Episode #14: Microneedling

Automated Microneedling utilizes tiny needles which penetrate into the skin at very fast rates (from 100 to 150 hz or repetition rate).

These tiny needle insertions create pinpoint bleeding which initiates the wound healing cascade to stimulate elastin and collagen.

This episode discusses the Exceed MN Pen and discusses pre-treatment recommendations as well as post treatment care.

We like to utilize Exosomes post treatment (refer to episode #12 for more info on exosomes).

Enjoy! 

Thank you for your listenership!

Transcript

MIC1 0:07

Hi everyone. I hope you're well. Thank you so much for joining back into our podcast. We've kind of had a little bit of a delay here because it's been a busy several weeks with couple of meetings, the A M W C meeting in Miami and then a S L M S meeting back in Phoenix, which was two weekends ago. So there's been a lot going on in the world of aesthetics. But Kane, how are you doing

MIC2 0:28

today? I'm doing great. Thank you. for asking.

MIC1 0:30

Good, good. Today we're to talk about microneedling. So this is not RF microneedling, but just straight microneedling and what we can do for that with the skin. And, and what I'd like to do, Kane, is I'd like to first talk about the device, the wound healing response that you get from it. And then also I wanna talk about how to prepare for it, what to expect, how many treatments, and how to heal, how, what the healing process is gonna be like. Perfect.

MIC2 0:57

So

MIC1 0:58

Provide some good basic information for everybody. Perfect.

MIC2 1:02

And,

MIC1 1:02

and, and before we start there, we do have a podcast episode on radio frequency microneedling, which is different than just microneedling.

MIC2 1:10

which is

MIC1 1:10

Discussing today. So if you're interested in the RF side of it, we'll listen to the other episode and that's on episode two. And we'll kind of talk about, we'll briefly cover you bring up a good point, the difference between microneedling and RF microneedling. But first let's talk, talk about microneedling. So microneedling creates these tiny little microchannels into the skin, little micro conduits, and they, it does this. is the name states with little tiny needles that are into the skin. This is often called pci, which is percutaneous collagen induction, meaning that it's creating collagen in the skin. So if you ever see pci, you're thinking about microneedling. Okay, I'll just say micro. Okay. And I'm even, I remember PC and I kind of wanna differentiate even between the manual devices, and you might have seen these different manual devices. In fact, it came out in the early 1990s was when the first manual devices came out. And these were rollers. They're called dermal rollers, and they're on a little tiny wheel and they roll across your skin. And then finally, there are automated devices which have the mechanical device, which we're gonna talk about, and the energy based one, which is the radio frequency microneedling. But Kane, I wanna go back to these manual devices, the reason why they've kind of been left in the dust and why these new stamped automated pins are utilized mores. When you think about a dermal. They're going at your skin, they're inserting into the skin in a tangential fashion. So what happens is there's extra tearing of the skin that can occur rather than something going perpendicular into the skin. And oftentimes patients would get a little, a lot of P IH with this post-inflammatory hyperpigmentation. So that's where the automated devices, or kind of a new iteration of them, and I gotta tell you, just the thought of a manual roller rolling across. Just sounds painful. Well, reminds me is like some tool. I can remember my mom having some sort of tool for sewing that was like that, that could roll over the face. Well, this roll over the face.

MIC2 3:10

face.

MIC1 3:11

It was just a sewing tool.

MIC2 3:12

that was

MIC1 3:12

A roller with needles in it, pricks it, and they're further differentiated between cosmetic devices and medical devices. The cosmetic devices only go to 0.3 millimeters, whereas the medical devices go go deeper than that. And the reality is you don't need to go so deep. I mean, e our device goes to 1.5 millimeters. I'd say the majority of the work is in the 0.5 to the one millimeter range of when we're utilizing this device. But that's kind of the difference of it. And. So when you have these mechanical automated devices, the main endpoint, when you realize when you're doing the treatment, what your is,

MIC2 3:50

is, is pinpoint.

MIC1 3:52

bleeding. You wanna get to pinpoint bleeding, because what that does is that starts a whole wound healing cascade. That's important for improving acne scars and also for wrinkles of the.

MIC2 4:06

the

MIC1 4:06

So you do wanna see that pinpoint. You wanna see that pinpoint bleeding? Can I back you up even like even more basic?

MIC2 4:12

Sure.

MIC1 4:12

Sure. Like,

MIC2 4:12

so

MIC1 4:13

we're gonna talk about the expectations of with microneedling, but why would anybody want micro. So microneedling is wonderful for the texture of the skin. it's FDA cleared. This is actually the one that we have is something called exceed, which is a Candela device that is dual cleared for both acne scarring and for wrinkles of the skin. So when you're talking about just improving the texture of the skin, whether it is a surgical. Or again, acne scars, which are more pitted,

MIC2 4:44

these

MIC1 4:45

of devices, you wanna have these insertions into the skin. And remember, this is a six pin device, but they run at a hundred to 150 hertz, which means you're laying down about 600 to 900 pulses per second into the skin. That's a, that's a lot of coverage to create this wound healing response. And, okay, that's one differentiator between this and. microneedling. Whereas with RF microneedling, you're single stamping anywhere from 25 to 49 needles. And certainly you might do two passes, but this is getting a lot more insertions into the skin than even RF microneedling. Now, there's benefits of RF microneedling that. Microneedling doesn't do such as tissue contraction, works on laxity, all of that. But there are some differentiators of why you would choose this over radiofrequency microneedling, and primarily that's for the, the, the scarring type of issue.

MIC2 5:40

acne, scarring,

MIC1 5:42

other types of scarring. And then, and then wrinkles. And wrinkles. And, you know, I choose wrinkles a lot with, with my RF micro kneeling as well. But usually it's in when patients also have a little bit of laxity that I wanna use an energy-based device to, to help with that. But this one, again, gets a lot more insertions into the skin, which can really help with texture. So the reason why it's important, and again, I'm not gonna belabor this, but I think having a little bit, a little modicum of understanding. Of how what's happening with the tissue healing response is important. And I'll just basically go over it. So initially when you get this wound, this kind of pinpoint bleeding that occurs on the skin, you go through hemostasis, which means that there's chemical mediators that are released, which basically constricts the blood vessels to stop the bleeding. So you have about. Five to 10 minutes of bleeding. And then you go into this inflammatory phase where you get, you've heard about neutrophils, cane, you've heard about macrophages. The macrophages actually release different factors that

MIC2 6:42

up-regulate

MIC1 6:43

like fibroblasts to, to create collagen. So that's kind of the inflammatory phase. And from, from a patient perspective, they're gonna be a little bit Perhaps little red, little swollen, maybe a little itchy for about four to six days, and that's, that encompasses the inflammatory phase. And then you go through a proliferative phase, which kind of overlaps with inflammatory, where you're beginning to produce. Collagen and elastin in the skin. And finally there's a remodeling phase. So where you get that nice benefit and that can last up to a year's time period. A lot of the studies show improvements at about 150 days post procedure. That's kind of where the, the sweet spot is with this. What do you mean? Hundred 50 days, that's when you start to see the results or that's how long they last. What do you mean by that? You, no, no. You'll start to see the results at about six weeks time period. But you know, kind of at that five to six month period you really see a lot of improvement with the skin. And the optimal number of treatments is four treatments every four weeks. They're at a monthly rate. So that's kind of the optimum treatment. So let me hit the pause button cuz you just said a lot and.

MIC2 7:48

a lot of

MIC1 7:49

I just kind of went over my head, so I'm gonna repeat what I think I kind of heard you say. So you do want to get to that end point of, of pinpoint bleeding. That's correct. It's kind of a sign that yes, it's, you're doing what you need to do and then what that does is it starts to create a healing process and inflammatory first. It's an inflammatory process. Well just think about as wound healing to create collagen. Yes. That and elastin process. And that's

MIC2 8:12

Essentially

MIC1 8:13

your body kind of

MIC2 8:15

producing

MIC1 8:15

that elastin in coll.

MIC2 8:17

Correct.

MIC1 8:18

To the wound, to heal the wound, which that's what you wanted, that's what you want to accomplish, which improves the appearance of the skin, the, the fine lines and wrinkles and also, and improves acne scarring. And there's some really impressive photographs with it as well. Some baseline and imposed. So you're really thinking this treatment from a, I want to improve the texture of my skin perspective.

MIC2 8:39

And

MIC1 8:39

that is most likely going to require.

MIC2 8:41

series

MIC1 8:42

That's exactly right. Four series every, what'd you say? Four. Four treatments. And you deliver them once a month? Once a month. Okay. You got it. How long would I expect to see those results last? For about a year. But remember, we are, every day we wake up, we are losing collagen. And so I tell patients, you know, every six months or so, you might wanna come in for a treatment or you might wanna supplement with another treatment, maybe a, a laser treatment, a non ABL of treatment. So there's different things that you can mix and match. And some folks might even be do a good job with starting off with one of these, then doing a laser and then switching back to one of these. So there's different ways that we can go about this, I think it's. Just all of a sudden fall off a cliff and, and it wore off. It's just a gradual correct.

MIC2 9:26

Aging

MIC1 9:26

process that. You can always enhance along the way. Right. And you wanna maintain it too, you know as you go along, you wanna kind of keep those results consistent. So I think it's important to also go over how to prepare for something like,

MIC2 9:40

something.

MIC1 9:41

So it's important too because there is gonna be pinpoint bleeding. You really wanna minimize your aspirin, your ibuprofen your fish oils about two weeks before treatment. That's probably the best for this. Now if you have had an ibuprofen within 10 days, that's okay, but I think that's the best thing to do is minimize your blood thinning medications, about two weeks.

MIC2 10:05

before.

MIC1 10:05

Okay. And then you also, patients can take some Anika if they like. Some patients really swear by Anika, but certainly something you can do. You wanna also your topical retinols or retinoic acids about three to five days before the treatment. You don't wanna be read, you don't wanna be shedding right before the treatment. And so then the other thing that we do is we call in a numbing cream and patients can apply this an hour before the treatment, and that way you're very comfortable during the treatment. I do think topical numbing is, I wouldn't say it's optional. I do think that's a mandatory thing. It is. I was gonna ask, how impair is it? That you have that top for? I think that it, it is important. It, it would, it is a little uncomfortable without the topical numbing. So because these are tiny needles that are going in, in

MIC2 10:51

multiple, multiple

MIC1 10:52

insertions and the way it's delivered, it's kind of in a circular motion that it's delivered. Because again, you wanna get to that pinpoint bleeding. So topical numbing is important to to have. And then right after the,

MIC2 11:03

treatment,

MIC1 11:05

What's done, and certainly you wanna sun protect all that even before and after the treatment. But right after the treatment, the the blood is cleansed away with some gauze pads, some topicals can be placed on the skin. We really like exosomes on the skin. I think that really helps to heal the tissue. Better, and it also stimulates more elastin in collagen. And we talked about exosomes. There's a a podcast on that as well. There's a episode on it that you could refer back to. But remember they've got growth factors in it. They've got lipids, they've got micro rna. And what they do is they. Talk to the different cells in the body, the senescent cells, the fibroblasts that are kind of those zombie-like fibrolasts that aren't doing, that aren't performing, and they wake them up and, and allow them to produce more collagen and elastin. So I do think that that is a nice topical to place on right afterwards. Yeah, there's a lot of like exciting science coming out more and more with exosome. So it's, it's pretty interesting to see where that's headed and, and I'm a little naive to this, so now exo. In the past when, when I would hear things like the vampire facial, is this something.

MIC2 12:12

that was.

MIC1 12:13

Done with microneedling and then, and then utilizing P R P, correct? Correct. That was done with p r P and P. RRP is kind of the first iteration of utilizing stem cells. But remember, the limitations of p RRP is that you're utilizing and trying to extract these growth factors from maybe 50 year old. If someone's 50 years old, they're sitting on your table and you're taking their blood. You have to make sure that you're spinning it the right way and how they ate the day before or did they drink wine, can all impact your stem cells and the growth factors. So now the second iteration, kind of the 2.0 method, is utilizing exosomes, which has

MIC2 12:50

a

MIC1 12:51

reproducible. Amount of growth factors and lipids, microRNA, I mean, I won't go through all the different things, but all the important elements to, to stimulate the collagen and elastin. Yeah, I

MIC2 13:03

the

MIC1 13:03

the vampire facial was like all the rage a few years ago, but you haven't really heard much about it. I mean, exosomes is really kind of,

MIC2 13:09

of just

MIC1 13:09

Taken that mantle and runway it is, and you don't have to extract the blood. There's many, there's many positives. And again, I think it's that having that consistency of the product, which is very, very important as well. Really it's, it's not now you can do it, it'd be called exome facial. Maybe called an exosome facial. Correct. And I put a little video of myself up where I had one done and you're, I was just a little bit red. But again, the more aggressive we are with it. The, and, and if patient's skin's a little sensitive, I, I would say about four to six days potentially of redness. Mine was only two days. I asked for a little bit more of a. Minimalistic one. I think we went to 0.5 and 0.7 millimeters on my skin. But you can go up to one, you know, one to 1.5 millimeters for a more extensive type. And certain skin types are better, more appropriate for that as well. Now, is there a particular area of the body or the face that this is typically done? Is it, you know,

MIC2 14:03

know, more

MIC1 14:04

down around the eyes, or is it the whole face or the mouth? It's the whole face. It's the whole face. Now we don't do it over the lid, so, but that's the one place that's excluded. But you can go under, under the eye area. And certainly in the lateral canal area around the eyes, that's, that's where we see a lot of wrinkles. And so that's a key area that can be done as well. And how long would I expect.

MIC2 14:24

the,

MIC1 14:25

The the whole procedure, the procedure actually takes about 20 to 30 minutes. It does not take long to do. And it's just a matter of kind of titrating the, the dosage of the, what you're delivering, the depth, and also the how, how quickly you're, you're applying these little needles in order to get to goal, but about. 20 to 30 minutes max is necessary for a treatment like this. And then post-treatment, just cleansing it over, placing some some topicals on as well. And then patients, I, we tell them don't wear makeup until the next day. Allow those little microchannels to heal over. And they'll heal over very quickly, but no makeup until the next day. They can wash their face at nighttime. They can. Own serums on at nighttime as well. And then certainly in the next morning they can put vitamin C serum. They might sting a little bit with vitamin C serum, it's more acidic. But that is a wonderful thing to have on the skin in the morning time too, since it's the antioxidant. Alright, cool.

MIC2 15:19

So

MIC1 15:20

this is a pretty simple procedure and, and

MIC2 15:22

one

MIC1 15:22

that can be really well tolerated with some good results and it's just,

MIC2 15:25

another,

MIC1 15:27

Another bullet in the chamber to, to

MIC2 15:29

help

MIC1 15:29

with the aging process. It is, and I'm just gonna give one final thing about why we chose, why we selected the XE device. And primarily it's a stainless steel device. It's, it is a German-made device. It's actually very robust, but it's FDA cleared and you always wanna have an FDA cleared device. You also wanna have a barrier sleeve that's on it because remember, you wanna be able to protect to not have blood products. Into the needle. So while there's other microneedling devices out there you always wanna choose an fda cleared one such as this, such as skin Pen is another good one. Eclipse is another good one. So those are just some names of, of some good devices. And then also the thing that I liked about this that sold me on it is that it's got a tilted it's got a tilting surface, which means that as you go around the bone

MIC2 16:18

structures,

MIC1 16:19

Tilts the whole plate tilt so that you can still go in, in a perpendicular fashion to make sure that you, that you have clean insertions into the skin. So that I thought was really important, especially if you're dealing with skin such as mine that could potentially hyper pigment with this, with the clean insertions, you won't. And so that's important to have as well. So, real quickly before we go, so you did mention af, FDA cleared. Are there devices that are not fda? Oh yeah. Kane. Yep. And there's a lot of issues that can occur with blood getting back into the pen and cross-contamination per patient. So you never, never, never, never wanna have a device like that. It might be cheaper, it might be less if that they're offering, but remember, always ask if it's FDA cleared. Very, very good point. Yeah. Maybe cheaper, but is it safer? Correct. Correct. So we want to choose devices that work Yes. But that are safe. And so that is, those are two important things in our practice. it's not safe, we're not gonna use it. If it doesn't give results, we're not gonna use it either. So that's it. That's all I got. And otherwise have a wonderful evening.

MIC2 17:27

And thank you again for listening and please rate and review us. Thank you.

MIC1 17:31

Thank you. Bye-Bye.