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Skin Needling

Skin needling can also be referred to as micro-needling therapy, collagen induction therapy (CIT), percutaneous collagen induction (PCI), derma rolling, dry tattooing, and intradermabrasion. A minimally invasive nonsurgical and non-ablative procedure, it involves the use of a micro-needling device to create minute, yet controlled skin injury.

There are a number of different skin-needling device brands in the market today. This review is a broad stroke study of the skin-needling process in general. This review does not provide proof or permission that estheticians should be providing micro-needing services. Estheticians should check state regulations for microneedling guidelines before rendering any services.

Before starting any micro needling procedures, patients need to be fully informed of the potential complications. It is imperative that they sign an informed consent form. This protects both patient and clinician in the event of an adverse result.

The purpose of the design of micro needles is to cause a measured degree of damage to the skin thus triggering the skin to heal, stimulating collagen development. The length of the needle will determine which area of the skin will be affected to trigger best aesthetic results.

Skin needling is not comparative to chemical peels, dermabrasion, or laser treatments, as skin needling directly targets specific skin layers, cells, and trigger points within the skin to produce the desired end result.

There are various skin-needling device designs available on the market. Some design options are needles secured on a circular roller that are rolled over the skin, needle stampers, and pens with cartridges with a cluster of needles at the tip.

Micro-Needling FDA Classifications: There are three classes for medical devices under FDA ruling. Class I includes devices with the lowest risk, and Class III includes those with the greatest risk. No matter the classification level, the FDA does not automatically approve a medical device just because of its named classification by the manufacturer.

Skin-Needling Process: Fine needles puncture the skin, creating a channel or minute wounds. It is the skin’s own physiological response to that damage that develops the desired aesthetic result. Once the skin is wounded, and depending on the depth and location of the wound, the skin’s regenerative potential brings about remodeling and the formation of new structures, eventually resulting in repair of the affected skin structure. Improvement is seen with multiple treatments; however, results can still be limited based on variables such as an individual’s age, health, skin type, skin quality, and extent of existing skin damage.

Needle Length and Performance: All sizes of needling cause injury to skin; however, according to Aust, Baithe and Fernandes, authors of the book, Illustrated Guide to Percutaneous Collagen Induction: Basics, Indications, Uses (Aesthetic Methods for Skin Rejuvenation), the length of the needle mainly determines if the device is cosmetic, medical, or surgical, and thus whose hands should administer the procedure.

• Cosmetic Needling or micro-needling extends to just below the stratum corneum (0.1–0.3mm needles; this type of needling does not cause percutaneous collagen induction [PCI]; it is merely a method to enhance penetration of topically applied active ingredients). No anesthesia required.

• Medical Needling extends into the papillary dermis. Medical needling (1–2mm needles; at this depth one can expect PCI). Local anesthetic cream is used. Performed on an outpatient basis.

• Surgical Needling extends as far as the reticulardermis or subcutis. Surgical needling (3mm needles; PCI). General or regional anesthesia is required.

Esthetician Regulations: It is recommended that skincare professionals know their scope of practice within their state and obtain the proper training before offering any new treatments or services.

Esthetician Guidelines:

Follow state regulations if allowable and under what conditions.
Quality instruments should be used. Poor quality instruments may lead to breakage of needles in skin.
Gain training on the device being used.
Client education: Review treatment plan and expectations pre-treatment.
Client consent: Ensure client understands and signs agreement.
Documentation of the treatment procedure in client chart.
Client post-treatment: Review at-home product use and updates.

Symptoms and irregularities that can be treated by micro needling vary depending upon:

size of needle
depth of needle penetration
the angle that the needle penetrates the skin
the angle that the needle withdraws from the skin
the speed at which the needles enter and leave the skin

Benefits of skin needling:

reduction of scars
reduction of wrinkles
reduction of acne
reduction of hyperpigmentation
reduction of hypopigmentation
improvement in skin texture, firmness, and hydration
reduction of hypertrophic scars caused by acne, surgery, thermal burns
fading of stretch marks
reducing fine lines and deep wrinkles
improvement in dyspigmentation/melisma
reduced risk of hyperpigmentation and scarring, therefore safe on darker skin

Possible Side Effects: The goal is to have minimal pain, redness, and discomfort to the patient/client receiving a skin-needling procedure. Generally, the procedure is well tolerated depending on the area to be treated and the severity of the problem. However, in cases where a longer needle is used and the treatment is facilitated by a physician, surface bleeding can occur.

Normally, the treated areas recover rapidly from skin needling. However, there are occasional side effects, which include:

Oozing and swelling during the recovery phase
Skin infection or herpes simplex
Milia development
Acne flare
Post inflammatory hyperpigmentation
Use of topical formulas with the treatment can sometimes produce undesirable skin reactions.

Post-procedure care: Skin needling is well tolerated by most patients, but dryness, scaling, redness, and swelling may be seen after treatment, lasting for several days or longer, depending on the depth of penetration of the needles. Clients can gently cleanse the area treated and, depending upon desired skin improvement, topical formulas and/or topical antibiotics can be recommended and prescribed.

Rejuvenation of skin may be seen as soon as one to two weeks and as long as six to eight months after the medical procedure. Burn scars are slow to respond. It can take up to six months to one year to see the final results from a single treatment.

Necessary follow-up treatments depend on the individual skin condition and desired results. Individuals must be evaluated on a case-by-case basis.

Resources:

http://www.dermalinstitute.com/ir/library/77_article_Skin_Needling_Hurting_or_Helping_.html

http://medestheticsmag.com/microneedling-classification

http://modernaesthetics.com/2015/04/microneedling-alegal-perspective-for-physicians

http://modernaesthetics.com/2015/06/rollers-and-thefda-fact-vs-fiction

http://www.kvmmedizinverlag.de/out/media/Illustrated_Guide_Percutaneous_Collagen_Induction.pdf

http://www.dermnetnz.org/procedures/needling.html

http://barefacedtruth.com/2014/10/21/cosmeceuticalsapplied-skin-microneedling-safety-efficacy-restorationsanity/

https://beautymagonline.com/sample-pages/1185-needling-09-1