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Microneedling: What you need to know, form dermatologist | Dr Davin Lim
In 99% of cases acne scarring will have a unique pattern that will consist of many different scar types. This includes box car scars, ice pick scars, rolling scars, tethered scars, hypertrophic scars, pick scars, pebble stone scarring, and atrophic scars. The amount of each will vary between each individual. Additionally the skin type of the patient will need to be taken in to consideration as well as the severity of these scars. Will microneedling address all these scars? Short answer is NO.
It’s an easy concept to understand, - treat the scar type with an appropriate method and you WILL get a response. So, what does microneedling do? Well it’s a form of CIT or collagen induction therapy and provides collateral damage to abnormal collagen. This treats surface scars such as mild rolling scars, tethered scars attached very superficially and also mild box car scars. The process itself can release cytokines that can benefit the upper layer of the skin and stimulate a controlled environment for normal wound healing, - essentially new collagen to replace old scars.
Microneedling packages are sold throughout Asia, in Australia and probably World wide. Why? Because it this treatment cost very little to perform. The microneedling device cost between $70 all the way to $2000 - a fraction of the cost of lasers, and much less than RF microneedling.
Skin tearing or ripping is a marketing ploy, sure it is true with poor technique and long needles on a derma roller if one uses a 0.25 to .5 mm needle, it does not apply. These needles are way too short to cause skin damage. If your epidermis is 100 microns, 0.25 mm needles penetrate almost 2.5 times the depth of the upper epidermis. Hence why you will see in my videos that I can cause lots of bleeding with 0.25 mm needles, obviously with the correct use of a dermaroller or skin needling.
The use of energy based stamping devices like INFINI micro-needling radiofrequency or Intensif is far safer than devices that provide high hertz vertical mechanical needling. Why? Because needle delivery is vertically delivered without sliding. If one is proficient at microneedling and with the correct lubrication gel or Hyaluronic acid, this creates minimal problems. However if one miss-times the movement, it results in skin ripping that is WORSE than skin needling. So, at the end of the day, you need a good microneedling device and someone proficient at conducting the procedure. Most companies ship the device, ask you to read a booklet and watch a KZfaq video - and you are fully trained to really Fu*K up someone’s face. Sorry about the profanity, however I would like to spend my time treating pathological scarring, and not iatrogenic scars- scars caused by trauma to the skin.
In summary, treat the scar type, this requires skill sets that most dermatologist or plastic surgeons do not possess- this means you HAVE TO BE proficient in all aspects of scar revision from scar excision, scar subcision, scar elevation, NOKOR subcsion, TCA CROSS, paint and peels. One should be proficient in testing dermal thickness prior to the use of high powered lasers including CO2 and erbium ablative as well as non-ablative lasers like Fraxel, and know when to apply these devices. PIE requires you to master all forms of vascular lasers, and atrophic scars need fillers or fat grafting. If you cannot fill proficiently you are not a scar revision specialist as most scars will have an element of atrophy- in this case fat atrophy not collagen atrophy. This is easy to test with a cannula. Do I employ microneedling- absolutely, in the correct context. I use manual microneedling with a tiny 30 g needle, and go vertical or obliquely into the scar to feel for the crunch. This way I cause as little collateral damage as possible to the surrounding tissue. Additionally with this technique I control the depth of the needles, and vary it according to feel.
In conclusion, microneedling can be useful in the management of mild non- tethered scars especially if treated early. I prefer manual treatment - a cross over with mesotherapy to achieve the best results. This treatment is only one skill set in the many that is need to treat acne scars.
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Thanks for watching, Dr Davin Lim. Brisbane. Australia. #dermatology #microneedling #acnescar