63 Microneedling

Tina S. Alster

Abstract

Microneedling has grown in popularity over the past several years for a variety of skin conditions such as scars, striae distensae, rhytides, and photodamage. The advantages of microneedling include its cost-effectiveness, high clinical efficacy, and excellent safety profile with low complication rate. As a result, microneedling is a valuable alternative or complement to more invasive procedures such as laser skin resurfacing and deep chemical peeling. Microneedling can be used as a stand-alone treatment or in combination with other therapies to optimize clinical outcomes.

Microneedling – scars – striae distensae – rhytides – photodamage – treatment

63 Microneedling

Key Points

The original microneedling devices consisted of evenly distributed needles affixed to a drum-shaped roller.
Microneedling devices have evolved to include corded and battery-powered pens with disposable tips containing 12 to 36 needles.
Automated pen devices offer variability of needle depth (0.25 to 3.0 mm) with a single cartridge and are small enough to treat areas difficult to access by a roller device.
In addition to their enhanced sterility and maneuverability, microneedling pens can more effectively and reliably penetrate into the deeper dermis to produce improved clinical outcomes.
Microneedling can successfully treat a wide variety of cutaneous conditions, including scars (atrophic, surgical, traumatic), rhytides, striae distensae, prominent pores, and photodamaged skin (actinic keratoses, dyschromia).

63.1 Preoperative Steps

Assess skin for a treatable condition.
Avoid areas of inflammation, infection, or recent sun exposure.

63.1.1 Microneedling Setup

Microneedling device and protective shield.
Single-use sterile needle tip.
Gliding gel (hyaluronic acid).
Ice water in bowl.
4ʺ × 4ʺ gauze.
Topical anesthetic.
Disposable gloves.

63.1.2 Microneedling Key Points

Conditions treated:
- Photodamage (actinic keratoses, dyschromia).
- Prominent pores.
- Rhytides.
- Scars (atrophic, surgical, traumatic).
- Striae distensae.
Avoid:
- Active infection or inflammation (e.g., acne, eczema).
- Recent ultraviolet light exposure or evidence of tan.
Prep:
- Mild (nonirritating) cleanser.
- Topical anesthetic.
- Antimicrobial solution.
Technique:
- Hyaluronic acid gel (or platelet-rich plasma) to facilitate device gliding.
- Skin traction with perpendicular device tip placement.
- Cross-hatch microneedling passes.
- Pinpoint bleeding endpoint.
- Ice water compression for hemostasis.
Postcare:
- Hydrating gel or cream (e.g., hyaluronic acid or hydrocortisone).
- Mineral sunblock (SPF 30 +).

63.2 Procedural Steps

Cleanse skin with nonirritating cleanser.
Apply topical anesthetic cream (30% lidocaine) for 30 to 60 minutes.
Remove anesthetic with antimicrobial solution (e.g., hypochlorous acid).
Apply thin layer of hyaluronic acid gel (or platelet-rich plasma) to facilitate gliding action of device (avoid use of excessive gel, which can interfere with the microneedling mechanism).
Select appropriate needle depth for lesion (deep rhytides and fibrotic scars typically require longer needle lengths of 2.5–3.0 mm, whereas superficial rhytides, shallow scars, and thin skin regions can be treated with shorter 1.0–1.5 mm needles).
Apply gentle traction of the skin to ensure perpendicular placement of the device tip and to assist smooth, vertical delivery of needles into the dermis (Fig. 63.1).
Exert minimal pressure to the skin to facilitate gliding action of the device.
Cross-hatch microneedling passes are made until lesional effacement and/or pinpoint bleeding is evident.
Apply sterile ice water or saline-soaked gauze to remove excess blood and to achieve hemostasis.

Fig. 63.1 Traction applied during microneedling. (Reproduced with permission from Hausauer AK, Jones DH. PRP and Mikroneedling in Aesthetic Medicine. Thieme; 2019.)