• Cutis Clinic

Microneedling Treatments

Microneedling treatments has taken a leap forward over the last decade.  Microneedling essentially involves the use of needles that penetrate the upper layers of the skin known as the epidermis down to the dermal layers.  Microneedling can be used to treat acne scarring, rejuvenate old skin, repair collagen and decrease wrinkles.  Microneedling can also help with some forms of pigmentation and to improve skin texture and tone, in turn decreasing skin laxity.

Microneedling, however, is used as a loose term to describe skin needling, skin rolling, derma rollers, Dermapen, RF needling and even sub-ablative treatments.  This article will describe skin needling detail and to decrease the confusion in regard to this loose term.

Here are some facts- fractional rejuvenation is an umbrella term to describe treating portions of skin, whilst leaving normal skin intact. This term was first described over 15 years ago in the context of laser skin resurfacing. Since then, marketing via cosmetic clinics have extended this term of ‘fractional skin resurfacing’ to include all aspects of needling- from dermarollers, Dermapens, microneedling, microneedling with RF and even bipolar ‘sub-ablative RF’, in addition to all the true fractional laser resurfacing lasers from non-ablative Fraxel though to ablative CO2 and erbium lasers. Confusing isn’t it? Microneedling is thus a non laser method that can mean a $2 skin roller all the way to a $75,000 generation 4 insulated RF microneedling device. The power of marketing can advertise ‘Fractional skin resurfacing packages from as cheap as $120 for 6 sessions.’ Hopefully this article will clear the confusion of microneedling in the context of what is available in 2017. No doubt with time, more devices will be developed, with better capabilities- this is the future of aesthetic dermatology.

I categorise microneedling as four generations.

First Generation Microneedling 

The first generation of microneedling involved the use of the derma roller.  Essentially 256 or more needles arranged in a barrel which is then rolled on your skin.  These needles, are usually made out of titanium and range between 0.25 ml all the way to 4 mm.  This is a crude way of microneedling as rolling especially with larger size and longer size needles can tear skin and cause more trauma.  This was advocated for the treatment of acne scars together with collagen remodeling known as CIT or collagen induced therapy. Most first generation micro needling devices can be done at home with minimal costs. Skin rollers or derma rollers can be purchased from stores like eBay from $5 and work just as well as $50 derma rollers. The technique of derma rolling or micro needling is more important than the BRAND of the skin roller. Just remember- a safe depth is 0.25 mm. This depth is also endorsed by the American Academy of Aesthetic Medicine as a safe at home derma roller or skin needling depth.

In my opinion does this procedure still work? 

Yes it does, however, it has been replaced with newer generation devices.  Home needling or microneedling with derma roller can be safely conducted using the 0.25 mL roller; however, skin infection must be prevented after this if there is any bleeding.  This can certainly help with mild acne scarring and very fine wrinkles.  It can also improve skin texture. Using a 1 mm roller of more can often result in scaring from the procedure if not performed correctly. Microneedling using a roller does work, but using a vertical delivery system is essential for safety if needles extend beyond 5 mm in length.

Skin needling with a Dermaroller can be safely performed at home for depths up to 0.25 mm. For added safety, second generation micro needling devices are better. Third generation devices like the Intensif performed at Cutis Clinic would suit 90% of patients. Fourth generation devices are reserved for the operating theatres as most patients require sedation.

Second Generation Microneedling 

The second generation of microneedling came about with what is known as the Dermapen.  Other brands such as Eclipse followed.  This involves vertical delivery of needles at a very high rep rate.  Vertical delivery once again can be controlled from a 0.25 mm all the way down to 4 mm.  This form of microneedling often involved the use of gel and microneedles applied over the surface of the face.  Once again, this stimulates collagen and elastin and can help with acne scars together with skin rejuvenation.  The upside about this procedure compared to the first generation derma rollers is that trauma to the skin is less as needles are delivered vertically rather than at an acute angle whereby ripping of the skin may occur with longer needles.  The limit of this procedure is that the spring rate is often weak in cheaper devices, meaning that fibrotic and thick acne scars are not addressed.  This form of needling does not produce any heat, which means that collagen is not broken down to its fullest extent.  This is also known as collagen induced therapy generation two. This form of microneedling can be combined with PRP or platelet rich plasma. This is also known as the Vampire face lift. PRP is taken from the patients blood, and spun. Platelets contain clotting factors but also cytokines or growth factors that help stimulate collagen and elastin- this improves skin texture and tone. Combining vertical or Dermapen Microneedling with PRP provides a much better outcome, in addition to much quicker healing times compared to microneedling alone.

Energy based microneedling such as the Intensif used at Cutis Clinic or the Infini RF used by Dr Davin Lim can reduce acne scarring. Most acne scar patients will benefit from 3-6 microneedling sessions. 

Third Generation Microneedling Treatments

The third generation of devices came about within the last five years and were invented in Korea.  Generation one devices were known as non-insulated microneedling.  The energy delivery system is known as radio frequency, it delivers controlled heat via non insulated needles to depth of up to 4 mm.  There are many different devices that provide this form of RF microneedling including EndyMed Intensif as well as Secret RF.  These third generation microneedling devices provide additional collagen remodeling via denaturation of collagen and heat.  This causes a cascade of events to happen including the generation of what is known as heat shock protein which further improvements scar remodeling and collagen induction.  This heralds collagen induced therapy generation three. I particular like the EndyMed Instensif for fibrotic acne scars, as even though the energy level is not as good as the INFINI RF, the solenoid motor is more robust, and the energy delivery is more consistent. Cutis Clinic has access to generation one through to gen 3 Intensif RF treatments.

Fourth Generation Microneedling Treatments

The fourth generation of devices include Infini RF.  This is a unique form of microneedling treatments due to the fact that the needles are insulated.  49 gold plated insulated needles are delivered with each microneedling pass.  The depth can be controlled from between 0.25 all the way to 3.5 mm down to the skin level.  This helps to denature and breakdown stubborn acne scars by delivering a controlled burst of radio frequency energy.  Insulation itself protects the upper layers of the skin known as the epidermis and hence targets the lower dermal areas.  Infini microneedling can be used to treat acne scars but also improve skin texture and tone reducing wrinkles but also treating other forms of scarring including surgical scars as well as chickenpox scars.  Insulation plays an important role, especially if you are treating darker skin types. This form of skin needling treats skin at specific levels- with accuracy to within 0.05 of a mm. In most cases 2-3 levels are treated, depending on the skin condition. Fourth generation microneedling can treat skin conditions ranging from skin laxity, pore size, poor skin tone, acne scars and even sun damage. This treatment is best combined with PRP as it results in even better collagen stimulation and faster healing times. Even with a high setting, conduced on a Friday, patients are back at work on a Monday.

To conclude, I have done many studies on the use of platelet-rich plasma in combination with microneedling in a procedure called over and under.  If patients have open pores and acne scarring which are on the surface, microneedling either with the Intensif system or the Infini system is first performed.  Approximately 6,000 holes are present on the skin surface, PRP is then infused into the area and a mask is worn for half an hour.  This ensures that PRP is saturated into the lower areas of the dermis.  If patients have significant wrinkles and acne scars, I often perform PRP under as well as microneedling.  This technique involves the injection of the patient’s own platelets rich plasma underneath the skin in the dermal layer.  This can also stimulate further growth factors and collagen to ensure that the treatment is as effective as possible.

Microneedling itself has largely replaced fractional laser devices such as Fraxel and many other fractionated systems.  The reason being is that if we are dealing with dermal remodeling, we want to spare the upper part of the skin. Remember microneedling is to treat the deeper surfaces of the skin. If you have skin pigmentation issues such as melasma, sun damage, freckles and age spots, lasers are still the go to devices for these conditions. For 2018, I do expect to see many other devices with insulated needles that can deliver accurate microneedling to specific areas of the dermis thereby targeting different levels.  The future looks bright as devices are in development and a lot of research will be published within the next year or so.

So what is the role of dermarollers and Dermapen?

IMO there is still a role for dermarollers- there are no differences in cheaper eBay item that contain titanium needles and cost $10 compared to $40 rollers. Stick to the 0.25 mm at home rolling, once every 2 weeks. As for Dermapen, I think its outdated, yes, it can work, but so does an iphone 1- better technology developed over the past 2 decades have given us better, safer, more effective treatments with less downtime. Microneedling treatments have evolved a long way from crude devices like the Dermaroller through to the latest micro needling treatments such as INFINI RF.

How will I know if skin microneedling is the treatment of choice for me?

For a free consultation on skin care and to see if skin micro needling treatments is for you book in my therapist at Cutis Clinic. As a guide, the majority of patients with mild to moderate acne scars or mild laxity will suit Intensif RF. As a Consultant Specialist I only perform fourth generation treatments with INFINI RF and PRP- this is suitable for patients with moderate to severe atrophic and rolling acne scars. This procedure is conducted under sedation in an operating suite at Cutis Clinic.

Dr. Davin Lim

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