Microneedling is a new type of treatment performed in cosmetic dermatology practices with a wide range of applications. It is mainly used to treat scars, acne, stretch marks, wrinkles and for overall facial and skin rejuvenation.
Because microneedling is relatively cheap, simple to perform and with no downtime, it has gained popularity over the past 10 years.
The treatment is also known as percutaneous collagen induction therapy (CIT) or as dermarolling from the brand name of the tool used to perform this minimally invasive procedure.
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Microneedle rollers or derma-rollers
The Dermaroller is a cylinder with tiny needles protruding from its surface; the needles have a height between 0.5 and 1.5 mm. The cylinder is attached to a handle and it is free to spin and the tool is sterile and disposable. The microneedle roller is pushed over the skin to roll it over the treatment area.
How does microneedling work?
Microneedling creates thousands of tiny puncturing wounds in the epidermis (outermost layer of skin) and on the superficial part of the dermis layer, known as papillary dermis. These wounds cause some bleeding with release of platelets; the platelets and the inflammation trigger a natural healing response with release of growth and healing factors, while also stimulating the fibroblasts to produce more collagen and elastin. Needles also break down old collagen, which will be removed and replaced by new collagen fibers. Healing is over within the first 5 days after treatment, but tissues remodeling goes on for several months.
4 to 6 treatment sessions are usually advised in order to achieve good results and depending on the patient’s characteristics and expectations. Treatment sessions are spaced from 1 week to 1 month apart.
Indications of microneedling
Microneedling is indicated for skin rejuvenation in the early stages of facial aging and photodamage both to treat lines and wrinkles and to treat skin laxity; the face, neck, arms and all body areas can be treated. It is also indicated to treat scars and stretch marks, pigmentation issues and melasma, and in the treatment of hair loss as adjuvant therapy to minoxidil. Skin needling is also used to enhance topical drug delivery to the deeper levels of the skin.
Microneedling with PRP
To speed and boost the effects of microneedling, it is sometimes paired with platelet-rich plasma treatment (PRP). This cosmetic procedure is also known as “vampire facelift” and has been popularized by celebrities such as Kim Kardashian and Bar Rafaeli.
Microneedling with RF
Fractional radiofrequency microneedling (RFM) is a treatment performed with a special tool: an array of insulated microneedles delivers the radiofrequency energy directly into the dermal layer.
Radiofrequency works by producing RF energy that is converted into heat in the tissues. Heating starts from the epidermis, the outermost layer of the skin, and gets to the dermis, a deeper layer, with less energy. For optimal effects, the dermis should be heated to 65-70 °C (149-158 F°) but doing this with a classic radiofrequency device would cause burns and damage to the superficial skin. Radiofrequency microneedling delivers the energy directly into the dermal layer, allowing for the optimal heating temperature to be reached while sparing the superficial tissues.
The treatment is safe and minimally invasive with no downtime. It seems to be effective in the treatment of scars, acne and for skin rejuvenation.
Pen microneedling for the skin (Dermapen)
Pen microneedling works the same way as dermarolling, but it employs a different instrument. Instead of the rolling cylinder with needles, the practitioner uses a pen-shaped electronic instrument with fine needles on the tip side which are capable of moving vertically. The speed or frequency of the puncturing vertical motion as well as the depth can be set on the instrument.
Difference between devices: dermapen vs dermaroller
There are a few differences between pen microneedling and dermarolling:
- Dermapen needles enter the skin perpendicularly while Dermaroller needles enter at an angle and exit at a different one, causing more trauma.
- Dermapen makes more holes with a smaller diameter, while Dermaroller makes fewer larger holes.
- Dermapen seems to heal faster and cause less pain and discomfort.
In the end the choice of tool depends upon the preference and experience of the doctor performing the treatment as well as the location of the area to be treated and the indication for the treatment.
Microneedling at home
Microneedling devices sold to be used at home or at nonmedical SPAs are different than those used by certified physicians. They are duller and with shorter needles and do not puncture the skin deep enough to produce the desired effects like stimulating collagen production. They may be able to produce minimal and often temporary effects by stimulating the blood flow in the treated area.
Moreover, at home devices tend to be reused, but the needles become duller and duller after each treatment. They should also be thoroughly cleaned between uses and kept sterile to avoid the risk of infection and complications. For all these reasons, it is advised to seek this type of treatment only at clinics with qualified practitioners.
Microneedling for Acne and Acne scars
Nonablative radiofrequency microneedling or RF microneedling is a novel type of treatment for acne lesions and acne scars. This technique is thought to reduce the activity of the sebaceous glands while also remodeling the dermis thanks to the deep heating produced by the RF device. Microneedling for acne seems to be safer than other treatment modalities such as lasers, in particular for Fitzpatrick’s skin types IV-VI, and is able to achieve a reduction in both inflammatory and non-inflammatory lesions as well as a reduction in sebum production according to several studies.
When it comes to treating acne scars, microneedling may be also combined with PRP, radiofrequency, vitamin C, or glycolic acid peels.
Pre-treatment instructions for skin needling therapy
Generally, it is advised to not use certain topical products such as isotretinoin and other retinoids, chemical peeling agents, and exfoliants for a period of time preceding the microneedling treatment: this is done to avoid increased sensitivity. You may be asked to not use certain anti-inflammatory medications or to not use blood thinning medications as well.
Sun exposure should be avoided both before and after treatment. Laser, IPL, dermabrasion, waxing and other procedures should also be avoided.
Active infections, open wounds, inflammatory rosacea are a contraindication for treatment.
On the day of treatment your skin should be clean so do not wear make-up, sunscreen, creams or lotions or you should clean your face at the clinic once you arrive.
The doctor will apply a topical anesthetic and disinfect the skin before starting the treatment.
Ask your treatment provider for detailed instructions and pre-treatment tips.
Microneedling after care, risks and side effects
Microneedling is a safe procedure with no down time. Some redness is to be expected for a couple of days. Minimal bleeding during the treatment is also normal.
You may be asked to not use anti-inflammatory medications after the procedure as they may interfere with the healing process which is triggered on purpose by the procedure.
You may apply make-up from the day after the procedure, but you may be asked to avoid using some of the products in your usual skincare regimen. Other cosmeceutical ingredients such as vitamin A and vitamin C may be advised as they may help with healing and collagen production.
You should avoid sun exposure for about 4 weeks, and you should wear your sunscreen starting from the day after the procedure.
Due to the bleeding caused by the procedure, there may be some bruising as well. Some peeling or flaking of the skin may be normal for the first few days.
Your specialist will advise you more in detail.
Cost of microneedling
Price varies depending on the chosen doctor and clinic, the country where you are being treated and on how large the area to be treated is. Usually, clinics offer packages of 3-6 sessions at a discount.
- In the USA the cost of microneedling is 100-700 USD per session
- In Australia the price is 175-600 AUD (135-465 USD) per session.
- In Thailand treatments start from 2-3,000 THB up to 20,000 THB per session (70-670 USD).
Sources
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P André – CRC Press, 2016
ISBN 978-1-4822-0809-2 - International Textbook of Aesthetic Surgery
N Scuderi – Springer, 2016
ISBN 978-3-662-46599-8
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L Ramaut – Journal of Plastic Reconstructive and Aesthetic Surgery, Jan 2018
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