Micro-needling - Old News? Best Microneedling Devices

Micro-needling

When you think about micro-needling, so many questions come to mind:

There are many ways of using micro-needling, which are the best practices? How efficient is micro-needling? When should you get a micro-needling treatment? Which device is the best? Is it better with or without serums? Which are the best serums to use? is PRP (vampire facial) really efficient? Should the needles go deep or not?

Many dermatologists, nurses, and medical estheticians use micro-needling daily to address skin concerns, and I think that all these Instagram posts and especially those about "the vampire facial" made micro-needling even more popular, let's uncover how micro-needling should be done.

What exactly is micro-needling? 

CIT (collagen induction therapy) is a common treatment in dermatology. Although fairly new in the USA, it has been used for many years in Europe. Microneedling, (also known as collagen induction therapy), is a process involving repetitive puncturing of the skin with sterilized microneedles. The treatment relies on trauma generated by needles. The needles penetrate the stratum corneum and create small injuries known as micro-conduits or micro-channels with minimal damage to the epidermis. This leads to the generation of growth factors that stimulate the production of collagen and elastin in the papillary layer of the dermis. These small traumas trigger a natural healing mechanism, this induces the release of growth factors such as TGF-beta, TGF-alpha, and platelet-derived growth factors, which in terms results of the realignment and creation of collagen by fibroblasts.

Micro-needling by itself is efficient, it is a minimally invasive procedure, which if done correctly and frequently can deliver amazing results.

Is PRP really that good? 

PRP has been all over the internet - more so since Kim Kardashian recorded herself during a treatment. However, PRP has some serious limitations, the composition of PRP varies from patient to patient (age, medical condition, healing capacity), it also varies depending on the device used to prepare it. Due to these inherent inconsistencies, you might not have the same results as your best friend, sister or neighbor. 

 What you are sure to get (if CIT is done correctly): The wound healing process triggered by collagen induction therapy.

What you are not sure to get: a plasma rich enough to make the price of the treatment worth your while. Not only do you need the treatment (CIT) done correctly, the differential centrifugation to be programmed correctly so that the Platelet-rich plasma can be extracted. Unfortunately, devices differ greatly in their capacity to collect and concentrate platelets depending on the method and time of their centrifugation. So basically, you might end up with a platelet-poor plasma, with a low concentration in growth factors. 

Why using serums? with peptides, growth factors, and active ingredients?

This is where things get interesting, and honestly great products tend to be underestimated when in reality these products provide practitioners with the most advanced, comprehensive, customizable solutions. They also allow the practitioner to broaden their range of treatments, differentiate themselves from other practitioners using micro-needling while delivering amazing results increasing patients satisfaction and the practitioner's revenue. So really, it is a win-win-win-win situation.

Let's begin with serums: Serums are usually made of one or multiple active ingredients/ agents (sodium hyaluronate/hyaluronic acid, vitamin A, C, E, and others, antioxidants, proteins...) tailored to address/improve a particular skin concern: stimulate skin renewal, improve the texture of the skin, decrease hyperpigmentation, protects the skin against daily aggressions, ultimately their "nutritive" roles are meant to boost the cell metabolism and cell renewal to restore skin mechanical properties and improved appearance. (hydration/moisturize, tone, exfoliation, cellulite, texture, stretch marks, scars, skin elasticity...). 

When applied in a clinical setting, serums nourish the skin and are designed to target the extracellular matrix modulation with the goal of optimizing the results of the treatments, whether the treatments are invasive (micro-needling) or non-invasive (iontophoresis, RF, etc...).

Serums provide a flash effect, which is great when combined with micro-needling because as a practitioner, and patient you can see some results shortly after the treatment.

Peptides:  Are short chains of amino acids acting as building blocks of proteins (elastin, keratin, collagen). They are cell regulators and have direct effects on collagen metabolism and influence collagen production. Peptides offer the promise of growth factor-like activities with improved skin penetration. Polypeptides/oligopeptides are made of chains of amino acids and have the ability to imitate a peptide sequence of molecules such as collagen or elastin. Through topical application, polypeptides have the ability to stimulate collagen synthesis and activate dermal metabolism.Some peptides like argireline (SNAP 8), which is a mimetic of Botox, and has been found to be safer than Botox, as well as very efficient in reducing wrinkles, (up to 48% upon 4 weeks of twice daily treatment.) (http://itpharmalab.us/productos/brands/it-pharma-en/action-face/)

Peptides provide immediate and long-term improvements. They play an important role in repairing wounds and improving skin conditions.

Growth Factors: Are proteins that play a key role in the regulation of a number of physiological processes. They play an important role in maintaining a healthy skin and promote the formation of collagen and elastic fibers. Topical application of growth factors also reduces signs of photoaging, promotes fibroblast and keratinocyte proliferation, and induces extracellular matrix, and have proven to be very efficient when applied after micro-needling to reduce signs of aging, promote fibroblast and keratinocyte proliferation, and to induce extracellular matrix formation. Growth factors are extremely important when considering their involvement in wound healing
The application of topical growth factors after micro-needling results in substantial clinical improvement in the signs of photo-aging in as little as 3 sessions, reducing signs of photoaging by improving skin texture as well as minimizing the appearance of wrinkles and fine lines.
To make sure you get results as a practitioner or patient with growth factors, you have to make sure that topical growth factors are used in conjunction with micro-needling, when micro-channels are open, penetration of growth factors becomes high, and thus become very efficient. If you do not use micro-needling or other methods to increase product penetration, the proteins will hardly penetrate the skin.Growth Factors provide immediate and long-term improvements. You will need to wait at least 1 month ore more to observe long term effect. Some companies claim that best results will be found 3 months post treatments. 

Which products, as a patient should you look for when going to your Dermatologist, plastic surgeon, cosmetic nurse, or medical esthetician? 

The first thin you want to ask, is whether the vials/ampoule are sterile or not. A sterile container helps avoid oxidation, contamination etc... This is very important.

Then you should ask where the products come from (country), and which brand it is. Usually, products made in Spain, France, or South Korean are a sign of quality.

Some of the top brands that we have been using and loving in order of quality, ingredients and efficiency are*: 

1. Inbiotec (ITPharma) (Most advanced formulation for targeted treatments - combo of peptides and growth factors with great actives ingredients, very comprehensive, great innovative company, although still not very known to practitioners I have met some of the top doctors from Spain and other countries that have been using these products)
2. IT Pharma line (Active ingredients and some peptides - great to customize treatments good ROI)
3. Dermaheal (Good formulations - although can be found on amazon, which honestly is not great for practitioners. More known but has a huge downside: it is accessible to anybody on internet)
4. Fusion Meso (Decent vials formulation for professionals, although better for post creams and skin preparation. The design is sleek, and products are on the cheaper end. Comparable to Institute BCN, Fusion Meso is same company as Oxynergy Paris, the name is confusing as it actually is from Spain. Not sure what they are trying to do here but it is misleading the consumer) 
5. Sesderma (a more established company, products are acceptable, although they do not provide the level of advancement in ingredients a professional would want, they have fewer solutions and are more post Tx skin care oriented) 
6. Institute BCN (would be the last one of the list, the design is ok but it is not a reflection of the quality of these products. I highly recommend to avoid this line, they are too cheap, you can find their products on the web alongside poor quality equipment, and other cheap skin care. Apparently from Spain although they claim to be they repack and do not directly manufacture. We found that their customer service and products were low quality products, after testing their peels, and solutions we had some issues and complains from patients. 

How deep should the needles go? 

Now, with the beauty of social media, and especially Instagram one can witness many different practitioners showing off their micro-needling "skills", however, I warn you, out of the hundreds of posts I have seen, only a few practitioners were actually doing it right or somewhat right.

With practitioners getting their "certifications" from questionable companies, we can understand why they use wrong motions (i.e spiral motion), press on the pen when doing the treatment, or use the wrong needle depth. Let's focus on Needle Depth.

 Recommended depth per area/ type of treatment:

• For CIT (micro-needling on the face): 0.50mm
  -> with 1 exception: scars
• Facial Scars: 1.5mm
  ->  But targeted, meaning only on the scars not the rest of the area, 1.5mm helps destroy scar collagen bundles
• Cellulite and stretch marks: 1.5mm -> to help break the tissue 
• For Hair: 0.20- 0.25mm-> Deep enough to stimulate hair growth and open channel for peptides, growth factors and active ingredients

Just some indications - if you bleed profusely during your treatment, your practitioner is probably going too deep.

Devices*

Skin Pen: Very expansive (around $5,000) decent device, the design is fine and it does the job but the ROI is not great. The SkinPen rattles after a few month, and it seems to be a common issue. I actually have colleagues that own skin pens and use other devices because of the rattling, noise, and low ROI. There is an online training video. (Few pointers there: the depth seem right, the technique is questionable, they do use the spiral technique, not the best direction when working under the eyes: you might want to go from inside to outside. Last the solution they use to apply on the skin seems to be non-sterile.)
 

Collagen P.I.N: Considering price/quality, it does not make the list as a favorite (between $1500 to $2000). Not only the design is poor but it is pretty standard, very loud, and is doesn't differentiate itself from cheaper pen found on amazon that are manufactured in China. Overall, it is not a very attractive device. After testing it I would not invest in it. I have had better devices for 1/3 of the price. No training videos online. 

AMTS2: Priced at $2000 - nice design, does have blue LED light (which is known to be antiseptic), and does the job just fine. This device is very powerful, so it is a little loud as well. You get a good grip when holding the pen, the quality of the needles seems to be pretty good. I would say out of the three and I justify my reasoning by the rational price/quality, that this is the most attractive one. ITPharma who is the company selling this device seems to be doing something right.







Having had all three in my hands I can tell you that this is the ranking: 

1. ATMS2/ ITPharma: price/quality seems good, price allows for a better ROI, design is sleek and upscale
2. SkinPen/ bellus medical: price/quality seems fair, price allows for a decent ROI, design is nice with some downside (rattling)
3. Collagen P.I.N/ induction therapies: price/quality seems low, allows for a decent ROI, design is poor with quality not reflected by price integrated this in an upscale clinic might be more challenging that the Skinpen and the AMTS2. 

These serums made of active ingredients, growth factors, and peptides can be used with regular micro-needling to enhance dramatically results, they can also be used with micro-needling devices such as Vivace (RF + micro-needling), and they can also be used with other conventional devices that help products penetration.

So there you have the info to make a conscious choice - now the questions to ask yourself is: what can I bring to my patients that will benefit them, benefit me and my practice and be different from what everyone else is doing.

*Reviews based on personal experiences