Advantages and Risk Considerations with Dermal needling

With the ever-growing consumer appetite for preserving and improving the skin’s youthful appearance, there are now proven strategies to help practitioners achieve beautiful skin. One of these is dermal needling.

Optimising skin health through regulating cell function is now an attainable goal.

• Ideal skin rejuvenation treatment programs protect the epidermis while preserving the dermal papillae, optimising cell function, breaking down scar tissue, and rebuilding the extracellular matrix with normal collagen, as opposed to scar tissue.

Here we will review the three pillars for successful treatments and advantages and risk considerations when performing dermal needling.

• Two points of intervention for regulating cell function include optimising cell nutrition and manipulating growth factors.

• Two growth factors in particular, (epidermal and growth factor and transforming growth factor-Beta3), have a positive effect in that they seem to be responsible for scarless wound healing.
• Medical needling complies with all the criteria of ideal skin rejuvenation
• Allows up to 80% more absorption of appropriate topically applied substances
• Releases epidermal growth factor and transforming growth factor Beta3.
• This treatment is also safe to use on all skin types when compared to most other treatment modalities.

Beyond collagen induction therapy

• Microneedling as a modality has now expanded beyond its use for just collagen induction therapy. As we know, the inherent mechanisms of normalising or ‘rebooting’ cell function form the basis for treating other conditions, such as hyperpigmentation, including melasma, vitiligo, acne, dermatitis, hair restoration etc.
• In addition, capitalising on the remodelling phases of wound healing induced by microneedling makes it ideal for scar treatments.
• Keep in mind that remodelling is required for hypertrophic/keloid scars while remodelling AND collagen induction are required for hypotrophic scars.
• This difference accounts for the frequency of treatments being every two weeks in the former and even two months in the latter.
• Just to clarify the differences – hypertrophic scars and keloids both form due to excess collagen during wound healing.
• Hypotrophic scars stay within the confines of the wound, while keloids can grow beyond. Keloids are also much more difficult to treat.

The three pillars for successful treatments

Microneedling is not magic to achieve success you need these three pillars

First

• One must establish the underlying cause of the condition they will be treating.
• This is because this will allow you to determine the depth of the target cells
• Pathology will help you determine the size of the needle to choose and how many treatments will be needed.
• It is also important as part of the Client Informed Consent and managing expectations.

Second

• You will need to be able to link product ingredients to the skin condition.
• Topical products help switch off the inflammation, reseal the barrier defense, moisturise, and supply nutrients after cosmetic needling.
• Product ingredients known to cause inflammation should be avoided.

Third

• You will need a complete understanding of cell function and life cycles to determine when to intervene with treatments. This will allow you to harness the power of nature—work with it, not against it.
• That means that you will need to determine the patient’s capacity for healing. Timing is everything in most aspects of life.
• Treatments at weekly intervals disrupt the natural 28-day process of wound healing at critical stages. This may result in the loss of the ideal synchrony of phases and cause chronicity, which is counterproductive.
• Negative outcomes in response to prolonged inflammation include excessive healing with scarring and fibrosis, and finally, the worst-case scenario, deficient healing.
• Naturally the above assumes you have chosen the right patient and avoiding those less likely to respond to a high risk of complications.

Advantages and risks of skin needling

Let’s start first with the advantages of microneedling as there are many:

Advantages

• With dermal needling, the epidermis is preserved and thickened over time, while normal cell-to-cell communication is improved.
• It leads to regenerative healing, as opposed to cicatricial healing with most other treatment modalities.
• Cell function is normalised.
• It can be used in most areas of the body including the face.

Skin needling advantages

• The fractionated approach leads to rapid healing and minimal downtime.
• Mechanical breakdown of scars leads to remodelling.
• There is no limit to the number of treatments, with incremental improvement.
• More affordable than laser resurfacing, without the associated risks.
• It is not typically associated with dyschromia or photosensitisation when considered in isolation. However, post-inflammatory hyperpigmentation may still occur in the presence of factors that amplify inflammation, e.g. aggressive treatments and combination therapy with other treatment modalities, photosensitising drugs and sunburn.

Disadvantages or risks

• The biggest challenge is adequate anaesthesia for aggressive treatments when using the larger needles 2.0mm and 3.0mm (3.0mm is now no longer manufactured in many parts of the world). This can pose a regulatory issue for non-medical practitioners.
• It takes time to see results.

More risks

• Needle stick injury to the practitioners or blood splatter is possible.
• It is easy to macerate the skin with electronic devices.
• Overtreatment may result in an exaggerated inflammatory response with associated scarring or post-inflammatory hyperpigmentation.

While microneedling as a treatment modality is an incredible procedure in addressing several skin conditions, achieving optimal treatment results requires both excellent knowledge of skin biology and physiology, as well as a thorough understanding of the pathophysiology and the skin condition you are treating.

On-going education is key.

As with all modalities, despite the benefits that microneedling can provide, errors in its use can also contribute to adverse reactions and undesirable skin injury.

The principles presented in this article were extracted from The Concise Guide to Dermal Needling – 3^rd Medical Edition, Revised and Expanded, by Dr Lance Setterfield. M.D.