Pioneered by plastic surgeon Desmond Fernandes, MBBCh, microneedling gained popularity for its ability to effectively treat surface scars and fine lines. As patients flock to aesthetic physicians around the world to address concerns such as wrinkles, stretch marks, scarring, rosacea and even tougher to treat concerns such as loose skin, microneedling has become recognized as one of the top aesthetic treatments for collagen induction therapy, and used in the treatment of hyperpigmentation, acne, scarring and overall skin rejuvenation. Today, it seems microneedling is a staple in nearly all cosmetic offices as new procedures, combinations and clinical research continue to demonstrate the versatility of this revolutionary treatment, and thanks to ongoing innovative and exciting advancements, microneedling continues to increase in popularity with both practitioners and patients, with what seems like no end in sight.
JD McCoy, ND Medical Director Contour Medical Gilbert, AZ
Desmer Destang, DDS, MSc(Ortho), MSc(Derm),
Suneel Chilukuri, MD Refresh Dermatology Houston, TX
Dianne Quibell, MD Cosmetic Laser Surgeon Aesthetic Physician Wellesley, MA
Carson Bauder, MD A New U Cosmetic and Weight Loss Center Ormond Beach, FL
Grace Kim, DO Dermatologist Couture Medical Las Vegas, NV
Microneedling’s main mechanism of action is the collagen induction that occurs as the skin responds to the micro-wounds that are created during treatment. This triggers the body’s healing process. With control over depth and delivery, physicians promote dermal rebuilding as cell turnover increases, which is why microneedling is lauded as a natural “regenerative” rejuvenation method for those who are looking to put off or avoid going under the knife for a surgical facelift.
JD McCoy, ND, medical director of Contour Medical (Gilbert, Ariz.) has devoted his practice to less-invasive cosmetic rejuvenation treatments and has been using microneedling on his patients for over a decade.
“I realized early on that this was a very useful treatment modality that pretty much everybody can incorporate into their practice,” he shared. “It is a very low-cost acquisition, so you don’t have to spend tens of thousands of dollars on another medical device, and you can get a very good microneedling device that is affordable and effective.”
The treatments Dr. McCoy performs include microneedling in combination with other devices for resurfacing, texture improvement and even hair rejuvenation, as he caters to both men and women. “The male population is a growing segment that responds very well to microneedling,” he explained. “I have a lot of male patients that come in for acne scars and I also have a lot of male patients that come in because I do hormone replacement in the office, so a lot of those patients cross over into the cosmetic side also.”
According to Dr. McCoy, microneedling can definitely be successfully used as a standalone treatment as well. “It is a big part of facial rejuvenation and hair rejuvenation, and using it to create a controlled entry can enhance the delivery of whatever topical I might use. As a practitioner, this versatility is great because much of what we do day-to-day is very artistic. Combining microneedling with various topical solutions allows you to customize the treatment and do things that are innovative.”
Taylor Benson, director of education and retail development for AKTIV Skincare (Kenilworth, Ill.) also takes advantage of microneedling as a topical delivery system. “One of my favorite treatment protocols for treating lackluster skin, hyperpigmentation and inflammation is to start with an AHA foaming cleanser, proceed with a microneedling treatment using an Alpha Arbutin + hyaluronic acid combo,” she began, “then I follow up the microneedling treatment with a 12% L-ascorbic acid and have the client use a stem cell moisturizer plus SPF. In minutes, the client is left with incomparable results of glowing, non-inflamed skin that lasts for weeks!”
As a result of the micro-channels that microneedling creates in the epidermis, creams for cellulite, skin plumping and skin tightening become more effective.
Some dermatologists are even using the treatment to promote blood flow or to administer hyaluronic acid more effectively. A study conducted by Macrene Alexiades, MD, PhD, and Girish S. Munavalli, MD, MHS, demonstrated that RF microneedling is an effective treatment for the fatty deposits above the knees, upper back and for the sagging skin of the upper arms; all areas that were traditionally considered difficult to treat.1
Some clever practitioners are using collagen induction benefits to reduce dark under-eye circles and improve volume under the eyes, as well as the neck. The increase in collagen and elastin helps tighten and firm the skin while new cells create a more youthful glow. In fact, the SkinPen® Precision by Crown Aesthetics (Dallas, Texas) has just received clearance by the U.S. Food and Drug Administration (FDA) for treatment of neck wrinkles.
Not only is microneedling effective for hard-to-treat issues such as adding volume under the eyes and body skin laxity, but it helps address other common patient concerns when used properly. Hyperpigmentation is a concern for darker Fitzpatrick skin types IV-VI, and while hyperpigmentation and scarring is always a concern when treating skin of color, with microneedling the depth of needle penetration stimulates collagen production without leading to these adverse effects.
Patients with skin of color are the primary demographic for Desmer Destang, DDS, MSc(Ortho), MSc(Derm), MSc(Aesth Med), medical director at Dermalogics Aesthetic Dermatology (St. Lucia, Caribbean). “There are very few treatment modalities that can be used on darker skin, but microneedling is very versatile,” she said.
According to Dr. Destang, microneedling is one of the few treatments that harmonizes how cells involved in skin rejuvenation function together. “These cells include the keratinocytes, fibroblasts, melanocytes and sebocytes,” she clarified. “Microneedling helps down-regulate the glands, so they are not pumping out as much oil in the skin. Using a combination of microneedling with a microtoxin infusion improves the quality of the skin at the same time.”
The versatility of microneedling shines when combined with other popular procedures that allow aesthetic physicians to customize treatment according to the patient’s concerns. With published clinical research about the benefits of microneedling on darker skin, Dr. Destang said that using the right serum can help avoid post-treatment complications on skin of color. “In the Caribbean with darker skin patients, acne, hyperpigmentation and melasma are primary concerns,” she shared. “When I use a serum with microneedling, I prefer one that is closer to a neutral pH like retinol and niacinamide. We have new pens with the infusion already attached to the microneedles so you can inject your serum at the same time for a faster treatment while patients get more of a post-treatment glow.”
To address acne scarring, Dr. Destang takes advantage of the synergy of microneedling with other treatments. “We sometimes use PDO threads for improving acne scar patients, because it smooths out the skin a lot better than using microneedling alone. I also focus on releasing scar tissue, so the skin is more pliable, and I use serum and dermal fillers, and some precision surgery at the same time.”
Microstamping is a viable option for darker Fitzpatrick skin types, according to Ms. Benson. One of her protocols includes a custom-blended treatment facial with a microstamping procedure using 25 .5 mm length needles prior to a moisturizer plus SPF. She explained that with this procedure there is no dragging of the needles across the skin, which provides the ability to work on Fitzpatrick I-VI without scarring or pigment complications.
“When working with Fitzpatrick IV–VI skin types, practitioners need to be cautious of trauma responses like keloid or hypertrophic scarring and hyperpigmentation,” explained Ms. Benson. “When dealing with skin that has more active melanocytes it is important to realize that in lighter skin types, there are about 20 melanosomes produced per one keratinocyte while with a skin of color there could be up to 200 melanosomes produced per one keratinocyte. During a microneedling procedure you are triggering both of these cells.”
Sunscreen is important for all skin types but may be even more important for darker skin. “SPF is mandatory for all skin colors as it will prevent activation of the melanocyte-stimulating hormone (MSH),” Ms. Benson pointed out. “MSH will bind to melanocytes that leads to hyperpigmentation of the treated area. In addition to stamping and not dragging you may also reduce the amount of inflammation caused by the procedure with .25 mm or .50 mm needles, which will benefit persons of color with more active melanosomes.”
Dr. McCoy also finds that microneedling benefits darker skin tones. “Microneedling is a valuable tool for any practice that treats ethnic skin of any kind. Often these are patients that have not been served with lasers; this is a treatment tool that can be well utilized. In general, both RF microneedling and regular microneedling is very forgiving to all skin types and the origins of microneedling come from areas where we are treating more ethnic skin. Nevertheless, using pre-treatment and post-treatment care helps reduce risks related to post-inflammatory hyperpigmentation or just generalized pigment change due to sun exposure.”
It is important to inform patients that microneedling may not be a one-and-done procedure. For best results, Dr. Destang advises her patients to do more than one treatment. “Our advice for the patient is you need a minimum of three treatments,” she emphasized. “Usually by the second treatment the patient sees a big difference in terms of severity of the acne and darkness of the discoloration, but microneedling works with the cycle of the skin, which is approximately 30 days. By doing three treatments, approximately three to four weeks apart, you cover three skin cycles, which will really bring out the fresh new cells for the best response.”
The Latest Technology
SkinPen Precision set the standard in microneedling through research and clinical trials, and was the first microneedling device to become FDA cleared. Engineered and manufactured in the U.S., physicians have been using the SkinPen device to provide dramatic rejuvenation results in a quick, comfortable and affordable procedure, and it is now cleared to improve the appearance of neck wrinkles and facial acne scars.
Suneel Chilukuri, MD, of Refresh Dermatology in Houston, Texas uses the SkinPen Precision to successfully treat a variety of patient concerns. “I switched to SkinPen because it had over 90 validation tests that showed both the safety and efficacy of the device,” he shared. “They truly set the standard in collagen induction therapy and microneedling. And, of course, they are the only microneedling device on the market that has been cleared for both the face and neck.”
Driving innovation forward, Cynosure’s (Westford, Mass.) newest addition to their best-in-class PotenzaTM radiofrequency (RF) microneedling system is the Fusion Tip. Using a dual-air chamber, this revolutionary design captures and releases air towards the skin with each pulse, enhancing the penetration of topicals into the skin by 67% for maximum results, with treatments that can be performed on all skin types, anywhere on the body and any time of year.
According to Dianne Quibell, MD, cosmetic laser surgeon and aesthetic physician from Wellesley, Mass., the industry has moved Wellesley, Mass., the industry has moved away from monopolar RF in favor of devices with only 2 MHz available. But Potenza users have both 1 MHz and 2 MHz at their disposal, and each provides different capabilities. “Potenza has been an asset to my practice and has allowed me to customize treatments based on my patient’s needs. Now with Fusion Tip, I am able to optimize patient outcomes while enhancing the topical results.”
When it comes to nonsurgical skin tightening, the PiXel8-RF system from Rohrer Aesthetics (Homewood, Ala.) makes it easy for physicians to customize treatments with a 25-pin, 49-pin or 64-pin tip (insulated or non-insulated) and adjust the energy levels delivered into the tissue as well as the depth of penetration (from .5 mm to 3.5 mm).
Carson Bauder, MD, of A New U Cosmetic and Weight Loss Center (Ormond Beach, Fla.) promotes the PiXel8-RF system in his practice to reduce the signs of aging and promote smooth, glowing skin for his patients. “The PiXel-8 yields significant skin tightening results with minimal downtime for patients. It has quickly become the most popular skin tightening device in our office. With a reasonable cost and ease of use for staff, this device is a must have for any medical/aesthetic office.” The PiXel8-RF is safe to use on all skin types and there is minimal to no discomfort when combined with the Zimmer Cryo-Mini Chiller.
Microneedling has proven to be a powerful option in a provider’s tool-chest of modalities for skin rejuvenation, but to maximize the skin’s ability to heal and repair, choosing the right topical adjuvants is critical. The channels created by microneedling provide direct access to metabolically active cells beneath the skin’s surface, where the application of carefully selected cytokines can increase that communication. AnteAGE’s (Irvine, Calif.) Growth Factor Solution contains naturally-secreted, and physiologically-balanced cytokines derived from human bone marrow stem cells, which have been shown to promote an anti-inflammatory and regenerative healing response in damaged tissue.
Grace Kim, DO, a board-certified dermatologist at Couture Medical (Las Vegas, Nev.) uses AnteAGE Growth Factor Solution with microneedling and prefers it over traditional Platelet-Rich Plasma (PRP) treatments. “We know that growth factors have a lot of antiinflammatory properties, but I prefer this serum over traditional PRP because only beneficial cytokines that help rebuild the skin are present in the Solution,” she explained. “The combination with microneedling offers a quick procedure with little downtime and big bang for your buck; you can really help your patients achieve a more youthful look.”
Today’s aesthetic patients include a wide range of demographics and skin types. Microneedling offers the versatility of a standalone treatment or to accentuate the benefits of other treatments while allowing aesthetic physicians to customize patient outcomes. And with the relatively low cost of acquisition, practices and patients can surely benefit from today’s innovative microneedling devices that are revolutionizing the cosmetic industry.
1. Alexiades M, Munavalli G. (2021). Single Treatment Protocol with Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits. Lasers in Surgery and Medicine. 10.1002/lsm.23397.