DERMAL COLLAGEN STIMULATION THERAPY BY MEDICAL ROLLER NEEDLING
Inappropriate facial laser therapy is costly, results do not last or are variable, post-inflammatory hyper-pigmentation and scarification is problematical. Possible judicious, fractional photothermolysis has improved this image in patients seeking facial skin rejuvenation and skin tightening. Because results do not last and are non permanent, the aesthetist cannot over promise and the patient's expectations, motives need to be assayed. In select patient's, a face lift can restore a sagging face, but does not rejuvenate the face. Often, a pulled result is seen and the face is changed from 3D to 2D appearance. Nonetheless, a face lift in the hands of talented surgeons renders results far superior and durable than IPL or laser. Medical needling is an option that should be offered to select patients seeking facial skin rejuvenation. Costs are in the range of R1500 and continuing home treatment can follow in select persons. Skin pre-and post procedural needling care is critical for good results. Pre-needling, the skin should be prepared with vitamin-A and C creams. Post-needling care includes careful washing and cleansing to avoid scabs and granuloma formation. Downtime is about 48 hours (initially red and bruised) and includes redness of the treated area and especially the neck.
ANY PROOF OF SCIENCE?
Yes, acupuncture (on which rejuvenating needling is based) has been shown to stimulate fibroblasts in the dermis and facilitate collagen deposition. Also, microdermabrasion and facial peels. This is however, a very slow process (because of background aging that continues unabated) and takes 3-6 months. A critical eye may detect positive skin morphological changes at 2 months. Fine lines and wrinkles can be improved due to the tightness that occurs and results are superior to IPL, PPX, RF and laser. The principle of improvement is dermal thickening that improves tone and texture of the dermis (i.e. rejuvenation by collagen induction therapy).
Needling, which like acupuncture, results in the creation of a tiny puncture wound and heals by first intention and collagen deposition/ tissue remodelling. Of importance is that acupuncture, leads to a release of TGF-b1 , a growth factor released by activated platelets. This factor, together with other platelet factors i.e. PDGF, VEGF and EGF , is also utilized during ACR/PRP (autologous cellular regeneration) for facial rejuvenation that is popular in the RSA, Japan , Europe, and Asia . For interested readers, click on the ACR/PRP menu for more details. For more information on medical needling refer to the website www.environ.co.za , a procedure locally pioneered by Dr Des Fernandez, a specialist plastic surgeon in Cape Town .
EXCLUSION CRITERIA FOR MEDICAL NEEDLING.
- Dermatological conditions affecting the face, herpes, infections
- Porphyria, vasculitis, SLE
- Bleeding disorders, anti-platelet agents, anti-coagulation
- Pustular acne
- Propensity to keloid formation
SUMMARY: The Mediroller or Environ Medical Roll-Cit are suitable devices for needling and facial rejuvenation.
- Under local topical anaesthesia, dozens of tiny fine holes are punctured into the target skin by a roller device loaded with sharp needles. These penetrate into the dermis where the fibroblasts are situated and collagen remodelling occurs. During the healing process, growth factors are released including TGF-b1 . Collagen synthesis stimulated by stem cells in the Space of Grenz may well be activated (with other mesenchymal cells). Keratinocytes, through growth factors stimulation may well produce improved tone and texture of the epidermis. Procedure time is about 30-45 minutes and an experienced practitioner/specialist should conduct the procedure. It is unlikely that the vitamin A cream is absorbed by the tiny holes and perforations made by the needles on the roller, because during the healing cascade the apertures are sealed and covered by epithelium within 24 hours.
- Pre-needling: vitamin A and C.
- Post-needling: wash carefully to avoid secondary infection and crusting. Apply local antibiotic cream to prevent secondary infection. Vitamin A creams are continued.
- Expect slight swelling, redness of the skin which may persist for more than 96 hours in susceptible subjects. Short-term bleeding and raw bruising appearance is well documented but resolves.
- Patient selection: moderate skin changes and persons with realistic expectations
- One sitting is the norm, but more treatments may be indicated to maintain and improve results.
- A laser rejuvenates and tightens by thermal damage and healing. Needling, results in rejuvenation by the inflammatory healing process and platelet derived growth factors.
Photoaged skin. Needling process ( see roller ) performed under local anaesthesia, and is a good alternative to fractional laser photothermolysis, RF or IPL.
Malar area of face. Immediate postprocedural needling end-point, showing small punctate bleeding. The tiny punctures stimulate dermal inflammation and wound healing. The platelets that form the plugs release growth factors that facilitate rejuvenation and collagen deposition. Down time in this patient was minimal and he portrayed minimal skin erythema for about an hour. Pre and post treatment includes careful application of a Vitamin-A based cosmetic cream.
BOLANDCELL ACADEMIC REFERENCES
- Langevin HM et al. Subcutaneous tissue fibroblast cytoskeletal remodelling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol 2006: 207: 767-74
- Bouffard NA et al. Tissue stretch decreases soluble TGF-beta 1 procollagen in mouse subcutaneous connective tissue: Evidence from ex vivo and in vivo models. J Cell Physiol 2007 : Epub ahead of print.
- Marx RE et al. Dental and craniofacial applications of platelet-rich plasma. Quintessence Books. 2005.
- Du Toit DF et al. Shoulder surgeon and autologous cellular regeneration-from bench to bed: Part 1-the link betwen the human fibroblast, connective tissue disorders and the shoulder. IJSS.2007:1; 87-95. See www.internationalshoulderjournal.org .