PEER-REVIEW | DERMATOLOGY | Figure 1 Male patient, aged
40 years, (A) before treatment and (B) 1 month post-treatment. The treatment was carried out using the Revive MN (AMIEA
MED,
MT.DERM GmbH, Berlin, Germany), Revive-HAP, 6-point needle plate
stimulates a wound healing repair and regeneration
mechanism that results in dermal regeneration, normalised ‘basket weave’ formation of collagen fibres, and increased angiogenesis2–4
. The effectiveness and excellent safety profile of the
treatments have resulted in the technique rapidly becoming established in Europe and Asia as a frontline medical aesthetic treatment for acne scars, texture, tone, lines and wrinkles, and laxity improvement in ageing and photodamaged skin, and more recently, for stretch marks2–4
.
Automated microneedling Microneedling is not a new procedure, but is a clinically-proven and well-recognised aesthetic treatment for ageing, photodamaged skin and scar tissue. Although microneedling is not a new technique, there have been a number of refinements over the last few years. From manual devices, the trend is now moving towards automated devices, particularly as there are some limitations with manual devices, including a fixed needle length, moderate to high patient discomfort, and the widespread availability of low quality and low cost devices. As a result of these limitations, automated devices
64 ❚
have been developed. This shift enables the practitioner to adjust both the speed and the depth of the needles throughout the treatments, as well as providing higher levels of patient comfort. Parameters such as needle length and the speed of needle movement can also be pre-set; therefore, penetration depth is controllable, which helps to reduce levels of pain associated with the procedure, for example. It is important to monitor the precision and power of
October 2013 |
prime-journal.com
the automated needling devices, as these features are paramount for the strength to penetrate into the dermis with minimal trauma, and they may vary from system to system. Additionally, and of further advantage, are features such as the tilting needle plates to ensure a perpendicular incision and a reservoir to bring substances directly into the dermis. In some electrical microneedling devices, the needle plate — owing to its construction with the capability of tilting — can be adapted to fit uneven skin surfaces, or to fit the irregularities to be treated. As such, the process of needle penetration is controllable and perpendicular.
Microneedling is not a new procedure, but is a clinically-proven and well-
recognised aesthetic treatment for ageing, photodamaged skin and scar tissue.
Mechanism of action The mechanism of action of microneedling is the controlled mechanical stimulation of the wound healing response with rapid closure of the micro-incisions. The wound healing response is the result of mechanical stimulation of the dermis, which leads to higher concentrations of platelet growth factors and enhanced fibroblast infiltration. As the wound closes quickly, the need for fibrosis is minimised and the safety profile enhanced. In particular, microneedling
leads to the gene expression of a number growth factors, collagen type I and glycosaminoglycan
(GAG). The treatment leads to an up-regulation of transforming growth factor (TGF)-b1 and TGF-b2 at 2 and 4 weeks after the treatment, followed by a strong down-regulation at 8 weeks post-treatment. This triggers the natural healing process through the up-regulation of TGF-β35 factors6
for the epidermal–dermal junction7
; up-regulation of collagen I, GAG, and growth ; and up-regulation of positive genes important . This leads to
normally-woven collagen and scarless healing. However, there is also a strong up-regulation of TGF-β3
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