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Microneedling: Where do we stand now? A systematic review of the literature
Abstract and Figures
Background
Patients who suffer from scars or wrinkles have several therapeutic options to improve the appearance of their skin. The available treatment modalities that provide desirable results are often overtly invasive and entail a risk of undesirable adverse effects. Microneedling has recently emerged as a non-ablative alternative for treating patients who are concerned with the aesthetic changes that result from injury, disease or aging.
Objective
This review aims to evaluate the current evidence in the literature on microneedling.
Methods
A systematic literature review was performed by searching the electronic databases Pubmed and Google Scholar. The reviewed articles were analysed and compared on study design, treatment protocol, outcome parameters, efficacy measurement and results to evaluate the strength of the current evidence.
Results
Microneedling was investigated in experimental settings for its effects on atrophic acne scars, skin rejuvenation, hypertrophic scars, keloids, striae distentiae, androgenetic alopecia, melasma and acne vulgaris. Several clinical trials used randomisation and single-blindation to strengthen the validity of the study outcome. Microneedling showed significant results when used on its own and when combined with topical products or radiofrequency. When compared to other treatments, it showed similar results but was prefered due to minimal side-effects and shorter downtime.
Conclusion
This systematic review positions microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles. The current literature does show some methodological shortcomings and further research is required to truly establish microneedling as an evidence based therapeutic option for treating scars, wrinkles and other skin conditions.
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... This information can help optimize the preparation and application of nanofat in various medical and cosmetic procedures. Nanofat is composed of vascular stromal cells, including mesenchymal stromal cells (MSCs), along with a mixture of lipids, growth factors, and cytokines, with a high expression of CD34 and CD49d [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. It has been established that nanofat contains adipose-derived stem/stromal cells (ASCs), and its potential application in regenerative medicine has been the subject of numerous studies [19]. ...
... The punctate bleeding obtained indicates that the papillary dermis has been reached [15]. Through the activation of many growth factors, microneedling promotes the induction of percutaneous collagen [16]. It may be possible to maximize outcomes by combining nanofat's capacity for regeneration with the additional stimulation of collagen synthesis and scarless repair offered by microneedling [12]. ...
Nanofat is a relatively novel technique in fat grafting that has gained significant interest in the fields of regenerative medicine, aesthetic and translational research. It involves the extraction of autologous fat from a patient, which is then transformed into “nanofat”, consisting of small fat particles with a diameter of less than 0.1 mm and containing high concentrations of stem cells and growth factors. This article focuses on the use of nanofat in facial rejuvenation and its potential for lipomodelling. Fat tissue is a “stem cell depot” and nanofat contains many stem cells that can differentiate into various cell types. The Lipogem technology, developed in 2013, enables the isolation of nanofat with an intact perivascular structure, utilizing the high concentration of mesenchymal stromal cells near the pericytes of the adipose vascular system. Nowadays nanofat is used primarily for cosmetic purposes particularly in rejuvenating and improving the appearance of the skin, especially the face. Indeed, it has wide applicability; it can be used to treat fine lines, wrinkles, acne scars, sun-damaged skin, scar repair, and as an alopecia treatment. However, further studies are needed to assess the long-term efficacy and safety of this technique. In conclusion, nanofat is a safe and minimally invasive option for tissue regeneration with considerable therapeutic potential. This study reviews the application and effects of nanofat in regenerative medicine and facial cosmetic surgery.
... 14 Moreover, microneedling can be combined with other therapies, such as platelet-rich plasma (PRP) or radiofrequency, to enhance collagen formation. 15,16 Following treatment, patients experience improvement in pigmentation, rhytides, and scars compared to controls. 16 Microneedling is also performed by our LME. ...
Objective
To provide an overview of the various treatment options available in the clinic to achieve periorbital rejuvenation.
Data Sources
Literature review and expert opinion.
Conclusions
Periorbital rejuvenation in the clinic can be accomplished through a variety of treatment modalities, including topical therapies, skin resurfacing, and fillers and injectables. Furthermore, some surgical approaches, such as upper blepharoplasties, ptosis, and brow lifts, can be performed in the clinic under local anesthesia with only mild oral sedation. However, the successful execution of such procedures depends on proper patient selection and maximizing patient comfort.
... 6 Micro-needling has relatively few side effects compared to other cosmetic procedures such as ablative laser treatment or dermabrasion. 12 The importance of adequate post-procedural aftercare in cosmetic dermatology to prevent adverse events and optimize outcome is well documented. [13][14][15] However, it is not known to date whether topical wound healing agents after micro-needling treatment may influence the effectiveness of the procedure. ...
Purpose:
In vitro study on the molecular effects of post-treatment after micro-needling applications with a dexpanthenol-containing ointment (DCO) using 3D skin models.
Patients and methods:
In this in vitro study, full-thickness human 3D skin models were treated with a micro-needling device according to its clinical application. For post-treatment, some of the models were additionally treated with a dexpanthenol-containing ointment (DCO). Histological samples were taken at 0, 24 and 48 hours. Gene expression analysis was performed after 24 hours.
Results:
Histological examination showed that DCO post-treated 3D skin models revealed a completed wound closure 24 hours after the micro-needling procedure. In contrast, DCO-untreated models still clearly exhibited the micro-needling lesions after the same period of time. After 48 hours, all models revealed a completed wound healing. In skin models that received micro-needling but no post-treatment with DCO, microarray analysis identified an upregulation of proinflammatory cytokines and chemokines and a downregulation of skin barrier and differentiation markers. In contrast, post-treatment with DCO leads to accelerated wound healing without affecting the initial inflammatory response caused by micro-needling, which leads to the subsequent collagen expression. This data was supported by qRT-PCR analyses.
Conclusion:
Post-treatment with DCO accelerates epidermal wound healing after micro-needling of 3D skin models without impairing the immunostimulatory properties of micro-needling. These findings can help to optimise the aftercare routine after micro-needling procedures and to shorten the downtime for the patient after treatment.
Platelet-rich plasma (PRP) is prepared by using autologous blood plasma enriched with platelet. PRP has been proven to be a successful analog to correct blood loss during cardiac surgery and cardiothoracic bypass. Some authors have demonstrated bone regeneration following tooth extraction with healthy compact bone by using PRP. Typical protocols include either 1 or 2 centrifugation steps to separate whole blood into 3 layers: a top plasma layer, middle leukocyte layer, and bottom red blood cell layer, to collect a concentrate of platelets in plasma. The rationale for use and therapeutic potential of a high concentration of platelets is based on their capacity to supply and release supraphysiologic amounts of essential growth factors and cytokines from their alpha-granules to provide a regenerative stimulus that augments healing and promotes repair in tissues with low healing potential.
Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.
Backgroud:
Idiopathic guttate hypomelanosis (IGH) is a common skin disorder with no standard treatment.
Objective:
Assess the efficacy and safety of 5-fluorouracil (5FU) compared with saline, delivered using a tattoo machine, to repigment IGH lesions.
Methods:
This split-body randomized single-blinded trial recruited adults with symmetrical IGH lesions. A tattoo machine was used to deliver 5FU in IGH lesions of 1 limb and saline in the contralateral limb. Outcomes were the number of achromic lesions 30 days after treatment compared with baseline, patient satisfaction, and local or systemic adverse events.
Results:
Twenty-nine patients (28 women) were included. The median number of achromic lesions decreased significantly in 5FU-treated limbs (baseline: 32, interquartile range (IQR) 23-37 × post-treatment: 12, IQR 6-18, p = .000003) and saline-treated limbs (baseline: 31, IQR 24-43 × post-treatment: 21, IQR 16-31, p = .000006), but reduction was significantly more pronounced in 5FU-treated limbs (p = .00003). All participants were satisfied or very satisfied with results on 5FU-treated limbs. There were no adverse events.
Conclusion:
5-fluorouracil delivery using a tattoo machine was more effective than saline to repigment IGH lesions, with high patient satisfaction and no adverse events.Clinicaltrials.gov: NCT02904564.
Background: Approximately 9.4% of the global population is affected by the acne. It is one of the most prevalent types of disease around world. Acne scars are produced after a severe attack of acne. Objective: This comparative study was carried out to find the outcomes of two main acne treatments carried out by dermatologist. Study design: It is a randomized and controlled based study conducted at Dermatology department of Liaquat University of Medical and Health Science, Jamshoro and Sir Syed Medical College and Hospital Karachi for the duration of six months from February 2022 to July 2022. Material and Methods: The study comprised of a total of 120 patients, among them there are 49 males and 71 females, divided in three groups. Group 1 contains patients who experienced dermapen microneedling technique. EMLA cream was applied to the face of patients for 40-60 minutes and then microneedling was performed gently. Every 2 weeks microneedling session was carried out and a total of 6 sessions were given to the patients. Results: The patient’s response to the treatment given was also evaluated by using the standard global scar grading system. The three groups reported statistically significant results. Most of the patients reported about improvement in group 1 and 3, however in group 2, 31 patients showed no improvement. Conclusion: The use of microneedling is much more effective than glycolic acid peeling, but if both techniques are used in an alternative manner, it not only gives positive results but also makes skin healthy smooth and shiny. Keywords: Microneedling, glycolic acid chemical peel and acne scars.
Dr Paul Charlson discusses the use of radiofrequency microneedling for skin rejuvenation and addressing skin concerns
Objective:
To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids.
Materials and methods:
Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars' thickness, skin ultrasound, and modified Vancouver Scar Scale were performed.
Results:
Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel.
Conclusions:
In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.
Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling has no influence on repigmentation of large hypopigmented scars. The goal of this study is to evaluate whether two established methods - needling (for improvement of scar quality) and non-cultured autologous skin cell suspension (for repigmentation) - can be successfully combined. Twenty subjects with mean age of 33 years (6-60 years) with scars from deep second and third degree burns have been treated. The average treated surface area was 94cm(2) (15-250cm(2)) and was focused on prominent areas such as the face, neck, chest and arm. Percutaneous collagen induction or "medical needling" was performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, non-cultured autologous skin cell suspension (NCASCS) was produced and applied using the ReNovaCell Autologous Cell Harvesting Device (Avita Medical), according to the manufacturer's instructions. The patients were followed 12 months postoperatively. Pigmentation changes were measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference was also obtained. Taken together, the pigmentation ratings and objective measures indicate individual improvement in 17 of the study participants. The melanin increases seen 12 months after NCASCS treatment are statistically significant. Medical needling in combination with NCASCS shows promise for repigmentation of burn cars.
Background:
The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH).
Objective:
To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars.
Methods:
Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated.
Results:
Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group.
Conclusion:
This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.
Fractional microneedling radiofrequency (FMR) is one of the promising methods in acne treatment. Moreover, bipolar radiofrequency (BR) generates heat thereby which induces neocollagenosis. FMR may have the potential to be a safe and effective treatment for the patients both with acne and acne scar. This study was performed to compare the efficacy and safety of FMR and BR in acne and acne scar treatment. Furthermore, mechanism of the FMR treatment was investigated through skin tissues obtained from subjects. Twenty subjects with mild-to-moderate acne and acne scars were treated in a split-face manner with FMR and BR. Two sessions of treatment was done 4 weeks apart in a total 12-week prospective single-blind, randomized clinical trial. Clinical assessment and sebum measurement were carried out for the evaluation of efficacy and safety. Skin tissues were acquired for investigation of molecular changes. FMR was more effective for acne scar especially in icepick and boxcar scar compared to BR. Both inflammatory and non-inflammatory acne lesions decreased by 80 and 65 % in the FMR-treated side at the final visit of 12 weeks, respectively. FMR treatment resulted in significant reduction of sebum excretion. Both treatments showed no severe adverse effects other than erythema. The FMR showed superior efficacy in acne and acne scar compared with BR. Increased expression of TGFβ and collagen I and decreased expression of NF-κB, IL-8 are suggested to involve in the improvement of acne scar and acne lesion by FMR.
Introduction:
Skin aging occurs through both intrinsic and extrinsic processes. Fractional radiofrequency (RF) with a microneedling array is the newest form of fractional therapy to be useful in treating aging skin. The current study utilized a noninsulated fractional RF microneedling system.
Methods:
This multicenter clinical trial saw 49 patients complete 3 monthly treatments with the new fractional RF microneedling treatments and be followed for 3 months following their last treatment. Pain during treatment was recorded as well as overall improvement using a GAIS scale. Adverse events were also noted.
Results:
Forty-nine patients completed all of the treatments and follow-ups. Mild to moderate erythema were reported immediately after treatment which lasted up to 12 hours after the treatment. Pain, as measured on a 1-10 VAS, was noted to 4, on average. The average Fitzpatrick's wrinkle scale score at baseline was 5.04 ± 1.22, 1 month after 3 treatments 3.829 ± 1.69 and 3 months after 3 treatments 3.5 ± 1.66. These results are statistically highly significant (correlated T-test, P < 0.001). Improvement was shown in 100% of patients while 65% of patients had significant improvement (GAIS levels 3-5). Significant skin tightening and skin lifting were also observed. No unusual adverse events were noted throughout the course of the study.
Conclusion:
This multicenter study showed significant wrinkle reduction, skin tightening, and lifting of the mid and lower face with the noninsulated fractional RF microneedling system. Lasers Surg. Med. 2016 9999:1-7. © 2016 Wiley Periodicals, Inc.
Background and objectives:
Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae.
Methods:
Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO2 laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment.
Results:
Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO2-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement.
Conclusion:
The results support the use of microneedle therapy over CO2 lasers for striae treatment.
Platelet-rich plasma (PRP) contains autologous growth factors, which could act synergistically with growth factors induced by skin needling in order to enhance the wound-healing response. The combination of treatments, carried out by using skin needling and PRP application, should enhance both efficacy of skin needling and PRP application. The objective of this study is to establish the effectiveness of the combined use of skin needling and PRP application in acne scarring treatment. Twelve patients affected with rolling acne scars were enrolled. Each patient underwent 2 sessions of treatments, each consisting of skin needling followed by PRP application on the right side of the face and skin needling alone on the left side of the face. Digital photographs of all patients were taken. Photographic data were analyzed by using the Sign Test (α<.05). The study showed that the scars severity grade in all patients was greatly reduced on all of the face, but the improvement was more efficient on the side treated with both skin needling and PRP. Our study showed that the combined use of skin needling and PRP is more effective than skin needling alone in improving acne scars.
Objective To compare the efficacy and safety of dermaroller treatment with that of TCA CROSS in acne scars. Methods We selected thirty patients of atrophic acne scars for the study. Group I patients underwent four sessions of dermaroller therapy four weeks apart. Group II were treated with four sessions of TCA CROSS technique four weeks apart. Results After four sessions of dermaroller and TCA CROSS each, marked improvement was seen in 40% patients in the dermaroller group and in 60% patients in the CROSS group. Moderate improvement was seen in 40% patients in dermaroller group and in 26.6% patients in the CROSS group and mild improvement was seen in 20% patients in dermaroller group and 13.3% patients in the CROSS group. Side effects were mild and infrequent in both groups. Conclusion Both treatments are equally effective and safe for the treatment of acne scars.