Microneedling

Thank you for discussing the controversy around at-home microneedling kits.

Thank you, for reviewing the wound healing process.

           Microneedling

       Micro needling is a therapeutic technique that was initially introduced for skin rejuvenation; however, this technique is now used for a wide variety of indications including acne, scarring, alopecia, hyperhidrosis, and stretch marks among others. Micro needling is a minimally invasive [procedure that relies on creating superficial and controlled puncturing of the skin using miniature needles. The premise of creating micro-punctures without damaging the epidermis allows for triggering regeneration via the wound healing cascade. The important chemical mediators that are triggered and released include platelet derived growth factor (PDGF) and tumor necrosis factor alpha (TNFa), which promote neovascularization and neocollagenesis. Micro needling is also beneficial to improve the penetration of drug delivery through the epidermis into the deeper dermal layers (Singh A).

                  There are multiple clinical studies that assess the benefits of micro needling on various conditions. For acne scarring and burn scarring, micro needling monotherapy or in combination with chemical peeling provided improvement in the visual appearance and increases in collagen production. For hair growth, micro needling was used in combination with topical or oral pharmacotherapy, and all subjects in the studies had hair regrowth after treatment (Iriarte C).

                  There are at home systems that are available for patients that may be interested in trying micro needling for themselves instead of receiving treatments in a professional setting. However, at home systems may lead to more adverse effects, such as pain, redness, swelling, and skin peeling. When micro needling is performed by a trained professional in a professional setting, such as a dermatologist’s office, topical anesthetics are applied beforehand. Additionally, a trained professional using equipment may use techniques that minimize side effects. Additionally, there is controversy that at home devices, such as dermarollers, may be more harmful than beneficial because they can cause infections because they may not be properly sterilized after each use and that the microneedles may become dull and can cause skin ripping, causing scarring (Gowda A).  

                  The clinical benefits of micro needling allow for high rates of efficacy in treating a wide variety of conditions in a noninvasive manner. Depending on the condition and the severity, patients may need 4 to 8 sessions to achieve satisfactory results. Additionally, this technology is mainstream and available in multiple forms for at home use for patients that may prefer to perform their own treatments.

Citations:

Gowda A, Healey B, Ezaldein H, Merati M. A Systematic Review Examining the Potential Adverse Effects of Microneedling. J Clin Aesthet Dermatol. 2021;14(1):45-54.

Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A. Review of applications of microneedling in dermatology. Clin Cosmet Investig Dermatol. 2017;10:289-298. Published 2017 Aug 8. doi:10.2147/CCID.S142450

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 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.

Microneedling is a minimally invasive cosmetic treatment used on various skin conditions. Licensed providers and technicians use tiny, thin needles to gently puncture the top layer of the skin. Although a relatively new procedure, it has taken the beauty industry by storm due to its processing effects. Microneedling encourages collagen production as “damage” done to the skin stimulates the body’s healing process to produce new, smooth, firm skin. Many people microneedle their face, however, it can also be done on the back, legs, arms, neck, and other areas of damaged skin. This procedure can treat scars, enlarged pores, and wrinkles which leave many individuals self-conscious. The idea of needles may leave people fearful, however, due to the length of the needles, only the surface gets penetrated. This allows quicker recovery periods than most procedures and people may apply numbing cream beforehand to aid treatment recovery. The only major side effects are redness and swelling with their short duration of skin downtime. These “micro-injuries” stimulate the skin’s repair process, fading scars and tightening the skin. As we age, our collagen levels decrease, leaving us with loose, thin, wrinkled skin. With this procedure, we can see minimal results within four treatments, however, maintenance treatments are recommended. 

Micro-needling treats other conditions such as burns, stretch marks, surgical scars, alopecia, and even hyperhidrosis. It is effective in conditions that pertain to the outermost layer of the skin. For example, deep acne scars such as ‘boxcar scars’ show none to minimal efficacy. Along with treating surface-level scars, any hyperpigmentation present can also be lightened. If not used as a treatment, micro-needling can be used to enhance a treatment. The tiny holes created on the skin allow topical medications and products to better penetrate the skin. This is primarily seen when applying a hair growth topical such as minoxidil. It is recommended to use a derma-needle roller at home before application. At-home devices use finer and tinier needles to allow safe usage without a licensed provider present. Due to the smaller needle lengths, they are not as efficient when attempting to reduce fine lines and scars on the skin.

Besides redness and swelling, in rare cases, short-term skin flaking can be seen. Although ideally performed for reducing scars, micro-needling can cause scars if not performed correctly. It is also recommended to not wear any makeup for 48 hours and increased sunscreen application is advised. It is essential to have a consultation before this procedure as many individuals are not candidates for micro-needling. Oftentimes, people confuse the benefits seen in acne scars for potential benefits in acne. Micro-needling would exacerbate active breakouts and prolong inflammation. Other groups that are not ideal candidates are patients with eczema, psoriasis, cold sores, and blood disorders.

As this is a cosmetic procedure for medical conditions and aesthetic purposes, prices run between $200 to $800 per session. It is important to note that customers should not always settle for lower prices as many companies perform micro-needling without the required expertise and licensure. In very rare cases, insurances may cover certain procedures if doctors deem them medically necessary. This new procedure has come in line with other beauty trends that improve the quality of life of its consumers.

References

1. https://my.clevelandclinic.org/health/treatments/23113-microneedling

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976400/

3. https://www.medicalnewstoday.com/articles/324138

4. https://www.ncbi.nlm.nih.gov/books/NBK459344/

Micro needling is also known as percutaneous collagen induction therapy. It is performed using a handheld, drum or pen shaped device that is usually electrically powered with tiny needles that make precise, microscopic punctures to the skin. This process creates microinjuries that are not visible to the skin and does not leave scars. Essentially these microinjuries work by helping to stimulate the skin to repair itself naturally through a process called dermal remodeling. The main purpose is to produce collagen production. The production of collagen and elastin starts the skin process, creating firmer skin. It is a popular cosmetic procedure which is used to reduce scars, acne, and wrinkles. In addition, micro needling is used to aid with alopecia and skin rejuvenation.

Although often seen as just a beauty enhancing tool, micro needling does aid in the skin conditions of acne scarring, surgical scars, enlarged pores and burn scars. A major benefit to the use of micro needling to treat these conditions is that there is not heat involved in the process. Micro needling benefits over its counterparts such as laser treatments are in its more limited side effect profile. People with dark patches of skin on their face, melasma or hyperpigmentation can undergo micro needling without the possibility of worsening the pigmentation and discoloration of their skin. Micro needling in skin treatments continues as a form of better penetrating medications into the desired skin area. For instance, people who are using minoxidil for alopecia treatment of hair loss can micro needle prior to the application of the medication.

Although, micro needling has a better side effect profile than other treatment options, there are several issues that may be experienced. Most of these side effects are temporary and go away with time. Micro needling can cause short term swelling, redness, and skin flaking. The usual duration of these side effects are a few days post- procedure. Micro needling can worsen active acne outbreaks. Therefore, it is advised that you should not undergo the procedure until the inflammation of the outbreak is gone. It is also safe practice that once you finish micro needling, your skin will be more sensitive to sunlight, so sunscreen application is extremely important.

During the process of micro needling, often the skin will bleed. This is dependent on each situation, like the area being treated, the length of the needles, and the pressure being applied. Although the thought of bleeding during a procedure is not usually a good, in microneedle it shows the beginning of skin rejuvenation. When the microinjuries occur, the skin will then go into the healing process. This process includes the formation of epidermal growth factors, and fibroblast. This is the beginning of treating those unwanted hyperpigmentation and the creation of new collagen in the skin.

Micro needling is a procedure that is best done by a professional who is trained in administering this procedure. A lot of beauty stores carry over the counter versions of micro needling equipment. However, if not done properly skin damage can occur. In addition, the concern of proper sanitation is something that is a risk when done at home.

References:

Gowda, Asha et al. “A Systematic Review Examining the Potential Adverse Effects of Microneedling.” The Journal of clinical and aesthetic dermatology vol. 14,1 (2021): 45-54.

“Microneedling.” Yale Medicine, Yale Medicine, 24 Sept. 2022, www.yalemedicine.org/conditions/microneedling.

Microneedling is a minimally invasive medical treatment for the skin that is used in clinical and aesthetic dermatology. It is characterized by penetrating the dermis to a uniform depth, creating a controlled skin injury using instruments that contain rows of thin needles. The purpose of the controlled skin injury is to speed up the healing process of the skin by induces rapidly-healing micropunctures with subsequent stimulation of collagen and elastin fiber production, ultimately resulting in skin remodeling. Most people get microneedling on their face, but it can also be done on the legs, back, neck or other areas where there is damaged or aging skin. Multiple treatments are usually needed to achieve desired results.

Originally designed for skin rejuvenation, microneedling has expanded its applications to include treating various forms of scars, alopecias, drug delivery, hyperhidrosis, stretch marks, and more. In some cases, it is combined with the delivery of radiofrequency energy to enhance dermal remodeling and clinical effects. It is now a commonly used procedure in dermatology and viewed as safe and inexpensive in comparison to other forms of treatments for skin rejuvination. Some other pros are that it is generally well-tolerated with minimal downtime. However, strong evidence for the efficacy of microneedling is not evident in the literature.

To delve into the physiology of the collagen induction therapy, microscopic punctures are generated, inducing controlled skin injury without causing significant damage to the epidermis. These microinjuries result in minimal superficial bleeding, triggering a wound healing cascade that releases various growth factors, including platelet-derived growth factor, transforming growth factor alpha and beta, connective tissue-activating protein, connective tissue growth factor, and fibroblast growth factor. In scar treatment, the needles break down scar strands, facilitating revascularization. Fibroblasts migrate and proliferate, initiating neovascularization and neocollagenesis, along with the deposition of an intercellular matrix. Within 5 days of injury, a fibronectin matrix forms, determining collagen deposition that leads to skin tightening lasting 5 to 7 years in the form of collagen III. Neocollagenesis depth reaches 5 to 600 µm when a 1.5 mm needle is used. Histological examination of skin treated with four microneedling sessions one month apart reveals up to a 400% increase in collagen and elastin deposition at 6 months postoperatively, with a thickened stratum spinosum and normal rete ridges at 1 year postoperatively.

As previously mentioned, there are a multitude of indications for microneedling. These include pigmentary disorders, scars and striae such as androgenetic alopecia or alopecia areata, skin rejuvenation from acne scars, burn scars, traumatic scars, varicella scars, hypertrophic scars, and stretch marks, melasma, periorbital hypermelanosis, and primary axillary hyperhidrosis.

While microneedling is generally well tolerated, some contraindications for the procedure does exist and these include active inflamed acne lesions, active herpes or other infections such as warts, chronic skin conditions such as atopic dermatitis or psoriasis, or immunosuppressed patients. Common complications, although negligible, include pain during the procedure, erythema, irritation, and mild edema, and some less common ones are hyperpigmentation, reactivation of herpes simplex, localized superficial infections, and among more. While the procedure carries minimal risks and is straightforward, healthcare providers bear an ethical responsibility to apprise patients of the limited evidence regarding its effectiveness.

References:

https://my.clevelandclinic.org/health/treatments/23113-microneedling

https://www.aad.org/public/cosmetic/scars-stretch-marks/microneedling-fade-scars

https://www.ncbi.nlm.nih.gov/books/NBK459344/

A new dermatologic procedure for regenerating the skin through an outpatient visit has evolved in the medical world. This instrument contains rows of multiple needles, that are 1.5 mm in depth and puncture to the dermis by approximately 5-600 µm. The well-controlled micro punctures form a skin injury without damaging the epidermis leading to a pathway for rejuvenated skin. The purposeful micro-injuries create superficial bleeding that releases platelet-derived growth factors, transforming growth factor alpha and beta, connective tissue activating protein, connective tissue growth factor, and fibroblast growth factor. When treating scars, whether from burns, trauma, or striae distensae also known as stretch marks, the needles break down the scars allowing them to revascularize. Through migration and proliferation of fibroblasts, neovascularization and neocollagenesis is initiated for the production of new tissue and collagen. The fibronectin matrix forms within five days, resulting in tightened skin based on the deposition of collagen.

Like Botox, this procedure is used for cosmetic and medical purposes. Microneedling is a process for stimulation of collagen and fiber production to heal mild acne scars, wrinkles, stretch marks, skin discoloration, enlarged pores and hyperhidrosis. In some cases, healthcare providers use microneedling to deliver drugs. The medication in the instrument will puncture and bypass the stratum corneum to deposit the drug directly up to the vascularized dermis. 15 to 45 minutes prior to the treatment, a topical anesthetic is applied to avoid a pain-free experience. Lidocaine and prilocaine cream (EMLA) are preferred agents. An antiseptic is used right before the instrument comes in contact with the skin. During the procedure, the needles are glided on taught skin and in a direction perpendicular to the hand holding the skin.

In this 15–20-minute procedure, the real work begins with proper post-care and implementing an aftercare plan for two to four weeks. Combining vitamin A and C serums will enhance the regeneration process and produce better clinical outcomes. Patients can resume their daily activities after treatment, but care is warranted for optimal results. Avoiding sun exposure and harsh chemicals for at least one week is recommended as well as thorough application of sunscreen during the day. Patients should be aware that results vary based on their body's healing capabilities and neocollagenesis will continue for approximately 3 to 6 months after the treatment. In the discussion and final decision with the board-certified dermatologist, the patient can receive treatment again after a minimum of three weeks.

Compared to other skin rejuvenating treatments such as laser, mechanical resurfacing, or chemical, microneedling is safe and relatively inexpensive. Though it is well-tolerated and safe there are contraindications to this procedure. Patients who should avoid or consult with a board-certified dermatologist before receiving treatment, are those who have active acne, especially inflammatory lesions, moderate-to-severe chronic skin conditions such as eczema or psoriasis, immunosuppressed patients including those on chemotherapy, and patients who received botulinum toxin injections. Overall, mirconeedling is a new and innovative procedure for treating uneven and textured skin that a board-certified dermatologist can perform for specific skin concerns.

References:

Cleveland Clinic medical. “Microneedling: What It Is, Uses, Benefits & Results.” Cleveland Clinic, my.clevelandclinic.org/health/treatments/23113-microneedling.

Microneedling - StatPearls - NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK459344/.

“Microneedling Can Fade Scars, Uneven Skin Tone, and More.” American Academy of Dermatology, www.aad.org/public/cosmetic/scars-stretch-marks/microneedling-fade-scars.

Yu Feng Lin & Fawziya Twam

Microneedling is a cosmetic procedure using very tiny needles to puncture the skin creating micro-injuries. It is a popular cosmetic procedure which is used to reduce scars, acne and wrinkles. It is also used to assist with alopecia and skin rejuvenation. The original use for microneedling was skin rejuvenation. The main purpose of microneedling is collagen production. The punctures lead to collagen and elastin production. Through this, the skin starts the process to firmer skin with an increased elasticity. Firming the skin is one way a goal is achieved. When the goal is to reduce wrinkles, microneedling is a cosmetic procedure proven to work. 

The increase in collagen is what assists in the decrease of scars due to trauma or simple growth such as stretch marks. It helps the skin rejuvenate leading to a more even tone throughout the skin. Stretch marks are normally lighter than the skin, but microneedling can also assist with hyperpigmentation. 

Another use for microneedling is stimulating hair growth. Microneedling is commonly used to treat alopecia. During this procedure collagen alone is not enough. In such cases minoxidil and platelet-rich plasma are used. In combination hair growth is stimulated and alopecia can be treated. 

As stated in the name, the instrument, called a dermaroller, is made of micro needles. Dermarollers are generally made using a cylinder which is attached to a handle. On the cylinder which is normally around 2 cm long, there are rows of microneedles attached. Holding the handle, the dermatologist can then roll the cylinder along the skin, using the needles to create the tiny punctures. The dermaroller is used up to 15 times in the same area. This is with the intention of creating the punctures on to the skin while keeping the epidermis intact and without damaging the skin. 

In some instances microneedles are used to deliver drugs through the skin. On the dermaroller, different types of needles can be used. There are solid microneedles, coated microneedles, dissolving microneedles, hollow microneedles, as well as hydrogel-forming needles. Solid microneedles are used to simply puncture the skin. Its main use is to induce collagen and increase the elasticity of the skin. If it is wanted for a drug to be absorbed through the skin, it can be applied in the form of a patch afterwards. Hollow microneedles contain reservoirs in order to directly deliver the intended drug into the skin. One flaw in the process is that since the needles are so small and then made hollow, it is likely for the needles to bend under pressure and no drug is delivered. Coated microneedles is similar to using solid microneedles. The drug is applied directly to the needle hence the name. Dissolvable needles are made using the drug itself. The drug is in a nontoxic polymer and encapsulated in a way taking the shape of the needle. It is then delivered into the skin, where the polymer will break down and the drug will be absorbed. The main polymer that has been used in dissolvable microneedles is fibroin. It is a silk-based protein and has the ability to be molded in the desired shape of the microneedle. Hydrogel-forming needles are similar in idea to dissolvable needles. The drug is also enclosed in a polymer. The difference is that the microneedles are meant to penetrate deep enough to go past the stratum corneum and into the hydrogel system. 

Although microneedling isn't meant to damage the epidermis, in many cases superficial bleeding can and will be seen. This can depend on the area, the length of the needles as well as the amount of pressure applied while the procedure is being done. The bleeding however, is a good sign. This shows the start of the skin rejuvenation process. When these micro injuries form, the skin will then go into the healing process. During this process epidermal growth factor, fibroblast growth factor, transforming growth factor alpha and beta, as well as vascular epithelial growth factor all take place. Type III collagen is formed as a result of microneedling in the early stages. Since the punctures are so small the scars during healing are not harsh, but after a few weeks the type III collagen becomes type I collagen further reducing the appearance of scars on the epidermis. This process is what assists with hyperpigmentation, old scars and stretch marks. 

References:

Commissioner, O. of the. (n.d.). Microneedling devices: Getting to the point on benefits, risks, safety. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/microneedling-devices-getting-point-benefits-risks-and-safety 

Donnelly, R. F., Singh, T. R. R., Garland, M. J., Migalska, K., Majithiya, R., McCrudden, C. M., Kole, P. L., Mahmood, T. M. T., McCarthy, H. O., & Woolfson, A. D. (2012, December 5). Hydrogel-forming Microneedle arrays for enhanced transdermal drug delivery. Advanced functional materials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627464/ 

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