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.
Because it works by stimulating collagen productionin the dermis, the support layer of the skin, microneedling is an excellent treatment option for a wide variety of concerns. You should be a good candidate for microneedling whether your goal is to correct a cosmetic concern or simply to support your naturally aging skin that stops making collagen naturally around 25 years of age. Microneedling is efficient at reducing enlarged pores, softening lines and wrinkles, and reducing the appearance of scars and stretch marks. Since the skin loses collagen over time mictoneedling is advantageous in the fight against sun damage and tissue laxity.
There are several reasons why microneedling is such a popular cosmetic treatment. The process takes only about an hour in most cases and it incurs essentially no downtime. Your skin may look red for a few hours after your treatment, but not so much so that you have to rearrange your schedule for several days. You may return to work or other activities immediately after you’ve had microneedling done. Another benefit of microneedling is that the treatment works naturally to rejuvenate your skin from the inside out. There are no incisions, no products, no “foreign substances.” It does, however, work better if you are on regular tretinoin (Retin-A) or, if you are younger than 45-50, retinol.
Microneedling is a form of collagen induction therapy that has been around far longer than most people realize. Ancient civilizations used this technique, though not in the same fashion we do today. The microneedling treatment that professionals perform is done with an automated instrument rather than a hand held needle or a needle-clad drum. The benefit of this is that the needles pass into the skin in a completely perpendicular pattern and penetrates only a specific depth. This significantly reduces the risk of tiny skin tears and the potential for scarring. During a microneedling session, the automated device quickly creates hundreds of micro-injuries in the dermis of your skin. Micro-injuries take very little time to heal. Their sole purpose is to trick the body into believing repair is needed. Repair comes in the form of increased collagen and elastin production, which the body makes for a prolonged period of time in response to the treatment. The increase in the body’s regenerative system works to rejuvenate the skin.
You might notice some of your microneedling results the same day you have your treatment! Many people report feeling like their skin has a new vibrancy to it right after their appointment. This early improvement expands into others as your body begins to flood the treatment area with an ongoing supply of collagen and elastin. The results of a single treatment occur over time with multiple sessions being cummulative. If you are trying to reduce significant wrinkling, however, it may take a year or more to see the final results/
Yes! Comfort is an important aspect of our treatment process. To minimize the sensation of this process, we’ll apply a topical anesthetic to the target area. This medication does not cause complete numbness like injections of lidocaine do. However, it achieves sufficient desensitization to make microneedling easily tolerable.
You can combine microneedling with other treatments to acheive more profound tissue rejuvenation. As previously said, we recommend everyone receiving microneedling be on either retinol or tretinoin. For significant wrinkling in the past we used leveling peels or ablative lasers. Their problem is that they have a 2-3 week down time. Instead, we now use microneedling after filling the worst wrinkles with one of the newer fillers that works well when injected in the dermis itself. (Although many people call them “dermal fillers,” we previously never actually injected the dermis with them since the old fillers caused a blue or green line, the tyndall effect.) We will discuss what you’d like to achieve and what concerns you have and will recommend a treatment plan using that information. To get the best results with the fewest risks and side effects, microneedling may be scheduled as a standalone procedure within your broader course of treatment.
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.