Microneedling is one way to markedly rejuvenate the skin and reduce wrinkling. In fact, our present protocol for rejuvenation of sun damaged, wrinkled, crinkled skin is beginning tretinoin, injection of the wrinkles to reduce as much as we can using Juvederm Volbella®, and then doing a series of Microneedling procedures. This has proved as effective as other methods with significantly less down time and expense.
The cornerstone of skin care to prevent wrinkles has been, for many years, the use of a retinol or tretinoin (Retin-A) particularly after the age of 25 to 30. This is because the skin stops continually making collagen, the substance that thickens and stiffens the skin at around that age. If the skin is not stimulated to continue the process of collagen production, the dermis, the support layer of the skin, thins and multiple crinkles and wrinkles result. If you have failed to use these in the past and have developed significant crinkles and wrinkles, then use of the more potent tretinoin is still the mainstay of skin rejuvenation.
Once you had developed aged appearing skin, the only treatment we used to have to correct the wrinkling/crinkling quickly was a leveling peel or laser resurfacing that removed the surface of the skin between the wrinkles to the level of the bottom of the wrinkles and allowed the skin to grow a new surface epithelium over a smoother dermal base. Since the surface of the skin was removed to the mid dermal level and, if the right laser or peeling agent was used, the dermis was stimulated to make significant new collagen and became thicker and smoother from within. The problem with both of these is that, because of the limitation of the body’s ability to resurface the skin quickly, like healing a scraped knee, they became the procedures with the longest downtime of any of the modern plastic surgical procedures. Although we could push the body some, the minimum downtime where the skin remains somewhat raw and oozing with either of these techniques is about 1 ½ to 2 weeks.
Because some lasers did not cause collagen stimulation, we learned a lot about the body’s ability to create its own collagen and what turned on its system to do so. This led to the development of the Fraxel Laser that did not remove the skin’s surface but simply poked multiple small holes in the dermis to stimulate significant collagen production. This laser, however, is quite expensive and its use is uncomfortable. Microneedling, a less expensive technology that can be done with topical skin analgesia, was developed to answer these problems. It does the same thing by using multiple small needles that create holes in the dermis and also turns on the body’s healing processes, markedly stimulating collagen production.
The procedure, done in the office or spa, uses a device that pushes the needles absolutely perpendicular to the skin so that there is only a very minute entry point. It also extends to a very precise adjustable depth, depending upon the skin in the area where it is used. Because of the marked success of this process, “Microneedling” rollers are now being sold for home use. The problem is that they do not produce uniform holes to the proper depth of the dermis and, instead of entering and leaving absolutely perpendicular, they enter and exit at an angle actually tearing the skin. These, therefore, either do not work or cause significant harm.
Although fillers have been called “dermal fillers” for many years, until recently no one actually injected the filler into the dermis, the support layer of the skin. If they did, frequently a greenish or bluish line would appear when light reflected off the filler within the dermis. Only in the last 10 years have we had fillers that did not cause this blue line, the Tindal effect. Belotero Balance® introduced in 2011 was the 1st. Juvederm Volbella®, a better option, was approved in 2016. These allowed us to actually inject fillers into the dermis elevating the surface of the wrinkle to reduce or eliminate it. We have also discovered that if the product is placed just at the bottom or under the dermis perpendicular to the wrinkles, it can stiffen the skin and prevent further wrinkling and allow the tretinoin to use some of the product to thicken and stiffen the skin more permanently. Using Microneedling also increases the body’s use of the hyaluronic acid in the filler to produce its own collagen. Other than some mild swelling and occasionally minimal bruising that can be covered with camouflage makeup, there is essentially no down time with this technique, a marked improvement over that of leveling peels and laser resurfacing.
Microneedling was actually 1st tested on reducing acne scars. It was found to do an excellent job of this. It also reduces other skin irregularities and can improve the appearance of large pores. Additionally, because the body’s natural tendency when healing is for the healing tissue to contract, it can tighten minimally loose skin in the treated area.
We perform Microneedling in the Spa. After cleansing the face, an anesthetic is applied and left long enough to allow the skin to become somewhat numb. The Microneedling device is moved over the area of concern. A soothing emollient is then applied.
Because of the numbing cream, most people find this only minimally uncomfortable.
Microneedling turns on the body’s healing system to cause it to repair itself and build new tissue. This activity tends to slow after a while although we are trying to get the body to continually create new collagen. We, therefore, generally recommend repeating the Microneedling once every 4-6 weeks for at least 6 sessions. Your body, however, will determine how often this needs to be repeated.
Because the body’s system is slow it will take some time to see significant results. When used with injecting the wrinkles, visible results will be even slower since most of the wrinkles have already been mostly corrected. However, at the time the filler should wear off, generally at about a year, the filled wrinkles should still be looking significantly better than before treatment. If we are treating acne scars or skin irregularities that have not been injected, they should gradually improve over time and reasonable results should be apparent within several months.