Needling: a regenerative dermatology technique

Needling, also known as skin needling or microneedling, is a relatively recent technique in regenerative dermatology.
The principle behind it is simple: by skillfully making thousands of micro-perforations through the epidermis to the upper part of the dermis, the cells of the epidermal and dermal will be activated.
The epidermal cells are centered and destroyed by the penetration of the micro-needle, which causes them to release growth (cytokines) and inflammatory induction factors (lymphokines).
The same, too, happens in the dermal cells where fibroblasts and blood vessel cells are also affected, leading to the escape of blood droplets into the dermis. These blood cells bring stimulating factors to the site of the trauma caused by the micro-needle, such as the oxygen from red blood cells or the cellular stimulus factors from platelets
In the past, needling was performed with tattoo-type needles and other similar instruments. Over time, the technique advanced, thanks to the introduction of special rollers coated with micro-needles of variable lengths and sizes, depending on the application to be performed.
More recently still, these rollers have since been replaced by vertical needling instruments, which move back-and-forth rapidly and have disposable tips with multiple-needles.
The speed and depth of perforation can be adjusted using regulators, allowing the tool to be adapted to various types of skin and conditions, as well as 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 needling is performed on the face, the stimulus caused by micro-perforation makes the skin more toned, thus reducing minor wrinkles or lines.
Needling can also reduce areas of poor vascularization, or pigmentation spots caused by sun damage.
By using longer needles, scarring (including acne scars) and excessive skin porosity can also be reduced. Needling can partially or totally reduce the imperfections caused by stretch marks in any location of the body. In cases of rosacea or couperose, needling can reduce or eliminate the component of vasodilation, thus clearing the skin.
Needle length and practical application (examples) Many are especially grateful to needling for the reduction of acne scars, which can often be very evident and a source of discomfort. Using the vertical needling technique, scars can be partially reduced 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 treatment area is wiped with a disinfectant solution. The operator then stretches the patient’s skin between their first and second fingers until it is completely flat. If an assistant is present, the operator will ask them to exert traction on the skin. Once the skin is flat, the disposable tip of the vertical needling instrument is applied, ensuring uniformity and constant pressure. When using 0.5mm needles, the treatment area must become completely red. In the case of longer needles, the area must be completely and uniformly covered with hemorrhage dots. After the micro-perforation, an Astringent gel with aluminum chloride is passed over the treated area to coagulate any micro-bleeding and to constrict and reduce inflammation of the area treated.
In the days following treatment, apply PEG Ointment to the treated area to promote complete repair.
The redness is short-lived, to the extent that it is often no longer noticeable by the next day. In summary:

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 tumors
• 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