From the primitive to the civilized world, skin needling is an art of the oldest kind. Dr Des Fernandes reports on the reality of the age old saying “no pain no gain”.
In 1988, Cape Town became the first place in the world to use cosmetic preparations with vitamin A to fundamentally change the appearance of photoageing.
Prior to this, Kligman had shown that retinoic acid (a medical version of vitamin A) could be used for treating photoageing. Cape Town became another world pioneering place in 1996 when skin needling was clinically researched and proved to be the most important way to safely thicken and rejuvenate skin by causing regeneration.
Needling skin was initially cast aside by most doctors as a barbaric way to treat skin – while laser-resurfacing dominated the field and drastically thinned thousands of people’s skins.
Because research in Germany has confirmed and explained the clinical research from Cape Town, skin needling is now becoming the only acknowledged method to rejuvenate skin and refine scars. It is also favourably competing with ablative and minimally ablative procedures.
While the technique may seem new, we actually have centuries of experience of needling skin because tattooing has been practiced in both “civilized” and “primitive” cultures all around the world.
Needling stands above all other currently used treatments because it has been shown to conclusively regenerate tissue and restore the natural lattice-distribution of collagen of the dermis. To date, it is the only skin treatment that regenerates elastin.
Now, I would like to stress one very important point: what we are talking about here is skin needling that penetrates through the skin and is painful and causes bleeding. If no bleeding occurs, the treatment won’t work. My research work using various length needles since 1996 has shown me that the ideal lengths for treating wrinkles and very shallow acne scars are between 1.0 mm and 1.5 mm. For burn scars and deeper acne scars I found that 3 mm should be used. The needles do not penetrate to the full depth. I called the process Collagen Induction Therapy and this term is used around the world and usually abbreviated to CIT.
Unfortunately there is growing disillusionment that bleeding is not essential – and that the same growth factors released from real medical needling will be induced by electrical changes – which are caused by deeper epidermal needling. In my earlier research I found no clinical evidence to confirm that.
I believe that the groups who copied the original ideas, thought that changes induced by superficial needling to enhance the effects of vitamin A, peptides and antioxidants would become even better if they needled deeper without using any topical products.
They missed the point: the results come from the topical products used, not from the process of needling the epidermis. The nerves in the skin are quite deep and that is why superficial needling cannot be felt – or at most is barely detectable as a “burring” on the skin.
The more holes you make, the better the result. That is why the most useless-feeling needling instrument is far more effective than a device that causes a pricking sensation. Only the stratum corneum should be pricked to a maximum depth of 0.02 mm, as recently defined by the FDA of the USA. Rollers with longer needles are uselessly painful and illegal in the USA.
For the best results in skin needling, research has confirmed that the skin should be pre-treated with vitamin A to get the optimal effects. “Cosmetic” needling instruments assist in skin perfusion of the nutrients and render even better results.
Medical skin needling has a wide list of indications and can be used on all ages and on all different coloured skins with safety. For results one has to cause bleeding of the skin. When we prick skin below the epidermis, we also have to prick blood vessels that lie immediately below the epidermis. When the blood vessel is pierced, it starts to bleed and automatically platelets are released to try and stop the bleeding.
These powerful little cells contain not only clotting factors, but also growth factors intended to speed up the healing process of the skin and the collagen. The deeper the needle hole, the greater the number of platelets will be released. It is this release of platelets that stimulates the regeneration of tissue, and the degree of improvement is directly related to the amount of bleeding. So for medical needling, the depth of the needle hole and the number of holes are equally important – in fact, the more the better.
Generally I recommend that the patient should have six sessions of needling done once a week under topical anaesthesia, or if they prefer, they could have one intensive session done with nerve block. The difference is that with the lighter sessions under topical anaesthesia, they can return to work the very next day, whereas after an intensive needling, they will be swollen and bruised for about four days.
To augment the results, I suggest the use of very low concentration peeling agents which “sterilize” the wound and also seem to promote even more growth factor release.
The results, according to many observers, outrank the results achieved with expensive machines. I have also used iontophoresis and sonophoresis of vitamin A and C immediately after the needling treatment to maximize the production of healthy collagen. Iontophoresis also tends to reduce the swelling of the skin.
In summary, Skin needling
- Tightens skin laxity and restores normal skin tension in the early stages of ageing. Some patients who are not sure if they want face-lift surgery may be satisfied with simple Percutaneous CIT. The arms, hands, abdomen, thighs, and buttocks can also be treated to give total rejuvenation. In fact this has become the only “anti-ageing full body treatment that we have.
- Treats fine wrinkles.
- Reduces Acne scarring.
- Stretch marks respond well to skin needling even when they have become “silvery” after a long time.
- Scars are always improved – even if they are white, old scars they can become more skin coloured.
- Burn scars – both flat and hypertrophic scars can be treated with success.
Advantages of PCI
- PCI does not damage the skin. The epidermis remains intact.
- Any part of the body may be treated.
- Skin becomes thicker, which has been repeatedly demonstrated in histological studies.
- The healing phase is short.
- Not as expensive as laser resurfacing which thins the skin.
- The skin does not become sun sensitive.
- Can be done on people who have had laser resurfacing, or those with very thin skin.
- I have never seen hyper-pigmentation in patients with darker skins e.g. African, Indian, Malaysian, Chinese and Mediterranean skins.
- Telangiectasia may disappear totally.
- Does not really have to be done by a doctor but should be done under their supervision.
- The technique of Medical Roll-CIT is easy to master. Medical Focus-CIT is useful for smaller areas.
- Can even be done with topical anaesthesia.
This is a simple technique and with the right tool it is easy and fast to puncture any skin thoroughly. While one treatment may not give the smooth appearance as seen with ablative laser re-surfacing, the epidermis is still normalised. if the result is not sufficient it can be repeated as often as necessary. The technique can be used on areas that are not suitable for peeling or laser re-surfacing.
Some Pitfalls to avoid
- Never use retinoic acid after needling. It irritates the skin and the patient is also less likely to use it properly.
- Never use Ascorbic acid preparations immediately after needling.
- Never use any strong peeling agents immediately after a peel. The peel will be very much deeper than expected and may cause scars.
- Needling is painful for about 20 minutes after the operation, so if the procedure has been done with general anaesthesia and without local anaesthetic infiltration, do make sure that the patient is given adequate analgesia before waking up.
Skin Needling induces collagen and elastin induction by employing the body’s natural mechanisms that for the first time, as far as we know, produces regeneration of the skin and its matrix. There is no scar formation and the procedure can safely be repeated until the desired effect is achieved. This can be repeated as often as necessary after face-lift surgery.
Sources: M. C. Aust, K. Reimers, A. Gohritz et al Percutaneous collagen induction. Scarless skin rejuvenation: fact or fiction? Clinical and Experimental Dermatology 35 (4) 437–439, June 2010
M.B.; B.Ch;F.R.C.S.E.
Plastic Reconstructive Surgeon
After qualifying M.B.; B.Ch. at the Witwatersrand University, Dr Des became a fellow of the Royal College of Surgeons at Edinburgh. Following his training as a Cardiac Surgeon with Prof Christiaan Barnard, he started specialising in Plastic Surgery. His mentor was Dr David Davies who generously showed him the heights of creative plastic and cosmetic surgery. Dr Des started private practice with Dr David Davies in 1980.
Since about 1990, Dr Des concentrated on facial plastic, reconstructive and cosmetic surgery only. This is because he wanted to gain a more focussed experience in order to deliver the best results he could.
Since Dr Des Fernandes founded Environ Skincare in 1990, vitamin A has become the cornerstone ingredient in the Environ Skin Care philosophy. It is an essential skin nutrient that has to be replenished every day for skin to appear healthier and more resilient. The introduction of vitamin A into skin care formulations was a ground-breaking development. Dr Des Fernandes, rated amongst the top five plastic surgeons in the world, was a pioneer in this field in the 1980s, and was the the first to successfully use vitamin A and antioxidants in a cosmetic product.
- Dr Des Fernandeshttps://www.aestheticappointment.co.za/author/dr-des-fernandes
