Introduction

Nowadays, there are so many techniques offered to fight facial aging. Microneedling and ionosonophoresis are one of the easiest and safest, with its mechanical and biological action for collagen formation, combined with a cutaneous administration of antioxidants.

Skin anatomy and physiology quick reminder:
Anatomy: about 5 kilos for about 2 square meters it is the medium between the organism and the surrounding.
- Epidermis: 0,1 to 4mm in constant renewing acts as an immunologic barrier. 80% keratinocytis but also melanocytis (Fitzpatrick scale) and Langherans cells for immunologic protection.
- Dermis: fibroblastis and blood cells with fibers of reticulin, elastin and collagen in a medium of mucopolysaccarids as hyaluronic acid.
- Hypodermis: fat lobules delimited by bands of collagen fibers.
Fatty stem cells will activate growing factors (vgef,igf,hgf,tgf-a) and their anti free radical actions.

Physiology: protecting from radiations, acting as a semi-permeable membrane. Homeothermic agent (sweat secretion), it is an immunatory agent as well as a sensory organ.

Oxydative stress

Oxidative stress mechanisms in tissue injury. Free radical toxicity induced by xenobiotics and the subsequent detoxification by cellular enzymes (termination).

Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal redox state of cells can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins, lipids, and DNA. Oxidative stress from oxidative metabolism causes base damage, as well as strand breaks in DNA

Skin aging

Intrinsic structural changes occur as a natural consequence of aging and are genetically determined. The rate of aging is significantly different among different populations, as well as among different anatomical sites even within a single individual. The intrinsic rate of skin aging in any individual can also be dramatically influenced by personal and environmental factors, particularly the amount of exposure to ultraviolet light, photodamage, for which microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. It considerably accelerates the visible aging of skin, also greatly increases the risk of cutaneous neoplasms.

The processes of elastic fibers degeneration and lysis run faster and at higher speed as compared to the degeneration of collagen fibers and start in the superficial dermis, subsequently affecting the deep dermis as well. The consequence of connective fibers lysis in the dermis is the gradual reduction in dermis thickness as a whole, particularly through a reduction in the quantity of collagen fibers. With the progress of senescence, there is a progressive reduction of dermis vascularization, due to a reduction in the number and size of vessels, caused in its turn by progressive alterations of vascular wall components that go as far as the ceasing of the vessel’s function. The effects of altering the structure and functionality of vessels are critical in triggering and running all processes of degeneration and alteration that accompany skin senescence

Microneedling

Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. 

The needle action is to be compared as an electric potential increasing the fibroblasts activity with neocollagenesis, neovascularization, and cytokine regulation tgfb3. There is also a growth factor stimulation.

It helps to improve the superficial cutaneous aspect, the penetration of active ingredients and decrease the trans epidermal loss of water.

Which method to select?

You can choose depending on the desired action, different types of stamps, rollers according to the number, shape, size of the needles you will find manual or electrical devices where you can choose speed, length etc….

In our experience considering anti-aging treatment, we use a derma-roller, 192 titanium with 1,5mm length needles.

We combine this technique with sonoionophoresis

The barrier properties of the skin only allow small, hydrophobic permeants to traverse the skin passively, greatly limiting the number of molecules that can be delivered via this route. The use of low-frequency ultrasound for the transdermal delivery of drugs, referred to as low-frequency sonophoresis (LFS), has been shown to increase skin permeability to a wide range of therapeutic compounds, including both hydrophilic molecules and macromolecules.

Transdermal delivery of macromolecules provides an attractive alternative route of drug administration when compared to oral delivery and hypodermic injection, because of its ability to bypass the harsh gastro-intestinal tract and deliver therapeutics non-invasively

Conclusion

Among the numerous treatments proposed in anti-aging and esthetic medicine, this non invasive technique at the same time safe and costless with no or little side effects as far as you respect the indications and a fortiori the contra-indication allows a formation of neocollagen and the administration of active ingredients as antioxidants to fight against the oxidative stress.