This sponsored article is a contribution from DERMAROLLER.

The success story of the microneedling begins in 1995 with the publication of “Orenteich et al.1” on successful subcision therapy of deep scars and wrinkles. In 1997 “Camirand et al.2” described the treatment of scars with a tattoo machine. They were able to show that the scar structure improves lastingly through multiple micro injuries. 2002 is regarded as the birth of the cosmetic microneedling. Fernandes published his work on collagen induction by microneedling. Since then, medical needling up to a depth of 2.5 - 3 mm and cosmetic needling, the so-called collagen induction therapy (CIT) with smaller penetration depths, have become firmly established. Microneedling offers an alternative to deep peelings or fractional laser treatments.

Mode of action and indications

The mode of action of microneedling is comparable to that of the fractionated laser, only in a cold way: the penetration of the needles into the skin leads to multiple micro injuries and the destruction of collagen fibres. In addition, it‘s postulated that the steel needles lead to disturbances of the electrical fields at the cellular level, which should lead to a modified wound healing reaction. The activation of wound healing cascades and repair processes leads to the release of growth factors, which ensure increased cell proliferation and angiogenesis. Collagen and elastin are built up, histological studies showed massive growth rates of up to 200%. In the course of remodelling, collagen 3 is additionally converted to collagen 1, which has a positive effect on scar formation. These processes lead to an overall increase in tissue firmness and skin thickness. Nerves or vessels are not injured during this treatment, only small capillaries are punctured so that a minimal punctiform bleeding occurs. The indications for the microneedling include all conditions in which the skin needs to be firmed or its texture improved. Areas of application are for example acne or surgical scars, wrinkle treatment, skin tightening, cellulite, striae distensae or androgenic alopecia.

Product overview

There are various treatment systems available for performing needling. Manual roller systems that are rolled over the skin are widely used. These have a fixed needle lengths and different roll widths and are suitable for treating large areas in a short time. However, due to the fixed needle length, problems arise when treating different areas with the requirement of different penetration depths in one session. Treatment, especially in hard-to-reach areas such as the nasal fold can be difficult, due to the width of the roller.

Manual stamping systems also work with fixed needle lengths. However, due to the smaller, mostly round base, they are more suitable for areas that are difficult to access. The advantage becomes a disadvantage when it comes to treating larger areas, where roller stamping systems are clearly inferior in terms of treatment speed.

Both systems are combined in electric stamp systems. On the one hand they make it possible to treat areas that are difficult to access, but on the other hand they are fast enough to treat larger areas due to the motor operation with stroke rates of up to 150 strokes per second. In addition, they offer the possibility of varying the needle length in one treatment, for example, different facial regions can be treated without the need for several attachments.

Implementation and results

The area to be treated is thoroughly disinfected. The needling system is then used to treat the area in various directions until microbleedings occur. The depth of treatment depends on the area and varies from 0.5-1.2 mm for cosmetic indications. If the treatment depth is greater, the therapy can be unpleasant and painful. Pre-treatments with a surface anesthetic offer more comfort for to the patient. Medical needling from with a penetration depth of 2.5 mm and more is usually performed under general or local anesthesia, depending on the area. Depending on the depth of penetration, the skin changes in the treatment area such as selective bleeding, erosions or swelling heal after one to three days.

For the aftercare scar therapy use of special oils is recommended. Cosmetic needling needs moisturizing serums in combination with rich skin care creams in order to rebuild the disturbed skin barrier as quickly as possible. As a positive aspect of needle penetration, active ingredients such as antioxidants, vitamins or trace elements can also be applied directly after the treatment. A consistent sun protection for at least two weeks with a SPF 30 or above is indispensable.

Depending on the indication, several treatment sessions at intervals of a few weeks are required; it varies from user to user. In the course of treatments, the skin becomes finer pored, firmer and thicker because of collagen induction. The wrinkle depth is reduced, scars become flatter and fit better into the surrounding level. The collagen remodeling phase lasts a minimum of four weeks.

PRP and serums

The original microneedling has been extended in recent years. On the one hand, different serums exist, which are worked into the skin by means of needling, on the other hand platelet rich plasma (PRP) is used. The most common serum is hyaluronic acid. For cosmetic indications, this is incorporated by means of needling and is supposed to improve the skin aspect due to its water-binding capacity. Finished cocktails are also frequently used to improve hair growth. These usually contain various vitamins of the B-series, essential amino acids and antioxidants. The benefits of this treatment regime are currently still controversially discussed, as the overall study situation is thin and the quality of the available studies is insufficient. In addition, there are case reports of undesired side effects with abscess formation and hair loss at injection sites. Compliance with the necessary hygiene standards and the education of patients about possible side effects are therefore indispensable. It must also be ensured that the serum used requires approval as a medical devices.

Platelet rich plasma is obtained from patient blood. Special kits are used to separate the collected blood after centrifugation into corpuscular components, platelet rich plasma (PRP) and platelet poor plasma (PPP). The PRP fraction is isolated for treatment. Besides platelets, this fraction also contains Transforming Growth Factor (TGF β1, β2), Platelet Derived Growth Factor (PDGF), Epidermal Growth Factor (EGF), Insulin-like Growth Factor (IGF 1), Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF). It is postulated that these growth factors stimulate hair growth. This field of research is still new and requires further progress before a final assessment can be made. The use of PRP for skin rejuvenation has been a subject of research for quite some time. The positive effect of PRP on wound healing, skin elasticity, and collagen formation and wrinkle formation has been proven. The use of PRP in cosmetic products indications is therefore more widespread and has been known in Hollywood as "Vampire Lifting".