PEER-REVIEW | MICRONEEDLING | needle into the dermis, needling devices with longer


needles and less dense needle arrangements will be used for invasive microneedling treatments compared to those used for non-invasive treatments. Depending on the performance of the needle (material, tip shape, diameter) or rather of the needle instrument, the needle used is between 0.5 and 3.0 mm in length. The actual penetration depth of the needle depends mainly on the number of needles per area, the performance of the needle tip, the needling pressure, and the acceleration of the needle swing as well as the flexibility of the skin. During invasive microneedling treatments the


epidermis is not injured across large areas but remains intact between the microlesions so that no structural weakening occurs of the epidermal and dermal skin layers. Furthermore, the expression of growth factors and proteins is induced through the procedure. These growth factors and proteins are associated with scar free healing and initiate dermal regeneration and remodeling of the skin. Through the repeated puncture of the skin surface with fine needles, the collagen synthesis will be stimulated in the area of linear scars and wrinkles5


During invasive microneedling treatments the epidermis is not


injured across large areas but remains intact between the


microlesions so that no structural


weakening occurs of the epidermal and dermal skin layers.


. In all cases, an


induction of collagen synthesis is achieved through adjacent sub- epidermal microlesions in the extracellular matrix. The resulting minimal bleeding activates the post-


traumatic wound healing cascade, whereby the collagen structures in the scar area are replaced by a new sub- epidermal collagen matrix. In the case of microneedling, the epidermis remains undamaged in contrast to ablative procedures. The PCI is an effective technique that offers the


advantage of improving the skin appearance through stimulation of collagen production, without postoperative hyper- or hypopigmentation or fibrosis of the skin compared to the usual ablative procedures, such as laser- resurfacing or chemical peels. Furthermore, it seems that through this method the result will occur via a true skin regeneration and not through skin degeneration as caused by ablative procedures. Similar observations were already made by Camirand and Doucet in 1997, as they treated hypertrophic scars with a tattoo gun and achieved very good results with a low complication rate6


. It also becomes clear that the


devices as well as the methodology are very similar between automatic microneedling and automated tattooing or rather during micropigmentation, for example, permanent make-up (PMU).


52  October 2015 | prime-journal.com


Illustrating the depths penetrated by minimally invasive epidermal microneedling (top) and the more invasive dermal microneedling (bottom)


Figure 3 Penetration depth achieved with two forms of microneedling


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