What’s the point in using needles?

Everyone has heard about the effectiveness of acupuncture needles in treating medical conditions but now in cosmetic medicine we are increasingly seeing the benefits of using needles to treat skin conditions including creating smoother and younger looking skin.

Skin needling is a minimally invasive non-surgical procedure that involves the insertion of small needles into the skin to cause small microscopic punctures. The traumatic channels created by the needling results in mechanical damage that activates the body’s natural healing response. In particular, the skin cells called fibroblasts are stimulated to produce more Collagen. Collagen plays a pivotal role in skin repair and is the main support protein in the skin and gives skin its fullness and elasticity.

In treating scars and wrinkles with needling, the principle is that by increasing the amount of collagen it will progressively smooth out the contour of the skin as the scars and wrinkles fill in from the bottom upwards to become closer to the level of the surrounding skin. The best results are achieved in patients who have a healthy lifestyle with a good immune system and are non-smokers.

The background of skin needling.

The practice of using a needle to treat skin problems is not new. One of the first doctors to describe skin needling as a scar treatment was the Swiss dermatologist Dr Philippe Simonin, who first published his findings in 1994. A South African plastic surgeon, Dr Desmond Fernandes in 1997, began to use a roller technique to deliver hundreds of punctures to cause bleeding and induce new collagen formation.

Skin needling is also called Collagen Induction Therapy (CIT) because of how effective it is in producing new Collagen or Scar Reduction Therapy (SRT) because one of the main uses is in treating scars. The term Microneedling Therapy is also used because the needles used are so small in thickness.

The main uses of skin needling.

The main uses of skin needling have been to improve depressed acne scars, rejuvenate skin texture and smooth fine lines and wrinkles. All skin types can be treated including dark skin and very sensitive skin.

One of the advantages of needling is that there is less damage to skin pigment cells (melanocytes) than with laser based treatments and hence a lower risk of causing skin pigmentation after treatment, which is especially important for patients with darker skin colour. Skin needling has also been used to treat stretchmarks, active acne and enlarged pores.

Another major use of skin needling that has gained popularity is the combination of skin needling and topical products to enhance the absorption and the effectiveness of skin products. Usually the main drawback on the effectiveness of skincare products is how well they can be absorbed through the outer epidermal layer of the skin, which can work as a barrier. Skin needling can enhance the absorption significantly by creating hundreds of tiny channels in the skin for the products applied to the surface of the skin to pass through and hence increase their efficacy. This is sometimes referred to as ‘Infusion Therapy’. Some studies suggest that certain topical products can penetrate up to 50-100 times better immediately after skin needling. Topicals that have been used in combination with skin needling include Hyaluronic acid, Vitamin C, Vitamin A, peptides and depigmenting creams (such as Hydroquinone).

Another treatment showing very promising results is the combination of Skin Needling and PRP (Platelet Rich Plasma). This is where a patient’s own blood is collected as for a blood test, spun in a centrifuge to separate the platelet portion of the blood and then applied to the skin during the needling procedure. The platelet portion of blood is very rich in natural growth factors and the needling allows these growth factors to penetrate into the skin and stimulate rejuvenation.

Skin needling has also been used in conjunction with other skin treatments such as Chemical peels to get better penetration of the peel, and before Photodynamic therapy of sun damaged skin to improve cure rates of skin cancers.

Skin needling devices.

Currently there are many skin needling devices available on the market. These range from devices designed for home use, to pen like devices used in beauty salons through to state of the art Radiofrequency needling machines used in cosmetic medical practices. It is important to realise that different devices mean different results.

Home needling kits are available that people use several times a week or even on a daily basis. These have shorter needles (typically 0.1- 0.2 mm) than those used in medical practices (up to 3.5 mm) and are designed to cause minimal trauma to the skin. Home use needling kits gently exfoliate the skin and allow for more effective application of topical products, they are not meant for collagen stimulation. Care needs to be taken if using home needling kits that the units are sterilised after use and are not shared with others. Great caution is advised if purchasing home use devices online as there are many copycat devices and also medical grade rollers that can be purchased online have the potential to cause skin damage and infection if not used correctly. Home kits are sometimes recommended to be used in combination with skin needling treatments performed in a clinic as part of a treatment plan.

In cosmetic medical clinics there are 2 main types of skin needling devices that are used.

  • The first type solely relies on the mechanical action of the needles to get their benefit. These devices include the DERMAPEN, the DERMASTAMP and various Dermarollers. The needles range in length with different lengths required to treat different areas of the skin.
  • The second type, in addition to the mechanical needling action, also heat up the skin through the delivery of Radiofrequency energy through the needles. These include devices such as the INFINI, SECRET, FRACTORA and PROFOUND. The Radiofrequency current creates targeted tissue heating deeper below the skin’s surface for greater collagen remodelling.

All medical grade skin needling treatments are best performed with topical anaesthetic cream to make the procedure quite tolerable. The anaesthetic cream is usually applied 30-60 minutes before treatment. The actual needling treatment takes about 30-60 minutes depending on the area being treated.

Skin needling after effects and results.

Skin needling is well tolerated with some initial reddening and swelling and then some scaling, redness and dryness that may last for several days. The skin may feel like mild sunburn especially if Radiofrequency has also been used. The downtime after treatment varies depending on the depth and intensity of needling which can range from gentle stimulation to significant bleeding and oozing. Usually expect to have about 48 hours downtime after skin needling but for very sensitive skin types and with more aggressive treatments, especially with Dermarollers, the recovery time can be 7-14 days.

Breathable makeup, such as Lycogel, can be used immediately after treatment and mineral makeup may be worn the day after treatment. Normal activities can be recommenced immediately but generally it is advisable to avoid excessive sweating (eg strenuous exercise, saunas) and swimming and spas for 48 hours.

The results from skin needling are not immediate and it can take about 2-3 months for the collagen remodelling to produce noticeable results. Some experts feel improvement may continue for up to 6-12 months after a treatment. The number of needling treatments depends on which device is being used, the condition being treated and the level of improvement being sought. Typically a series of treatments are needed initially and then in certain conditions such as skin rejuvenation patients may come in once a year to maintain results.

Skin needling is an exciting addition to the ever increasing range of treatments available in cosmetic medical clinics. The procedure is achieving great results, especially with acne scarring and skin rejuvenation, and has particular advantages over laser based treatments especially in darker skin types.

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