Microneedling and Injectables for Post Acne Scars

Introduction

Combining microneedling with injectables, rejuvenates facial skin by enhancing the body's natural healing processes. This technique targets aging signs, such as wrinkles and decreased elasticity, particularly around the eyes, lips, and other delicate areas. Pairing microneedling with injectables like Botox, Juvéderm, and Revanesse offers a comprehensive skin refreshment solution. These minimally invasive procedures provide quick, long-lasting effects with minimal recovery time, addressing wrinkles, fine lines, uneven texture, and volume loss. This approach delivers an effective, thorough cosmetic skincare treatment.

What Are the Benefits of Combining Microneedling and Injectables?

When microneedling and injectables are combined, a well-rounded skincare approach results.

1. Improved Skin Firmness and Texture: Microneedling helps to tighten loose skin and smooth out rough texture. It also boosts collagen production, which is essential for youthful skin.

2. Addressing Volume Loss: Injectables like fillers (Juvéderm, Revanesse) are great for adding volume to areas that have lost their fullness over time.

3. Targeting Wrinkles: Both treatments are effective against wrinkles. Microneedling focuses on skin laxity and fine lines, while injectables can fill deeper wrinkles and fine lines.

4. Comprehensive and Lasting Results: Combining both treatments can lead to more thorough and long-lasting skin improvements.

5. Treating Deep Wrinkles: For those stubborn, deep wrinkles that do not respond as well to just one treatment, combining microneedling with neuromodulators (like Botox or Xeomin) or fillers can give the best possible outcome. This combination ensures that the skin's surface and deeper layers are treated effectively.

Why Is Treating Post-acne Scars Particularly Challenging for Dermatologists?

Post-acne scars are a tough challenge for dermatologists, as there is no single best treatment. Their high occurrence after moderate-to-severe acne and the negative impact they have on patients' lives make them distressing issues. This study examined how effective two different combinations of microneedling are for treating post-acne scars.

Microneedling Basics:

Microneedling is a popular, minimally invasive office procedure for treating scars. It creates tiny channels and wounds in the skin, triggering a healing response that boosts collagen and new blood vessel formation. These tiny channels also help topical treatments absorb better into the skin.

Platelet-Rich Plasma (PRP):

PRP is made from the patient’s blood and is rich in growth factors that promote healing. It has become popular for treating post-acne scars when used with noninvasive procedures.

Past Studies on MN and PRP:

• Study 1 showed that combining microneedling with PRP improved scars more than MN alone.

• Study 2 found microneedling with PRP was better than MN with topical vitamin C.

• Study 3 showed that microneedling with PRP was as effective and safe as other scar treatments.

• Study 4 demonstrated that microneedling with PRP was significantly more effective than MN with distilled water.

• Study 5 found no significant difference between microneedling with PRP and MN with non-cross-linked hyaluronic acid.

Botulinum toxin-A (Botox):

Botox is commonly used to relax muscles and smooth wrinkles. It is being explored for off-label uses, such as treating scars, by injecting it in small doses under the skin. Botox can weaken superficial muscle fibers attached to scars, reducing their appearance.

Combining Microneedling and Botox:

Microneedling helps break up scar tissue and stimulate collagen production. Combining microneedling with Botox allows for better penetration of Botox into the skin. This combination can be less painful and requires less skill than deeper injections of Botox.

Botox Effects on Skin:

Studies show Botox increases collagen production and reduces collagen breakdown. It also enhances blood vessel formation and reduces scar tissue without affecting wound healing.

Randomized Controlled Trials:

A trial showed that using a fractional CO2 laser followed by topical Botox improved wrinkles more than saline as a control. This study used microneedling to enhance Botox penetration, making it a cost-effective and easier alternative to lasers.

Safety and Side Effects:

Both treatments were safe, with minimal side effects, like mild pain and short downtime. No pigmentation issues were found in dark-skinned patients. Using a lower concentration of Botox avoided muscle paralysis, targeting only the superficial fibers.

What Are the Clinical Benefits of Microneedling?

Painless Procedure:

• Microneedling is nearly painless compared to hypodermic needle injections, making it more tolerable for patients, including those with needle phobia.

• The micron-sized needles used in microneedling avoid activating the nociceptors in the dermis, reducing pain.

• Shorter microneedles are less likely to reach and stimulate nociceptors, making the procedure more comfortable for patients.

Minimally Invasive with Small Lesion Size:

• Microneedling causes less tissue damage and shorter recovery times than hypodermic needles.

• Clinical studies show that microneedling causes minimal bleeding and quicker recovery than hypodermic needle injections.

• Despite penetrating the skin, microneedling has a low risk of infection due to the skin's self-defense mechanisms.

Equipment:

• Diverse Devices: Various microneedling devices are available, including stamp devices for localized treatment and drum-shaped rollers for larger areas.

• Customization: Electronic stamp devices allow practitioners to adjust penetration speed and needle depth, minimizing patient discomfort and enhancing effectiveness.

• Single-Use Cartridges: To prevent cross-contamination, stamp devices use single-use tip cartridges.

• Home-Care Devices: Needles for home-care devices are shorter and less than 0.3 mm, making them suitable for self-treatment.

Treatment Technique:

• Before treatment, patients should avoid sun exposure and topical agents. The skin should also be clean and free of cosmetic products.

• Local anesthesia or nerve blocks can be used for sensitive areas.

• Lubricants like hyaluronic acid are applied during the procedure to deliver active ingredients through the microchannels.

• Practitioners can select appropriate needle length and penetration speed based on the treatment area and skin type.

• After treatment, patients should avoid sun exposure and certain skincare products. Over-the-counter pain relievers can manage mild side effects like burning and tenderness.

Post-Operative Care:

• Patients may feel a burning sensation similar to sunburn and have soreness and tenderness, which usually subsides in a few hours.

• Patients should avoid sunblock, beauty products, and alcohol for 12 hours after treatment and direct sun exposure for two weeks.

• Edema and erythema typically resolve within a few days, and normal skincare routines can be resumed after a week. Some patients may need antiviral medication to prevent herpes simplex outbreaks.

What a Person Needs to Know About Treatment Scheduling and Spacing?

Properly spacing the treatments is key to getting the best results and avoiding risks.

1. Microneedling and Neuromodulators (Botox/Xeomin): Wait at least one week between these treatments. Ideally, schedule Botox or Xeomin two to four weeks before microneedling on the face or neck.

2. Potenza™ RF Microneedling and Fillers (Including Lip Fillers): Maintain a minimum two-week interval between these treatments, regardless of which one to do first.

3. Bottom line: Combining microneedling with injectables can significantly improve the skin’s texture, firmness, and overall look with minimal downtime.

What Does a Person Need to Know About Skin Aging and Rejuvenation Treatments?

1. Causes of Skin Aging:

• Gravity and Bone Resorption: As a person ages, gravity and bone loss affect their facial structure.

• Decreased Tissue Elasticity: The skin loses its bounce and flexibility.

• Redistribution of Subcutaneous Fullness: Fat under the skin shifts, causing sagging and wrinkles.

1. Microneedling Therapy:

• Microneedling, also known as collagen induction therapy, is a minimally invasive treatment that uses a device with tiny needles to create controlled skin injuries.

• It helps rejuvenate skin on the face, neck, décolleté, hands, and arms by stimulating collagen production and enhancing skin texture.

1. Areas Benefiting from Microneedling:

• Periocular (around the eyes).

• Perilabial (around the lips).

• Cheeks.

• Neck.

• Back of hands and arms.

1. Autologous Blood Concentrates:

• Platelet-Rich Plasma (PRP): Rich in growth factors, PRP promotes healing and rejuvenation.

• Platelet-Rich Fibrin (PRF): A newer, more advanced concentrate that is rich in growth factors and does not require blood thinners.

1. Platelet-Rich Fibrin (PRF):

• Preparation: Made using low-speed centrifugation without adding anticoagulants, PRF retains more platelets, white blood cells, and growth factors.

• Types of PRF: Depending on the centrifugation protocol, PRF can be solid or liquid, each with distinct properties and applications.

1. Low-Speed Centrifugation Concept (LSCC):

• Lower centrifugation speeds increase the concentration of platelets and growth factors in PRF, enhancing its regenerative potential.

1. Growth Factors and Skin Rejuvenation:

• Growth factors are proteins that aid in cell communication and wound healing by promoting collagen production, angiogenesis, and reducing inflammation.

• These factors are crucial for rejuvenating aging skin, similar to their role in wound healing.

1. Microneedling Procedure:

• It involves creating microchannels in the skin to promote collagen production and enhance the absorption of topical agents.

• Microneedling triggers an inflammatory response, followed by proliferation and remodeling phases, leading to long-term skin improvement.

1. Combining Microneedling with PRF:

• Using PRF with microneedling boosts the healing process by delivering growth factors directly into the skin, promoting better and faster rejuvenation.

1. Safety and Efficacy:

• Patients can expect gradual and long-term improvement in skin quality, with minimal downtime and fewer side effects compared to more invasive treatments like laser resurfacing.

Combining microneedling with PRF or other autologous blood concentrates offers a natural, effective way to rejuvenate aging skin. This approach leverages the body’s healing mechanisms to enhance skin texture, firmness, and overall appearance, providing significant benefits with minimal risks and downtime.

Conclusion

Combining micro needling with injectables like Botox, fillers, PRP, and PRF offers a comprehensive approach to skin rejuvenation, targeting issues like wrinkles, texture, and volume loss. This synergistic treatment enhances collagen production, improves skin firmness, and ensures long-lasting results with minimal recovery time.

Effective for both superficial and deep skin concerns, these minimally invasive procedures are safe and well-tolerated. Proper scheduling and post-treatment care are essential for optimal outcomes. Ultimately, this combined therapy leverages the body's natural healing processes to achieve significant and enduring skin improvements.