Microneedling

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A complete guide to microneedling and its varied roles in modern aesthetic medicine  Microneedling is an increasingly common procedure in the day-to-day practice of dermatologists across the globe. Minimally invasive and requiring minimal downtime, the process can be used to address a range of cosmetic and dermatologic concerns, including rejuvenation of the skin, transdermal delivery of drugs, skin textural irregularities, luminosity, and treatment of dyschromia, melasma, and scarring. Treatment is administered with pens, rollers, and, stamps that have been designed to stimulate the release of growth factors and induce collagen production, working to enhance the appearance of patients of all ages and skin types. 
Edited by leading dermatologist Dr. Elizabeth Bahar Houshmand, 
brings together practical instruction, top tips, and exciting new research to provide all those working in aesthetic medicine with an essential guide to this multifaceted procedure. The book includes a global approach and insightful discussion of topics including: 
The therapeutic benefit of microneedling when skin injury, disease, or aging causes aesthetic changes in the skin The advantages of microneedling, including its decreased risk of pigmentation changes or scarring compared with other procedures The practical skills and technology used in the implementation of different microneedling techniques Tips for applying microneedling to a wide range of skin types The use of microneedling to inject platelet-rich plasma Based upon the latest research and industry practices, 
 is an invaluable tool for all dermatologists, dermatologic surgeons, and other aesthetic medicine practitioners looking to provide their patients with the best possible care.

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Table of Contents

1 Cover

2 Title Page

3 Copyright Page

4 List of Editors and Contributors

5 Cosmetic and Aesthetic Procedures in Dermatology Series

6 Preface

7 1 Introduction to Microneedling Introduction History Mechanism of action The devices Pens Stamps Rollers DermaFrac Clinical considerations Conclusion References

8 2 A Short History of Skin Needling Introduction My classical technique of skin needling using a roller The best chemicals to be used Selected peptides The frequency of needling Conclusion References

9 3 The Value of Medical Needling in Burn Scars Introduction Science Dermal remodeling Increase in skin elasticity Normalized perfusion Increase in skin moisture content Increase of epidermal thickness Role of vitamins in wound healing No dyspigmentation after medical needling Clinical results Medical needling Medical needling and ncascs Conclusion References

10 4 Skin Care Used with Microneedling Introduction Pre‐ and posttreatment skincareRole of peptides Role of growth factors Role of platelet‐rich plasma Role of vitamin a and vitamin c General considerations: pretreatment, during treatment, and post‐treatment References

11 5 Treatment of Hyperpigmentation with Microneedling Introduction Principle and mechanism of action of microneedling Hyperpigmentation Melasma Microneedling in melasma Periorbital melanosis Microneedling in periorbital melanosis Microneedling with biological agents for hyperpigmentation disorder Microneedling technical and clinical considerations Clinical considerations Preprocedure care Operative technique Postprocedure care Contraindications References

12 6 Treatment of Acne and Acne Scars with Microneedling Background Etiology of acne and pathogenesis of acne scars Pathogenesis of acne scars Epidemiology and types of acne scars Description of various interventions Microneedling treatment Procedure Various types of microneedling devices Home‐care dermaroller Fractional radiofrequency microneedling Light emitting microneedling device Microneedle delivery systems Discussion Conclusion References

13 7 Microneedling and Platelet‐Rich Plasma (PRP) Introduction Platelet‐rich plasma – what is it? Combination therapy History of PRP The PRP microneedling procedure Indications Alopecia Platelet‐rich plasma – monotherapy and alopecia treatment Microneedling Combination of microneedling and PRP Combination therapy: alopecia areata treatment Conclusion References

14 Index

15 End User License Agreement

List of Tables

1 Chapter 7Table 7.1 All the growth factors.Table 7.2 Importance of alpha granules in hair loss.

List of Illustrations

1 Chapter 1 Figure 1.1 Original microneedling roller created by Dr. Desmond Fernandes in... Figure 1.2 The electric pen‐shaped device has adjustable settings to control... Figure 1.3 Pen: Single‐use cartridge with adjustable frequency and needle le... Figure 1.4 Microneedling stamp: fixed needle length with customizable vial f... Figure 1.5 Current rollers with fixed needle length; some current models are... Figure 1.6 DermaFrac™: Microneedling device combining simultaneous customize...

2 Chapter 2 Figure 2.1 The very first case of needling; long‐term result. (a) Before any... Figure 2.2 Long‐term effects of skin needling with a 1.0 mm roller and using...

3 Chapter 3Figure 3.1 Needling device.Figure 3.2 Schematic illustration of medical needling and the effects on the...Figure 3.3 Microarray analyses of TGFß1, ‐2, and ‐3 expression levels in tre...Figure 3.4 Immunofluorescence visualization of collagen I: Staining with ant...Figure 3.5 Immunhistochemical staining, anti–collagen I. Needled animal with...Figure 3.6 Immunhistochemical staining, antielastin. Untreated animal immuno...Figure 3.7 Immunhistochemical staining, antielastin. Needled animal with eig...Figure 3.8 Immunhistochemical staining, anti‐VEGF. Untreated animal immunofl...Figure 3.9 Immunhistochemical staining, anti‐VEGF. Needled animal. VEGF show...Figure 3.10 Immunofluorescence visualization of GAGs (Alexa488‐conjugated) a...Figure 3.11 Immunhistochemical staining, anti‐GAG. Needled animal with eight...Figure 3.12 Masson’s trichrome staining. Untreated animal (control).Figure 3.13 Needled animal with eight weeks of skincare. Collagen fiber bund... Figure 3.14 One‐month‐old active burn scar due to open fire burn injury. Not...Figure 3.15 Needling was performed one month after trauma (just after the ep...Figure 3.16 Result after a second deep needling one year after the second ne...Figure 3.17 Hypertrophic burn scar, lower arm, 5 years post‐trauma.Figure 3.18 Improvement of the hypertrophic burn scar six months post–3mm ne...Figure 3.19 Full Face burn scars after a deep second‐ and third‐degree burn ...Figure 3.20 Improvement of the skin and scar condition six months after a 3m... Figure 3.21 Forehead scar with hypopigmented areas before and with better re...Figure 3.22 Hypopigmented scar after hot‐water burn (a) 16 months post‐traum...Figure 3.23 Hypopigmented scar after burn, lower back, 24 months post‐trauma...Figure 3.24 Improvement of the melanin level and thereby repigmentation of t...Figure 3.25 A post‐burn keloid (a) is not the same as a true keloid and skin...

4 Chapter 5Figure 5.1 (a) Before treatment picture of mixed type melasma in 39‐years ol...Figure 5.2 Automated microneedling pens.Figure 5.3 Needling roller (hydroroller) with a bottle connection to combine...Figure 5.4 Automated microneedling device.Figure 5.5 Topical agents of drugs or bioactive agents are typically applied...Figure 5.6 Topical agents of drugs or bioactive agents are added during the ...Figure 5.7 Pinpoint bleeding and erythema is the visual end point of the ski...Figure 5.8 (a) Before treatment. (b) Skin needling treatment on melasma pati...

5 Chapter 6Figure 6.1 A patient (a) before and (b) after treatment with MNRF.

6 Chapter 7Figure 7.1 Collagen induction therapy: needling forms minute perforations of...Figure 7.2 Makeup of PRP: PPP, PRP, and RBC. Plasma: 55–91% water, 7% protei...Figure 7.3 PRP for skin rejuvenation. Gentle traction is applied, in a steri...Figure 7.4 Acne scarring at (a) baseline and (b) three months after three ne...Figure 7.5 (a) Histologic image showing a thin epidermis and flattened rete ...Figure 7.6 Steps for PRP collection in a single‐spin method. (a) Blood colle...

Guide

1 Cover Page

2 Title Page

3 Copyright Page

4 List of Editors and Contributors

5 Cosmetic and Aesthetic Procedures in Dermatology Series

6 Preface

7 Table of Contents

8 Begin Reading

9 Index

10 Wiley End User License Agreement

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