COMMENT ▼
Microneedling: a versatile and popular
treatment option
Abstract
Micro-needling, also known as collagen induction therapy, is a process
involving the repeated puncturing of the skin with tiny, sterilized needles.
Carrying out precise, controlled wounding of the skin in this way, allows
for controlled healing, which leads to skin rejuvenation and the treatment
of a number of conditions through cell turnover and increased collagen
production.
Key words
► Microneedling ► Collagen induction therapy ► Skin ► Rejuvenation
A
lthough many articles point to the
beginning of the 20th century as the advent
of microneedling, it could be argued that
its use stretches back even further than
this. We could point to the first uses of acupuncture
by the Chinese in 100 BC. Of course, acupuncture is
considerably different from microneedling, but the
end goal of promoting the body’s natural, self-healing
process, is the same.
If we are looking for something more similar to
modern microneedling, we have to fast-forward to 1905,
when German dermatologist Dr Ernst Kromayer used a
number of motor-powered dental burs, which varied in
size, to treat scarring, hyperpigmentation, and other skin
ailments. Despite the innovations by Kromayer, further
advancements wouldn’t be made until late in the century
(MDPen, 2019).
The first of these was by Dr Andre Camirand in
1996, through the practice of medical tattooing.
Camirand had been trying to treat and conceal
scarring on his patients by tattooing pigment into
their skin. However, he began to notice that the
tattooed pigment was dissolving and being replaced
by actual melanin. What’s more, the scarring itself was
showing marked improvement in texture, colour and
LOUISE WALSH
Dermatology and Cosmetic Nurse Prescriber,
The Skin Nurse
e: louise@theskinnurse.co.uk
280
Downloaded from magonlinelibrary.com by 155.198.030.043 on August 6, 2019.
overall appearance. However, the most remarkable
thing about this development is that it didn’t appear
to be the pigment causing these improvements, but
the needles used to apply the pigment.
Further research and experiments led to the idea
that puncturing scars with a tattoo gun, without
pigment, could break down some of the scar tissue,
as well as other material that had built up inside it.
Camirand’s theory proved correct and, after multiple
sessions, all of his patients saw significant benefits
from his pioneering treatment.
Shortly afterwards, in the same year, plastic surgeon
Dr Desmond Fernandes developed his own technique
for purposely penetrating the skin, using a small
needle stamp. He used this device to stimulate collagen
production in the skin, finding an effective way to treat
scarring, wrinkles, and other signs of ageing. He named
his method (minimally-invasive) percutaneous collagen
induction (PCI).
Fernandes then went on to develop the first widely-
used microneedling device, the original Dermaroller,
and is credited, in a sense, as being the father of modern
microneedling (Garcia, 2019).
Since then, a variety of microneedling devices
have been developed, with significant increases in
effectiveness, as well as decreases in cost. This potent
combination of better results and lower treatment
prices have seen microneedling surge in popularity,
with little to no signs of slowing down any time soon.
In fact, the technology involved in creating the devices
has evolved to the point that many are designed
for home use, with the user being able to apply the
technique themselves.
How microneedling works
The main principle behind microneedling is the
precise penetration of the skin to cause self-healing.
Needles of different lengths are used to repeatedly
penetrate the skin at differing depths, depending on
the skin condition that is being treated. However, the
typical size is 0.5-1.5 mm in length, with a diameter of
© 2019 MA Healthcare Ltd
0.1 mm.
These needles, pre-sterilized by gamma irradiation,
are used to pierce the stratum corneum to create holes,
or microconduits, while causing minimal damage to
Journal of AESTHETIC NURSING ► July 2019 ► Volume 8 Issue 6

the epidermis. This causes the growth factors, such
as TGF-alpha, TGF-beta, and platelet-derived growth
factor (PDGF), to which stimulate the production of new
collagen (neocollagenesis) and elastin cells in the dermis.
This, upon healing, makes the skin firmer, smoother, and
gives it a more youthful appearance.
This process leads to the development of new
capillaries, or neovascularisation, in the treated area.
Not only does this lead to faster recuperation (and less
down-time), but it also results in a reduction in scarring,
and enhanced blood flow and, consequently, nutrient
transportation, thereafter.
In addition, though the damage to the epidermis is
minimal, it still allows for the enhanced absorption
of topical treatments, such as retinol, tretinoin and
vitamin  C, by the thick stratum corneum, through a
process known as microneedling trans-dermal delivery
(Fernandes, 2005; Doddaballapur, 2009; Iriarte et al,
2017).
Aesthetic uses for microneedling
One of the main reasons microneedling has become
increasingly popular is that it is useful for a variety of
aesthetic treatments. This includes:
►► Anti-ageing/skin rejuvenation, including the
reduction of wrinkles and fine lines to create firmer,
younger-looking skin
Surgical Instrument
Specialists
Aesthetic & Cosmetic Surgical Instruments
& Procedure Packs’ are now available from
FCL Surgical.
www.fclsurgical.com
© 2019 MA Healthcare Ltd
FCL Surgical (T/A Apex Surgical)
32 Longbridge Lane,
Ascot Business Park, Derby,
DE24 8UJ.United Kingdom.
Tel: +44 (0)1332 321819
www.fclsurgical.com
Volume 8 Issue 6 ► July 2019 ► Journal of AESTHETIC NURSING
▼ COMMENT
►► Hyperpigmentation
►► Hair loss, through the induction of stem cells in the
scalp
►► Scarring, particularly acne scarring, although it is also
effective in reducing body scarring
►► Stretch marks.
However, as well as its versatility, its widespread use
is also down to its ease, low cost, (relative) lack of pain
and invasiveness, and lack of downtime compared
with other popular cosmetic procedures (Iriarte et al,
2017; Galan, 2019).
Available microneedling devices
As mentioned earlier, microneedling devices have
developed to the point they can be used for self-
application. This means that devices on the market
generally fall into two categories: those designed for
use by aesthetic practitioners and those suitable for
home use. Devices with needles longer than 0.5 mm
are designed for professional use, as they have the
ability to deeper penetrate the layers of the skin.
Devices deemed suitable for self-application have
needles under 0.5 mm long.
Microneedling’s rapid, and still growing, popularity
means there is a wide variety of microneedling devices,
including the Dermapen, Dermaroller, Dermastamp,
Dr Pen, Skin Pen, and many others – usually containing
FCL Health Solutions Ltd
Hawthorns House, Halfords Lane
Birmingham, UK. B66 1DW
Tel: +44 (0)121 272 1885
www.fclhealth.com
281
Downloaded from magonlinelibrary.com by 155.198.030.043 on August 6, 2019.
 COMMENT ▼
the term ‘pen’ or ‘roller’ in line with the terminology
associated with the treatment (Singh and Yadav, 2016;
Skin Pen, 2019).
Considerations for aesthetic
practitioners
There are a number of considerations that professional
aesthetic practitioners need to be aware of regarding
microneedling. These either fall into the category of
their own professional conduct or effectively guiding
clients through the process.
Professional conduct
The professional conduct aspect mainly concerns
hygiene and cleanliness. This is something that goes
without saying but bears repeating due to the nature
of the treatment, with the patient’s skin being so
exposed and compromised. For a start, as mentioned
above, the needles should be pre-sterilised and single
use only.
Additionally, it is best to use a cordless device for
complete manoeuvrability, although a consistent power
supply throughout the procedure is vital too.
Also, and most importantly, microneedling is not
recommended for pregnant women. This is due to the
fact that the healing process draws nutrients into the
treated area, depleting the pool usually reserved for the
developing foetus.
Patient considerations
When it comes to things to consider when taking clients
through the process, as with all aesthetic procedures,
AdobeStock/BudimirJevtic
Microneedling can not only be used for skin rejuvenation, but also for treating hyperpigmentation, hair loss, scarring and stretch marks
282
Downloaded from magonlinelibrary.com by 155.198.030.043 on August 6, 2019.
these too fall into three categories: managing their
expectations, informing them of the risks, and advising
them on safe and effective aftercare.
The main aspect of managing the patient’s
expectations is letting them know that the best results
of the treatment take time. Although they will enjoy
some initial results within 3–4 days, when most of the
inflammation has subsided, they will see the best results
after 60–90 days. This is because it takes time for the
collagen and elastin cells to be stimulated and cause the
skin to look replenished.
It is also important to let the patient know that
optimal results come with repeated treatments.
This enables the skin to become accustomed to
the procedure and allows the practitioner to use
longer needles, penetrating the skin further and
inducing deeper remodelling of the dermis. It is for
this reason that many aesthetic practitioners offer
packages comprised of multiple treatments, with
sole treatments reserved for clients who have already
undergone several of them before.
Risks
Although microneedling carries few risks, like any
cosmetic procedure, they still exist, so it is imperative
to inform the patient of these risks during the
consulatation. These risks include bruising, bleeding,
scarring, pigmentation problems, and infection—
particularly as the skin is vulnerable after the
procedure.
Another set of risks the aesthetic practitioner may
need to educate their clients on are those that come
Journal of AESTHETIC NURSING ► July 2019 ► Volume 8 Issue 6
AdobeStock/Focusandblur
Microneedling is a popular treatment due to its versatility, low cost, relative lack of pain and invasiveness, and lack of downtime compared with
other skin rejuvenation treatments
with using microneedling devices at home. This issue
may be raised in a consultation, as an enquiry from
an existing client who has never had the procedure,
or, conversely, from one who has undergone
microneedling treatment several times and feels
comfortable doing it alone.
The first thing to make clear is that the devices
available for home use are different from those used by
professionals. For a start, they are not able to penetrate
as deeply as those designed for medical use, which makes
them less effective. There is also the fact that home-
based devices are not as strictly regulated as the ones
used by aesthetic practitioners, so there is no guarantee
of their quality or hygiene levels.
The technique for using a microneedling device on
oneself can be tricky and is best done after being shown.
However, even then, the risk of doing it incorrectly and
causing damage to the skin should still be taken into
consideration.
Also, there are additional risks from infection, with
the client naturally not being as aware or vigilant as
a professional practitioner. This could come from
cross-contamination of the area where they keep their
microneedling device, or from applying incorrect topical
treatments afterwards.
Finally, we come to the prescription of effective
aftercare. This includes avoiding sun exposure, wearing
sunscreen, not wearing makeup, and refraining from
exercise for a few days after the treatment (Cassata, 2016;
Cherney, 2018; Canadian Board of Aesthetic Medicine,
2019; DermaSpa, 2019; Galan, 2019).
Volume 8 Issue 6 ► July 2019 ► Journal of AESTHETIC NURSING
▼ COMMENT
Conclusion
Microneedling has come a long way since it was
first experimented with, and it is reasonable to
consider that its applications in aesthetic medicine
will continue to expand. It is also more accepted and
known of as a regular skin procedure for our clients
in our clinics. It is a great stand alone procedure
for skin health and rejuvenation and also a great
Key points
„„ Micro-needling, also known as collagen
induction therapy, is a process involving the
repeated puncturing of the skin with tiny,
sterilized needles
„„ Carrying out precise, controlled wounding
of the skin in this way, allows for controlled
healing, which leads to skin rejuvenation
and the treatment of a number of conditions
through cell turnover and increased collagen
production
„„ Microneedling is a popular treatment due to
its versatility, low cost, relative lack of pain and
invasiveness, and lack of downtime compared
with other skin rejuvenation treatments
„„ As with any treatment, there are risks involved,
and any practitioner should ensure that they are
fully trained and qualified before considering
providing this treatment
283
Downloaded from magonlinelibrary.com by 155.198.030.043 on August 6, 2019.
 CLINICAL ▼

accompanying treatment to offer alongside injectable
procedures. However, every procedure has risks, and it
is imperative that the aesthetic practitioner makes the
patient fully aware of these risks before any course of
treatment commences.
References
Canadian Board of Aesthetic Medicine. Why add
microneedling to your practice? 2019. https://tinyurl.com/
y5ew3lfv (accessed 24 June 2019)
Fernandes D. Minimally invasive percutaneous collagen
induction. Oral and Maxillofacial Surgery Clinics of
North America. 2005; 17(1):51–63. https://doi.org/10.1016/j.
coms.2004.09.004
Galan N. What is microneedling? Benefits and use. Medical
News Today. 9 January 2019. https://tinyurl.com/y3hdg2oe
(accessed 24 June 2019)
Garcia C. Micro-needling: a little history. 2019. https://
trulyalive.net/microneedling-history/ (accessed 24 June
2019)

Cassata C. Microneedling: the latest craze in skin care.
Healthline. 7 June 2016. https://www.healthline.com/
health-news/microneedling-latest-craze-in-skin-care#1
(accessed 24 June 2019)
Cherney K. Microneedling: collagen induction therapy.
2018. https://www.healthline.com/health/microneedling
(accessed 24 June 2019)
DermaSpa. Microneedling. 2019. https://tinyurl.com/y6ftg76a
(accessed 24 June 2019)
Doddaballapur S. Microneedling with Dermaroller. J
Cutan Aesthet Surg. 2009; 2(2):110–111. https://doi.
org/10.4103/0974-2077.58529
Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A. Review of
applications of microneedling in dermatology. CCID. 2017;
Volume 10:289–298. https://doi.org/10.2147/CCID.S142450
MDPen. The hisotry of microneedling and facelifts. 2018.
https://mdpen.co/news/the-history-of-microneedling-and-
facelifts/ (accessed 24 June 2019)
Singh A, Yadav S. Microneedling: advances and widening
horizons. Indian Dermatol Online J. 2016; 7(4):244–254.
https://doi.org/10.4103/2229-5178.185468
Skin Pen. Cosmetic Needling vs. medical needling. 2019
https://tinyurl.com/yyfg2dmk (accessed 24 June 2019)

CPD reflective questions

„„ Do you provide microneedling services within your practice? If so, how could the information included in this article influence
the way you use it?
„„ If you do not offer this service in your practice, why is this the case?
Do you think that offering this procedure could add value to your clinic?
„„ What steps do you take to reduce potential patient safety complications in your practice, and what policies or guidelines do
you follow?
„„ Are there any devices used in your practice with which you feel less familiar? How can you improve your knowledge of them?

‘Like’ us on Facebook
www.facebook.com/
jaestheticnursing
284 Journal of AESTHETIC NURSING ► July 2019 ► Volume 8 Issue 6

Downloaded from magonlinelibrary.com by 155.198.030.043 on August 6, 2019.