch marks, and is a transdermal drug delivery system for macromolecular biopharmaceuticals and immunobiologicals. It can improve aesthetic appearance and ultimately bring confidence in those who feel vulnerable with their skin conditions.

References

Singh, Aashim, and Savita Yadav. “Microneedling: Advances and Widening Horizons.” Indian Dermatology Online Journal, Aug. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4976400/#:~:text=Microneedling%20has%20been%20found%20to,the%20dermis%20at%201%20year.

Microneedling

Microneedling is a procedure to treat scars involving repetitive puncturing of the skin to disrupt the collagen connecting the scar tissue. When tissue is damaged, the body forms scar tissue including atrophic, hypertrophic, and keloid scars. Atrophic scars are commonly formed after inflammatory acne leaving indentations in the skin. This is due to a destruction of collagen and is permanent. The duration and severity of the acne, as well as a delay in therapy affects the formation of atrophic scars. A needle of 1 mm is most commonly used. Needles tend to be longer for treating scars and for thicker skin like around the nose. Shorter needles are used for aging skin and should also be used on thin skin like around the eyes. The needle punctures the stratum corneum, creating controlled injury with minimal damage to the epidermis. The small holes formed will promote collagen and elastin production in the lining of the dermal blood vessels. Studies have shown there is also upregulation of vascular epithelial growth factor (VEGF), fibroblast growth factor (FGF)-7, epidermal growth factor (EGF), and transforming growth factor (TGF)-β (Juhasz & Cohen). Neovascularization and neocollagenesis help to remodel the skin. After a few weeks, type III collagen that is newly formed turns into type I collagen, decreasing the appearance of scars.

Microneedling is indicated for pigment disorders, alopecia, acne scars, burn scars, hypertrophic scars, and primary axillary hyperhidrosis. Microneedling is contraindicated in patients with active acne or herpes infection, moderate or severe eczema or psoriasis, keloidal tendencies, immunocompromised patients, and it should not be used in areas that patients have received botox (Litchman, G. et al.). There are many advantages of this procedure over other skin procedures. The most important is that microneedling does not cause hyperpigmentation like laser procedures or chemical peels. This procedure causes less damage to the skin by maintaining the integrity of the epidermal layer.

A cross-sectional study conducted on 50 patients demonstrated the efficacy of microneedling for post acne scars. The patients underwent 4 procedures of microneedling every 3 weeks. 73% of patients showed downgrading from grade 4 to grade 2. In 20 patients that had grade 3 scars, 20% went to grade 1. Furthermore, all patients that had grade 2 scars downgraded to grade 1 (Farrukh, et al.). These results display how microneedling is significant in the treatment of post-acne scarring.

A study was conducted to determine whether microneedling combined with platelet-rich plasma worked better for acne scars rather than microneedling on its own. Platelet-rich plasma contains growth factors and bioactive cytokines (Kang & Lu). The study proved that there was increased efficacy when these procedures were used in combination. The results showed improved satisfaction of patients and better Goodmans Quality Scores (GQS) from dermatologists. There was also no difference in side effects like erythema or edema. There is a possible synergistic mechanism between these two procedures. The microwounds that are created during microneedling may provide enhanced absorption of the growth factors and cytokines by the skin (Kang & Lu). There is increased collagen and elastin deposition demonstrating a synergistic effect.

Acne and acne scarring can create psychological issues for many people. Microneedling is a way to change people's lives and improve confidence by eliminating scars. Studies have proven its efficacy in renewing the damaged skin.

Resources

Farrukh, A. K., Ahmad, S., Mehrose, M. Y., Saleem, M., Yousaf, M. A., Mujahid, A. M., Rehman, S. U., & Tarar, M. N. (2019). Efficacy Of Micro-Needling On Post Acne Scars. Journal of Ayub Medical College, Abbottabad : JAMC, 31(3), 336–339.

Iosifidis, C., & Goutos, I. (2019). Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature review. Scars, burns & healing, 5, 2059513119880301. https://doi.org/10.1177/2059513119880301

Juhasz, M. L. W., & Cohen, J. L. (2020). Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, cosmetic and investigational dermatology, 13, 997–1003. https://doi.org/10.2147/CCID.S267192

Kang, C., & Lu, D. (2022). Combined Effect of Microneedling and Platelet-Rich Plasma for the Treatment of Acne Scars: A Meta-Analysis. Frontiers in medicine, 8, 788754. https://doi.org/10.3389/fmed.2021.788754

Litchman, G., Nair, P. A., Badri, T., & Kelly, S. E. (2022). Microneedling. In StatPearls. StatPearls Publishing.

Sitohang, I. B. S., Sirait, S. A. P., & Suryanegara, J. (2021). Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials. International wound journal, 18(5), 577–585. https://doi.org/10.1111/iwj.13559

Written by Aleksandra Agranovich

Microneedling is a common technique that is frequently used by dermatologists to encourage collagen production. This treatment involves the use of small sterilized needles and a lot of skin surface area. Overtime, the pricking of the skin may cause some slight tissue injury, which in turn, will stimulate collagen production. Micro needling is mostly used on the face to correct acne scarring, dark spots, wrinkles, and large pores.

A microneedling session lasts around thirty minutes and is generally non-invasive. Some of the most common side effects of this technique include redness and irritation post procedure. Licensed physicians, nurse practitioners, and estheticians may be able to perform this technique with proper training. The cost of microneedling heavily depends on the specialist that you are visiting and is not usually covered by insurance.

According to the American Academy of Dermatology Association (AAD), the skin’s healing process after microneedling can help reduce the appearance of scars and dark spots as well as improve skin elasticity. In addition, some studies suggest that microneeedling can even improve hair growth in patients who have alopecia. The most common type of alopecia in men and women is referred to as androgenetic alopecia. Not only does microneedling induces collagen formation, but it also stimulates the production of hair growth factors and neovascularization. According to one study, microneedling can increase hair density, thickness, and quality-especially when combined with other treatments (Ocompo-Garza, 2020).

It is important to remember that microneedling might not work for everybody. Patients who have skin conditions such as psoriasis, eczema, or dermatitis should not consider this procedure due to skin irritation. In addition, patients who have active wounds and severe acne may have to wait until their condition clears up. After any type of microneedling procedure, it is very important to limit sun exposure, makeup, and acne product use. During the first week of recovery, dermatologist recommend staying hydrated, to avoid alcohol-based products, and to use a cooling mask or spray.

References

Ocampo-Garza SS, Fabbrocini G, Ocampo-Candiani J, Cinelli E, Villani A. Micro needling: A novel therapeutic approach for androgenetic alopecia, A Review of Literature. Dermatol Ther. 2020;33(6):e14267. doi:10.1111/dth.14267

Afzal AK, Ahmad S, Mehrose MY, et al. Efficacy Of Micro-Needling On Post Acne Scars. J Ayub Med Coll Abbottabad. 2019;31(3):336-339.

https://www.healthline.com/health/microneedling