Tuesday, March 23rd, 2021
Microneedling is one of several technologies that markedly rejuvenates the skin and reduces wrinkling. Here we will discuss those technologies and other things that you can do to improve the quality and appearance of your skin.
The cornerstone of skin care to prevent wrinkles has been, for many years, the use of a retinol or tretinoin (Retin-A) after the age of 30. This is because the skin stops continually making collagen, the substance that thickens the skin, at around 30 years of 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 that could correct the wrinkling/crinkling 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. The problem with this is that, because of limitation of the body’s ability to resurface the skin, 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 is somewhat raw and oozing with either of these technologies is about 1 ½ to 2 weeks.
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 injected filler. 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®, equally as good if not better, 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 prevent further wrinkling of the skin and allow the tretinoin to use some of the product to thicken and stiffen the skin. Other than some mild swelling and occasionally minimal bruising that could be covered with camouflage makeup, there is essentially no down time with this technique.
The one thing that leveling peels and laser did was markedly stimulate the dermis to build significant new collagen at a faster rate than it did with just the use of tretinoin. The 1st improvement to markedly improve the rate of the skin’s collagen production was development of the Fraxel Laser, a laser that, instead of removing the surface of the skin, simply poked holes in it. Since injury to the dermis is the one thing that causes the skin to markedly produce collagen, this significantly turned on the body’s healing processes. This laser, however, is quite expensive and uncomfortable. Microneedling was developed to answer these problems. It does the same thing by using 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 a physician’s office, uses a device that pushes the needles absolutely perpendicular so that there is only a very minute entry point. 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 in the dermis and, instead of entering and leaving absolutely perpendicular, they enter and exit at an angle actually tearing the skin.
These latter two developments have allowed us to now achieve skin rejuvenation comparable to leveling peels and laser but without the significant downtime. 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 Volbella®, and then doing a series of Microneedling procedures, all with minimal to no downtime.