He published an article in 2006 about a procedure he has used fifty times.
Dr. Desmond Fernandes is a celebrity in skin rejuvenation, ever since he published “Minimally invasive percutaneous collagen induction” in the 2006 edition of Oral and Maxillofacial Surgical Clinics of North America. In that article, Dr. Fernandez described the benefits of a minimally invasive skin treatment that is now recognized effective in the management of many skin conditions including scars (particularly acne scars), stretch marks, and wrinkles. The “father” of dermarolling demonstrated that the minor trauma created by using small diameter needles to create hundreds of perforations per square centimenter in the skin resulted in a robust healing response that produced fibroblast proliferation with coincidental secretion of collagen and elastin. Dermarolling can be used to treat practically any skin surface and is most commonly used on the face.
Most dermatologists now offer collagen induction therapy (CIT) in the medical office setting. Because of its demonstrated safety and efficacy, manufacturers of needling devices now offer models that enable do it yourself treatments at home. While there are certain differences in the indications and types of equipment used for home treatment, the mechanism of action is the same: induce a physiologic healing response through deliberate controlled trauma including creation of thousands of microscopic channels through which topically applied actives can gain ready access to deeper dermal layers, something impossible to achieve with an intact stratum corneum. The major difference between home devices and those used by the professionals is the length of the needles and consequently the depth of penetration into the skin.
People with active infections or those prone to keloid or other abnormal scar formation should not undergo micro-needling procedures.
Subcision, a type of needling used to treat acne vulgaris scars was first described by Orentreich and Orentreich in 1995. An article two years later by Camirand and Doucet described needle dermabrasion using a “tattoo pistol”. When Fernandes described his cylindrical device for use in percutaneous collagen induction therapy, the dermaroller was born. The standard dermaroller used for acne scars is a drum-shaped roller studded with 192 fine microneedles in eight rows, 0.5-1.5 mm in length and 0.1 mm in diameter. The instrument is sold pre-sterilized by gamma irradiation and medical dermarollers are for single use only. Home devices are often used repeatedly by consumers although care to maintain cleanliness and to preserve needle sharpness are of paramount importance. Of course, the safest course of action is for single use of all dermarollers.
In dermarolling, the stratum corneum is pierced to create microconduits (holes) without damaging the epidermis. Rolling over an area fifteen times with a dermaroller with 8 rows of 24 needles (192 needles) creates approximately 250 holes per square centimeter. Microneedling into deeper layers leads to the release of growth factors which stimulate the formation of new collagen (natural collagen) and elastin in the papillary dermis, as well as new capillaries. While of proved benefit in scar reduction, percutaneous collagen induction therapy is of clear benefit in the treatment of photoageing.
In office-based microneedling, the area to be treated is first anesthetized with topical anesthesia for 45 minutes to one hour after which a topical antiseptic is applied. Rolling is then performed 15-20 times in horizontal, vertical, and oblique directions. Pin-point bleeding is to be expected and easily controlled. Once completed, the area is wetted with saline pads. Depending on size of area treated, the procedure lasts for 15 to 20 minutes, A minimum of six weeks is recommended between two treatments as it takes that long for new natural collagen to form. For moderate acne scars, three to four treatments may be needed.
Post Procedure Care
Microneedling is well tolerated. Erythema typically lasts 2-3 days and photoprotection is advised for at least a week. Antibiotic creams can be used although infections are extremely uncommon. Microneedling is cost effective, well tolerated and can be done on all skin types and on areas not suitable for peeling or laser resurfacing, such as near eyes. It can be combined with other acne scar treatments like subcision, chemical peels, microdermabrasion, and fractional resurfacing, to achieve maximal benefits.
Where the Action Is
Micro-needling involves both major layers of the skin. Even the shortest needles are designed to pierce the stratum corneum of the epidermis to allow penetration of medications and active ingredients to reach the dermis. Longer needles pierce the dermis to varying degrees to induce minor trauma and initiate a physiologic healing response that results in fibroblast proliferation and increased collagen and elastin deposition. Because the skin varies in thickness on different parts of the body, different needle lengths are appropriate for different areas. See the chart below.
It is important to stress that in micro-needling, the longer the needle used mandates that the interval between treatments should also be longer. As noted above, needling into the deeper dermal layers requires time for desired changes to occur. More frequent use can produce a state of chronic inflammation that is in fact counterproductive. Use of very short needles intended only to allow improved active penetration through the epidermis can be more frequent, up to two or three times a week. Perforations in the stratum corneum are short lived and seal within an hour of their creation.
Proper needle length is determined by the objective being sought. Needles longer than 1.5 mm should not be used on the face.
Shorter needle lengths (0.25mm) are used to increase penetration of actives into the skin and to achieve overall improvement in skin color and texture
Longer needle lengths (2.0mm, 2.5mm, 3.0mm) are used for more severe cases, deep scars and wrinkles, rejuvenation of badly damaged skin, in areas other than the face.
Miniature versions of the dermaroller called dermastamps have been developed and are used for localized scars, eg. varicella scars. Needles vary in length and procedures with the derma-stamp can be performed in as little as two or three minutes.
Newer mechanical devices use battery power to repeatedly and rapidly administer dermastamp type needles. They allow controlled and precise delivery of micro-needling to large or limited areas of treatment.
Micro-needling Enhances Penetration of Actives
The skin, particularly the stratum corneum, is extremely effective at keeping the outside world “out”, making it difficult for topical application of therapeutic substances to reach deeper skin layers. Each dermarolling session creates thousands of “channels” that provide direct penetration to the dermis. Actives can be applied during or after the dermarolling although patency of the channels following the procedure is limited in duration. For maximum effect, they should be applied immediately following the procedure.
Results that Speak for Themselves
We will do a “part 2” on this soon. Stay tuned.