Mastering Microneedling | Featured in Modern Medical

This article was featured in Modern Medical in March 2020, written by Beatrice Van, L.M.E.

Headline from the Modern Medical article "Mastering Microneedling" by Beatrice Van, L.M.E.

Microneedling is not a magic wand but when following proper protocol and sanitary procedures and addressing all the above contraindications and medical history, a practitioner can truly help change the lives of clients.

Microneedling, also called collagen induction therapy, has become an increasingly widespread skin treatment for those who want to improve the look of their skin, boost collagen, and minimize acne scarring, photoaging, and stretch marks without invasive treatments while optimizing topical delivery for treating conditions like melasma and acne.

It involves pricking the surface of the skin multiple times using very fine, short, sterile needles to create hundreds of microscopic punctures, which kick the skin's natural healing process into high gear to improve skin texture, reduce the size of pores, and minimize the appearance of wrinkles and scars.

The micro-injuries created during microneedling signal the body's immune system to react and heal, resulting in a higher cell turnover rate and increased collagen and elastin production, which can help reverse and slow down the signs of aging. Because of the treatment's ability to activate the generation of new skin cells, just a few sessions of microneedling will noticeably reduce fine lines and wrinkles and reduce the appearance of stretch marks, hyperpigmentation, and pores.

During and post treatment there is a window of opportunity for temporary penetration and diffusion for optimal delivery. Collagen induction therapy is about more than collagen induction. Microinjury of the skin appears to reset or reboot cellular function. If melanocytes over-produce or underproduce pigment, microneedling normalizes melanogenesis. The same is said for keratinocytes when hyperkeratinization exists or sebocytes that overproduce oil. Therefore, needling plays an important role in treating acne.

How Does Microneedling Work?

The body's natural response to healing is used to increase collagen and elastin in the skin.

Skin care professionals create thousands of microchannels during the treatment, which allows for leakage of blood, serum, and lymph in a controlled and temporary manner. The injuries initiate the wound healing, then a cascade of growth factors is released, which in turn triggers new collagen synthesis.

This process has two major benefits: it effectively stimulates collagen formation and provides a clear channel for topical serums to be absorbed through the surface of the skin. By persistently triggering this healing process with a series of microneedling treatments, the body keeps repairing the skin incrementally and cumulatively to offer a result like fractional laser treatments and chemical peels with minimal downtime.

Benefits and Disadvantages of Microneedling

There are many benefits for both the aesthetician and the client to offer and receive microneedling treatments.

As always, check with your state board to ensure it is under your scope of practice and look for a certificate training course to gain hands-on experience with the equipment.

There are many criteria to consider before offering this treatment, for example, whether a client is the right candidate for this treatment, cross-contamination, allergic reactions, post-inflammatory hyperpigmentation, which can be experienced differently depending on skin type and color, scarring, glycation, granulomas, and nerve injuries.

Contraindications for this treatment include skin cancer, pregnancy, open lesions, a compromised immune system, including autoimmune diseases, diabetes, acne, dermatitis, emotional instability, anticoagulants, infected skin, fungal skin infections, active rosacea, psoriasis, raised moles or warts, and a nickel allergy.

When meeting with clients who are on blood thinners, have clotting disorders, skin types IV, V, and VI, or rosacea, approach this treatment with caution. As mentioned earlier, for darker skin types, such as those on the Fitzpatrick scale of IV to VI, post-inflammatory hyperpigmentation can and has been a significant complication.

Treating these skin types too aggressively, such as with too many passes or depth of needle, combining this treatment with intense pulsed light therapy, lasers, or chemical peels, can provoke too much inflammation and may trigger post-inflammatory hyperpigmentation.

It is important to approach all skin types with a progressive rather than an aggressive approach. Before combining treatments, make sure to perform each treatment individually to see how their skin reacts and tolerates injury. Collagen induction therapy is great partnered with other non-ablative treatments, such as light emitting diode (LED) therapy, dermaplaning, microdermabrasion, chemical peels, enzyme masks, lymphatic drainage, micro current, and laser or intense l pulsed light therapy.

Best Practices for Microneedling

Before treating a client, be sure to conduct a thorough consultation, which should include a concise medical history intake form and discussion, standard face diagram to chart outstanding facial features, scars, wrinkles, and so on, as well as a diagnostic history used to establish the cause of the skin condition being presented for treatment.

Questions on the consultation form should provide enough information to give the practitioner a clear picture to assess health and suitability for the treatment. Questions should cover general medical and cardiac history, skin healing such as a history of keloid scarring, prescribed hormones or hormone-altering medications, lifestyle, other prescribed medications, and self-prescribed supplements.

The consultation should also include a baseline reference point for later developments and means by which to measure client progress. Before and after pictures are vital for recording the skin's initial condition and to observe changes in skin tone, texture, and resilience. The consultation also establishes reason-able expectations of how the client and practitioner will perceive the end results.

In addition to the consultation, utilize a client progress report to document depth, speed, anesthetics used (if in your scope of practice) the skin's initial response to treatment, any additional comments on how the skin responded to the treatment, as well as pre- and posttreatment products, areas avoided, and why.

For the practitioner and the spa's safety, create an informed consent document that each client will sign and date prior to receiving microneedling treatments. A post-treatment signature is also important when documenting post-treatment care and a daily homecare regimen, expectations for the first five days following each treatment, and the importance of good hygiene to help prevent infection, which can lead to further complications including post-inflammatory hyperpigmentation.

Post-treatment instructions include avoiding touching newly treated skin, heavy fragrances including fabric softeners and dryer sheets, harsh products such as retinoids, astringents, and drying products, exfoliation, and pet dander. As mentioned before, microneedling creates small, open wounds on the skin to force the skin to heal so proper hygienic practices are important for preventing infection.

The client would not rub an open wound in dirt and the same idea goes with a fresh microneedling session. The client should also avoid makeup for 12 to 24 hours or until the next day at the earliest, direct sun exposure, and sunscreen for the first four hours post-treatment. Healing and calming antioxidants, as well as growth factor serums, will help support a healthy recovery process.

Safety First

Before offering microneedling, seek for hands-on training and certification to identify what clinical end point looks like.

Do not mistake this treatment with the "vampire facial," also known as platelet-rich plasma (PRP). It is important to mention that excess blood, that is more than pinpoint is not acceptable. Microneedling is not the vampire facial and as a certified, advanced aesthetician drawing blood is not within scope of practice.

Also, be sure not to break the skin so seriously that it causes excessive bleeding. Pinpoint bleeding is the only acceptable way to see blood with this treatment. Anything more and it is being done incorrectly. Finally, make sure to have insurance for this procedure. Always use a brand-new, sterile needle cartridge each time. Showing the client the sterilized cartridge is never a bad idea.

Wear single-use disposable gloves, blot pinpoint bleeding, and dispose blood tinged gauze in a double-zipped bag and place in the trash immediately post-treatment. Dispose of used needle cartridges in a sharps container.

All too often, there are less than sanitary practices used in spas — to prevent from becoming a headline in the news, review and practice all board instructed sanitary practices to protect yourself and, most importantly, the client.

There are a few methods and needling devices for collagen induction, such as tattoo devices, rollers, radio frequency combined with microneedling, and handheld electronic devices. Aside from price, it is important to keep in mind the client's safety, performance of the device, quality of needle cartridges, and FDA approval when considering which brand of microneedling to use.

Always keep in mind that price does not equal quality. Due diligence and research are important when selecting new equipment for client services.

In conclusion, microneedling is not a magic wand but when following proper protocol and sanitary procedures and addressing all the above contraindications and medical history, a practitioner can truly help change the lives of clients. Keep in mind that product selection is crucial to the efficacy of each treatment. Using topical products to support the body's natural inflammation process and provide calming and healing ingredients is important to help reseal barrier defense. These products should also include moisture and essential nutrients. Best results are seen with a series of treatments spaced apart according to the client's healing time. Typically one treatment every two to four weeks will provide beneficial results that the practitioner and the client will see.

References

Microneedling, Published WorkBeatrice VanDermascope