What is microneedling?
Microneedling, also called skin needling, collagen induction therapy (CIT), percutaneous collagen induction (PCI), or more commonly known as the dermarolling is a minimally invasive skin rejuvenation procedure that involves the use of a device that contains fine needles. Its claims and methods are perceived as simple, exciting, tempting and scary at the same time. Dermaroller has recently attained popularity because of media coverage and the fact that it can be used safely with minimal training. During the microneedling treatment, slim, fine needles push below the surface of the skin and cause what is called a micro-wound. When these wounds are created, the body’s natural defences are triggered and it begins to produce new skin cells, capillaries and collagen to repair the damage. This natural repair process caused by microneedling eventually leads to younger-looking skin which is also firmer and plumper. This is mainly the result of collagen growth of the collagen. The procedure is usually performed by a qualified skin care specialist in a clinical setting. The needles that are used for the treatment can vary in their size, length and construction, depending on the type and the intensity of treatment that is needed. There are many brands and manufacturers of microneedling tools on the market, including Innopen, dermarollers, Dermapen, Dermastamp and multiple other in-office and at-home devices. At-home devices usually have shorter needles and provide significantly less penetration and injury, and therefore may be less effective. Many individuals who want a younger-looking skin or who want to treat the imperfections on their face or other exposed skin are turning to this treatment because it has several advantages over other types of procedures that treat the same issues.
A brief history of microneedling
The earliest form of microneedling, acupuncture, traces its roots to the Chinese centuries ago. The important milestones in the development of microneedling are:
- Among the earliest proponents was Michael Pistor, the French doctor who is credited with having developed Mesotherapy in 1952.
- Dr Philippe Simonin, a Swiss French dermatologist, published the results of his Electroridopuncture (ERP) technique in 1994. His study examined 600 patients, split into two patient groups — Skin Ageing and Old Scars. After 10 treatments on all patients, 40% of the Skin Ageing group showed significant improvement and 22% moderate improvement. In the patient group with Old Scars, 60% improved with 5–6 treatments. The best results were obtained for old fibrous and depressed scars.
- Dr Des Fernandes, a plastic surgeon and founder of the Environ skin care range, introduced skin needling using a roller for treating wrinkles at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei in 1996.
- In 1997, Andrea Camirand, a Canadian surgeon, used tattoo-guns to treat scars caused by plastic surgery. He reported surprising improvement in texture and colour of facial scars after camouflage tattooing done on scars. The insertion of tattoo gun needles led to the breakdown of scar collagen tissue and stimulated the synthesis of new healthy collagen leading to improvement of scar texture. This microneedling technique soon disappeared from the operation rooms because it was tedious.
- The German inventor Professor Horst Liebl sought a new and considerably faster way of microneedling. He integrated nearly 200 non-traumatic micro needles of medical grade into a drum shaped device. Now the previous “static” needling was transformed into a “dynamic” needling process to treat larger skin areas in lesser time. He called his invention Dermaroller and patented and trademarked it in the year 2000.
- In 2006, Dr Des Fernandes developed Percutaneous Collagen Induction (PCI) therapy with the Dermaroller. Dermarollers gained popularity in the treatment of acne scars, stretch marks, and post-surgery scars.
How does microneedling work?
Microneedling relies on the principle that growth factors are released once the needle pierces the stratum corneum (the outermost layer of the epidermis). These growth factors are believed to be responsible for the treatment of various skin conditions. At a microscopic level, proliferated skin cells, such as fibroblasts, migrate to the point of injury and transform into collagen fibers, resulting in increased fiber strength and elasticity. This treatment improves your skin by increasing the production of collagen, facilitating natural repair and growth and making the skin stronger and thicker. The new collagen fills depressed scars and wrinkles from the bottom up, lifting the depression so they are level with the surrounding skin. This process takes two to three months to produce visible results, and can also help thicken thinner, fine skin types.
Microneedling leads to three major phases of natural wound healing which results in enhanced stimulation of new healthy skin:
Phase 1 (days 1–3) Inflammation
Activated by piercing the dermal tissue, platelets release cytokines and growth factors which act as signals for the body’s immune system. White blood cells (neutrophils and macrophages) are sent in to disinfect the wounds, clear the debris, increase the blood supply and begin the creation of fresh, new skin.
Phase 2 (days 3–5) Proliferation
In this phase, the fibroblasts, keratinocytes and epidermal cells continue to divide to populate the areas of damage and secrete growth factors and extracellular matrices, such as elastin and collagen, will be laid down and deposited with new tissue formation.
Phase 3 (days 6–30) Remodelling
During this phase, collagen and elastin producing fibroblasts proliferate in the puncture wounds formed by the microneedles and migrate. The collagen in the newly formed tissue is now replaced with even stronger collagen and the dermis contracts to create a youthful firm, but supple texture to the skin.
What are the most effective uses of microneedling?
Microneedling can be used to treat and improve the following skin conditions:
Wrinkles
Ageing skin droops and develops wrinkles, lines and furrows. The severity of these changes in an individual depends on the genetic tendency, skin type and exposure to environmental factors. Wrinkles occur when the skin loses suppleness and tightness as it ages. It is seen more commonly in areas of skin which are stretched regularly such as around the eyes (crow’s feet), forehead and mouth. By renewing the production of collagen the skin becomes plumped out, thicker and retains its elasticity.
Acne scars
A significant proportion of acne sufferers will have some form of scarring to show for it. Medical studies suggest that between 30% and 95% of patients with acne develop some form of scarring. Importantly, seeking early treatment for acne helps to reduce the risk and severity of acne scarring. Microneedling mechanically breakdowns existing scarring and stimulates the production of collagen and elastin, vital components of healthy skin. This has the effect of smoothing out the skin due to the reduction of the size and depth of acne scars. Clients usually have an immediate glow to the skin, but the visible changes develop over a course of several days and weeks. Results can continue to improve for up to 6 months after the treatment as collagen production continues. Not all acne scars are well suited to treated by microneedling. In particular, microneedling is not well suited to treat keloid scars as there is mixed evidence of its effectiveness. Keloid scars are formed when scar tissue forms on the skin in excess, because of excess collagen production. Individuals with keloids scars should consider alternative treatments such as the use of steroids.
Stretch marks
Stretch marks are caused by prolonged skin distension due to pregnancy and weight gain. It can also be caused by prolonged use of oral and topical corticosteroids which hinder the formation of collagen and elastin fibres. There is no effective treatment to correct stretch marks as the epidermis in stretch marks is weakened and the support structure beneath it is compromised. Microneedling will improve the density of the epidermis by stimulating the epidermal growth factor but it is important not to overpromise results.
Rosacea
Rosacea is most commonly seen after age 30, and may initially resemble a simple sunburn or a mysterious redness. Early treatment is key. Rosacea cannot be cured but it can be controlled. Microneedling can help control rosacea by stimulating the epidermal growth factor which increases the density of the epidermis. This lessens the appearance of vessels beneath the skin and the overall redness. It strengths collagen in both vessel walls and connective tissue that supports the vessels. It also increases the availability of cell nutrients and antioxidants.
Hair loss
Hair loss can be caused due to a variety of factors such as genetics, iron deficiency, infections (bacterial, fungal and parasitic) and hypothyroidism. Microneedling can help correct hair loss by increasing the availability of cell nutrients and stimulating blood flow in the scalp. It releases vascular endothelial growth factor which promotes hair growth and increases hair follicle size. Microneedling is primarily used in combination with topical products such as Minoxidil.
Pigmentation
Pigmentation occurs in two different forms — passive and inflammatory. Inflammatory pigmentation occurs as a result of the activation of our skin’s natural defence mechanisms. Melanin moves up to defend against trauma caused by factors such as sun exposure, poor products or injury. Passive pigmentation results from an internal imbalance which stimulates the melanin stimulating hormone. These imbalances can be caused by pregnancy, hormonal imbalances, the contraceptive pill and various medications. Microneedling can correct pigmentation by increasing the availability of skin lightening actives. It also normalizes the cell signalling function which when overstimulated, causes overproduction of pigment.
What are the benefits of microneedling?
Microneedling is becoming very popular treatment as it has a number of benefits:
- The microchannels created by microneedling increase the absorption rate of serums, increasing their overall efficacy. Medical studies have shown that microneedling can increase serum absorption by as much as 1,000 times.
- It can be performed on all skin types and most areas on the body.
- Microneedling can be combined with other acne scar treatments like subcision, chemical peeling, microdermabrasion and fractional resurfacing giving maximum benefits.
- It leads to regenerative healing, as opposed to cicatricial healing (with a risk of scar tissue formation) with most other alternative treatments.
- It is more affordable than laser resurfacing and does not have the associated risks. Six to ten sessions at a gap of four weeks are generally sufficient.
