ArticlePDF AvailableLiterature Review

Microneedling: A Review and Practical Guide

Authors:
  • Washington Institute of Dermatologic Laser Surgery
  • McDaniel Institute of Anti-Aging Research

Abstract and Figures

Background: Microneedling is a relatively new treatment option in dermatology and has been touted for a broad range of applications including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery. The significant increase in minimally invasive procedures that has been reported over the past several years suggest that microneedling may occupy a specific niche for patients who desire measurable clinical results from treatments with little to no recovery. Objective: To review the published medical literature relating to microneedling in dermatology and provide a practical guide for its use in clinical practice. Materials and methods: A thorough literature search of microneedling in dermatology using PubMed was conducted, and all references pertaining to skin scarring and rejuvenation were reviewed. Based on the information presented in these publications and the authors' clinical experience, a microneedling technique is outlined for clinical practice. Pretreatment recommendations, intraoperative technique and treatment end points, and postoperative considerations are outlined. Results: Microneedling produces substantial clinical improvement of scars, striae, and rhytides with expedient recovery and limited side effects. Controlled dermal wounding and stimulation of the wound healing cascade enhances collagen production and is likely responsible for the clinical results obtained. Conclusion: Microneedling is a safe, minimally invasive, and effective esthetic treatment for several different dermatologic conditions including acne and other scars, rhytides, and striae. Given its expedient post-treatment recovery, limited side effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling.
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Microneedling: A Review and Practical Guide
Tina S. Alster, MD* and Paul M. Graham, DO
BACKGROUND Microneedling is a relatively new treatment option in dermatology and has been touted for
a broad range of applications including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia,
melasma, enlarged pores, and transdermal drug delivery. The significant increase in minimally invasive pro-
cedures that has been reported over the past several years suggest that microneedling may occupy a specific
niche for patients who desire measurable clinical results from treatments with little to no recovery.
OBJECTIVE To review the published medical literature relating to microneedling in dermatology and provide
a practical guide for its use in clinical practice.
MATERIALS AND METHODS A thorough literature search of microneedling in dermatology using PubMed
was conducted, and all references pertaining to skin scarring and rejuvenation were reviewed. Based on the
information presented in these publications and the authors’ clinical experience, a microneedling technique is
outlined for clinical practice. Pretreatment recommendations, intraoperative technique and treatment end
points, and postoperative considerations are outlined.
RESULTS Microneedling produces substantial clinical improvement of scars, striae, and rhytides with
expedient recovery and limited side effects. Controlled dermal wounding and stimulation of the wound healing
cascade enhances collagen production and is likely responsible for the clinical results obtained.
CONCLUSION Microneedling is a safe, minimally invasive, and effective esthetic treatment for several dif-
ferent dermatologic conditions including acne and other scars, rhytides, and striae. Given its expedient post-
treatment recovery, limited side effect profile, and significant clinical results, microneedling is a valuable
alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling.
The authors have indicated no significant interest with commercial supporters.
Microneedling, also known as percutaneous
collagen induction therapy, is a relatively new
treatment option in dermatology. Although laser skin
resurfacing has long been considered the treatment of
choice for photoaged and scarred skin,
1
microneedling
has recently been touted for a broad range of
applications including skin rejuvenation, acne scarring,
rhytides, surgical scars, dyschromia, melasma, enlarged
pores, and transdermal drug delivery. The reported high
efcacy, safety, and minimal post-treatment recovery
rates associated with microneedling have increased
patient satisfaction and clinician awareness of this
popular procedure. According to the American Society
of Plastic Surgery, minimally invasive, nonsurgical
procedures accounted for approximately 89% of all
cosmetic procedures conducted in 2015.
2
This signicant
increase in minimally invasive procedures suggests that
microneedling may occupy a specic niche for patients
who desire treatments with little to no recovery, while
still attaining measurable results. Microneedling has
become an integral part of the daily treatment algorithm
and has greatly changed the approach to the correction
of facial rhytides and acne scarring. This article aims to
outline the available published literature on the subject
and provide a practical guide for practitioners who are
interested in offering this highly effective and safe
cosmetic procedure to their patients.
Background and Mechanism of Action
In 1994, Orentreich and Orentreich rst described the
use of a skin needling procedure using a technique
*Washington Institute of Dermatologic Laser Surgery, Washington, District of Columbia;
Department of Dermatology,
St. Joseph Mercy Hospital, Ann Arbor, Michigan
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 1076-0512 ·Dermatol Surg 2017;0:18·DOI: 10.1097/DSS.0000000000001248
1
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called subcisionto release brous strands respon-
sible for depressed cutaneous scars and rhytides.
3
The
process involved the insertion and maneuvering of
a tri-beveled hypodermic needle into the skin under the
cutaneous defects to disrupt the underlying connective
tissue that tethered down the skin in these areas.
3
Three years later, Camirand and Doucet reported
signicant improvement in the clinical appearance and
texture of surgical scars with needle dermabrasion,
a process conducted using a tattoo gun devoid of ink.
4
It was not until the early 2000s when the rst micro-
needle stamping device was used to treat facial rhy-
tides and skin laxity. Using the principles outlined by
earlier needling pioneers, Fernandes developed
a drum-shaped device covered in tiny needles to pro-
duce cutaneous microwounds to improve facial rhy-
tides and skin laxity.
5,6
Research has been conducted in both animals and
humans to elucidate the mechanism by which micro-
needling works. It has been hypothesized that the
creation of numerous microchannels in atrophic acne
scars physically breaks apart the compact collagen
bundles in the supercial layer of the dermis while
simultaneously inducing the production of new col-
lagen and elastin underneath the scar.
7,8
For treatment
of supercial rhytides, microneedling is believed to
work in a similar fashion, relying heavily on the pro-
duction of new collagen to ll in and elevate the
existing furrow. The creation of abundant micro-
wounds directly stimulates the release of various
growth factors that play a direct role in collagen and
elastin synthesis and deposition within the dermis.
9
More specically, the creation of microchannels
induces a controlled skin injury with minimal epider-
mal damage and stimulates the dermal wound healing
cascade (inammation, proliferation, and remodeling)
to take place. This leads to the release of platelet-
derived growth factor, broblast growth factor (FGF),
and transforming growth factor alpha and beta (TGF-
aand TGF-b).
10,11
Neovascularization and neocolla-
genesis occur secondary to broblast proliferation and
migration.
12
After the cutaneous injury, a bronectin
network is created, providing a matrix for collagen
type III deposition, which is eventually replaced by
Type I collagen. This transition can occur over weeks
to months, resulting in clinical skin tightening and
rhytide reduction.
6,10
In addition to the increased gene
and protein expression for Type I collagen, there is also
up-regulation of glycosaminoglycans and various
growth factors including vascular endothelial growth
factor, FGF-7, and epidermal growth factor.
10,11
Based on histologic analyses 1 year after a series of
microneedling sessions, increased collagen deposition
in the reticular dermis with a normal lattice architec-
ture, increased elastic ber deposition, a thickened
epidermis (granular layer hyperplasia), and a normal
stratum corneum and rete ridges have been shown.
1315
In another study, Aust and colleagues
11
demonstrated
up-regulation of TGF-b3 which promotes regenera-
tion and scarless wound healing. The altered ratio
after microneedling of TGF-b3overTGF-b1and
TGF-b2 (the latter being responsible for brotic
scarring) may partially explain the benecial basis of
this procedure.
11
Device Specifics
There are many microneedling devices on the market,
each of which creates numerous epidermal and dermal
microwounds to stimulate collagen production. A
range of xed needle rollers and electric-powered pen
devices with disposable sterile needle tips are avail-
able.
9,16
These devices vary based on the needle length,
quantity, diameter, conguration, and material.
Manual rollers and electric-powered pens are oper-
ated by gliding perpendicularly over the skin surface
until ne pinpoint bleeding is achieved.
9,1619
Electric
pens offer several advantages over roller drum devices
including the ability to easily adjust their operating
speeds and penetration depths thereby permitting
treatment of large surface areas efciently and at
varying needle depths as necessary. The disposable
needle tips limit the risk of infection and also permit
treatment of small focal lesions such as traumatic scars
or upper lip rhytides which would be hard to do to
accomplish with a roller drum.
Optimal clinical outcomes are achieved when needle
depths are adjusted to the specic skin location (and
thickness). For example, thick sebaceous skin will
require deeper needle penetration in comparison with
thin periocular skin. One study found that needle
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penetration depth up to 1.0 mm was consistent with
the specic adjustable setting on the electric-powered
microneedling device, whereas needle lengths exceed-
ing 1.0 mm (e.g., 1.5 or 2 mm) demonstrated shallower
dermal penetration than anticipated.
20
An additional
study demonstrated that a needle length of 3 mm
penetrated to a depth of 1.5 to 2 mm, further sup-
porting that increased needle lengths may be inaccu-
rate to the specic selected depth.
16
Since it is well known that vitamins A and C are vital for
production of new collagen and protection of existing
collagen,
6,21,22
it is not surprising that combining
microneedling with topical antioxidants have been
shown to enhance the regenerative process of
microneedling-induced wound healing. Aust and col-
leagues
10
demonstrated a 140% increase in epidermal
thickness after the combination of microneedling and
topical vitamin A and C use over a period of 8 weeks
(compared to a 22% epidermal thickness increase with
topical antioxidant use alone). Pretreatment priming of
the skin with antioxidants may also serve to increase
gene and protein expression responsible for skin
regeneration.
10
Cautionis advised with concomitantuse
of topical products of any type during a microneedling
procedure due to the risk of granuloma formation. In
a case series published in 2014, 3 patients developed
biopsy-proven foreign-body type granulomas after the
application of topical vitamin C during micro-
needling.
23
Subsequent patch testing in these patients
demonstrated a positive hypersensitivity to various
chemicals within the topical vitamin C formulation.
23
Dermatologic Applications
Microneedling has been extensively studied over the past
decade with several published reports describing clinical
efcacy, treatment specics, histologic analyses, and
combination therapies.
24
The most well-described indi-
cations for microneedling in dermatology include acne
scarring, periorbital and perioral rhytides, skin laxity,
post-traumatic/burn scars, and striae distensae.
25
Scars and Striae
More publications have outlined the use of micro-
needling for acne scarring than for any other skin
condition.
2628
Clinical improvement of acne scars has
been substantiated by histologic skin changes.
Although various microneedling protocols have been
outlined, a series of 3 to 5 treatments at 2- to 4-week
intervals typically produce clinical improvements
ranging from 50% to 70%.
29,30
Rolling and boxcar
acne scars have been shown to be more effectively
treated than ice pick scars.
25
Similarly, other types of
atrophic scars and burn scar contractures and striae
distensae have also been improved with micro-
needling.
3134
Unlike full ablative laser skin resurfac-
ing which is typically limited to treatment of full
cosmetic units, it is possible to microneedle discrete
areas of scarring without producing lines of demar-
cation between treated and nontreated areas.
Rhytides and Skin Rejuvenation
Microneedling has been proven effective in the treat-
ment of facial rhytides in multiple publications.
3537
Fabbrocini and colleagues demonstrated perioral
wrinkle severity improving by 2 points on the Wrinkle
Severity Rating Scale after microneedling treatment.
35
Signicant increases in collagen Type I, III, and VII as
well as elevated levels of tropoelastin was reported by
El-Domyati et al. after a series of 6 microneedling
sessions.
36
The amount of dermal collagen was shown
to increase with cumulative treatment.
36
The reorga-
nization of existing collagen bers and simultaneous
increased production of new structural dermal com-
ponents after microneedling is believed to be respon-
sible for the observed skin tightening. The resultant
increase in both dermal collagen and elastic bers
further supports the mechanism by which rhytides are
reduced and softened after a series of microneedling
sessions are performed. These ndings indicate a lag
time of at least 6 to 8 weeks from initiation of treat-
ment to clinically apparent results from dermal colla-
gen production. It has, thus, become the protocol for
patients to receive a series of 3 to 6 at biweekly or
monthly microneedling sessions to achieve optimal
improvement of rhytides and skin rejuvenation.
Treatment Protocol
Because of the slow integration of microneedling in
many dermatology practices, the authors sought to
increase the awareness of the procedural technique to
ALSTER AND GRAHAM
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increase the popularity of this treatment entity.
Although the microneedling procedure often varies by
practitioners, the technique the authors have devel-
oped produces substantial clinical results with con-
trolled dermal wounding while stimulating the wound
healing cascade necessary for adequate collagen pro-
duction. The use of an electric-powered microneedling
device (e.g., Eclipse or Collagen P.I.N.) with dispos-
able needle tips (containing 1236 needles), adjustable
speeds, and depths of penetration (13 mm) is a rela-
tively easy treatment to incorporate into a cosmetic
dermatology practice. Although device design varies
by manufacturer, all of the available handheld devices
work similarly. The treatment protocol can be applied
to any electric-powered microneedling device with
adjustable depth and speed (Table 1).
Pretreatment Recommendation
All patients may continue the use of any home skin
care regimen (including retinoids, antioxidants, and
growth factors) up until the time of the procedure.
Oral anticoagulants do not need to be discontinued
as the risk of uncontrollable bleeding during the
microneedling treatment is negligible. Since the
microneedling procedure is often used in combination
with other treatments such as injections of hyaluronic
acid ller and chemical peels and various dermatologic
lasers, no wash outperiod is necessary before ini-
tiation of treatment. It is, however, recommended that
for same day treatments, the order of treatments be
applied from deep to supercial (e.g., injectables
before microneedling and/or laser irradiation) to
maintain visual landmarks and prevent diffusion of
injectables caused by tissue edema or bleeding.
Clinical Assessment
In addition to evaluation of the treatment area(s),
a meticulous visual assessment of overall skin quality
and texture should be made. A thorough synopsis of
the procedure, including the risks, benets, and alter-
native treatment options should be discussed with the
patient. A consent form should be reviewed in its
entirety, leaving time for patient questions before
treatment. Photography of treatment areas should be
performed before each session to adequately assess
clinical progress. Comparison of baseline and post-
treatment photographs, as well as clear expectations
of the anticipated number treatments, is vital to patient
satisfaction and facilitates an appreciation of clinical
outcomes.
Treatment Contraindications
Contraindications to microneedling treatment are
limited. Contraindications include inammatory
acne, active herpes labialis or other local infection
within the treatment area, keloidal predisposition, and
immunosuppression.
25
In addition, care should be
taken with concomitant microneedling near botuli-
num toxin injection sites to avoid potential unwanted
toxin diffusion.
Pretreatment Considerations
Although any skin phototype can be treated, it is rec-
ommended that treatment be delayed in patients with
a history of recent sun exposure (or who are visibly
tanned) until all traces of suntan have faded to avoid
post-treatment dyspigmentation. Individuals with
a history of oral herpes labialis may be at increased risk
TABLE 1. Microneedling at a Glance
Treatable conditions: scars (atrophic/burn/other),
rhytides, skin laxity, striae
Contraindications: active infection, acne, keloid
predisposition, immunosuppression
Treatment preparation: mild cleanser, topical 30%
lidocaine, hyaluronic acid gel
Technique
Perpendicular device placement with manual skin
traction for smooth delivery of microneedles
Multidirectional placement (cross-hatching) of
microneedle passes
Use pinpoint bleeding as guide to treatment end
point
Manual pressure with ice water compresses for
hemostasis
Post-treatment care
0–4 h: hyaluronic acid gel
4–72 h: 1% hydrocortisone/nonallergic moisturizer/
physical sunblock SPF 30+
48 h: makeup application
5–7 h: resume active product use
Side effects: mild erythema, edema, skin flaking ·48–
72 h
Repeat treatments: biweekly to monthly ·3–6
sessions; maintenance (variable)
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for viral reactivation during the post-treatment period.
In these patients, a 1-week course of oral antiviral
therapy as a prophylactic measure (beginning on the
day of treatment) is recommended to minimize this
complication. In addition, microneedling over any
inammatory acneiform lesions may predispose the
patient to the development of bacterial microabscesses
or granulomas. As such, avoidance of treatment in
patients with active acne or other inammatory lesions
is recommended.
Skin Preparation and Anesthesia
Meticulous skin preparation is important to decrease
the risk of supercial skin infections. A gentle skin
cleanser to remove makeup and debris from the skins
surface should be used before application of a topical
anesthetic cream or gel to the treatment area(s). The
authors typically apply a compounded 30% lidocaine
cream (nonoccluded) for 20 to 30 minutes which is
removed with water-soaked gauze and alcohol prep
immediately before the microneedling procedure.
Device Preparation
A handheld microneedling device (e.g., Collagen P.I.
N; Induction Therapies, Louisville, KY or Eclipse
MicroPen Elite; Eclipse Aesthetics, Dallas, TX) pow-
ered by a battery pack or alternating current power
cord is used at adjustable depth settings ranging from
0 to 3.0 mm. When used with corded power, the device
speed can be adjusted, ranging from 10,250 to 23,750
rpm. With battery power, the device speed is xed at
13,500 rpm. Sterile disposable needle cartridges (12
array count/32 gauge and 36 array count/30 gauge)
can be used to tailor therapy based on the specic
treatment location. In general, skin on the forehead,
lower eyelids, and nasal bridge are treated with needle
depths ranging from 0.5 to 1.0 mm, whereas the
cheeks, perioral regions, and scars or striae in various
body parts are typically treated with needle depths 1.5
to 3.0 mm. As a general rule of thumb, thicker or more
brotic skin can be treated with deeper needle depths.
Treatment Technique
Depending on the specic location to be treated, it is
often helpful to divide the region into quadrants. For
example, when treating the perioral region, the left
upper, left lower, right upper, and right lower regions
can be treated individually for more precise and uni-
form microneedling coverage. Gentle traction of the
skin with one hand while simultaneously lowering the
microneedling device perpendicular to the skin with
the other hand assists the smooth delivery of micro-
needles into the skin (Figure 1). It is important to apply
sufcient hyaluronic gel (supplied by the device com-
pany) on the treatment area surface to facilitate the
gliding action of the microneedling device and to
prevent untoward injury to the overlying epidermis.
The treatment technique involves a combination of
horizontal, vertical, and oblique device passes over the
treatment areas, repeating approximately 3 to 6 times
or until ne pinpoint bleeding is observed (Figure 2).
When treating deep rhytides or scars, a rockingor
Figure 1. Microneedling device is placed perpendicular to
the skin’s surface with a thin layer of hyaluronic acid gel.
Manual skin traction facilitates smooth gliding of hand-
piece and uniform delivery of microneedles across the
skin.
Figure 2. Pinpoint bleeding serves as a guide to indicate
treatment end point.
ALSTER AND GRAHAM
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stampingtechnique can be used to increase the
density of microneedling channels created. Since nee-
dle lengths exceeding 1.0 mm may not penetrate to the
corresponding dermal depth, it is useful to use pin-
point bleeding as the clinical end point of treatment.
When the clinical end point of uniform pinpoint
bleeding has been achieved, ice water-soaked sterile
gauze can be applied to remove excess blood and
hyaluronic gel. Treatment can then be pursued in an
adjacent treatment area or quadrant. The use of tap
water is discouraged because of its possible contami-
nation with pathogenic organisms which could
potentially increase the risk of infection in the treat-
ment areas. If any bleeding persists after cleansing the
treatment area, gentle pressure with dry sterile gauze
should be applied for several minutes. A thin layer of
hyaluronic acid gel can then be applied to the treat-
ment region and allowed to dry.
Postprocedure Recommendations
For the rst 4 hours after the procedure, the patient is
instructed to apply the provided sample of hyaluronic
acid gel to the skin. After 4 hours, a 1% hydrocorti-
sone cream or a nonallergenic moisturizing cream can
be applied to the treatment regions 2 to 4 times daily
for 2 to 3 days. The use of a nonchemical (or physical)
sunblock with SPF 30 or higher is advocated (on top of
the moisturizer) during the rst post-treatment week.
Application of makeup may be resumed 2 days after
the procedure and any active skin care products that
the patient used pretreatment can be resumed in 5 to 7
days (when all traces of skin erythema have resolved).
Microneedling treatment sessions are generally rec-
ommended at biweekly to monthly time intervals until
the desired clinical results are achieved (Figures 3 and
4). Some patients elect to receive ongoing (single)
microneedling treatment sessions on an annual or
semiannual basis to maintain and/or enhance their
cosmetic outcomes.
Side Effects and Complications
Microneedling is considered a noninvasive esthetic
procedure and has a low rate of associated adverse
effects. The most common and expected side effects of
treatment include mild erythema, localized edema,
and skin aking, which typically resolves within 48 to
72 hours. Pinpoint bleeding is self-limited and resolves
within minutes after the procedure with application of
gentle manual pressure and ice water-soaked gauze.
Figure 3. Atrophic acne scars before (A) and after 3 microneedling sessions at monthly intervals in the absence of con-
comitant treatments (B).
Figure 4. Perioral rhytides before (A) and after 3 microneedling sessions at monthly intervals without other treatment
modalities (B).
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Dyspigmentation was once a feared complication in
darker skin phototypes (Fitzpatrick IV, V, VI), but is
rarely seen in the absence of ultraviolet light exposure on
microneedled treatment areas. A histologic analysis of
skin melanocytes 24 hours after microneedling demon-
strated neither change in melanocyte number nor any
epidermal disruption.
7
In a case series published in 2014,
3 patients developed granulomas after the use of topical
vitamin C serum during the microneedling session.
23
The
use of topical medications with or immediately after
a microneedling procedure may increase the incidence of
adverse effects because of the creation of channels within
the epidermis and dermis that acts as a gateway into the
body allowing for the development of an immune
response to immunogenic particles.
38
Itis,thus,imper-
ative to counsel patients on the avoidance of non-
prescribed skin care products for the rst week after the
microneedling procedure as these may potentially induce
a local or systemic hypersensitivity reaction. In addition,
physicians need to use extreme caution when applying
topical agents to the skin immediately after the micro-
needling session to avoid such complications. More
research is needed on transdermal substances and
delivery vehicles to help minimize these risks.
Conclusion
From the introduction of microneedling by Orentreich
and colleagues
3
using the concept of subcision,
microneedling quickly morphed into a dynamic pro-
cedure using handheld electric-powered devices.
Microneedling is a safe, minimally invasive, and
effective esthetic treatment modality for numerous
dermatologic conditions including acne and other
scars, rhytides, and striae. With its fast post-treatment
recovery, limited side effect prole, and impressive
clinical results, microneedling is a valuable alternative
to more invasive procedures such as laser skin resur-
facing and deep chemical peeling. In addition, micro-
needling has demonstrated denitive histologic
changes that are directly responsible for the clinical
improvement observed.
This manuscript highlights the science behind this
promising procedure and provides a simple step-by-step
treatmentprotocolforpracticaluse.Additionallong-
term studies are needed to determine the duration of
improvement and the ideal treatment parameters to
achieve maximum clinical results with minimal recovery.
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0:0:MONTH 2017 7
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
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Address correspondence and reprint requests to: Tina S.
Alster, MD, Washington Institute of Dermatologic Laser
Surgery, 1430 K Street NW, #200, Washington, DC
20005, or e-mail: talster@skinlaser.com
MICRONEEDLING REVIEW
DERMATOLOGIC SURGERY8
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
... Amongst minimally-invasive procedures, microneedling is a popular and fast-growing cosmetic treatments 3 . Microneedling has shown effectiveness in skin rejuvenation, scar remodeling, melasma, and other pigmentary skin disorders 2,[4][5][6][7][8] . It is achieved by using solid needle pins to puncture the epidermis (or dermis, depending on needle length) which creates microwounds that trigger a downstream wound healing cascade 9 . ...
... In 1.5 mm length needle conditions, the needles reached the dermal papillary region. Pinpoint bleeding, which is typically used as a reliable end point for the procedure in clinics, was observed in the tissue ( Supplementary Fig. 1f) 6 . After 6 days of culture, the control samples ( Fig. 1b) maintained similar morphology compared the Day 0 samples (Fig. 1a). ...
... Microneedling is a popular option within the aesthetic procedure portfolio due to its minimal downtime and availability for use at both a home and professional level 6 . It is demonstrated to have a wide array of target applications, from skincare to hair-loss 20 . ...
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Microneedling is a popular skin resurfacing and rejuvenation procedure. In order to develop better adjunct products for consumers, there is a scientific need to establish greater understanding of the mechanism in which microneedling stimulates regeneration within skin. The purpose of this study is to develop a physiologically relevant ex vivo tissue model which closely mimics the actual microneedling procedure to elucidate its mechanism of action. In this study, human ex vivo skin was subjected to microneedling treatment and cultured for 6 days. Histological analysis demonstrated that the ex vivo skin was able to heal from microneedling injury throughout the culture period. Microneedling treatment stimulated proliferation and barrier renewal of the skin. The procedure also increased the levels of inflammatory cytokines and angiogenic growth factors in a dynamic and time dependent fashion. The tissue demonstrated hallmark signs of epidermal regeneration through morphological and molecular changes after the treatment. This is one of the first works to date that utilizes microneedled ex vivo skin to demonstrate its regenerative behavior. Our model recapitulates the main features of the microneedling treatment and enables the evaluation of future cosmetic active ingredients used in conjunction with microneedling.
... The depth of the micro-punctures is very important for the success of the procedure and for obtaining appropriate results, and depends on the area of the skin (different epidermis thickness) and individual features. Usually, the proper depth is established by observing so-called "pinpoint bleeding" [29,30]. That depth on the neck and cleavage skin is estimated to be between 1.5 and 3 mm [30]. ...
... Usually, the proper depth is established by observing so-called "pinpoint bleeding" [29,30]. That depth on the neck and cleavage skin is estimated to be between 1.5 and 3 mm [30]. Such punctures may be painful, so topical analgesic creams can be used. ...
... There are three stages in this process: inflammation, proliferation, and remodelling. Obtaining punctate haemorrhages due to skin blood-vessel punctures leads to the release of platelets and numerous growth factors such as platelet-derived growth factor, transforming growth factor-alpha, and epidermal growth factor [29,30,33]. The punctures immediately stimulate fibroblast activity, which starts the one-week stage of inflammation [29]. ...
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Although interest in aesthetic medicine is growing, the focus is often placed outside of the facial area, namely on the skin of the neck and cleavage. Exposure to the sun and muscle movements cause the prompt development of wrinkles that may appear there, even before they show up on the face. We conducted a literature review devoted to micro-needling to identify its role in anti-ageing treatments and to determine the gaps in current knowledge. A search in Medline identified 52 publications for neck and face micro-needling. Micro-needling is an anti-ageing procedure that involves making micro-punctures in the skin to induce skin remodelling by stimulating the fibroblasts responsible for collagen and elastin production. It can be applied to the skin of the face, neck, and cleavage. Two to four weeks should be allowed between repeated procedures to achieve an optimal effect. The increase in collagen and elastin in the skin can reach 400% after 6 months, with an increase in the thickness of the stratum granulosum occurring for up to 1 year. In conclusion, micro-needling can be considered an effective and safe aesthetic medicine procedure which is conducted at low costs due to its low invasiveness, low number of adverse reactions, and short recovery time. Little evidence identified in the literature suggests that this procedure requires further research.
... Furthermore, accelerated keratinocyte turnover enhances epithelial melanin clearance. 39 Its possible role in treating hyperpigmentation is through the interaction between keratinocyte, melanocyte, and fibroblast leading to remodeling of most of the epithelium, basement membrane, and connective tissue. 25 Furthermore, the microscopic wounds created by MN trigger regenerative wound repair. ...
... 40 Multiple growth factors required in the healing mechanism such as fibroblast growth factor, platelet-derived growth factor, and transforming growth factor are released ultimately leading to neovascularization, neocollagenesis, and elastin formation at the epithelium/connective tissue junction with thickening of the stratum spinosum all of which contributes to the lightning of hyperpigmented tissues. 16,32,39,41,42,43 These regulatory growth factors trigger the chemotaxis of fibroblasts and subsequent collagen synthesis and deposition of 'scarless collagen' which is stimulated when the fractional channels penetrate into the epithelium and underlying connective tissues. 35 The current study found that the MN technique for gingival depigmentation is a successful procedure and most participants were satisfied with the results produced from the MN technique. ...
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Background: In individuals who have an excessive gingival display, gingival hyperpigmenta
... Scarring from acne, ageing skin, sagging skin, scars from trauma or burns, and drug delivery. Most commonly, dermatologists use microneedling to treat skin renewal, surgical scars, melasma, enlarged pores, drug delivery, and dyschromia (1) . ...
Article
Background: Combination of microneedling and chemical peeling is a simple cost-effective treatment for acne scars. Objective: To compare efficacy and safety of combining microneedling with 35% glycolic acid (GA) peel versus microneedling with 15% trichloroacetic acid (TCA) peel in facial atrophic acne scars. Methods: Forty acne scars patients were randomly divided into 2 groups of 20 each. Patients underwent microneedling followed by 35% GA peeling in Group 1 and 15% TCA peeling in Group 2 at 2 weekly intervals. Improvement was graded by Goodman and Baron's qualitative and quantitative global acne scar grading systems, physician's global assessment, and visual analogue scale (VAS). Skin texture was graded by VAS. Results: On comparing qualitative and quantitative acne scar grading within groups, there was significant difference from the baseline. When the two groups were compared for quantitative and qualitative acne scar grading, the difference was statistically not significant at the end of therapy. In VAS, greater number of patients assessed response as excellent and good in Group 1 than in Group 2 indicating better skin texture improvement in Group 1. Conclusion: Both combinations were equally efficacious in treating acne scars. Glycolic acid peel delivered additional advantage of improvement in skin texture.
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Micro-coring technology (MCT) removes cores of skin without formation of scars, thereby tightening skin and reducing skin wrinkling. The purpose of this study was to evaluate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of facial wrinkles. Methods: This prospective, multicenter clinical trial included fifty-one subjects who underwent MCT treatments of the mid to lower face. The primary study endpoint was change in the Lemperle Wrinkle Severity Scale. Secondary study endpoints were change in Global Aesthetic Improvement Scale (GAIS), participant satisfaction, and evaluation of treatment outcome by an independent review panel. All study endpoints were evaluated at 1, 7, 30, 60, and 150 or 180 days after treatment. Procedure bleeding, pain, and early healing profile were also captured. Results: The mean Lemperle Wrinkle Severity Scale change was 1.3 grades. Improvement in the GAIS was reported for 89.7% (87/97) of treated sites, and average improvement of GAIS was 1.5. Participants reported satisfaction with 85.6% of treatment sites. The independent review panel correctly identified 84.2% of the post-treatment photographs as post-treatment. Procedure bleeding and pain was mild with good healing responses and patient-reported average down time of 3 days. Conclusions: The results of this study demonstrate the safety and efficacy of MCT with the dermal micro-coring device for the treatment of moderate to severe facial wrinkles. MCT led to significant improvement of facial wrinkles with high patient satisfaction and fast recovery time and should be considered in patients who are seeking minimally invasive treatment for wrinkles of the face.
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The microneedling technique was initially introduced for skin rejuvenation in cosmetology. The technique is minimally invasive and therefore explored for the treatment of multiple dermatological conditions. High effectiveness, very less side effects and quick recovery time are the benefits of skin microneedling as a cosmetic, and medical treatment. Over the last two decades, the applications of microneedling in skin science have grown drastically. The technique is effective in the treatment of acne scar, vitiligo, alopecia, melasma, and skin cancer. The current review focuses on the cosmetic as well as therapeutic applications of microneedling for the treatment of various skin problems.
Article
Objective Evaluating the improvement rate of the scar according to the patient’s and observer’s opinions after treatment with the microneedling. Methods 16 patients (12 females and 4 males), aged 16-30 years who had a cleft lip scare were included in the current study. All patients suffered from a visible defective scar in the upper cleft lip. All patients were treated with a microneedling pen device combined with a topical application of oil-based hyaluronic acid. The procedure was performed in 4 sessions performed with 3-week intervals between sessions. The scars were assessed by the patient and observer scar assessment scare (POSAS). Results After the treatment with the microneedling technique pain, itching, thickness, flexibility, color and relief were improved significantly (p<0.05) ( the improvement percentage: 36.6%, 44.44%, 67.28%, 65.57%, 59.79%, 54.57% respectively). According to observer’s opinion: vascularization, pigmentation, thickness, flexibility, topography and surface area were improved significantly (p<0.05) after the treatment with the PCI technique ( the improvement percentage: 40.60%, 52.63%, 61.55%, 60.25%, 53.72%, 41.63% respectively). Conclusions The microneedling treatment can be considered an effective method for the treatment of the defective scars resulting from the cleft lip plastic surgery. As well as, the microneedling technique is a simple, easy, safe, non-invasive, and low-cost procedure.
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Melasma is an acquired hyperpigmentation disorder. Microneedling is an alternative treatment for melasma especially by improving penetration of pharmacological agents into the skin. Objective: The main objective of this review was to systematize and analyze available evidence on the efficacy and safety of microneedling alone or associated with topical agents in reducing skin stains and improving melasma-related quality of life in adult patients. Methods: Only randomized clinical trials were included. The following databases were consulted: MEDLINE, Embase, Cochrane and the gray literature. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) was used to assess risk of bias. Results: The search retrieved 719 records and 7 studies were included. A total of 368 participants (96.19% women) were evaluated. Two studies were split-face. Most of the studies evaluated microneedling associated with tranexamic acid. High risk of bias was presented by most studies, especially in the safety outcome. A significant decrease was observed in the MASI, mMASI or hemi-MASI scores, regardless of the topical agents associated. Meta-analysis was not possible due to the heterogeneity of the studies. Conclusion: Based on the results of this review, microneedling can, in association with topical agents or isolated, be used safely in the treatment of melasma in the clinical practice, obtaining results on reduction of stain severity and improvement of patients' quality of life.
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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.
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Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications.
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Objective: Treatment of acne scarring is always a challenge. Microneedling therapy or percutaneous collagen induction is a new addition to the treatment modalities for such scars and has been reported to be simple and effective in atrophic acne scar treatment. The aim of this study is to evaluate the clinical effect and objectively quantify the histological changes of acne scarring in response to skin microneedling. Design: A prospective clinical study. Participants: Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Measurements: Patients were photographed, and skin biopsies were obtained at baseline as well as one and three months from the start of treatment. Histometry for epidermal thickness and quantitative evaluation of total elastin; newly synthesized tropoelastin; collagen types I, III, and VII; and newly synthesized collagen were performed for all biopsies. Results: Compared to the baseline, patients' evaluations revealed noticeable clinical improvement in atrophic post-acne scars in response to skin microneedling. There was a statistically significant increase (p<0.05) in the mean of collagen types I, III, and VII and newly synthesized collagen, while total elastin was significantly decreased (p<0.05) after the end of treatment. Conclusions: Multiple minimally invasive sessions of skin microneedling are an effective treatment for post-acne atrophic scars as it stimulates the repair processes with the advantage of being a relatively risk-free, in-office procedure with minimal patient recovery time.
Article
Full-text available
Background: Skin needling is a technique used to improve the appearance of acne scarring. Objective: To comprehensively review the medical literature regarding skin needling as a treatment for acne scarring. Methods: A literature search was performed using the PubMed, Medline, and Embase databases, in addition to reviewing the bibliographies of relevant articles. Results: Ten studies presented patients treated with skin needling alone, while eight studies discussed skin needling in combination with other treatments for acne scarring. All studies showed improvements in scarring after needling, with 12 reporting statistical significance. The median number of treatments when needling was used alone was three, the median duration between treatments was 4 weeks, and the median needle length used was 1.5 mm. Reported adverse events were infrequent and included post-inflammatory hyperpigmentation, “tram track” scarring, acne, and milia. There were no reports of bacterial infections. Limitations: The studies reviewed were heterogeneous in design and of variable validity, with some not reporting statistical significance. Conclusion: There is moderate evidence to suggest that skin needling is beneficial and safe for the treatment of acne scarring. However, double-blinded, randomized controlled trials are required to make more definitive conclusions.
Article
Full-text available
Background: The use of growth factors in skin rejuvenation is emerging as a novel anti-aging treatment. While the role of growth factors in wound healing is well established, their use in skin rejuvenation has only recently been to be studied and no controlled trials have been performed. Objective: We evaluated the anti-aging effects of secretory factors of endothelial precursor cells differentiated from human embryonic stem cells (hESC-EPC) in Asian skin. Methods: A total of 25 women were included in this randomized, controlled split-face study. The right and left sides of each participant's face were randomly allocated to hESC-EPC conditioned medium (CM) or saline. To enhance epidermal penetration, a 0.25-mm microneedle roller was used. Five treatment sessions were repeated at 2-week intervals. Results: Physician's global assessment of pigmentation and wrinkles after treatment revealed statistically significant effects of microneedling plus hESC-EPC CM compared to microneedling alone (p<0.05). Skin measurements by Mexameter and Visiometer also revealed statistically significant effects of microneedling plus hESC-EPC CM on both pigmentation and wrinkles (p<0.05). The only minimal adverse event was mild desquamation in one participant. Conclusion: Secretory factors of hESC-EPC improve the signs of skin aging and could be a potential option for skin rejuvenation.
Article
Background: Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The microwounds created stimulate the release of growth factors and induce collagen production. The epidermis remains relatively intact, therefore helping to limit adverse events. The indications for microneedling therapy have grown significantly, and it is becoming a more widely used treatment in dermatology. Objective: A comprehensive review of microneedling in human subjects and its applications in dermatology. Methods and materials: A search was performed using PubMed/MEDLINE and Science Direct databases. Search terms included "microneedling," "needling," and "percutaneous collagen induction." All available studies involving human subjects were included in the discussion, with priority given to prospective, randomized trials. Results: Studies demonstrate microneedling efficacy and safety for the treatment of scars, acne, melasma, photodamage, skin rejuvenation, hyperhidrosis and alopecia and for facilitation of transdermal drug delivery. While permanent adverse events are uncommon, transient erythema and postinflammatory hyperpigmentation are more commonly reported. Conclusion: Microneedling appears to be an overall effective and safe therapeutic option for numerous dermatologic conditions. Larger and more randomized controlled trials are needed to provide greater data on the use of microneedling for different dermatologic conditions in different skin types.
Article
Background Aesthetic micro-needling (MN) has demonstrated skin permeability to cosmeceutical ingredients and platelet-rich plasma by creating reversible micro-channels in the skin. Objectives The purposes of this study were to determine: (1) actual needle depth-penetrations by adjusting needle lengths in a disposable tip of an electric MN device; (2) time-dependent passage of pigment and platelets; and (3) safety and efficacy profiles in patients. Methods Excised micro-needled pre-auricular skin was used to determine actual depths of tissue penetration with six needle lengths, and the presence of massaged pigment particles (histological examination) and fluorescein-labeled platelets (confocal laser microscopy) in 1 mm depth micro-channels over an hour. Patients were treated for wrinkles and skin laxity, scars, and alopecia with cosmeceuticals and plasma-rich platelets. Results Actual needle penetrations closely matched settings up to 1.0 mm, but were less consistent at settings from 1.5 to 2.5 mm. The optimal time for massaging pigment particles and labeled platelet-rich plasma (PRP) down 1.0 mm micro-channels was between 5 to 30 minutes after MN. Patients treated in the Skin Care Center (cosmeceuticals, 0.25-1 mm depth) and Surgical Center (PRP, 0.25-2.5 mm) demonstrated statistically significant improvements (P ≤ .05) in wrinkle effacement, skin laxity, scar softening, and hair growth by Patient and Observer Satisfaction Scores at 12 months. The average hair count in a 10 mm spot size at baseline (88.3 ± 22.5) increased at the 12 month evaluation period (133.6 ± 13.8). All patients experienced minimal side-effects. Conclusions MN alone or in combination therapy resulted in safe and effective treatments from implemented guidelines. Level of Evidence 3[Embedded Image] Therapeutic
Article
Background: Dark circles (DC), seen in the periorbital area, are defined as bilateral, round, homogeneous pigmented macules whose aetiology is thought to be multifactorial. Available treatments include bleaching creams, topical retinoic acid, chemical peels, lasers, autologous fat transplantation, injectable fillers and surgery (blepharoplasty). Objective: To evaluate the efficacy and safety of a combination of microneedling and 10% trichloroacetic acid (TCA) peels in the treatment of DC. Materials and methods: Thirteen female patients with mild to severe infraorbital DC were included in the study. The patients were aged between 21 and 61 years. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% TCA solution to each infraorbital area for five minutes. The effect was photo-documented and a Patient and Physician Global Assessment was evaluated. Safety was assessed by evaluating early and delayed adverse events. Results: Almost all patients showed significant aesthetic improvement. Both Physician and Patient Global Assessment rated a fair, good or excellent response in 92.3%. The procedure was well tolerated. Mild discomfort, transient erythema and oedema were quite common during or immediately after the procedure. The patients were followed up regularly every month for four months, and no recurrence was recorded. Conclusion: Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.
Article
Introduction: A trend is currently observed towards the indication of less invasive procedures, isolated or combined, in the treatment of stretch marks, scars, and the effects of aging. Microneedling is an option that stimulates collagen production without causing the total de-epithelization observed in ablative techniques. Objective: To carry out an experimental study aimed at establishing the correlation between thelengths of the cylinder's needles used for microneedling with the depth of the damage inflicted to the skin. Methods: Biopsies were performed in skin areas of alive pigs that underwent microneedling with cylinders containing 192 needles of 0.5-1, 1.5-2 and 2.5 mm. Results: Microscopic examination carried out immediately after the procedure revealed vascular ectasia with extravasation of red blood cells, affecting the papillary dermis with 0.5 mm needles and reaching the reticular dermis with longer needles. The authors propose classifying the inflicted injury as mild (0.5 mm needles), moderate (1.0 and 1.5 mm needles), and deep (2.0 to 2.5mm needles). Conclusion: The microneedling procedure can be indicated for a broad spectrum of skin alterations when the goal is to stimulate the production of collagen. Establishing the relationship between the length of the needle used and the resulting damage to the skin assists in choosing the microneedling tool used in different directions.
Article
BACKGROUND Laser skin resurfacing was popularized for photoaged and scarred skin 2 decades ago. Since then, several technologic advancements have led to a new generation of delivery systems that produce excellent clinical outcomes with reduced treatment risks and faster recovery times.OBJECTIVES To review the evolution of laser skin resurfacing from pulsed and scanned infrared laser technology to the latest techniques of nonablative and ablative fractional photothermolysis.MATERIALS AND METHODS All published literature regarding laser skin resurfacing was analyzed and collated.RESULTSA comprehensive review of laser skin resurfacing was outlined and future developments in the field of fractionated laser skin treatment were introduced.CONCLUSION Laser skin resurfacing has evolved such that excellent clinical outcomes in photodamaged and scarred skin are achieved with rapid wound healing. As newer devices are developed, the applications of this technology will have a dramatic effect on the delivery of medical and aesthetic dermatology.
Article
Background Postacne scarring is disfiguring, both physically as well as psychologically. Over the past two decades, multiple modalities for treatment of acne scars have emerged and microneedling with dermaroller is one of them.Objective To evaluate the efficacy and safety of microneedling treatment for atrophic facial acne scars.Material and Methods Thirty-six patients (female – 26, male – 10) of postacne atrophic facial scars underwent five sittings of dermaroller under topical anesthesia at monthly intervals. Objective evaluation of improvement was performed by recording the acne scar assessment score at baseline and thereafter at every visit. Pre- and posttreatment photographs were compared, and improvement was graded on quartile score. Final assessment was performed 1 month after the last sitting. Patients were asked to grade the improvement in acne scars on visual analog scale (VAS, 0–10 point scale) at the end of study.ResultsOf 36 patients, 30 completed the study. The age group ranged from 18 to 40 years, and all patients had skin phototype IV or V. There was a statistically significant decrease in mean acne scar assessment score from 11.73 ± 3.12 at baseline to 6.5 ± 2.71 after five sittings of dermaroller. Investigators' assessment based on photographic evaluation showed 50–75% improvement in majority of patients. The results on visual analog scale (VAS) analysis showed “good response” in 22 patients and “excellent response” in four patients, at the end of study. The procedure was well tolerated by most of the patients, and chief complications noted were postinflammatory hyperpigmentation in five patients and tram-trek scarring in two patients.Conclusion Microneedling with dermaroller is a simple and cheap, means of treatment modality for acne scars remodulation with little downtime, satisfactory results and peculiar side effects in Asian skin type.