Microneedling

Microneedling is a minimally invasive cosmetic procedure dermatologists use to treat various skin conditions. It involves superficial and controlled skin puncturing with the help of fine, sterile and stainless-steel needles.

Anatomy and Physiology of the Skin

The skin is the body's largest and primary protective organ of the human body. It is made up of three layers of tissues. The upper layer is the epidermis, the layer below the epidermis is the dermis, and the third layer is the subcutaneous tissue.

1. The epidermis provides a waterproof barrier and contributes to the tone of the skin.
2. The dermis contains connective tissue, hair follicles, blood vessels, lymphatic vessels, and sweat glands.
3. The subcutaneous tissue (hypodermis) is made of fat and connective tissue.

The skin covers the entire external surface and serves as a first-order physical barrier against the environment. Its function includes:

1. Protection against microorganisms, dehydration, ultraviolet light, and mechanical damage.
2. Sensation of pain, temperature, touch, and deep pressure starts with the skin.
3. Mobility: The skin allows smooth movement of the body.
4. Endocrine activity: The skin initiates the biochemical processes involved in Vitamin D production, which is essential for calcium absorption and normal bone metabolism.
5. Exocrine activity: The skin secretes products that can harm the body such as urea and ammonia. 
6. Immunity development against pathogens.
7. Regulation of Temperature: Skin participates in thermal regulation by conserving or releasing heat and helps maintain the body’s water and homeostatic balance.

Microneedling is a well-tolerated procedure. It can be done on all skin types, even on areas that are not suitable for procedures like peeling or laser resurfacing, for example– near the eyes. Microneedling helps treat several conditions:

1. Reduces the appearance of scars, especially acne scars
2. Decreases fine lines and wrinkles
3. Reduces large pores
4. Improves skin’s elasticity
5. Decreases hyperpigmentation (dark spots)
6. Reduces stretch marks
7. Smoothes uneven skin tone
8. Increases hair growth

The right candidates for microneedling are those with acne scars, hair loss, wrinkles, and stretch marks.

1. Microneedling for Acne Scars
   1. Acne is a common skin condition affecting 80% of people aged 11-30. People have been worried about acne for a long time. But this innovative treatment has been a game-changer ever since its inception.
   2. Studies have shown that microneedling for acne scars has been proven to be very effective. Microneedling facial treatment can reduce acne scars by forming new tissue, thus rejuvenating the skin with a spotless glow.
   3. Here are the microneedling before and after results. Notice the spotless and radiant skin after the treatment in each person.
   4. Microneedling for acne scars can turn out to be one of the best treatment options. However, it should be combined with other acne scar treatments to maximise results. Other acne scar treatments include chemical peels, subcision, microdermabrasion, fractional resurfacing, etc.
2. Microneedling for Hair
   1. Studies suggest that microneedling hair can help induce stem cells in the hair follicles, thus leading to hair growth.
   2. It is also thought to promote the absorption of several hair loss medications, such as minoxidil and topical steroids, indirectly stimulating hair growth.
   3. Microneedling hair might be a good treatment option, particularly for male pattern baldness, also known as androgenic alopecia.
   4. Microneedling hair helps by promoting hair growth or by thickening hair.
3. Microneedling for wrinkles and stretch marks
   1. Microneedling facial treatment, due to its healing quality, works fantastic for reducing fine lines and wrinkles on the face. It results in tightening the skin, thus preventing ageing. Microneedling also diminishes the appearance of stretch marks as it boosts collagen and elastin production.

Microneedling is a simple procedure carried out in the doctor's clinic with the help of a derma roller. It is used to cause punctures or micro-injuries in the skin. A derma roller resembles a pen and has small stainless steel needles inserted. The entire procedure usually takes 2 hours, depending upon the size of the area to be treated. Three to four sittings of microneedling facial treatment are usually required for moderate acne scars.  Most people might need 4 to 6 sittings to notice a difference.

1. Microneedling works by puncturing the skin with microscopic wounds using thin needles. Creating these tiny wounds triggers the skin’s repair mechanisms and stimulates collagen production.
2. The main idea behind microneedling is to stimulate collagen production. Hence it is often referred to as collagen induction therapy or percutaneous collagen induction. Collagen is a protein in the connective tissue present throughout the body. It holds the cells and tissues together and is produced in the tissue while healing. 
3. Due to the tiny abrasions caused by microneedling, growth factors are released. Growth factors are proteins that help grow new tissues in the body. These growth factors encourage the skin to produce new collagen and elastin. After the procedure, new capillaries are also formed, which along with collagen production, collectively reduces scarring.
4. According to the American Academy of Dermatology Association (AAD), microneedling can help reduce the visibility of scars and dark patches while enhancing skin elasticity.
5. It's a simple, safe and effective procedure to treat various skin conditions.

Microneedling is done through the following steps:

1. Step one: Preparing the patient
   The patient is made to lie down in a supine position. The area to be treated is exposed and well-lit.
2. Step two: Preparation of the area
   The area will be prepared by applying antiseptic and saline. Then the doctor will numb the patient’s skin before starting the procedure with the help of a local anaesthetic agent. Commonly used anaesthetic agents include a mixture of lignocaine and tetracaine. This is done to decrease the pain and discomfort. This step lasts for around 45 minutes to an hour.
3. Rolling
   After numbing the area, the doctor will stretch the skin and perpendicularly use the derma roller for 15-20 minutes over five times each in horizontal, vertical, and oblique directions. While rolling, pin-point bleeding, also known as petechiae, occurs, which will be controlled by the doctor.
4. Post-rolling
   After rolling, the area is wetted with saline pads or ice packs to comfort the patient. The doctor may apply a cream or serum to soothe the skin and minimise discomfort and side effects.

Before the microneedling, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Microneedling

1. Before microneedling, the patient must inform the dermatologist about any current medications they’re on.
2. The patient should avoid medications such as ibuprofen and Accutane (used for acne treatment) well before the procedure to prevent adverse reactions. 
3. The doctor may also suggest stopping using topical retinoids and exfoliants before the procedure.

On the day of Microneedling

1. The patient will be asked to sign the consent form in the presence of his/her family.
2. Vitals will be monitored.
3. The patient will then be shifted to the operation theatre.

A patient who has undergone microneedling can expect the following after the surgery:

The recovery process in the hospital

1. After the surgery is complete, the patient will be moved back to the hospital ward so that he/she can recover.
2. The patient might also notice erythema, commonly known as redness, in the area that has been treated. This can last for up to 2 to 3 days. 

Recovery process/expectation after hospital discharge

1. The patient may resume their day-to-day activities from the very next day of microneedling facial treatment since this procedure has a very low downtime of 24 hours. However, the doctor will instruct to protect oneself from sunlight (photoprotection). 
2. The doctor will advise using sunscreen and following sun-protective measures daily. 
3. Local antibiotic creams can also be prescribed in some cases to prevent infections.
4. Patients are advised to follow these skin care steps after each session to speed up healing:
   1. Stay hydrated
   2. Use antioxidant serum on the skin
   3. Use a cooling mask
   4. Use collagen-stimulating peptides
   5. Avoid products with retinol and alpha hydroxy acids
   6. Avoid applying makeup
   7. Avoid getting sweaty

First follow-up appointment

1. A minimum of 6 weeks gap is recommended between two sittings since that is how long it takes for new natural collagen to form.

This procedure has recently gained wild popularity for its raving list of benefits. Microneedling benefits include: 

1. Reduce the appearance of scars:
   Microneedling for acne scars is one of the best treatment options. It reduces scars by stimulating collagen production. Due to the healing property being one of several microneedling benefits, it is widely recommended as a microneedling facial treatment. 
2. Reduce the appearance of fine lines and wrinkles:
   Microneedling works as an anti-ageing treatment modality as it reduces the appearance of fine lines and wrinkles.
3. Diminishes the appearance of stretch marks:
   It boosts the production of collagen and elastin, which helps reduce the appearance of stretch marks.
4. Effective:
   Microneedling has actually been known to rejuvenate and plump the skin in very little downtime.
5. Safer:
   It's a safe procedure causing minimal discomfort to the patient.
6. Less expensive:
   Microneedling is cheaper than other alternatives for skin conditions, such as laser therapy.

Microneedling is a minimally invasive procedure. It can have some side effects but is generally well tolerated and accepted by most people. Microneedling is considered to be safe for most people with good overall health status. This is one of the main benefits of microneedling, due to which most people choose it.
Common microneedling side effects include:

1. Erythema or redness after treatment
2. Oedema after treatment

Less common side effects of microneedling include:

1. Scarring
2. Infections
3. Bruising
4. Peeling

Microneedling hair can also cause some side effects, most of which disappear within five days of treatment. Side effects of microneedling hair include:

1. Bruises
2. Redness
3. Pain
4. Oozing of blood from wounds
5. Swelling
6. Scarring due to needles

Delay in Microneedling can cause the skin condition severe.

1. Microneedling costs in India can range anywhere from INR 2000 to 5000. Considering that you'd need at least six sessions to notice results, the total microneedling cost in India would range between INR 12,000 to 30,000. 
2. Radiofrequency Microneedling (RF Microneedling) is an advanced microneedling procedure that costs from INR 10,000 to 25,000 per session. Many derma rollers are also available online that is comparatively light on the pocket, but their effectiveness and safety are not yet proven.