Microneedling Updates and Trends

Microneedling, also known as collagen induction therapy, has emerged as a top, minimally invasive treatment for aesthetic skin rejuvenation, and there appears to be no letup in demand. According to leading market research agency Data Bridge Market Research, the current microneedling growth rate is forecast at 10.5%, thanks to the increased acceptance of routine aesthetic treatments among a broader market of consumers. As more patients flock to microneedling for effective and lasting results, physicians are adding it to their armamentarium of aesthetic procedures to meet this rising demand.

As the name implies, collagen induction therapy increases circulation and stimulates the body’s production of collagen and elastin for healthy and more youthful skin. Creating pin-point injuries to the skin, microneedling stimulates cytokines and other growth factors, causing the skin to create fresh, collagen-rich tissue. The latest automated microneedling pens offer quick and more cost-effective alternatives to fractional lasers that can treat an array of skin concerns including acne scars, sun damage, stretch marks and aging skin.

SkinPen^® Precision from Crown Aesthetics (Dallas, Texas), helps practices around the world grow their businesses with microneedling. Jennifer Holman, MD, a dermatologist based in Tyler, Texas shared the many benefits of this technology with us. “It provides excellent results for acne scarring and is a great tool for drug delivery to treat melasma and actinic keratosis,” she stated. “The SkinPen treatment is reliable, delegable, and produces real results. The cost to bring this service into an office and disposable costs are excellent as compared to laser and light-based devices.”

SkinPen procedures are short and work for all skin types. Elika Hoss, MD, assistant professor of dermatology at the Mayo Clinic (Scottsdale, Ariz.) also uses it in her practice and told us, “This FDA cleared device has 14 stainless steel medical grade needles that create 1600 micro-injuries per second, and can treat as deep as 2.5 mm into the skin.” The result is a treatment that is customizable and requires little to no downtime.

Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C., believes there is a place for microneedling in every aesthetic practice. “My microneedling device of choice is Collagen P.I.N.,” she shared. “It is always in my pocket and I use it to treat everything from wrinkles to scarring. I often microneedle scars and rhytides in localized areas, (e.g., cheeks and perioral region) at the same time as full face non-ablative fractionated laser resurfacing.”

The Collagen P.I.N^TM from Collagen P.I.N. (Louisville, Ky.) offers a choice of 12- or 36-needle cartridges. The 36-needle option allows rapid results by creating more microchannels for natural collagen synthesis. The device can be used with the battery or optional cord with speed adapter, allowing users to penetrate scar tissue more effectively. It can be used alone or in conjunction with other treatments including laser therapy and dermabrasion.

The Rejuvapen NXT^® by Refine USA (Jacksonville Beach, Fla.) incorporates a uniquely beveled tip, designed with a medical grade HEPA filter to eliminate suction and clogging while blocking airborne blood pathogens. According to H. William Song, MD, founder and CEO of Omni Aesthetics (Oakland, N.J.), the ergonomic design minimizes operator fatigue, “which is important for our busy practice because we have multiple providers using the device throughout the day.”

The Rejuvapen NXT highlights the latest trend in microneedling with customizable treatments, device performance consistency and optimized results. Features include 9-speed settings, a precise infinite dial, patent-pending ISO seal and a digital brushless motor. “This medical grade microneedling device delivers safe and reliable results for patients of all skin types and severity of aging,” Dr. Song added. “The motor is hard wired, instead of battery operated, so the power is substantial and consistent. The fact that Rejuvapen NXT is FDA cleared gives us added confidence that our clients are receiving a treatment that has been clinically proven to deliver safe and effective results.”

JD McCoy, NMD, medical director of Contour Medical in Gilbert, Ariz., finds that microneedling with radiofrequency (RF) is his patient’s preferred treatment. “We rarely do standard microneedling anymore. RF microneedling yields faster and more significant results. My estimation is that eight to ten standard microneedling sessions are equivalent to one RF microneedling treatment. Improved results have been achieved by thinking about multiple depths/planes for treatment, delivering energy in a multi-level approach, longer pulse widths of energy (300-500 ms) and moderate to high fluence.”

As Dr. McCoy explained, he incorporates a specific protocol. “Most patients do best with two treatment sessions two to three months apart. Patient comfort with higher energy RF microneedling treatments helps with the entire experience – topical anesthetic, nitrous (if available), local anesthetic and patient hydration (the more hydrated the tissue is, the more comfortable the treatment experience will be and potentially the result will be improved).”

Microneedling RF devices are versatile in the way they use “injectable” energy. Targeted RF devices provide precise, high-focused energy, while other devices are utilized to cover larger areas. Dr. McCoy uses this combination strategy to offer his patients customized treatments. “Areas to be contoured are treated with the targeted RF device first, followed by treatment over the entire region. This helps address areas that historically have been difficult to treat such as under eye bags, jowl, buccal cheek heaviness, chin and jawline. I have patients dressed with Duoderm in the areas we treat with targeted energy and use a 24-ppm silver gel to assist with healing.”

Devices such as the Secret^TM RF by Cutera (Brisbane, Calif.) utilize bipolar RF energy with microneedling technology to address skin concerns for a wider demographic. According to Manu Aggarwal, MD, of the Vein Care Center Laser Specialist in Lima, Ohio, “Traditional microneedling without RF has limitations for darker skin types and cannot heat tissue for optimal results without downtime. But Secret RF allows us to take care of all skin types and colors without the risks of hyper- or hypopigmentation while addressing multiple concerns.”

Both non-insulated and semi-insulated microneedles treat a wide range of indications, while application of precisely controlled RF energy in depths of 0.5 to 3.5 mm induces Secret RF dermal remodeling. The choice of 25- and 64-pin handpiece tips allows physicians to treat both the face and body in under 20 minutes. “I feel the technology gives me the best tools to treat my patients’ concerns from skin texture, photo-aging and more. I love showing them their results, even over a year later,” Dr. Aggarwal shared.

Minimal downtime is a theme that remains consistent with physicians when it comes to microneedling, but some doctors have found ways to deliver even more benefits. As Dr. Hoss told us, “I often combine microneedling with platelet-rich plasma (PRP). This improves results for quicker healing, and a shorter duration of post- procedure erythema. Patients appreciate that their own PRP and collagen production provides long-lasting and natural results.”

With Dr. Hoss’s technique, “After cleaning and numbing cream, PRP is applied to the skin. We then do microneedling with multiple passes in different directions, to create micro-injuries in the skin. The goal is to have redness and pinpoint bleeding as your end result. After the treatment, the remainder of the PRP is applied to the skin. Once this has dried, patients are asked to allow it to remain on the skin for several hours to maximize results.”

Microneedling and lasers work very similarly; creating numerous, tiny skin injuries, which initiates production of new collagen and elastin. Some innovative physicians have found that these technologies also work well together for customized treatments with more effective results.

The Vivace Experience^® from Aesthetics Biomedical in Phoenix, Ariz. boasts a precision robotic motor that creates a virtually pain-free experience compared to other devices in providers’ offices, quickly becoming a favorite among consumers and celebrities and accumulating several awards and titles.

David Vasily, MD, a dermatologist from Bethlehem, Pa. uses The Vivace^® Microneedle RF device with other treatments and technologies like the Cool Peel, vascular lasers like the VBeam and resurfacing lasers. “The Vivace has been surprisingly effective for treating resistant rosacea vessels as well as scar neovascularization,” he reported. “We often use the Vivace in combo with lasers to address post Moh’s Surgery scars with good success.”
When paired with other procedures, microneedling treatments become more individualized and creative. Dr. Vasily emphasized, “They allow us to offer treatments that are a level of therapeutic intervention above and beyond facilities with only one or a few devices. The combo possibilities with Vivace are endless.”

For Randy Waldman, MD, a facial plastic and reconstructive surgeon in Lexington, Ky., his microneedling device of choice is the PiXel8-RF Micro Needling System from Rohrer Aesthetics (Homewood, Ala.), which he uses for fine lines and wrinkles, large pores and to improve elasticity. He explained how it works well with other treatments, “The PiXel8-RF is great for skin tightening, facial dyschromia and acne scars. I sometimes use it as a facelift follow-up treatment for continued improvement in the skin’s appearance, and for patients who are not ready for facelift surgery.”

The PiXel8-RF has a unique design for tissue coagulation and hemostasis, with adjustable energy and insulated or non-insulated microneedles that can be adjusted from .5 mm up to 3.5 mm, for individualized treatment. As Dr. Waldman shared, “I think every aesthetic practice will benefit from having this device as part of their toolkit. I use it as a complement to injectable fillers and lasers, but mainly as a standalone procedure, incorporating three treatments, spaced one month apart. Many patients continue monthly treatments because they see great results.”

The Addition of Skincare for Improved Results

Microneedling works as an effective transdermal delivery system, creating microchannels that physicians use for the application of specialized formulas. Shino Bay Aguilera, DO, a board certified dermatologist and dermatologic surgeon in Fort Lauderdale, Fla. takes advantage of this benefit with the MG Collection^TM by Dp Dermaceuticals (Miami, Fla.). He explained that their formulations use HylaFuse^TM Complex, a triple-weight hyaluronic complex designed to deliver treatment actives deeper into the skin. “Hyaluronic acid holds 1,000 times its weight, so it is great for hydration,” he reported. “Their standout products include MG-HA35 and MG-HA35+, which feature 35 mg per mL of this complex, a higher concentration than most products on the market today.”

Dr. Aguilera pointed out that the MG-HA35+ formula also includes Geranylgeranylisopropanol (GGP), a revolutionary telomeres technology that helps prolong the life of a cell. But he has other favorites in the collection, too. “I also like the MG-BL, a brightening serum that treats inflammation and hyperpigmentation. The bioactives prevent melanin overproduction from injury and sun damage. Also, the MG-R.A.S. products are incredible for reverse aging by improving laxity. It also promotes collagen production and wound healing using antioxidants, vitamins, peptides and botanical extracts.”

Microneedling gives practitioners the opportunity to treat patients of all skin types for a variety of concerns comfortably and quickly with little downtime. And now, breakthroughs in skincare technology allow continued treatment by supplying healing products and botanicals to speed recovery at home.

Epionce Essential Recovery Kit^® is an all- in-one take-home kit for post-procedure barrier repair. It is clinically proven to reduce erythema and TEWL post-treatment, and to reduce 95.5% of Malassezia yeast in 30 seconds. Carl Thornfeldt, MD, founder and CEO of Epionce in Boise, Idaho uses microneedling to treat scars, comedomal acne and sebaceous hyperplasia as a solitary therapy, combined with superficial chemical peels, RF or LED for anti-aging to reverse photodamage in the skin and for acne.

When it comes to post treatment, Dr. Thornfeldt explained the importance of taking part in the patient’s healing with the all-in-one approach of the Epionce kit, “The Epionce Essential Recovery Kit provides all of the key functions for proper healing: semi-occlusion, hydration, accelerating epidermal and barrier repair and preventing microbial infection, and it is the only post-procedure kit documented to statistically significantly improve signs of photo-aging four weeks after the procedure compared to standard acetic acid soaks and a lanolin-based ointment regimen.”

With technology that allows physicians the opportunity to treat more patients, treatment versatility and proven results, it is easy to see why microneedling is quickly rising in the field of aesthetic dermatology. As well, patients benefit from an array of customized, minimally invasive procedures, making microneedling a trending treatment that is a win for all.