Needling: a regenerative dermatology technique

Needling, also known as Skin Needling or Microneedling, and in Italian as Regenerative Skin Microperforation (MCR), is a relatively recent technique in regenerative dermatology.
The principle behind it is very simple: if we deliberately create thousands of microperforations through the epidermis down to the upper layer of the dermis, we inevitably trigger a significant and complex response.
In fact, the stimulus caused by the microperforation activates both the cells of the epidermis and those of the dermis.
The epidermal cells targeted and destroyed by the penetration of the microneedle release both growth factors (cytokines) and inflammatory mediators (lymphokines). The same occurs in the dermal cells, where, in addition to fibroblasts, blood vessel cells are also affected, leading to the leakage of blood droplets into the dermis. Blood cells also deliver, to the site of the trauma caused by the microneedle, stimulating factors such as the oxygen carried by red blood cells or the cell-stimulating factors of platelets.

Initially, needling was performed using needles similar to those used for tattoos, along with the same equipment.
More recently, the technique has improved with the introduction of specialised rollers coated with micro-needles of varying lengths, depending on the intended application.
The rollers were subsequently replaced by vertical needling devices.
These are devices that move rapidly back and forth and are fitted with a disposable multi-needle tip. On these devices, the perforation speed and depth can be adjusted using controls. This allows the device to be adapted to different skin types and skin conditions, as well as to different areas of the face and body.
In the practice of Regenerative Dermatology, perforations of 0.5 mm, 1 mm and 1.5 mm are used.

Applications of the needling technique

When microneedling is performed on the face, the stimulation caused by the micro-perforations tightens the skin, thereby reducing fine lines or wrinkles caused by sagging. The same stimulation reduces areas of poor blood supply or patchy pigmentation caused by sun damage, and by using longer needles, acne scars or other scars and excessive skin porosity can be reduced.
Needling can partially or completely reduce, depending on the case, the imperfections caused by stretch marks anywhere on the body.
Even in cases of rosacea or couperose, the use of needling helps to reduce or eliminate the vasodilation, thereby lightening the skin.
Needle length and practical application (examples).

One particularly popular application is the reduction of acne scars. The scars left by acne are often very noticeable and cause distress to those affected. Using the vertical needling technique, it is possible to reduce the appearance of these scars, at least partially, after just one or two treatment sessions.

With needles reaching a depth of 0.5 mm:

• General facial regenerative stimulus
• Reduction of photoaging signs
• Reduction of facial lines (minor wrinkles)

With needles reaching a depth of 1 mm:

• General facial regenerative stimulus
• Reduction of wrinkles
• Reduction of stretch marks
• Reduction of abnormal pigmentation

With needles reaching a depth of 1.5 mm:

• General facial regenerative stimulus
• Reduction of wrinkles
• Reduction of scars
• Reduction of porosity

Is it painful?

While needling with rollers was painful, the vertical needling instruments only cause discomfort.
However, this can be reduced by applying an aqueous gel, similar to those used in ultrasounds, to the treatment area which allows the instrument to glide more easily.

The Needling technique

The technique is simple: the area to be treated is wiped with a disinfectant solution. If the practitioner is working alone, they then stretch the skin between their index and middle fingers until it is flat, or ask an assistant to pull the skin taut; at this point, they begin to move the disposable tip of the micromotor across the skin, applying even and constant pressure. The treated area should turn completely red when using 0.5 mm needles, or be completely and evenly covered with pinpoint haemorrhages when using longer needles. Once the microperforation is complete, apply Dermasana with Aluminium Chloride to the treated area to coagulate any micro-bleeding, and to astring and reduce inflammation in the treated area.
At home, apply PEG ointment to the treated area for a few days to promote complete healing.
The redness is short-lived and usually disappears by the day after the procedure.

In breve:

What happens after the treatment

After needling, the skin appears uniformly red, and some small bleeding points are visible.

The skin will be fully repaired within three to seven days.
During these days the treated area should be dressed with PEG Ointment.

When to avoid needling

Needling cannot happen if the patient has one or more of the following:

• Active infections
• Coagulation alterations
• Healing defects
• Skin tumours
• Active acne
• Ongoing eczema or Atopic Dermatitis
• Psoriasis
• Diffuse actinic keratosis
• Diffuse raised nevi

How many needling treatments are needed

To achieve the desired result, multiple needling treatment sessions must be scheduled.
In general, three treatments at intervals of one month are required to begin to see results.
This number will vary depending on the initial condition and the results sought.

Needling treatment with PDT

Needling can be combined with photodynamic therapy (PDT) for photodynamic peeling.
As needling causes inflammation, the treated area is in the prime condition for photodynamic treatment. If, the day after needling, the photosensitizer aminolevulinic acid is applied for about three hours, and then exposed to red light at 630nm wavelength, administering about 75 J/cm2, photodynamic peeling occurs.
While the two techniques have different mechanisms, together they act in synergy and enhance one another.

Needling with drugs and vitamins

The cutaneous micro-perforations can also penetrate drugs and vitamins that would otherwise barely penetrate the skin’s surface on their own.
In practice, however, this application is more theoretical than practical because drugs such as retinoic acid that are known to stimulate the skin have excellent penetrative ability already. Other organized substances that cannot penetrate as easily, such as hyaluronic acid, make no difference to the skin even if injected into the derma.

Vertical needling with Dermapen 4