Ep 206 – A Deep Dive into Microneedling

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0:01:31.8 Maggie Staszcuk: Hello, and welcome to ASCP's Esty Talk. I'm your cohost, Maggie Staszcuk, and ASCP's education program manager. 

 

0:01:37.6 Ella Cressman: And I'm Ella Cressman, licensed esthetician, certified organic formulator, international educator, and content contributor for Associated Skincare Professionals. 

 

0:01:46.2 MS: So we're taking a deep dive into microneedling, Ella. And I wanna know, do you get microneedling? Do you do microneedling? What's your thoughts?  

 

0:01:54.1 EC: Yes, and I perform my own microneedling on myself. 

 

0:01:58.3 MS: Okay. Okay. 

 

0:02:00.1 EC: I don't go get it done because you have all the tools. I love it. 

 

0:02:02.4 MS: I love it too. I especially love microneedling with radio frequency. 

 

0:02:06.2 EC: Ooh, for the tightening?  

 

0:02:08.8 MS: Yes, for all the things. Very antiaging. I love it. And I will admit I've been afraid to do it to myself, but I do have a device, and it is straight outta China, before all the regulation came down on microneedling devices. It's in this little pink and gold box, and I've got a couple little tips. I mean it is definitely not on par. 

 

0:02:33.1 EC: Is this an RF one?  

 

0:02:34.7 MS: No. 

 

0:02:35.0 EC: This is just a regular one. 

 

0:02:35.1 S1: Yeah. And this is just straight microneedling. 

 

0:02:36.9 EC: Oh, nice, nice. Those work?  

 

0:02:40.8 MS: I mean I'm sure it would work, but I also feel like I would do it to myself and then the next day, come in like, I don't know, Jack the Ripper or something. 

 

0:02:48.5 EC: I love it. Do it and then come to my shop, I'll fix you up. 

 

0:02:51.7 MS: And then you'll fix me. Yeah, yeah, for sure. So since this is a deep dive, let's start with talking about the history of microneedling. I know there are a lot of aestheticians out there that already know all about this procedure, but we're just gonna share the education here. So use of microneedling. This was first recorded actually in 1905, and it was by a German dermatologist, his name was Ernst Kromayer. And he used dental burrs mounted on a motor-driven flexible cord. So if you can envision this?  

 

0:03:23.3 EC: Mm-hmm. 

 

0:03:26.2 MS: And he got this brilliant idea, this was how he was gonna remove scars, birthmarks, hyperpigmentation. And it took nearly 90 years later, it was in 1995 that Dr. Fernandes developed a new technique in also treating scars and wrinkles, and this was with hypodermic needles. So basically just puncturing the skin. He later developed it into a little needle stamp. And just FYI, he also is the founder of skincare brand Environ. Yeah, so today, these methods of application, they've changed, thanks to new technology and FDA regulation, and today we have electrically-powered devices, what you all are familiar with, with tiny needles that make precise microscopic punctures in the skin. 

 

0:04:09.7 EC: You know when I first started using microneedling, when I first became certified, what like was used professionally? The rollers. Do you remember the rollers?  

 

0:04:22.4 MS: I do. Yeah, they were... My understanding of the rollers is that... "Controversial" isn't really the word, but they weren't effective because it was described that as that pin rolls, the needle then gets caught in the skin and makes a tear. 

 

0:04:34.7 EC: That's what they would say. There was the same thing, like there was different depths, but there was also talk about it being different than these stamps, like as being, like you talked about with Dr. Fernandes, or like it was gonna be less painful than these stamping motions. Which is ironic because now you come into what's acceptable now and widely available, where there's like the shorter needle depth, available or really you can get any of these available on Amazon, anything. But you can have these different depths at home. And some even like over-the-counter companies use them as part of their regimen, but what is it, and is it effective? Let's talk about it. It's also known, microneedling as CIT or collagen induction therapy, and that goes back to the original intention of Dr. Kromayer, who wanted to puncture and stimulate new skin cells. 

 

0:05:31.2 EC: So it inserts these tiny needles into the skin to encourage the body's natural wound-healing response, controlled wounding with controlled healing, one would hope. The micro channels then fill with new collagen, elastin hyaluronic acid, the body's natural synthesis, and it leaves the skin looking plump, dewy, fresh, glowing, young. Keep going. The depth of the needle penetration is dependent on several factors, and what you're going to use it for. What is the skin condition, but also what is permissible in your state? Here in Colorado, it's 0.5 and below you can use without medical supervision. Anything higher, you do need medical supervision for, which we should talk about, something interesting in light of your golden pink box and the capabilities of that. What's really cool about these open channels, because the new language a lot of people are talking about is microchanneling, is that you could potentially also with these channels open, deliver product deeper into the skin. 

 

0:06:34.0 EC: It's something that's been practiced for a long time. You can see it with like PRP, you've heard of PRP, or PRF is another one, and now you've seen exosomes, of course hyaluronic acid, brightening agents, anything, but there is a school of thought... There's two schools. You're in this school that says, "Leave it alone, just use hyaluronic acid, that's it." Or this one is like, "Pile it on. Let's get everything we can out of this service." The difference is, the opportunity for granuloma, if you're putting... Depending on what you're putting on top of the skin, what's shimmying down into these microchannels could encourage granuloma production or presentation, that's the difference. When you look into the studies of that happening, it's interesting to see the exact percentage, but that's something else that you can... Really gonna go back to your training. Something to consider postCIT therapy or microchanneling is that your skin could look like you had nothing done or it could be very red. This is gonna depend on, of course your genetics and how your skin responds but also the depth of needle penetration. Because you're inspiring these new cells, basically, there could be an opportunity for expiration of the old cells. So you could peel, you might not, and you might. If you do peel, it could take up to seven days for it to finish, the most important thing is postcare, what you do the 24 to 48 hours after these types of services. 

 

0:08:08.7 MS: What school of thought do you land in? Pile on the product or no product or just hyaluronic acid?  

 

0:08:15.4 EC: I land in, gently place the product. That is intentional. So my microneedling I use, the majority of what I do, I always consider, What could happen pigment-wise? I don't want hyperpigmentation. And a lot of times we're in Colorado, hyperpigmentation is huge here. So I like to drop intentional brightening agents in. So I keep it pretty simple, but it's the same. That's one thing, where it's the same for almost everybody, but I love this treatment all year round, I love it, it's so nice, it's... The other thing that... I use a device like your device that you have, and there's different needle concentrations that the... The gauge, so you have a 36 to 12, or even nano, you can do that too, which is needleless, but that device is gonna depend on how much product I'm going to use too. But most always, it's that brightening agent and a hyaluronic acid. 

 

0:09:15.0 MS: Okay, I fall into the different camp as you, so I am just hyaluronic acid or no product for probably like the first 24 hours and then I just do sensitive product until I feel like the skin has healed. 

 

0:09:30.7 EC: I think that's smart, and I don't think that either answer is wrong. 

 

0:09:34.7 MS: No, you're right. 

 

0:09:35.5 EC: And I don't think that either answer is wrong because I think there's that piling it on. Right? Because I think some people can put so much on, and depending what you're putting on... I saw one protocol where they were dropping hyaluronic acid and they were putting on oil and they were putting on this heavy cream and retinoids and all these things after. When you're looking at how those work in the skin, how they inspire different histological response in the skin, and then you're putting 'em down deeper. Whoa, girl! So that's my opinion. Hold that thought, we'll be right back. 

 

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0:11:00.2 EC: Okay, here we go. Let's get back to the podcast. 

 

0:11:02.9 MS: So let's talk about indications and contraindications in the same vein. This is used to improve things like skin texture, creeping, scarring, fine lines, wrinkles, it can diminish pigmentation. And there was a 2008 study that was published that showed skin treated with four microneedling sessions one month apart showed up to a 400% increase in collagen and elastin six months posttreatment. 

 

0:11:28.1 EC: I love this. Let me tell you why. Business building. 

 

0:11:33.6 MS: Totally. 

 

0:11:34.4 EC: That being said, take a picture. This is the way I describe this. The full results are gonna be in one month, and that's when we schedule our second appointment. The full results from that will be in two months, that's when we schedule our third and so on. They're coming in, they're bought in and then they have 'em take a before picture and a during picture and an after picture because after the fourth treatment, they have to come in four weeks later for another service like a gentle peel or something, corrective facial, so I'm seeing them at least five times. 

 

0:12:03.0 MS: Yeah, I mean you can sell this in a series. And I think also, it's important to educate your client here, it's not immediate gratification, that skin has to regenerate, and that takes time depending on their age as well. We all know. We say, "On average 28 days for solid renewal, blah, blah, blah." So yeah, I mean you said it, this totally is business building and getting them back in the door, totally. So it's important to prep the skin, obviously, with good quality skincare leading up to the treatment, making sure that skin is healthy and prepared to receive a service like this, and then ensure that your client is following the proper postcare, like you said, Ella, SPF. Definitely. 

 

0:12:45.9 EC: You know what I hear? Business building. Now that's six appointments, so that's six months of seeing this claim, guaranteed. 

 

0:12:52.5 MS: Yeah. And retail. 

 

0:12:54.4 EC: And retail. Stop. 

 

0:12:56.7 MS: Love it. Easy breezy. Yeah. So although this treatment is indicated really for all skin types, you always wanna be careful with those higher Fitzpatricks. And be sure again, you're prepping that higher Fitzpatrick if necessary with skin lighteners to reduce the melanocyte activity for several weeks leading up to the treatment. And then clients with active acne, they are contraindicated. Be sure first you're treating that active acne before then going in with a microneedling treatment so that you're not spreading the bacteria. So clients suffering from rosacea, it's possible that they could experience flare-ups, so again, be sure that the skin is prepped and it's healthy and prepared to receive the microneedling treatment. 

 

0:13:36.0 EC: You know what you could do with rosacea? Is the nano. 

 

0:13:40.8 MS: Totally. Nano. Great, great treatment for people like that. Other contraindications are gonna be things like bleeding disorders, active herpes. And I will say caveat there. If somebody is prone to cold sore outbreak, they could go on their antivirals leading up to procedure. Skin infections in the area to be treated, eczema, psoriasis. And when in doubt, just don't treat. 

 

0:14:03.5 EC: A hundred percent, it is very broad, like it has a lot of versatility, but it's not for everyone necessarily. The other thing about contraindications or something to keep in mind is posttreatment, explaining what they need to do for the first 24 hours. I had a client who we did a microneedling treatment on, and she called me the next day, she had a reaction. Most maybe next day or two days later, she had a reaction and just on her forehead, and it was these bumps. So I had her come in, she sent me a picture, I couldn't really see, so I had her come in. And it was where she sprayed her bangs. So the hairspray was getting in and irritating those microchannels. So I was like, "Oh there it is. There it is." So it was interesting but being careful to just keeping anything... No sweating, no wetting, no heavy petting. That's my guidelines for especially this service but any kind of ablative or corrective treatment. 

 

0:15:00.1 EC: Speaking of, there are different types of devices, I guess we can say. We already talked about the rollers. There also used to be... You know what? In antiquity, they were talking about, they had these like primal stamps that they would use too for rejuvenation, they thought, or tattooing, which could be, but they had these stamps or derma rollers. Those are still used by the public now. I haven't seen anybody using them professionally. Have you heard that... 

 

0:15:29.7 MS: No. No, I haven't. I think we've advanced. 

 

0:15:32.8 EC: I think so too. Those were hard because they were very expensive, and so you had to work that into... When you look at the cost per treatment, the ROI versus on those tips, on the tips that fit in a device versus these rollers, it's about half or a fraction depending on where you... What country you get them from. 

 

0:15:52.3 EC: So the other thing with those is, as Maggie said, there was commentary on, they don't go straight in and straight out, it would roll in and roll out, and so the stimulation but also the risk of tearing the skin. I never had anybody tear, I never had anybody get a granuloma or anything, but the potential's there. 

 

0:16:10.1 EC: The other that we've kind of talked about is nano needling, so this is needleless needling. And it's not channeling either, this is more pushing. So they have these tips, these specific-looking tips, a lot of them have this pyramid shape or this patented pyramid shape that they use, and it pushes, in theory, pushes serums or such into the skin. So this would be an opportunity to pile it on if you wanted to because this is epidermal, you have no risk of dermal whatsoever because this is just really stratum cornea maybe a couple of years in, but no big deal. 

 

0:16:49.6 EC: Then you have the electronic handheld devices, and wow, has this technology come a long way, especially in the last six years, seven years? As you mentioned, you were able to get it online, a lot of people can get theirs online, the price is remarkably a lot less than before. But these have pins and you have tips, and the tips have the stamping mechanism... Or the handheld device has a stamping mechanism that works with the tips and you have the ability to switch depths, which is interesting. So if you have a pin, be sure that you're only going up to the depth permissible by your state unless you have medical supervision because it's just. 

 

[vocalization] 

 

0:17:35.5 EC: It's tempting, it's very tempting. Unless you're doing it on yourself, then go for it. But the thing about that is those tips, you can have the different... You have the 36, the 12, I think they even has a 64. I never use it, I usually use the 12. 

 

0:17:48.4 EC: And then you have radio-frequency microneedling, which is your favorite. And it's where the microneedling tips are attached to a device, and the device pushes the tips into the skin, and then radio frequency energy is released. What that does is it adds an element of heat to potentially the dermis and it tightens the skin. This could help with fat reduction, but it also could inspire melanin production. So something to keep in mind, like Maggie was saying, precare is really important here, depending on where you're having this done. Very, very effective for the body, for stretch marks, for a lot of different applications. 

 

0:18:32.2 EC: And I think that something else we can say is these types, these microneedling can be head to toe, it could be face, it could be chest, it could be arms, it could be anywhere that you wanna address laxity or hyperpigmentation. 

 

0:18:46.4 MS: Yeah, stretch marks even. 

 

0:18:48.5 EC: Stretch marks, a 100%. 

 

0:18:50.5 MS: So with so many different types of devices, as well as needle depth, it's important to know your scope of practice. Effective in 2018, the FDA started classifying all microneedling devices for aesthetic use into class two. So knowing that you could have a state where your rules and regulations dictate that estheticians cannot use a class two device unless they are working with a medical director, there could also be an amendment to the rules where you can specifically use microneedling devices even though they are class two devices. 

 

0:19:22.5 EC: What is California? Do you know?  

 

0:19:25.5 MS: California? I think that microneedling is outta scope. 

 

0:19:27.5 EC: And dermaplaning is outta scope too. 

 

0:19:29.1 MS: Yeah. Yeah. 

 

0:19:30.1 EC: Interesting. 

 

0:19:31.3 MS: California is very strict about the rules for aestheticians. States that do not directly address microneedling, the law needs to be interpreted to determine whether estheticians can, again, like I said, use class two devices or operate below the stratum corneum. Some states have rules outlining the use of microneedling devices with or without a medical director and the depth at which you can penetrate the epidermis. So depth is really important, especially when it comes to rules and regulations. Ella, you were talking about this earlier, like in Colorado for instance, you can go to a depth of 0.5 millimeters without a medical director. If you can perform microneedling with a medical director, it'd be up to the delegation of that director in terms of how far you can penetrate. 

 

0:20:12.7 EC: What are you gonna do with your device at home? Are you... 

 

0:20:15.8 MS: I'm scared. 

 

[laughter] 

 

0:20:18.3 EC: You've got to do at least a 0.5. You got this, it's not... It doesn't... Nothing. Put a nano tip on. Order a nano tip. 

 

0:20:25.8 MS: You know how old this device is? It's like when microneedling first came on the market, this thing's probably from like Alibaba. 

 

0:20:32.8 EC: Oh, we'll see if it goes first. See if it'll turn on first, and then try it, try it on your arms or something. 

 

0:20:40.8 MS: Yeah, that's what I'll do. 

 

0:20:40.9 EC: Take a picture. 

 

0:20:41.9 MS: And then I'll text you to book an appointment. 

 

0:20:43.0 EC: And pile on product. Yes. Come on in, I will needle you. No problem. 

 

0:20:49.5 MS: Yeah, yeah. Now listeners, we wanna hear from you, have you incorporated microneedling to your treatment menu? What kind of results are you seeing? Share with us on social media through Instagram, Facebook, or by emailing getconnected@ascpskincare.com. Thank you for listening to ASCP Esty Talk. And as always, for more information on this episode or for ways to connect with Ella and myself or to learn more about ASCP, check out the show notes.