*Sponsored post: Environ Skin Care*
Images courtesy of Environ Skin Care
Few figures have shaped modern aesthetic medicine as profoundly as Dr Des Fernandes. A Cape Town-based plastic surgeon, researcher, and founder of Environ Skin Care, Dr Fernandes pioneered medical, surgical and cosmetic skin-needling, now known globally as percutaneous collagen induction therapy (CIT) or micro-needling.
Beginning his clinical research in the mid-1990s, he developed the world’s first roller-type device for skin-needling in 1997, laying the groundwork for one of the most effective regenerative treatments in aesthetic practice today.
In this exclusive conversation with Aesthetic Appointment Journal, Dr Fernandes shares the science, history, and practical wisdom behind this South African innovation that became a worldwide phenomenon, and how consumers can use needling safely at home.
You started researching skin needling in the mid-1990s. What first gave you the idea that controlled needling could help the skin repair itself, and how did your background as a surgeon influence that discovery?
DF: Ideas do not simply materialise in anyone’s brain. They come from understanding through experiences over time, from quite diverse concepts.
I started the idea without knowing that the process of needling would regenerate skin. My work in 1994 was stimulated by the concept that I worked under in regard to upper lip (smoker’s) lines. I believed that there was a fibrotic attachment between the lip-skin groove and the underlying muscle. I thought that if one could “fenestrate” that tethering fibrotic band, then the skin would be able to expand up and lighten the line.
I used a thick needle and found that indeed there were fibrotic bands pulling skin towards the muscle, and after a treatment, the lip grooves were significantly less visible. I gave a talk in 1995 in Taipei at an international plastic surgery conference on this work. The problem was that all the patients experienced severe bruising, and a few developed small nodules under the skin. I was struggling to find a way to avoid this when, in 1997, I attended a lecture in São Paulo by André Camirand on doing “dry needling or needle abrasion” with a tattoo artist’s device for changing facelift scars. Because I am a lateral thinker, I saw this as the solution to my problem outlined above.
Within a short space of time, I suggested to my patient, who came in for treatment of her upper lip grooves, that we should try mechanical needling. I should mention that I had the equipment because I was trained in tattooing by Mr Adams, who was the doyen of tattoo artists in Cape Town in 1985. I did the standard technique, filling in a large even colour (of course, without colour).
The other important point is that I told the patient to use vitamin A, C and antioxidants (Environ Skin Care) prior to the procedure and to continue thereafter. A month later, I saw there was improvement, but not acceptable to me, and I persuaded her to let me do a repeat procedure. A month later, there was appreciable improvement, and she agreed to do one more treatment. Each treatment left her with a rather red, swollen upper lip for several days.
After three treatments, there was a clear smoothing of the upper lip, but I had no idea at that time why the skin had changed. I had to do several other patients and more extended areas before I started to realise that the changes must be from the release of growth factors.
By then, I felt that the holes from mechanical machines were too close to each other and didn’t go deep enough, so I designed the roller. Concurrently, I was fascinated by the work of Colin Fergusson, whom I met in Cape Town in 1985 when he reported on his work on cleft palates in Australian crocodiles and the role of transforming growth factors.
I should mention that I was the head of the Cleft Lip and Palate Unit at Red Cross War Memorial Children’s Hospital from 1989 to 2000; without this, I would not have been familiar with Fergusson’s work. By 1996, he had deduced that TGF-beta-3 was responsible for regeneration, and when I looked at my results after six months, I thought TGFβ-3 had to be involved. By 1998, I believed that platelet-derived growth factors, but TGFβ-3 in particular, were responsible for the smooth, healthy skin I was achieving.
Histology at that time showed no evidence of scarring after needling; indeed, the collagen formed a normal lattice or network quite distinct from scarring. That was the first proof of needling causing regeneration. As you can see, my work as a plastic surgeon, my involvement in cleft lip and palate surgery, my training from a tattoo artist, and my penchant for reading and lateral thinking came together to reach the understanding of what needling was doing. All we needed now was to get scientific proof.
Your early trials in Cape Town helped define the first medical protocols for needling. What did those early treatments teach you about how the skin responds, and were you surprised by how long-lasting the results were?
DF: I think I was lucky because I had already seen the excellent changes that one gets from topical vitamin A and antioxidants, which is why, by the time I started needling, I insisted that my patients should use topical vitamin A.
Only much later was I pleased to discover that by prepping the skin with cosmetic forms of vitamin A, we were able to almost quadruple the improvement of needling.
I never changed my idea about vitamin A, but I realised that one needed more than that and, as it happens, I was simultaneously working with peptides from about 1996. I was boosting the effects of topically applied cosmetic vitamin A, C, and peptides with the new idea of low-frequency sonophoresis first described by Samir Mitragotri in 1996, which I adapted to professional treatment. That regimen, I believe, is the way to achieve the best results as easily as possible.
From my early experience, I realised that acne scars could benefit, so, against the mainstream plastic surgery views, I started that and then extended it to burn scars. I didn’t know what to expect, and the results certainly surprised me, but gave me confidence that I was right in my assumptions about platelet-derived growth factors.
Of course, I should point out that in 1997, I started needling my own face to get an understanding of what the patients were experiencing.
You recently spoke at ICOPLAST 2025 about how far needling has come. How have techniques changed over time, such as needle depth, treatment spacing, and who is best suited to benefit?
DF: Over time, I have become convinced that I was right that one needs the holes to be separated by normal skin and that mechanical needling causes too much inflammation. Rolling needling is arguably the safest procedure and the most effective cosmetic ever prescribed.
Initially, I used full injection or general anaesthetic and 3 mm needles, but fortunately realised that 1.0–1.5 mm length needles were particularly useful for photoaged skin, moderate acne scars, stretch marks, and lax skin.
The change of needle depth was very important because 3 mm needling causes bruising and inflammation, and the swelling may take 5–10 days to become acceptable. That significantly reduces the number of people who can benefit from needling. Of course, it’s also expensive. People wonder if it is painful, but that is only in the first few hours; thereafter, it changes from being sensitive to a little tender. Generally, people hardly use painkillers after the first day.
One of the benefits of using a roller is that one cannot over-needle. This is potentially a risk when doing needling with a mechanical pen because the machine will insert a needle right next to an established hole, whereas with the roller, the needle slips into the nearest holes because we are not overcoming the natural resistance of the skin.
Fortunately, I decided to do 1.0 mm needling because I knew that it could be done with local anaesthetic. I decided that we would need to repeat the needling several times to get as many holes as we would get with full anaesthesia. The question was when we should repeat. With the 3 mm, I had been repeating the needling first at one year, then six months, and then once a month.
I remembered my initial work with the tattoo artist’s pen, which was about 1 mm, and at the same time, I was informed by Matthias Aust about his laboratory work on needling. The TGFβ-3 stayed uplifted for two weeks, and I reasoned that it would be good to needle again while the TGFβ-3 is raised.
I also knew from Colin Fergusson that the higher the level of TGFβ-3, the greater the regeneration. That is why the science leads us to repeat the needling every 7–10 days. This regimen met with great opposition and still does, because people do not understand the importance of achieving the highest titres of TGFβ-3.
Strangely, I met resistance from the very laboratory that proved the value of needling. They believed that by needling early, I would cause a drop in TGFβ-3. I simply replied: “Prove me wrong.” They repeated the experiments and found better results from needling at 1.0 mm weekly × 4 compared to 3 mm once a month × 4. They furthermore showed that topical vitamin A made a massive difference in the results of skin thickness and collagen deposition. The benefits also extend to lightening hyperpigmented areas more effectively.
In summary, the technique of needling has not changed in my hands because rolling is the safest and most effective way to treat skin. It’s the easiest technique to learn and, importantly, with this inexpensive device, one can work in the most difficult conditions. More people live in the third world than in the first world. I do use a pen-like device for surgical scars, but not for any extended areas, even though I have never had a complication from mechanical needling. I am sure that is because I was trained by an expert.
Because I realised that people do not know enough about needling, I needed to write a book for patients to explain Why You Need Needling. Photoageing is becoming the most common reason, followed closely by acne scars. When I walk in the streets, I see how many people seem unaware of the benefits they would get from needling for their acne scars. Victims of burns also benefit enormously, and currently, I am researching needling for very thick, debilitating scars.
Environ has always paired science with safety, especially when translating in-clinic innovation to at-home care. With “home rollers” now becoming very popular, what should people know before they start rolling at home, and how can they make sure they’re using safe, effective devices?
DF: Home rollers are one of the introductions I feel most proud of. They are simple to use; we just have to explain how you need to roll in at least four different directions. The client has to make sure that they keep their rollers clean, especially if they needle after applying their cosmetic regimen.
My research work 25 years ago showed that subjects who needled over their creams got irritated skin after a while because they were not clearing their rollers properly, and the residual creams around the needles became contaminated, leading to irritation. That’s why I advised people to needle before applying the cosmetics.
Unfortunately, the idea has been copied by many companies that try to make the roller as cheap as possible. The Environ plastic roller (Cosmetic Roll-CIT®) is made with a special non-reactive plastic, and the needles are made from surgical stainless steel to remain sharp for as long as possible.
I have seen other rollers claiming various advantages which I wish were true, but they aren’t. I don’t know how to guide people to use the best roller. We make ours according to the standards that we have set for our skincare.
The Environ gold roller (Gold Cosmetic Roll-CIT®) has a pre-eminent place for me for safely needling every day. The barrel is coated with gold, so it needs gentle cleaning. Gold is antiseptic. The needles are the same surgical stainless steel. I use my roller every day for at least five minutes.
You’ve always said that needling and topical skincare work best together. Can you explain how ingredients like vitamin A, vitamin C, and peptides support the skin after needling, and why preparation is so important?
DF: As I pointed out above, the recommendation is not a thumb-suck. When I started using vitamin A topically in preparation for needling, I only understood that vitamin A induced its changes by means of growth factors, and we also knew from the early ’90s that vitamin A promoted TGFβ-3. It seemed logical, but I had to wait for Matthias Aust’s seminal work to have the scientific proof that vitamin A and C made a dramatic difference to the result.
When we included matrix-generating peptides, we got further improvement. If you can get your skin as healthy as possible and automatically generate faster growth of cells, with clear differentiation and active fibroblasts producing healthy collagen, then common sense should make it obvious that the skin is properly prepared for needling.
I think many people seem to think that I am just saying this to promote Environ Skin Care. I like to point out that the products Matthias Aust used in his experiments were Environ vitamin A products.
At this stage, I know of no other preparation molecules that do even a fraction of what vitamin A does. Many people use synthetic hyaluronic acid to prepare skin without knowing that vitamin A is the strongest stimulant of the natural production of hyaluronic acid.
Not all devices are created equal. What makes a professional-grade roller or pen different from the cheaper versions sold online, and how can clinics or consumers tell the difference?
DF: I don’t know how to answer this except to say that these are not easy devices to manufacture, whether they are rollers or pens, and I would only use a device made by a reputable company. The fly-by-night companies that produce cheap devices are only there for profit. The reputable companies are there for the results that they can achieve.
The next thing is to be sure that the person doing the needling has had full instructions and training. The complications that we see are generally from people using cheap, unreliable instruments without any proper training. Generally, if you can buy it online from non-reputable companies, it’s probably not ideal.
Environ has always focused on medical science rather than marketing. How does this philosophy still guide the brand today, especially when it comes to treatments like needling?
DF: I suppose that this has actually worked against Environ by concentrating on science and not boasting through marketing. We persist in scientific support for what we do, and I hope this will continue for many years to come.
Many years ago, we set up stringent protocols so that needling could be trained and done as effectively and safely as possible.
Skin needling began right here in South Africa and is now used all over the world. What does that mean to you personally, seeing your innovation and work help so many people globally?
DF: I feel proud and vindicated that the idea that attracted so much criticism and disdain has been recognised. I was humbled when, in 1999, an American surgeon commented after my lecture that needling was going to be the paradigm shift in skin treatments for the 21st century. I was amazed when I was featured on Channel 5 in San Francisco for about 20 minutes, a few hours after my lecture.
I have been awarded a Gold Medal for Lifetime Achievement from an international dermatological society (DASIL) for my work in promoting needling, so I feel that my message to help as many people with scars as possible has been accepted.
However, there are still millions – maybe more – who could benefit from needling. We need to join together to find ways to make the results even greater. The more minds that think about it, the greater the chance of finding other methods to improve the results. We have explored LEDs, PRP, and the advantages of low-frequency sonophoresis, but there are more exciting discoveries ahead.
Regenerative aesthetics is a fast-moving field. Where do you see the future of needling, especially alongside new advances like exosomes and growth factors? And are there particular developments or combinations that excite you from a biological standpoint?
DF: I am personally not a fan at this stage of extraneous exosomes because I believe we should each make our own healthy exosomes. It’s reprehensible that some companies promote topical exosomes in skincare products. There might be a role for them under special conditions when the skin has been needled, but there is no guarantee of safety at this stage. Exosomes may contain DNA and RNA fragments, which may only manifest much later.
Growth factors show promise, but again, growth factors are extremely complex because one ratio of two growth factors might produce an important advantage, whereas a different ratio of the same growth factors might give the opposite effect.
Obviously, I cannot talk about Environ research. The gold standard at this stage is the combination of vitamin A and C and matrix-generating peptides – vitamin A because of its multitudinous activities, vitamin C because it is essential to produce healthy collagen, and matrix-generating peptides to enforce the activities of vitamin A and C.
The future of skin needling will probably be enhanced by the cooperation of many minds searching for answers.
After more than 30 years in practice, what would you say are the golden rules of safe, effective skin needling? If you could leave both practitioners and patients with three take-home lessons, what would they be?
DF:
- There is no doubt that rule 1 is to prepare the skin and maintain it with topical cosmetic vitamin A and vitamin C. Peptides are more expensive, so not everyone can afford them.
- If you are doing 1.0 mm needling, then do sessions of 4 to 6 at intervals of 7–10 days. I recommend the roller as the safest and most effective.
- Don’t be disillusioned if you don’t get the best result after one session. Some people have low platelet counts (e.g. me!) and hence do not have as many platelet-derived growth factors as people with high platelet counts, who generally achieve impressive changes from needling. Just repeat the treatment until you get closer to the desired result.
Where to find Environ products
Environ treatments and products are available through authorised stockists across South Africa. For more details and to find a stockist near you, visit the Environ website.
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About the author
Rochelle is the founder and driving force behind Aesthetic Appointment. With a passion for the aesthetics and pro-ageing industry in South Africa, she has been in the aesthetic publishing industry since 2012, dedicated to creating a valuable platform for insights and knowledge, bridging the gap between patients and doctors - delivering reliable, medical-based information. Rochelle firmly believes in the power of a good skincare regimen, especially when started at home, and is committed to educating consumers about the myriad of treatments, procedures, and products available to them.
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.