Microneedling has significantly gained popularity over the last few years because of a general desire for less downtime and natural interventions. Treatments that stimulate collagen, such as Sculptra injections, laser treatments, and Platelet Rich Plasma/Platelet Rich Fibrin, are becoming more popular than dermal fillers due to the shift towards biostimulatory therapies.
How Long has Microneedling Been Around?
Microneedling as a concept has been around for over a decade, but the creation of high-velocity devices designed to deliver many punctures rapidly is limited to the past two decades. Skin Pen, one of the industry leaders, launched its device in 2018 after receiving FDA approval. Since then, the practice of microneedling has made many advances, which continue today.
How Does Microneedling Work?
Microneedling works by creating small punctures in the skin, which results in collagen creation through the body’s natural healing process. The puncture sizes can vary by needle or device, and some devices can deliver punctures to different depths, ranging from 0.1 to 3mm. Punctures are typically 0.07mm wide, which is why the skin heals so quickly. Once microchannels are created in the skin, they stay open for 24 hours, and during that time, agents can be placed on the skin, which will then penetrate the skin to the depth of the microchannel. Materials placed on the skin before the treatment can be pushed into the skin during the creation of the channels. Agents used can vary and can be tailored to the patient’s specific needs, making the treatment very versatile.
Factors that Influence the Quality of the Treatment
On the face, the epidermis is about 0.05 to 0.12 mm thick, while the dermis varies significantly by region, ranging from approximately 0.4 mm on the eyelids to over 1.0 mm on the forehead and cheeks. Choosing the appropriate depth of treatment will determine if you are in the correct layer of the skin for the treatment to be effective. Typically, this is in the dermis, so the microneedles need to be between 0.2 and 1mm in depth of penetration; otherwise, you will be puncturing into the subcutaneous fat, which will not provide the desired effect. In addition to depth, the number of passes will influence both the healing time and the extent of treatment.
What Agents Are Best Used in Microneedling?
Currently, platelet-rich plasma, platelet-rich fibrin, and Polynucleotides are popularly used. All 3 agents add additional collagen stimulation to the end result. PRP/PRF will provide more collagen stimulation than polynucleotides, but Polynucleotides will have a superior hydrating effect to PRP/PRF. As microneedling gains popularity, other novel agents are being used, and the list of options keeps expanding.
Botox has also been used in microneedling, with the intended effect of sweat reduction (must be a minimum of 0.5mm), pore size reduction, and decreased oil production. Some practices have coined this as a Glow-Tox treatment. Practitioners are also using exosomes, small packets of cell signaling agents, during microneedling for collagen stimulation. Currently, though, exosomes are still being investigated for their efficacy as well as which manufacturers provide the best product. Recently, hyaluronic acid products, such as Skin Vive, have been introduced to further increase the hydration of the skin. When done together during a microneedling session, Skin Vive and Botox are collectively known as Glow-Tox Plus.
These or other agents can be added after the treatment, for absorption through the microchannels in the first 24 hours. Popular ingredients include niacinamide, tranexamic acid, and other pigment-reducing agents.
What About At-Home Devices?
At-home devices that can puncture at least 0.5mm can be considered effective for the entirety of the face. For eyelid treatments, 0.25mm is sufficient. Also, the needles themselves need to be smooth and sharp in order to prevent micro skin avulsions, which can lead to visible scarring. Most importantly, tips for microneedling devices should not be reused, as sterility would be compromised, and there is no effective cleaning method after even a single use that can guarantee sterility. Also, the technique should be tailored to the area of treatment, with regard to depth and number of passes, or the treatment may be ineffective or too aggressive, causing injury. So, home devices could potentially be of value, but they need to be chosen very, very carefully; otherwise, they can damage the skin. They also cannot take the place of professional microneedling, since the agents discussed in this article cannot be obtained outside of a medical practice.
