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Endpoint with Skin-Needling Treatments

August 13, 2021

As many may know the two global authorities in dermal needling are Dr. Des Fernandes and Dr. Lance Setterfield. 

Dr. Setterfield has dedicated his whole professional practice to the study and training of this procedure.  His latest manual – The Concise Guide to Dermal Needling (Third Medical Edition – Revised and Expanded) is available in Australia through APAN, we are currently his agents. While we ordered 100 manuals, we currently only have SEVEN manuals left for purchase. So, if you wish to purchase one, please do not hesitate to contact us.

One of the key areas of concern when it comes to dermal needling is what should be the endpoint with skin needling treatments.  Here is a brief recommendation by Dr. Setterfield:

As far as the endpoint goes, pinkness is adequate.  Bleeding or petechiae are no longer desirable endpoints.  Less is best.  There are two general approaches when it comes to determining adequate treatment.  The first is the number of passes and the second is the visible endpoint.


There is a wide range of recommendations depending on who you speak to.  Many companies that sell electronic needling devices err on the side of conservatism due to medicolegal concerns, because they do not have medical directors to advise them.  Two passes are recommended by some.  Experts that lean towards provoking inflammation tend to recommend far more passes (10-20 passes) at greater needle depths. (Remember that there are other factors to consider in this equation: motor speed and power, needle length, number, and configuration all play a role.) With rollers, the recommended number of passes varies anywhere from 16 to 40.  Treatments based on a number of passes do offer standarisation for protocols, and many companies and clinics have opted for this approach due to the legal protection it affords them.  This does have its downsides, however.  Patient variables, such as skin thickness, create exceptions to the rule.  Inexperienced practitioners tend to rely heavily on “recipes” and get into trouble when failing to recognise these exceptions.  They feel safe within the boundaries that these protocols afford which may lead to a false sense of assuredness.


This is possibly the most widely embraced method of determining adequate treatment. In the early days where the bleeding was the desired endpoint, it took the guesswork out of the process.  As evince points to clinical success at lesser needle depths, the trend moved towards less aggressive treatments that had erythema as an endpoint.  The problem with this approach is that erythema tends to be delayed when using electronic devices as compared with rollers.  Theoretically, one must trust that adequate treatment has been achieved after 10 swift passes, despite a lack of erythema.  Part of the problem is that not all devices are created equal. Due to variances in motor power, the number of needles, and the possibility that needle depth may not equal the actual setting on the dial, practitioners cannot trust that adequate treatment has been provided in the absence of erythema or bleeding.  This is where experience plays a big part.  Clinicians should be familiar with their device’s strengths and weaknesses and adapt their approach accordingly.  Unfortunately, in the absence of clinical trials ascertain optimal needle depth and an optimal number of punctures per square cm, practitioners are left to make judgment calls, which for some is beyond comfort zone or clinical experience.

Previous treatments with, e.g. laser, IPL, Thermage®, etc, reduce capillary blood supply, and hence petechiae will also be less after needling.  Medical needling restores the capillary network through angiogenesis due to the release of endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF), so you may notice that there is more bleeding with subsequent needling treatments, especially with acne scars.

Remember that injury below the surface is what counts and not what is visible from outside. The downside of the “light” treatment is that it may be necessary to do more overtime to get an adequate result, but it is very unpleasant to have to endure an aggressive treatment.

If you wish to gain further knowledge from Dr Setterfield you can either purchase a copy of his manual from this link:

Or you can undertake Dr Setterfield’s online Diploma course

The updated manual is needed when undertaking this training.

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