Overview of Microneedling
Microneedling is a type of skin treatment that uses tiny needles to make controlled punctures in the skin (referred to as the dermis). These small, intentional wounds trigger your body to produce more collagen and elastin fibers, which are substances that help keep your skin youthful and fresh. By doing so, it encourages your skin to repair and rebuild itself.
Originally, microneedling was designed to make your skin look younger. But these days, it’s also used for treating a range of skin conditions, such as different types of scars, hair loss (alopecia), excessive sweating (hyperhidrosis), stretch marks, and for the application of certain skincare medicines. Some practitioners also combine it with a treatment called radiofrequency energy, which they believe can improve the skin’s restoration process and its results.
Microneedling has become a popular choice among skin professionals. It’s viewed as a safe, affordable alternative to other skin treatments that require more recovery time. However, whilst it is widely chosen for a range of skin needs, please be aware that the effectiveness of microneedling has not been strongly proven in medical research literature.
Anatomy and Physiology of Microneedling
Collagen Induction Therapy is a procedure which involves creating tiny punctures in the skin. These punctures, while small, still initiate the same healing process as larger wounds without causing noticeable damage to the surface skin layer. This healing process triggers the release of various cells and proteins that help repair and regenerate the skin.
If you’re having this treatment for scars, the tiny needles used in the process break down scar tissue and allow new skin vessels to form. As these new skin cells migrate and multiply, they start to form collagen, a protein that gives the skin its structure. Around 5 days after the treatment, a network of fibronectin, another type of protein, forms and guides the formation of new collagen in the skin. This newly-formed collagen can help to tighten your skin, with effects lasting for up to 5 to 7 years.
Usually, a longer needle (1.5-mm) is used for the procedure and can trigger collagen production to a depth of 5 to 600 µm in your skin. Research has shown that after 4 microneedling sessions spaced a month apart, there is a four-fold increase in collagen and elastin in the skin 6 months after the treatment. Even after a year, the skin showed normal and improved structures.
The same microneedling procedure is also used to deliver medications into your skin effectively, as it helps to bypass the surface layer of the skin and allow medications to reach the deeper layers. In fact, microneedling has been found to increase the size of the skin’s pores by about 47%, which may contribute to the improved penetration of medications into your skin.
Why do People Need Microneedling
Microneedling is a treatment which involves making tiny punctures in the skin for various benefits. Here are some reasons why you might need microneedling:
* Problems related to skin pigmentation.
* Scars, including the following types:
* Scars related to acne, including atrophic (sunken), boxcar (wide, round or oval), rolling (wave-like) and ice-pick (deep and narrow) scars. Note that deeper scars such as boxcar, ice-pick, and linear scars may not respond as well to this treatment.
* Scars caused by burns.
* Scars from an injury.
* Scars from chickenpox.
* Hypertrophic scars, which are raised, often shiny, and redder than the surrounding skin.
* Stretch marks.
* Hair loss conditions such as Androgenetic Alopecia (when used alongside a 5% minoxidil solution) and Alopecia Areata (when used with a topical steroid).
* To promote skin rejuvenation, which can help reduce wrinkles.
Microneedling is also used in combination with skin-lightening products for treating Melasma, a condition that causes dark, discolored patches on the skin, and Periorbital Hypermelanosis, which causes dark circles around the eyes.
Another use of microneedling, when combined with fractional radiofrequency, is for treating primary axillary hyperhidrosis, a condition that causes excessive sweating in the armpits.
When a Person Should Avoid Microneedling
Microneedling is a beauty treatment that’s usually safe and easy to handle. However, there are a few reasons why someone might not be able to have the procedure done. These include:
1. Active acne, particularly inflammatory spots (the big, red, sore ones)
2. Active cold sores or any other local infection (like warts) where the treatment would take place.
3. Chronic skin diseases that are moderate-to-severe, like eczema or psoriasis. These are conditions where the skin becomes red, scaly, and itchy.
4. Patients who are prone to developing keloids, which are large, raised scars.
5. Patients whose immune systems are weakened, perhaps due to chemotherapy.
In addition to these points, if a patient is going to have an injection of botulinum toxin (like Botox) around the same time as their microneedling, care should be taken to avoid accidentally spreading the toxin to undesired areas.
Equipment used for Microneedling
In skin care centers and medical clinics, a variety of microneedling devices are used. The most commonly seen tools are needle rollers that don’t adjust and electronic pens that have replaceable tips.
The size of the needles chosen depends on what skin issue is being treated and where on the body the treatment is happening. For example, if treating scar tissue, longer needles between 1.5 to 2.0 mm are often used. On the other hand, to treat signs of aging or wrinkles, smaller needles typically between 0.5 to 1.0 mm are used. It’s also important to consider the skin type when deciding the needle length. For example, oily, thick skin found on the nose might need deeper penetration than delicate skin around the eyes.
There are also different types of microneedling tools that are used for different purposes:
- Fractional radio frequency microneedling
- Home-care rollers with very small needles (about 0.1 mm long) which help skincare products penetrate the skin better
- Devices that combine microneedling with a vacuum component to infuse products into the skin
- Microneedling tools that include LED light
Preparing for Microneedling
A cream that numbs the skin, containing two active ingredients called lidocaine and prilocaine (EMLA), is put on the area that needs treatment. To keep the cream in place and help it work better, a piece of clear tape is put over it. This is left on for between 15 to 45 minutes. After this time, the cream is carefully cleaned off using a gentle saline solution. This is simply salted water that helps to remove any leftover cream. Next, a solution that kills germs may be used to further clean the area before starting the medical procedure. This is done to help prevent any infections.
How is Microneedling performed
The entire process of microneedling involves using a special tool on your face to help rejuvenate your skin. This is usually done by stretching out the skin with one hand while the microneedling device is moved across the skin with the other. If a needle roller is used, you would move this over the skin around 15 to 20 times in different directions – up, down, and at an angle. The goal is to have a consistent pattern across your face until you notice tiny spots of bleeding. This is when you know the process is complete. Afterwards, you would apply a saline pad to the treated areas. The complete treatment for your entire face usually takes about 15 to 20 minutes.
This treatment works best when followed with serums that contain vitamins A and C. These serums assist in healing the tiny little holes made by the microneedling process, which ultimately helps achieve better results for your skin.
After the Treatment
People typically handle the microneedling well, with only minor side effects like redness, slight puffiness, and some skin peeling for about 2 to 3 days. You can go about your normal day-to-day activities starting the day after the treatment. However, it’s advised to use sunscreen regularly and avoid the sun and any harsh chemicals on your skin for at least a week.
After the procedure, some people might notice clear fluid draining from their skin. This is a normal part of the healing process and you can gently blot this with a clean, damp cloth. Don’t expect to see results immediately as the skin rejuvenation process continues for about 3 to 6 months after the treatment. This treatment can be done again after at least 3 weeks have passed.
Possible Complications of Microneedling
Usually, complications after a medical procedure are minimal. Here are some of the common ones you might experience:
1. You might feel some pain during the procedure. But don’t worry! When the doctors use some skin-numbing drugs (‘topical anesthetics’), this pain is usually very little.
2. You might notice some redness, irritation, and minor swelling. These typically go away in a few hours or days.
There are other potential side effects, but these are much rarer:
1. Your skin might become darker (‘hyperpigmentation’), but this is less likely than with some other treatments like laser therapy.
2. The procedure might trigger a cold sore outbreak if you’re prone to them (this is called ‘herpes simplex reactivation’).
3. You might get a localized skin infection, like impetigo.
4. If you’re allergic to something in the serums used during the procedure, your body might react by forming small, hard bumps (or ‘allergic granulomatous reactions’).
5. If you’re allergic to the material of the needle used, you could develop a skin rash (‘allergic contact dermatitis’).
6. There’s a chance you could be exposed to blood during the procedure.
Note that all these complications are very rare and the procedure is generally safe and well-handled by medical professionals.
What Else Should I Know About Microneedling?
Microneedling is a skin rejuvenation method that comes with both benefits and drawbacks.
Benefits:
- The recovery time is typically shorter compared to other skin improvement methods.
- Compared to other treatments, microneedling is relatively inexpensive.
- The technique is simple and easy to learn.
- Microneedling is generally well accepted by patients.
- Compared to some other skin therapies like CO2 laser resurfacing and deep chemical peels, microneedling has a lower risk of causing skin pigmentation changes. This is because it doesn’t damage the top layer of skin, which could make your skin more sensitive to sunlight and uneven color.
- Microneedling can be combined with other treatments for acne scars, including subcision (a minor surgical procedure), chemical peeling, microdermabrasion (a type of skin exfoliation), and fractional resurfacing. This can provide maximum benefits.
Drawbacks:
- Solid, evidence-based guidelines for using microneedling are currently lacking. Most advice comes from personal experiences and smaller studies.
- There’s a shortage of direct comparison trials against other treatment options.
