If you mentioned collagen induction therapy (CIT) or skin needling as recently as 3 years ago, most aesthetic physicians would have rolled their eyes and veered the discussion instead towards ablative and non-ablative resurfacing devices. Not so, these days.
In the last 2 years, percutaneous collagen induction (PCI) or microneedle therapy has been experiencing a surge in popularity in plastic surgery and dermatology offices as a minimally invasive skin rejuvenation procedure that involves a device containing fine needles passed over the skin surface. These needles create tiny punctures in the skin surface. The process of repair of this controlled skin injury then leads to neocollagenesis and elastin production, which tightens the skin and improves texture.
The procedure can be used to reduce pore size, improve the texture and appearance of scars, and even soften stretch marks (Figure 1). With some companies partnering with other technologies, we may be seeing CIT in combination treatments to treat alopecia and tattoo removal in the near future.
Figure 1. Collagen induction therapy can be used on a variety of scars including acne, facial and lip scars.
Percutaneous Collagen Induction
Though proponents of microinjury to the skin involving needles can be dated back to the 1950s, Des Fernandes introduced the idea of using a skin roller with needles for vertical perioral wrinkles at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei in 1996. Since then an array of microneedle devices have made become available in the cosmetic market. In 2013 at the Winter American Academy of Dermatology meeting 1 or 2 exhibitors featured microneedle delivery systems compared to 2014 where there were more than half a dozen.
Because CIT does not cause significant injury to the epidermis it can be used on multiple skin phototypes as well as areas of the face including around the eyes. It is also a year-round procedure as long as the patient does not have sunburn or an active tan. As an in-office procedure it is safe and effective with downtime ranging from 3 to 5 days depending on the type of device used and how aggressive the practitioner is with the device. Inherent in the procedure is the use of topical agents placed on the skin surface that penetrate to improve skin texture and firmness. The exact formulation used during CIT varies by practitioner and many of the device manufacturers vend their own formulations to accompany their device.
Most microneedle devices have 2 main differences: diameter and length of the microneedles and whether they are battery or cord-powered systems. Tips can be beveled or flat and can be manually or mechanically operated. Professional grade devices typically look like electric razors with a rounded handle. Consumables per device also vary from tips to sterile plastic sleeves to topicals placed on the skin at the time of the procedure.
If considering purchasing a device, here are some key factors to consider:
- What is the depth of needle?
- What the needle cartridge is made of?
- Are the needles placed in a scattered design or circular?
- Is there a risk of suction of the skin that can lead to broken capillaries?
- Can the needle depth be adjusted?
If buying a mechanical pen, ask about where the motor is manufactured and whether the needle cartridges are proprietary or can be interchanged with other brands. Proprietary cartridges tend to be more expensive; however, if it is not proprietary there is no way to know whether a vendor is just heat stamping their logo on a mass produced device. Lastly, make sure the design itself is ergonomic as it is hand-held and should be able to reach tight spaces, such as the philtrum and around the eyes.
Article continues on page 2
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The Process
Because the procedure is bloody, sterile conditions and room set up should be carefully monitored at all times. Microneedle therapy sessions are generally carried out every 4 to 5 weeks. The patient is numbed with topical anesthesia for approximately 45 minutes. Compounded formulations are preferred because prescription strength topicals do not provide adequate comfort during the procedure. After anesthesia is removed and the skin cleansed, the device is rolled over the skin.
Proper technique aids in optimal results. If the skin is not held taut, areas can be missed or uneven rolling can occur. Topical agents are placed on the skin surface to act as adjuvants to the treatment itself and patients are often given wound care instructions that include additional products with peptides and growth factors for at-home use. Most manufacturers offer training to staff though regulations on who can perform procedures vary from state-to-state.
Downtime also varies depending on depth of the needles used. Typically, patients generally leave the office with erythema and their skin is pink for the subsequent 1 to 3 days. Powder make-up can be applied over the area at day 3 and at that point cosmesis is acceptable to return to work.
The Future
As the technology behind CIT becomes more accepted and widely used, so too are possibilities for applications. Combinations with plasma rich protein (PRP) could offer promise for not only skin rejuvenation but also the potential to help with hair growth. Some manufacturers are also using the technology to lighten tattoos. Longitudinal double-blind studies are needed to fully assess CIT, however, anecdotal evidence has been compelling to date.
Kavita Mariwalla, MD, is director, Mariwalla Dermatology, and
assistant clinical professor of dermatology, SUNY at Stony Brook, in Stony Brook, NY.
Disclosures: The author reports no relevant financial relationships.
Related Reading
1. Aust MC, Fernandes D, Kolokythas P, et al. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity.
Plast. Reconstr. Surg. 2008;121(4):1421-29.
2. Fernandes D, Signorini M. Combating photoaging with percutaneous collagen induction. Clinics in Dermatology. 2008;26(2):192-99.
3. Leheta T, El Tawdy A, Abdel Hay R. Percutaenous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg. 2011;37(2):207-16.
If you mentioned collagen induction therapy (CIT) or skin needling as recently as 3 years ago, most aesthetic physicians would have rolled their eyes and veered the discussion instead towards ablative and non-ablative resurfacing devices. Not so, these days.
In the last 2 years, percutaneous collagen induction (PCI) or microneedle therapy has been experiencing a surge in popularity in plastic surgery and dermatology offices as a minimally invasive skin rejuvenation procedure that involves a device containing fine needles passed over the skin surface. These needles create tiny punctures in the skin surface. The process of repair of this controlled skin injury then leads to neocollagenesis and elastin production, which tightens the skin and improves texture.
The procedure can be used to reduce pore size, improve the texture and appearance of scars, and even soften stretch marks (Figure 1). With some companies partnering with other technologies, we may be seeing CIT in combination treatments to treat alopecia and tattoo removal in the near future.
Figure 1. Collagen induction therapy can be used on a variety of scars including acne, facial and lip scars.
Percutaneous Collagen Induction
Though proponents of microinjury to the skin involving needles can be dated back to the 1950s, Des Fernandes introduced the idea of using a skin roller with needles for vertical perioral wrinkles at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei in 1996. Since then an array of microneedle devices have made become available in the cosmetic market. In 2013 at the Winter American Academy of Dermatology meeting 1 or 2 exhibitors featured microneedle delivery systems compared to 2014 where there were more than half a dozen.
Because CIT does not cause significant injury to the epidermis it can be used on multiple skin phototypes as well as areas of the face including around the eyes. It is also a year-round procedure as long as the patient does not have sunburn or an active tan. As an in-office procedure it is safe and effective with downtime ranging from 3 to 5 days depending on the type of device used and how aggressive the practitioner is with the device. Inherent in the procedure is the use of topical agents placed on the skin surface that penetrate to improve skin texture and firmness. The exact formulation used during CIT varies by practitioner and many of the device manufacturers vend their own formulations to accompany their device.
Most microneedle devices have 2 main differences: diameter and length of the microneedles and whether they are battery or cord-powered systems. Tips can be beveled or flat and can be manually or mechanically operated. Professional grade devices typically look like electric razors with a rounded handle. Consumables per device also vary from tips to sterile plastic sleeves to topicals placed on the skin at the time of the procedure.
If considering purchasing a device, here are some key factors to consider:
- What is the depth of needle?
- What the needle cartridge is made of?
- Are the needles placed in a scattered design or circular?
- Is there a risk of suction of the skin that can lead to broken capillaries?
- Can the needle depth be adjusted?
If buying a mechanical pen, ask about where the motor is manufactured and whether the needle cartridges are proprietary or can be interchanged with other brands. Proprietary cartridges tend to be more expensive; however, if it is not proprietary there is no way to know whether a vendor is just heat stamping their logo on a mass produced device. Lastly, make sure the design itself is ergonomic as it is hand-held and should be able to reach tight spaces, such as the philtrum and around the eyes.
Article continues on page 2
{{pagebreak}}
The Process
Because the procedure is bloody, sterile conditions and room set up should be carefully monitored at all times. Microneedle therapy sessions are generally carried out every 4 to 5 weeks. The patient is numbed with topical anesthesia for approximately 45 minutes. Compounded formulations are preferred because prescription strength topicals do not provide adequate comfort during the procedure. After anesthesia is removed and the skin cleansed, the device is rolled over the skin.
Proper technique aids in optimal results. If the skin is not held taut, areas can be missed or uneven rolling can occur. Topical agents are placed on the skin surface to act as adjuvants to the treatment itself and patients are often given wound care instructions that include additional products with peptides and growth factors for at-home use. Most manufacturers offer training to staff though regulations on who can perform procedures vary from state-to-state.
Downtime also varies depending on depth of the needles used. Typically, patients generally leave the office with erythema and their skin is pink for the subsequent 1 to 3 days. Powder make-up can be applied over the area at day 3 and at that point cosmesis is acceptable to return to work.
The Future
As the technology behind CIT becomes more accepted and widely used, so too are possibilities for applications. Combinations with plasma rich protein (PRP) could offer promise for not only skin rejuvenation but also the potential to help with hair growth. Some manufacturers are also using the technology to lighten tattoos. Longitudinal double-blind studies are needed to fully assess CIT, however, anecdotal evidence has been compelling to date.
Kavita Mariwalla, MD, is director, Mariwalla Dermatology, and
assistant clinical professor of dermatology, SUNY at Stony Brook, in Stony Brook, NY.
Disclosures: The author reports no relevant financial relationships.
Related Reading
1. Aust MC, Fernandes D, Kolokythas P, et al. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity.
Plast. Reconstr. Surg. 2008;121(4):1421-29.
2. Fernandes D, Signorini M. Combating photoaging with percutaneous collagen induction. Clinics in Dermatology. 2008;26(2):192-99.
3. Leheta T, El Tawdy A, Abdel Hay R. Percutaenous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg. 2011;37(2):207-16.
If you mentioned collagen induction therapy (CIT) or skin needling as recently as 3 years ago, most aesthetic physicians would have rolled their eyes and veered the discussion instead towards ablative and non-ablative resurfacing devices. Not so, these days.
In the last 2 years, percutaneous collagen induction (PCI) or microneedle therapy has been experiencing a surge in popularity in plastic surgery and dermatology offices as a minimally invasive skin rejuvenation procedure that involves a device containing fine needles passed over the skin surface. These needles create tiny punctures in the skin surface. The process of repair of this controlled skin injury then leads to neocollagenesis and elastin production, which tightens the skin and improves texture.
The procedure can be used to reduce pore size, improve the texture and appearance of scars, and even soften stretch marks (Figure 1). With some companies partnering with other technologies, we may be seeing CIT in combination treatments to treat alopecia and tattoo removal in the near future.
Figure 1. Collagen induction therapy can be used on a variety of scars including acne, facial and lip scars.
Percutaneous Collagen Induction
Though proponents of microinjury to the skin involving needles can be dated back to the 1950s, Des Fernandes introduced the idea of using a skin roller with needles for vertical perioral wrinkles at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei in 1996. Since then an array of microneedle devices have made become available in the cosmetic market. In 2013 at the Winter American Academy of Dermatology meeting 1 or 2 exhibitors featured microneedle delivery systems compared to 2014 where there were more than half a dozen.
Because CIT does not cause significant injury to the epidermis it can be used on multiple skin phototypes as well as areas of the face including around the eyes. It is also a year-round procedure as long as the patient does not have sunburn or an active tan. As an in-office procedure it is safe and effective with downtime ranging from 3 to 5 days depending on the type of device used and how aggressive the practitioner is with the device. Inherent in the procedure is the use of topical agents placed on the skin surface that penetrate to improve skin texture and firmness. The exact formulation used during CIT varies by practitioner and many of the device manufacturers vend their own formulations to accompany their device.
Most microneedle devices have 2 main differences: diameter and length of the microneedles and whether they are battery or cord-powered systems. Tips can be beveled or flat and can be manually or mechanically operated. Professional grade devices typically look like electric razors with a rounded handle. Consumables per device also vary from tips to sterile plastic sleeves to topicals placed on the skin at the time of the procedure.
If considering purchasing a device, here are some key factors to consider:
- What is the depth of needle?
- What the needle cartridge is made of?
- Are the needles placed in a scattered design or circular?
- Is there a risk of suction of the skin that can lead to broken capillaries?
- Can the needle depth be adjusted?
If buying a mechanical pen, ask about where the motor is manufactured and whether the needle cartridges are proprietary or can be interchanged with other brands. Proprietary cartridges tend to be more expensive; however, if it is not proprietary there is no way to know whether a vendor is just heat stamping their logo on a mass produced device. Lastly, make sure the design itself is ergonomic as it is hand-held and should be able to reach tight spaces, such as the philtrum and around the eyes.
Article continues on page 2
{{pagebreak}}
The Process
Because the procedure is bloody, sterile conditions and room set up should be carefully monitored at all times. Microneedle therapy sessions are generally carried out every 4 to 5 weeks. The patient is numbed with topical anesthesia for approximately 45 minutes. Compounded formulations are preferred because prescription strength topicals do not provide adequate comfort during the procedure. After anesthesia is removed and the skin cleansed, the device is rolled over the skin.
Proper technique aids in optimal results. If the skin is not held taut, areas can be missed or uneven rolling can occur. Topical agents are placed on the skin surface to act as adjuvants to the treatment itself and patients are often given wound care instructions that include additional products with peptides and growth factors for at-home use. Most manufacturers offer training to staff though regulations on who can perform procedures vary from state-to-state.
Downtime also varies depending on depth of the needles used. Typically, patients generally leave the office with erythema and their skin is pink for the subsequent 1 to 3 days. Powder make-up can be applied over the area at day 3 and at that point cosmesis is acceptable to return to work.
The Future
As the technology behind CIT becomes more accepted and widely used, so too are possibilities for applications. Combinations with plasma rich protein (PRP) could offer promise for not only skin rejuvenation but also the potential to help with hair growth. Some manufacturers are also using the technology to lighten tattoos. Longitudinal double-blind studies are needed to fully assess CIT, however, anecdotal evidence has been compelling to date.
Kavita Mariwalla, MD, is director, Mariwalla Dermatology, and
assistant clinical professor of dermatology, SUNY at Stony Brook, in Stony Brook, NY.
Disclosures: The author reports no relevant financial relationships.
Related Reading
1. Aust MC, Fernandes D, Kolokythas P, et al. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity.
Plast. Reconstr. Surg. 2008;121(4):1421-29.
2. Fernandes D, Signorini M. Combating photoaging with percutaneous collagen induction. Clinics in Dermatology. 2008;26(2):192-99.
3. Leheta T, El Tawdy A, Abdel Hay R. Percutaenous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg. 2011;37(2):207-16.
