Today, treatments are valued at over $540 million with an expected compound annual growth rate (CAGR) of 7.5% from 2022 to 2030, stemming in part from continued innovations in technology and an ever-increasing range of treatments.1
According to Diane Duncan, MD, a plastic and reconstructive surgeon in Fort Collins, Colo., there are more than 20 microneedling systems available in the U.S. While mechanical microneedling is the main tool for skin resurfacing, radiofrequency (RF) microneedling adds the ability to lift and tighten skin within the same treatment.
“Non-thermal microneedling is popular, but in my opinion, not nearly as effective as thermal or RF microneedling,” Dr. Duncan stated. “In order to get clinical results from non-thermal microneedling, a fairly aggressive approach with multiple passes is needed.”
“I think the concept of using artificial intelligence (AI) and a very intelligent measurement of energy is the trend,” stated J.D. McCoy, NMD medical director at Contour Medical (Gilbert, Ariz.). “The latest device from BTL Aesthetics (Marlborough, Mass.), Exion, uses AI so that each pin senses skin impedance, allowing the device to adjust energy accordingly. A single pass is all that is needed, so treatment comfort and efficiency are optimized. In the extended mode, RF energy can be delivered twice as deep as the needle depth chosen.”
The Versatility of Microneedling
Desmer Destang, DDS, MSc, medical director at Dermalogics Aesthetic Dermatology (St. Lucia, Caribbean) treats mainly patients with darker skin types.
“Microneedling represents the only treatment to date that can be used on all skin colors to facilitate harmonious cellular communication between the fibroblasts, melanocytes and keratinocytes. Because of this amazing super-power, microneedling can be combined with several treatments. RF is the main booster for microneedling to date and works especially well for skin laxity and acne scars. We also love doing smooth polydioxanone (PDO) thread skin therapy at the same microneedling appointment for patients with wrinkles and acne scars .”
H.L. Greenberg, MD, a board-certified dermatologist and founder of Las Vegas Dermatology (Las Vegas, Nev.), incorporates microneedling as part of his skincare and spa services. “Microneedling remains one of the best procedures we have for skin rejuvenation. We use it to help get rid of pigment after Q-switched Nd:YAG laser treatment for melasma and with platelet-rich plasma (PRP) for faster wound healing and to improve long-term results,” he shared. “We often add a CO2 Lift mask to assist in absorption of post-treatment wound healing and we sometimes use ProGen PRP and SkinPen from Crown Aesthetics (Dallas, Texas) for microneedling, while analgesia is enhanced with the ProNox system.”
Dr. McCoy also combines microneedling with Q-switched lasers. “The number one combination I have right now for treating melasma is a combination of RF microneedling with a fractionated Q-switched laser,” he shared. “Also, many of my patients do not have a lot of time, so to accomplish a lot in a single treatment, we sometimes stack a BroadBand Light (BBL) photofacial with microneedling.”
“I frequently combine other energy-based technologies with my RF microneedling treatments,” reported Monica Boen, MD, a dermatologist at Cosmetic Laser Dermatology (San Diego, Calif.). “To treat facial photodamage, I will perform a laser treatment for redness or broken blood vessels with the Vbeam® laser from Candela (Marlborough, Mass.) and for brown spots I will use the PicoWay® laser (Candela). I can do either on the same day as the microneedling treatment. This multimodal approach improves results and can be performed safely if you are experienced with energy-based devices,” she continued.
Dr. Boen added that she also customizes treatments with the help of a specialized microneedling device. “I sometimes combine microneedling with hyaluronic acid (HA) filler using a special device where I can infuse HA into the skin during the RF microneedling treatment. I may also combine RF with biostimulatory fillers to enhance results,” she explained.
Board-certified dermatologist and dermatologic surgeon Dennis Gross, MD from New York City, N.Y., who has been practicing for 25 years often combines microneedling with injectables. “Microneedling can be used to deliver microdroplets of things like dermal fillers or botulinum toxin for enhanced results. I may combine it with neurotoxin or filler and professional retinol peels. Delivering neurotoxin and filler with microneedling allows us to treat a wider area than traditional injections,” he reported.
“We also stack CO2 on top of microneedling,” Dr. Gross continued. “This really refines the patients’ results for more tightening and resurfacing. In addition, we pair microneedling with light-emitting diode (LED), which can help with the inflammation response.”
Training and Managing
Complications Practitioners and physicians who want to add microneedling to their practice can find training with most device manufacturers. “Each company has a different technique based on their device.
Observe the procedure and choose a device that you think works based upon their papers and research,” Dr. Greenberg recommended.
Dr. Destang had some words of caution for practitioners. “While I love the newer RF microneedling devices, clinicians need to dial down the energy setting for darker skin,” she clarified. “Melanocytes are easily aggravated. Their role is protective, and melanin is a protective skin antioxidant. Higher energy and heat settings on dark skin signals these cells to produce higher levels of eumelanin, so one runs the risk of post-inflammatory hyperpigmentation (PIH) if not careful.
Collagen P.I.N.® from Induction Therapies (Louisville, Ky.) is designed to deliver a better microneedling experience for the patient and providers. “I routinely use Collagen P.I.N. alone for the treatment of scars, enlarged pores and perioral rhytides,” reported Tina Alster, MD, a dermatologist in Washington, D.C. “It can also be used in conjunction with energy-based treatments such as fractionated and pulsed dye lasers or micro-focused ultrasound to enhance clinical results.”
This device allows for a smooth treatment application and is equipped with cord-free operation. “The battery holds its charge throughout the day, making it practical in a clinical setting,” Dr. Alster explained. “It is easy to use and maneuver in difficult areas such as around the nose. Single-use disposable sterile tips are easily attached to the handpiece and can be used for large treatment areas without needing replacement.”
Dr. Gross’ go-to device is the Secret PRO from Cutera (Brisbane, Calif.), which combines fractional CO2 laser technology and RF microneedling. According to Dr. Gross, the RF microneedling pins deliver a predetermined depth of RF energy, while the fractional CO2 laser ablates only a fraction of the skin, mitigating the risk of side effects and downtime. “The combination of both of these devices on one platform allows for a more precise, targeted treatment and is the first dual system to stimulate neo-collagenesis from the bottom up and top down,” Dr. Gross reported. “It has much less pain and downtime compared to other devices on the market with notable improvements that include increased skin thickness and collagen production.”
Genius by Lutronic (Billerica, Mass.) is an AIbased microneedling platform that utilizes real-time tissue feedback to deliver micro-coagulation zones precisely and comfortably with every pulse, while presets are available for all skin types and multiple conditions. According to Jay Burns, MD, plastic surgeon at Resurrect Skin M.D. (Dallas, Texas), the device gives realtime feedback during the energy delivery to optimize the desired effect and predictable injury in the dermis. “It has a high torque motor in the handpiece which, when coupled with proprietary extra sharp needle design, gives me precise needle penetration depth that delivers accurate energy,” explained Dr. Burns. “I have more confidence in the Genius system than any other RF system currently on the market. It is an important part of our practice and is a workhorse for our patients.”
SkinPen® Precision allows physicians to offer their patients noticeable rejuvenation results with a non-invasive treatment that is quick, comfortable and affordable, making it a popular choice among patients. “I have always trusted and used SkinPen Precision because of the safety and efficacy research that has gone into the device,” reported Jason Bloom, MD, a facial plastic and reconstructive surgeon at Bloom Facial Plastic Surgery in Bryn Mawr, Penn. “It was the first FDA-approved microneedling device and the only one with two separate FDA-approved indications.” SkinPen serves as an entry point technology for practitioners, helping them generate highly satisfied patients while contributing to the growth of their practice. This device is designed to improve the appearance of wrinkles on the neck for individuals with Fitzpatrick skin types II - IV, as well as to enhance the appearance of facial acne scars in adults aged 22 years and older, regardless of Fitzpatrick skin type.
Virtue RF from SHEnB (Seoul, South Korea) is a solid and versatile device. According to dermatologist Kim Min Seung, MD (Gangnam-gu, Seoul, Republic of Korea), it is a user-friendly device with the ability to customize pulses and frequencies and has multiple handpieces and tips to help physicians deliver custom treatments. “The DeepRF handpiece is highly effective for facial contouring and addressing upper eyelid ptosis due to its unique features,” Dr. Seung reported. “The numbver and spacing of needles on the treatment tip is an important consideration because of facial contours; if the size of the tip is too large, the depth of each needle becomes inconsistent. Virtue RF takes these factors into consideration, allowing for the formation of an appropriate RF current. I use the Smart tip for improvement of melasma and facial skin texture and the Deep tip to address melasma and enhance facial skin texture.”
Dermatologist Stacy Chimento, MD (Bay Harbor Islands, Fla.) prefers the Profound Matrix™ from Candela because it allows her to offer a robust microneedling treatment for all skin types. One of the features of the multi-application system is the customized treatment applicators and real-time impedance monitoring, while the Matrix Pro applicator delivers customized depth and energy settings in a single insertion. “The Profound Matrix system is the most versatile multi-modality RF device on the market,” noted Dr. Chimento. “The combination of ProMatrix microneedling with sublative is my favorite treatment to perform for deep collagen and elastin boosts to improve skin laxity with superficial micro-crusting for a luminous texture. This is now my all-inone device to address all skin concerns.”
DP4 microneedling pen from Dp Derm is what dermatologist Shino Bay Aguilera, DO (Fort Lauderdale, Fla.) favors. DP4 is a fractional micro-channeling device that combines Bluetooth, radiorequency identification dual power and turbo-cut battery systems. According to Dr. Aguilera, it allows for precise control over the depth of penetration and has adjustable speed settings of up to 120 rotations per second. Large areas can be treated faster, while speed and depth are controlled with the touch of a button. “This device has significantly elevated my aesthetic practice. Treatments can be customized to suit individual patient needs for optimal results,” Dr. Aguilera shared. “The DP4 has proven to be a game-changer because of its ability to address various skin conditions such as wrinkles, acne, pigmentation, scars and rosacea, and has become an invaluable tool in my practice.”
Enhancing Microneedling Treatments with Topicals
Dr. McCoy, who has been doing nonsurgical hair restoration for about 15 years, says he has seen the best results since adding RF microneedling as part of an advanced protocol. “I combine microneedling with topical exosomes and then use a high-powered red LED light to improve overall cellular function. Exosomes are more powerful than PRP and they do not need a blood draw, so this combination protocol only takes a little over an hour.” After monitoring his protocol with standardized clinical photography, he and his patients noticed improvements in thickness, hair quality and hair growth after just the first treatment.
“Hair loss is something both men and women deal with, so it has been great to offer a solution that actually works,” reported medical aesthetician Victoria Gadbois, founder of Victorious Skincare (Davidson, N.C.). Ms. Gadbois uses AnteAGE MD® Hair Solution, from AnteAGE (Irvine, Calif.), formulated specifically to maximize the results of clinical hair microneedling treatments. “The science behind AnteAGE is what makes it different, with specialized techniques that influence bone marrow mesenchymal stem cell cultures to produce conditioned media focused on hair growth. Bio-identical growth factors and cytokines, each with proven efficacy in hair follicle stimulation, are added to make this the most scientifically advanced product of its type. It offers the client a way to continue their in-office treatments for the best possible results.” She added that her clients notice thicker, healthier hair and less hair loss especially when brushing or showering.
Developed by Exocel Bio (Doylestown, Penn.), Exovex is a serum packed with high-quality exosomes. Marina Peredo, MD, a dermatologist and founder of Skinfluence Medical PC (New York City, N.Y.) explained that Exovex exosomes are guaranteed concentrations of non-lyophilized, 100% pure exosomes. “I use Exovex exosomes to enhance the results after a laser or microneedling procedure,” Dr. Peredo shared. “They relieve the post-treatment burning sensation and patients will find decreased pain levels, a reduction in inflammation and less downtime.” Exovex utilizes mRNA and growth factors within active exosomes to stimulate cellular repair mechanisms. According to Exocel Bio, users report dramatic improvements in skin rejuvenation and hair growth, a reduction in fine lines and wrinkles, as well as enhanced skin tone and texture.
With the many topicals available, there is one that was designed specifically to maximize microneedling results for anti-aging. RevitaFirm Wrinkle Release Serum by Martinni Beauty (Richmond, Calif.) is a post-procedure serum that includes ingredients to speed healing and that are beneficial for skin health. This comprehensive list of ingredients featuring growth factors, peptides, hyaluronic acid, elastin and amino acids improves the skin barrier while stimulating fibroblast and collagen production. Amino-peptide and Acetyl Octapeptide-3 provide a Botox-like effect to help lift skin, and Oligopeptide-1 helps to repair damaged cells, enhance cell metabolism and minimize the look of wrinkles. To round it off, niacinamide helps minimize pores, making this a truly comprehensive serum to enhance microneedling treatments.
1. “Microneedling Market.” The Brainy Insights, Jan. 2023, www. thebrainyinsights.com/report/microneedling-market-13269.
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.