Advanced Skin Needling with Dermapen. Tony Chu Dermatology Unit Hammersmith Hospital London, UK

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1 Advanced Skin Needling with Dermapen Tony Chu Dermatology Unit Hammersmith Hospital London, UK

2 Applications Atrophic scarring face, back and chest Acne and chicken pox Facial rejuvenation Treatment of hypertrophic burn scars Treatment of stretch marks

3 Acne Scarring Common after moderate to severe acne Major impact on Quality of Life of the affected individual Large number of modalities have been evaluated for the treatment of acne scarring but few have a good clinical effect Essential to identify the type of scarring present and to use the appropriate techniques

4 Acne Scarring Three types of acne scarring are recognised Ice pick Box Rolling Ice pick scars are uncommon and the majority of patients have a mixed picture of the other two types of scarring

5 Types of acne scarring Ice-pick Box Rolling

6 Acne Scarring Ice-pick scars are generally very fibrotic and little will improve them bar punch excision Box and Rolling scars may be soft will totally flatten with minimal stretching of the skin, or may be tethered will not fully flatten with minimal stretching of the skin Box scars can be difficult to get a good cosmetic result with Rolling scars are the most satisfying

7 Tethered scars Fibrous scar tissue Holding the scar down New collagen production Will not provide enough Pressure to elevate the scar fully

8 Ice Pick and Small Box Scarring

9 Box and Rolling Scarring

10 Box and Rolling Scarring

11 Rolling Scarring

12 Percutaneous Collagen Induction Dermaroller Stainless steel acupuncture needles 0.25mm needle gauge 1.5mm needle length

13 Percutaneous Collagen Induction Dermapen Stainless steel acupuncture needles 0.33mm needle gauge 0.5 to 2.5mm needle length Speed from 1 (25 to 30/sec) to 7 (85 to 90/sec)

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17 Mode of Action Phase I Initial injury by needles leads to a cascade of cytokines and growth factors Neutrophils are the dominant cell type Gradual replacement by monocytes Minimally Invasive Percutaneous Collagen Induction Desmond Fernandes, MB, BCh, FRCS(Edin)

18 Mode of Action Phase II Tissue proliferation Monocytes predominate releasing growth factors for fibroblasts Collagen III produced Kertinocytes stimulate growth of epidermis and promote collagen deposition Neo-angiogenesis Surge of matrix deposition

19 Mode of Action Phase III Final remodelling phase Takes several months Collagen type III converted to collagen type I Skin becomes tighter Blood supply normalises

20 Before 6 months after PCI Collagen stained pink and elastin stained brown Approximately 400% more collagen and elastin in the post procedure histology section. (Giemsa, original magnification x40).

21 Histology Findings Following PCI using Dermaroller Model MF8 Before: Collagen fibers stained violet 6 weeks after: Dramatic increase of new collagen and elastin fibers

22 Histology of skin showing puncture sites where the needle has penetrated (arrows). The tracts are curved, reflecting the path of the needle as it rolls into and then out of the skin. The holes are about four cells wide and will heal rapidly. (H&E, original magnification x40)

23 Adjustable A single Dermaroller has a set needle length Operator has some control and how quickly the procedure is performed Dermapen has adjustable needle length so the needle length can be changed during the procedure to treat deeper scars Dermapen has variable speeds

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26 Versitility Able to treat small areas Unlike the Dermaroller, can get right up to the nasolabial folds, treat the upper lip with ease and also treat the nose

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28 Advantages of the Microneedle Therapy Minimal risks Short healing period within days No permanent injury to dermis No sun-sensitivity after the treatment Out-patient treatment with topical anaesthesia The PCI can be repeated without any restriction All skin types can be treated Thin or pre-lasered skin can be treated

29 BEFORE AFTER

30 BEFORE AFTER

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33 Additional Treatments TCA CROSS for box scars Subcision for tethered scars Platelet Rich Plasma to enhance the effect

34 TCA Chemical Reconstruction of Skin Scars (CROSS) Use 100% trichloracetic acid Apply carefully to the base of the scar using a sharpened orange stick As soon as frosting starts, wash off with normal saline When the face has been treated, get the patient to carefully wash with plain water Scar instantly turns white (30mins) with background erythema After 2-3 days a small scab develops which falls off after 3-7 days

35 TCA Cross Peels Results are variable with some patients seeing improvement after the first treatment Most patients need 3-6 treatments Always do a patch area first to see how the skin reacts Dark skin may show some transient pigmentary change

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38 Subcision Use of 18.5 gauge NoKor needle to separate the tethering scar tissue The subcision procedure encourages new collagen production

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40 Subcision Back and forth Fan

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43 Platelet Rich Plasma Platelets contain a large number of growth factors By purifying platelets and injecting them intradermally into the scar prior to Dermapen, the effect can be enhanced Some operators use the PRP topically prior to the Dermapen

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48 Facial Rejuvenation Obvious advantages of the Dermapen Less painful Easy to treat areas close to the eye and upper lip Variable needle length depending on area of skin to be treated Less downtime

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53 Before and After Dermapen

54 Treatment of Stretch Marks Dermaroller has been shown to be an effective treatment of stretch marks Induction of collagen and elsatic fibres improves the cosmetic appearance to the skin Dermapen will more accurately target the skin defects

55 Before and After Treatment with Dermaroller

56 Burn Scars Good evidence that micro needling can help improve burn scars, even when they are old and established Established hypertrophic burns scars can become softer and more elastic with treatment

57 Burn Scar with Successive Dermapen Treatment

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