Microneedling. Группа авторов
dermatology, clinicians will have the tools available to help treat patients with the most advanced techniques and with the most appropriate guidance that has been presented to date. Each volume in this series has been meticulously thought out; each is edited by one of the most significant thought leaders in our field, and each chapter will bring to life this incredible field we live in, and illuminate how we are able to transform lives and make our patients better.
We hope you enjoy this series of books as they are rolled out. It is our joy and pleasure to bring them to you.
Michael H. Gold, MD
Series Editor
Preface
The skin is our canvas. As a board certified dermatologist, it is my mission to help all my patients achieve healthy, beautiful skin. Through education, teaching, and research this is possible. This textbook is a continuation of this mission, inspired by the drive to create the best possible outcomes for my patients, and the love of being a physician and educator.
Over the last several years, minimally invasive procedures have significantly increased in the worlds of dermatology, plastic surgery, and aesthetic medicine. This textbook is a global consortium of the leaders in these fields and experts on microneedling.
Microneedling is an outstanding option for patients of all skin types and ethnicities who desire measurable clinical results from treatments with little to no downtime. It is a relatively new option in dermatology and has been utilized for a broad range of applications, including skin rejuvenation, acne scarring, rhytides, surgical scars, dyschromia, melasma, enlarged pores, and transdermal drug delivery.
Microneedling is a safe, minimally invasive, and effective aesthetic treatment for several different dermatologic conditions. Given its expedient post‐treatment recovery, minimal side effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures. The chapters of this book discuss the various applications in detail.
I want to thank my family and mentors for their support always. I also want to give a special thank‐you to Dr. Michael Gold. He is an innovator in our field and I am happy to call him my dear friend, mentor, and colleague.
Elizabeth Bahar Houshmand, M.D.
Diplomat American Board of Dermatology
Diplomat American Board of Internal Medicine
Fellow American Society of Laser Medicine
Instagram: @HoushmandMD
Website: Houshmanddermatology.com
1 Introduction to Microneedling
Elizabeth Bahar Houshmand
Houshmand Dermatology and Wellness, Dallas, TX, USA
Introduction
Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The microwounds created stimulate the release of growth factors and induce collagen production. The epidermis remains relatively intact during the procedure.
Microneedling initially was utilized as a collagen induction therapy for facial scars and skin rejuvenation, but it is now widely used for multiple indications, including transdermal delivery system for therapeutic drugs and in combination therapies. The indications for microneedling have grown as research and clinical applications have expanded widely in dermatology and dermatologic surgery.
In this textbook, the authors highlight the constantly evolving research and developments in microneedling techniques and instruments, along with microneedling’s applications in dermatology and aesthetic medicine. We are honored to provide a comprehensive and global perspective from key opinion leaders in dermatology and plastic surgery from around the world.
History
Microneedling, or percutaneous collagen induction therapy, was introduced in the 1990s for the treatment of scars, striae, and laxity [1]. The use of needles for nonablative skin treatment was first described by Orentreich and Orentreich in 1995 as subcision surgery, which is the release of depressed scars and wrinkles with a needle from their attachment to the underlying skin. This controlled trauma leads to the formation of connective tissue to fill the created gap.
Figure 1.1 Original microneedling roller created by Dr. Desmond Fernandes in 2001. Fixed needle length of 3.0 mm multiuse roller; designed for reuse on a single patient for approximately six treatment sessions. The original rollers were not able to be autoclaved at that time. They were sterilized by soaking in instrument cleaning fluid.
Source: Dr. Desmond Fernandes.
In 1996, skin needling using a roller device was introduced by Fernandes at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei [2]. In 1997, Camirand and Doucet introduced dry tattooing without pigment as needle dermabrasion and proposed it as a technique to improve the appearance of scars [3].
Fernandes, in 2001, developed the original percutaneous collage induction dermaroller with needles. His pilot roller device was a drum‐shaped tool, with a cylinder and 3 mm needles that reach the fibroblasts deep in the reticular layer (see Figure 1.1).
Zeitter et al. confirmed Fernandes’s findings and made a modified roller. They concluded that 1 mm needles show similar results to 3 mm needles, with the advantage of less downtime, swelling, and pain [3, 4].
Mechanism of action
The mechanism of action is thought to be a disruption of the epidermis and dermis. Micropunctures are created using microneedles, which produce a controlled skin injury without damaging the epidermis. The mechanical microinjury results in the classic wound‐healing cascade and stimulates cellular proliferation and migration through the stimulation of growth factors (see Figure 1.2).
These microinjuries lead to minimal superficial bleeding and set up a wound‐healing cascade with release of various growth factors, such as platelet‐derived growth factor (PDGF), transforming growth factor alpha and beta (TGFα and TGFβ), connective tissue activating protein, connective tissue growth factor, and fibroblast growth factor (FGF) [5]. The needles also break down the scar strands and allow them to revascularize. Neovascularization and neocollagenesis are initiated by migration and proliferation of fibroblasts and laying down of an intercellular matrix [6, 7]. A fibronectin matrix forms five days after injury and determines the deposition of collagen, resulting in skin tightening persisting for five to seven years in the form of collagen III. The depth of neocollagenesis has been found to be 5–600 μm with a 1.5 mm length needle. Histological examination of the skin treated with four microneedling sessions one month apart shows up to 400% increase in collagen and elastin deposition at six months postoperatively, with a thickened stratum spinosum and normal rete ridges at one year postoperatively [8]. Collagen fiber bundles appear to have a normal lattice pattern rather than parallel bundles as in scar tissue [9].
