Dr. Monica Li discusses medical and cosmetic microneedling applications, including pearls for safe and effective treatment.
Monica K. Li, MD, FRCPC, FAAD, Clinical Instructor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
“Microneedling in the recent five-six years has been reborn. It’s not a new technique or technology,” said Monica K. Li, MD, FRCPC, FAAD, who presented “Microneedling Research and Treatment Pearls: Perspectives from Canada” during the Advances in Microneedling Techniques Around the World session at the 2023 American Academy of Dermatology (AAD) Annual Meeting.
“In fact, if we look back at the medical literature, in the last 30 years, we’ve had other dermatology colleagues, and those in plastic surgery, use microneedling techniques in their practices.”
Historically, it was a drum roller or stamping device, said Dr. Li.
“…in clinical practice now we use an electrically powered pen that has a disposable tip, consisting of 12 to 36 microneedles.”
According to Dr. Li, microneedling works by creating a controlled wound injury, which triggers a wound healing cascade with various growth factors that leads to the production of new collagen and elastin.
“Hence, because of the way it works, we can use microneedling for various medical and cosmetic applications.”
Microneedling can be used to improve the appearance of acne, surgical, and traumatic scars and striae distensae, the former on both facial and nonfacial sites, she said.
“And the good thing about microneedling, which is excellent given changing demographics in our patient practices, is that it can be used across the skin spectrum.”
Published research has demonstrated that microneedling technology is virtually colorblind and safe to use on all skin tones and skin types, said Dr. Li.
“We can also use microneedling to treat, for instance, photo damage, such as wrinkles and textural abnormalities or irregularities. It can also be used to facilitate transdermal drug delivery because we’re creating these microchannels that can allow for certain medications to be better penetrating into the dermis for delivery of its effects.”
Overall, microneedling is a cost-effective treatment that can be used for a variety of applications, delivers effective results, and has a low complication rate, said Dr. Li.
Microneedling Pearls
“First of all, make sure a patient is properly and adequately numb. In my practice I use a topical 30% lidocaine in a base for anywhere from 30 to 60 minutes prior to delivering the treatment.”
This ensures patients are comfortable and at ease during treatment, she said.
“Another pearl is that when we’re actually delivering the treatment, we want to make sure the microneedling device is held in a perpendicular way to the skin with gentle traction. We’re trying to deliver the treatment with a cross hatching technique so that we don’t get skip areas.”
According to Dr. Li, microneedling makes it possible to treat focal, discrete areas that might otherwise be difficult to reach with other, larger laser and energy-based devices. Another benefit is that microneedling does not leave lines of demarcation.
“So we can really hone in and zone in on certain areas that are bothersome for patients such as upper lip rhytides or certain patches of area that show stretch marks.”
A word of caution: Only use topical agents approved for intradermal use during or in the hours following a microneedling procedure, said Dr. Li.
“…if those topical agents are not approved for intradermal use, it can lead to allergic contact dermatitis and possible granuloma formation, which can be very challenging to resolve and of course, very distressing for both the clinician and the patient.”
For example, because oral tranexamic acid is approved, you can use topical tranexamic acid during microneedling, she said.
“Likewise, if we are thinking transdermal drug delivery, we can consider the use of topical bimatoprost, especially if we’re thinking of treating as a trial for vitiligo to help with repigmentation.”
The microchannels created by microneedling will remain open for about three to four hours, said Dr. Li.
“But for the first 24 hours post procedure, patients should not be applying makeup. Any products that cannot be delivered through the skin safely should not be used.”
Some microneedling device manufacturers have intradermal approved products that can be used during the procedure as a glide for their device as well as products to provide to patients for at-home use after treatment, said Dr. Li.
“Finally, when we’re delivering the treatment, make sure we set patient expectations that microneedling still should be performed typically as a series of treatments. Patients should upfront understand that it is not typically ‘one and done’. These treatments are typically spaced three to four weeks apart.”