microneedling a basic overview. recent advances. growing technique for the different indications.

1. Microneedling: Advances and
widening horizons
Kamal jung shahi
2nd year Resident
NGMC-TH

2. History
• The advent of the concept of microneedling dates back to 1995 when
Orentreich and Orentreich described dermal needling in the form of
subcision for scar treatment.
• In 1997 : plastic surgeon Camirand who used tattoo guns without ink
to take-off tension from postsurgical scars.
• Later by a German inventor Liebl in 2000 and a plastic surgeon
Fernandes in 2006 self-designed a drum-shaped device with multiple
fine protruding needles and used it for percutaneous collagen
induction.

3. Introduction
• Skin needling is also called collagen induction therapy.
• It is a minimally-invasive non-surgical and non-ablative procedure
for skin rejuvenation that involves the use of a micro-needling device
to create a controlled skin injury.
• simple, cheap, safe, and effective technique requiring minimal
training.

4. Principle : collagen induction therapy.
• The needles create holes by piercing through the stratum corneum. This
leads to the release of growth factors, which stimulates collagen and elastin
production in the papillary dermis.
• In addition to that, new capillaries are also formed.

6. Pathophysiology of percutaneous collagen induction:
• Platelets and eventually neutrophils release growth factors such as TGF-α,
TGF-β, platelet-derived growth factor, connective tissue activating protein
III, connective tissue growth factor, and others that work in concert to
increase the production of intercellular matrix.
• Monocytes then also produce growth factors to increase the production of
collagen III, elastin, glycosaminoglycans, and so forth.
• Approx. 5 days after skin injury, a fibronectin matrix forms with an
alignement of the fibroblasts that determines the deposition of collagen.

7. Scarless healing induced by transforming growth factor-beta3:
• Percutaneous collagen induction (PCI) initially upregulates TGF-β1 and
-β2 levels at two and four weeks post-treatment, followed by a
significant downregulation at eight weeks.
• TGF-β3 shows a strong upregulation two weeks post-needling,
without downregulation at four and eight weeks after treatment.
• These findings suggest that PCI could offer a new approach to
rejuvenate and enhance skin appearance and quality by reducing or
preventing scarring

8. Skin regeneration and remodeling of extracellular matrix:
• PCI (Percutaneous Collagen Induction) impacts gene expression in skin,
promoting extracellular matrix remodeling.
• Increase in Gene and protein expression of collagen I, glycosaminoglycans
(GAGs), and growth factors like VEGF, EGF, and FGF7, crucial for skin
regeneration.
• Collagen fiber bundles were qualitatively increased and more loosely
woven after medical needling.
• Epidermal-dermal interface showed regular dermal papillae and
maintained cellular polarity and differentiation.
• Connective tissue network within the reticular dermis was thickened and
organized.
• This study observes regeneration processes after PCI, indicating potential
for regenerating healthy skin in vivo.

9. Percutaneous collagen induction and postinflammatory dyspigmentation:
• The number of melanocytes was unchanged after medical needling.
• Additionally, DNA microarray experiments demonstrated (2 weeks post-
operatively):
• Interleukin-10 was increased
• MC1R gene (Melanocortin 1 receptor), coding for a melanocyte-stimulating
hormone, indicated a faint down-regulation
• Therefore, in opposite to dermabrasive procedures, percutaneous
collagen induction therapy appears to have a lower risk of
dyspigmentation.

10. Phases of healing following microneedling:
• Inflammation:
• on average visible inflammation phase lasts approx 48 hours.
• Chilled cooled mask soaked in hyaluronic acid (reduce atleast 50% erythema in 30
minutes).
• Visible edema is minimal but if appears fade within 48 hours.
• Proliferation :
• Starts immediately and reaches peak approx 2 months later.
• Remodelling.:
• New collgen fibre III integrate into existing skin matrix.
• Improvement is seen 3-4 weeks after treatment.
• Longer duration to mature collgen III to I
• Atrophic scar: 2-3 weeks
• Hypertrophic scar: many months.

11. Important considerations:
• Devices based on needle length, drum size, and automation.
• High ratio of tip length versus diameter of 13:1 is an important property of good
needles.
• Length of needle = indication of procedure
• For acne and scars : 1.5–2 mm.
• For ageing skin and wrinkles : 0.5 mm or 1.0 mm
• Minimum time interval between two sittings of microneedling depends upon the
indication.
• More is the needle length, greater should be the interval between two sittings of
microneedling.

12. VARIOUS INSTRUMENTS AND TECHNIQUES
A. Dermaroller
B. Dermapen
C. Dermafarc
D. Derma-stamp
E. Microneedle delivery systems
F. Fractional radiofrequency microneedling
G. Light emitting microneedling device

13. A. Dermaroller
• FDA registered Five basic types of medical dermarollers;
i. C-8 (Cosmetic type), is the basic dermaroller needle length of
only 0.13 mm (130 μm) used for enhancing penetration of
topical agents. It is completely painless.
ii. C-8HE (Cosmetic type for hair-bearing surfaces, scalp) has a
needle length of 0.2 mm (200 μm). Even this length is below
the pain threshold.
iii. CIT-8 (CIT: Collagen Induction Therapy, Medical type) has a
needle length of 0.5 mm (500 μm) and helps in collagen
induction and skin remodelling.
iv. MF-8 type has a needle length of 1.5 mm (1500 μm). This
creates deeper microchannels on the whole epidermis and
dermis and at the same time destroys scar collagen bundles.
v. MS-4 is the only dermaroller that has a smaller cylinder, 1 cm
length, 2 cm diameter, and subsequently 4 circular arrays of
needles (total 96 needles) that have 1.5 mm length. It is mostly
used on facial acne scars.

14. Home-care dermarollers (C-8) are
• Used by patients themselves.
• Needle length less than 0.15 mm and are
• Available for reduction of pore size, fine lines, and sebum
production, as well as for transdermal delivery of substances
such as lipopeptides and other antiageing products.
• Can be used twice or thrice a week for up to 100 times.
• Cleaned in hot tap water and shaken dry.
Beauty Mouse
• another approved device intended for home use.
• It contains a total of 480 needles of approximately 0.2 mm
size on 3 separate drums strategically placed inside a
computer mouse shaped device.
• It has been developed to ensure coverage of larger skin
surface areas, such as the arms, legs, and buttocks for the
treatment of stomach or thigh stretch marks and cellulite.

15. B. Derma-stamp
• These are miniature versions of the
dermaroller.
• Needle lengths (0.2–3 mm) and a diameter
of 0.12 mm that are used for localized scars
such as varicella scars.
• Advantage over the dermaroller is that a
more focussed treatment of individual
scars is possible.
• It causes vertical penetration to create
infusion channels in the skin and is
considered ideal for use on isolated scars
and wrinkles

16. C. Dermapen
• Automated microneedling device which looks like a pen.
• Uses disposable needles and guides to adjust needle length for
fractional mechanical resurfacing.
• The tip has 9–12 needles arranged in rows.
• Rechargeable battery to operate in two modes, namely, the
high speed mode (700 cycles/min) and the low speed mode
(412 cycles/min) in a vibrating stamp-like manner.
• Advantage:
• Reusable in different patients .
• Safe as the needle tips are hidden inside the guide, and
• More convenient to treat narrow areas such as the nose, around the
eyes and lips.
• Less painful and more economical as there is no need to buy a
new instrument every time.
• This technology has been designed to overcome the issues of
varying pressure application and the subsequent depth of
penetration achieved.

17. D. DermaFrac
• Combines microdermabrasion, microneedling,
simultaneous deep tissue serum infusion, and
light emitting diode (LED) therapy.
• DermaFrac treatments target aging and sun
damaged skin, acne, enlarged pores, uneven skin
tone, wrinkles, fine lines, hyperpigmentation, and
superficial scars.
• It takes approximately 45 min to complete full face
treatment when all four modalities are used.
• This noninvasive, cost-effective treatment carries
the advantage of having no downtime with
individualized selection of serums for infusion.

18. E. Microneedle delivery systems
• Microneedle delivery systems provide a minimally
invasive and painless approach for transdermal drug
administration, particularly suitable for vaccines.
• Types of microneedles include solid, coated,
dissolving, hollow, and swellable polymer
microneedles, fabricated using microfabrication
techniques.
• Materials used for microneedle fabrication include
silicon, metals like titanium, natural and synthetic
polymers, and polysaccharides.
• Solid-coated microneedles pierce the superficial skin,
allowing topical application and drug delivery.
• Dissolving or biodegradable and hollow
microneedles directly deliver drugs into the dermis,
bypassing the superficial layers for enhanced
absorption.

19. G. Fractional radiofrequency
microneedling.
• combines microneedling with radiofrequency technology, broadening its
applications. Key points include:
• Insulated Needles: Insulated needles penetrate the skin and release
radiofrequency currents from the tips, creating thermal zones in the
dermis and accessory glands without harming the epidermis.
• Dermal Remodeling: This process stimulates long-term dermal
remodeling, neoelastogenesis, and neocollagenesis, promoting skin
rejuvenation.
• Adjustable Depth: Needle depth can be adjusted from 0.5 mm to 3.5 mm,
allowing precise targeting of different dermal layers.
• Controlled Tissue Damage: Operators can control tissue damage by
adjusting power levels and energy pulse durations.
• Disposable Tip: The main energy delivery system typically features a
disposable tip with 49 gold-plated needles.
• Safe for Various Skin Types: As it doesn't harm the epidermis, fractional
radiofrequency microneedling is considered safe for darker skin types.
• Indications: Applications include scar treatment, hyperhidrosis, skin
tightening, rejuvenation, and more.

20. H. Light emitting microneedling device
• LED microneedling rollers have been recently launched.
• These incorporate titanium microneedles and LED light to combat
wrinkles and scarring.
• These devices have not yet been explored and no published data is
available regarding its efficacy

21. PROCEDURE
• Simple office-based procedure lasting 10 to 20 minutes depending on
the area to be treated.
• Proper Counselling
• The skin should preferably be prepared preoperatively for at least a
month with vitamin A and C formulations twice a day to maximize
dermal collagen formation.

22. • Under topical anesthesia containing eutectic
mixture of lignocaine and prilocaine/tetracaine
for 45 minutes to 1 hour.
• Preparation of the area with antiseptic and
saline.
• Skin is stretched with one hand, and
perpendicularly, rolling is done 5 times each in
the horizontal, vertical, and oblique directions
with the other hand.
• Treatment endpoint is identified as uniform pin-
point bleeding which is easily controllable.

23. • Post-procedure, the area is made wet with saline, or ice packs can be
used for comforting the patient.
• Thereafter, the patient is advised to use sunscreen regularly and follow
sun-protective measures.
• No post-treatment sequelae except slight erythema and edema lasting
for 2–3 days.

24. APPLICATIONS OF MICRONEEDLING IN DERMATOLOGY
• Wide range of indications.
• Tried alone as well as in combination with other treatment modalities
such as chemical peeling, platelet rich plasma, radiofrequency,
subcision, punch elevation, and lasers.
• It is often used in conjunction with a topical formulation, and hence,
enhances its penetration and action.

25. I. Skin rejuvenation
• A significant increase in level of collagen type I, III, and VII, newly
synthesized collagen and tropoelastin from baseline was observed after
6 microneedling sessions at 2-week intervals by El-Domyati et al.

26. II. Scars
• Acne scar
• Non acne scar

27. Table: Fractional microneedling radiofrequency trials for acne vulgaris

28. III. Androgenic alopecia and alopecia areata

29. IV. Pigmentation—Melasma and periorbital hypermelanosis

30. V. Miscellaneous conditions

31. CONTRAINDICATIONS
• Active acne
• Herpes labialis or any other local infection such as warts.
• Moderate to severe chronic skin disease such as eczema and psoriasis
• Blood dyscrasias, patients on anticoagulant therapy.
• Extreme keloidal tendency.
• Patient on chemo/radiotherapy.

32. Advantage Disadvantage
Preservation of Epidermis Blood Exposure:
Repeatability: Anesthesia Requirement:
Suitability for Sensitive Areas Swelling and Bruising:
Short Healing Phase Longer Interval for Results:

33. Pre (a, c, e) and post (b, d, f) treatment
photographs of post-acne atrophic scar patients
after 4 sittings of microneedling done 1 month
apart
Post-varicella scars (a,c) showing improvement
(b,d) after 3 microneedling sittings done 1
month apart

34. Significant improvement in post-traumatic scar over the nose
after 1 sitting of subcision followed by 3 sittings of
microneedling done 1 month apart

35. REFRENCES
1. Ferguson Mark W. J. and O'Kane Sharon 2004Scar–free healing:
from embryonic mechanisms to adult therapeutic interventionPhil.
Trans. R. Soc. Lond. B359839–850.
2. Singh A, Yadav S. Microneedling: Advances and widening horizons.
Indian Dermatol Online J. 2016 Jul-Aug;7(4):244-54. doi:
10.4103/2229-5178.185468. PMID: 27559496; PMCID:
PMC4976400.
3. The Role of the Anti-Inflammatory Cytokine Interleukin-10 in
Tissue Fibrosis Emily H. Steen, Xinyi Wang, Swathi Balaji, Manish J.
Butte, Paul L. Bollyky and Sundeep G. Keswani