By Dr Lance Setterfield

Perhaps the greatest weakness in industry training on microneedling is that the focus tends to be predominantly on how to use the device.  It is assumed that practitioners already know how to select and treat their clients/patients for various skin conditions, and microneedling is just one more tool to reach for in their toolbox.  However, microneedling does bring some special considerations to the mix.

For instance, hydroquinone is a recognised treatment for hyperpigmentation.  Microneedling is also helpful in normalizing melanin formation.  Practitioners assume that if one mode of treatment is good, adding another will double the result. 

They are astounded when the pigment worsens.  How can that be? Hydroquinone is a photosensitiser.  Used alone, inflammation is not a factor.  Although the industry touts microneedling as being colour-blind (safe to use in all skin types), there are combined factors that induce complications, photosensitising being one. Combine this with the inflammatory response that microneedling provokes and you have the underlying cause for PIH in this instance.

There are many things to consider before deciding on a course of action, but one should start with answering three questions:

  • Is this an appropriate client/patient to treat?
  • Am I sufficiently qualified to treat this condition?
  • Will this condition respond to needling?

Many practitioners put the cart before the horse and begin with the 3rd question.  I am frequently asked privately (or even on Facebook), “Can I treat “this” or “that “, particular condition with microneedling? (In other words, they are asking the third question first).  One might assume they have already asked and answered the first two questions in the affirmative.  However, one should never assume.  A wise old doctor told me during internship many decades ago, never to prescribe treatment based on another doctor’s findings.  That advice has saved me many times.  Never assume! 

First, when someone poses a question like this, it confirms that they are not qualified to do the treatment, regardless of what degrees they hold.  Microneedling is a complex subject with serious complications and one’s education in this field should already be completed before even venturing to include it in their clinic. 

Second, this disregards the fact that there is a person attached to the other side of the skin condition.  Each person is unique, and it is their unique factors that determine whether a condition can or cannot be treated. Thus, when practitioners contact me stating they have someone coming in the treatment of x,y, or z, and what needle depth should they use, this is totally the wrong way to approach things.  We cannot treat a ‘condition’ and lose sight of the patient.

Here are the five “P’s” of success in microneedling that require appropriate consideration before a treatment is determined:

  • Patient selection
  • Product selection
  • Pen selection
  • Penetration depth
  • Period between treatments

To gain full detail of these five “P’s” please purchased Dr Lance Setterfield’s latest Third Medical Edition – Revised and Expanded manual – The Concise Guide to DERMAL NEEDLING.

Dr Setterfield is considered a world-authority of the practice of dermal needling. His latest edition of his manual will walk you through how to achieve leading results through the appropriate and safe application of these procedures.  This manual is considered the Bible of Dermal Needling. 

Access your copy here