Transcript Needling - Bellus Medical
Advanced Microneedling Training
© COPYRIGHT 2013 BELLUS MEDICAL LLC. ALL RIGHTS RESERVED.
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How Does Medical Needling Work?
• 0.5mm – 3.0mm
• Uses very fine, surgical stainless steel needles to make channels into the epidermis and dermis to release growth factors • Promotes scarless healing and deposition of normal woven collagen rather than scar collagen • Similar to Fraxel, without the negative loss of dermal papillae, potential destruction of melanocytes, abnormal collagen, coagulated growth factors • Allows 80% more product into the skin (compared to 7-10% normally)
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Collagen Induction Therapy
Microinjuries allow for release of serum containing cytokines and growth factor*
*Fernandes, D. OralL Maxillofacial Surg Clin 2005; 17:51-63
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Phases of Wound Repair
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Most Effective Uses of Dermal Needling
Wrinkles Thin skin Hyperpigmentation Rosacea Loss of Resiliency Premature aging Scars Epidermal density and strength Lax skin UV damage Stretch marks Hair restoration
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Features of Healthy Skin
Soft, compact stratum corneum, with strong skin barrier Dense spinosum layer with consistent, strong cell-to-cell adhesion Even color, with melanocytes that distribute melanin uniformly Resilience Dermis rich with collagen and elastin fibers Good dermal and epidermal hydration: Extracellular matrix rich with glycosaminoglycans
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The Three Layers of the Skin
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Optimizing the Keratinocytes
Basic epidermal topical requirements: Omega 3 Omega 6 Ceramide Squalenes Sphingolipid Phospholipid
Epidermal Cell Requirements
Omega 3
• Kiwifuit seed oil • Lecithin • Hemp see oil • Flax seed oil • Camelina oil
Omega 6
• Hemp seed oil • Borage oil • Evening Primrose oil • Rice bran oil
Ceramide
• Yeast (pichia anomala extract) • Wheat extracts
Squalenes
• Rice bran oil • Olive oil
Sphingolipid
• Yeast (pichia anamola extract)
Phospholipid
• Lecithin
Optimizing the Melanocyte
Unfortunately, melanocytes lie between most anti-aging treatment modalities and the targeted fibroblasts, and are often sacrificed in overzealous attempts to obtain greater injury through aggressive injury.
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Optimizing the Melanocyte
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Optimizing the Melanocyte
5 intervention points:
• Block UV radiation • Block Melanin Stimulating Hormone (MSH) before it stimulates the keratinocytes and melanocytes • Inhibit tyrosinase, the enzyme needed to form melanin in the melanosome • Interfere with L-Dopa, the building blocks for pigment in the melanosomes • Interfere with transfer of pigment from the melanosome to the keratinocyte
Product Ingredients Affecting Melanogenesis*
MSH Active Ingredient
Magnesium ascorbyl phosphate Ascorbyl tetra isopalmitate Niacinamide Arbutin Azelaic acid Paper mulberry Aloesin Glabridin Glucosamine Ascorbic acid *Florence Barrett-Hill. Secretions. Cosmetic Chemistry.
Tyrosinase Pigment Granule Melanosome Transfer
Compounds Affecting Melanogenesis*
Compounds
Lumixyl Melanostat Sulforawhite Whitesphere Lightocean *Florence Barrett-Hill. Secretions. Cosmetic Chemistry.
MSH Tyrosinase Pigment Granule Melanosome Transfer
Ingredients TO AVOID* with microneedling
Substance
Kojic Acid** Hydroquinone*** *Florence Barrett-Hill. Secretions. Cosmetic Chemistry.
**Banned in some countries. May cause dermatitis long term.
***Banned is some countries. Potential carcinogenic effect.
MSH Tyrosinase
Pigment Granule Melanosome Transfer
Medical Needling eliminates the risk of melanocyte heat injury and actually optimizes cell function, making it the ideal treatment for all skin types.
Lance Setterfield, Dermal Needling, Medical Edition, 2010
Optimizing the Fibroblast
Requires injury to stimulate:
• • • • • • • chemical peels Levulan and photodynamic therapy IPL Thermage Fraxel CO2 Laser
Ingredients for Optimal Fibroblast Function
Growth Factors Magnesium ascorbyl phosphate Ascorbyl tetra isopalmitate Retinyl palmitate Retinol Copper peptides Beta-carotene DMAE Hyaluronic Acid *Florence Barrett Hill. Secretions, Cosmetic Chemistry 2009 **all above have antioxidant and anti-inflammatory properties and can be used on compromised and high-risk skins excepts retinol.
Aids in Collagen Synthesis
Aids in GAG Synthesis
Prevents Oxidative Stress
Prevents Lipid Peroxidation
Ingredients for Optimal Fibroblast Function
Glucosamine Super dismutase oxide Resveratrol (Bioflavanoid) Matrixyl® Amino acid Proline Amino acid Lysine Ascorbic acid Zinc Calcium *Florence Barrett Hill. Secretions, Cosmetic Chemistry 2009
Aids in Collagen Synthesis
Aids in GAG Synthesis
Prevents Oxidative Stress
Prevents Lipid Peroxidation
Preserve the Epidermis
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Epidermis is complex, highly specialized organ
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0.2mm thick
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Only protection from the environment
Preserve the Epidermis
Traditional Ablative Therapies
• Damage the skin to cause fibrosis of the papillary dermis • Epidermis thinned • Dermal papillae destroyed • Severe changes in dermis
Preserve the Epidermis
Resultant Collagen from Ablative Therapies:
• Parallel (scar) orientation rather than normal, lattice network • Scar collagen will be resorbed by the body over time – all scar collagen is • Fine wrinkles will be visible due to thinned epidermis and lack of dermal papillae
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Collagen Induction Therapy
CIT Promotes deposition of fresh new collagen without scar formation*
Left, before CIT. Right, six months after CIT, more collagen (pink) and elastin (brown) can be detected. Estimated > 400% more collagen and improved epidermal/dermal thickness *Fernandes, D. OralLMaxillofacial Surg Clin 2005; 17:51-63
Preserve the dermal papillae
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Exchanges oxygen, nutrients, and waste products between the epidermis and dermis
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Provides strength between the epidermis and dermis to prevent the deterioration and separation of the dermal/epidermal junction, which presents as wrinkles
Break Down Scar Tissue
Allows the epidermis to lift and lay flat, eliminating any shadowing
Induce Regenerative Healing
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Collagen forms from the base upwards
•
Opposite of Regenerative Healing is “Cicatricial healing”: leaves a scar when the formation of new connecting tissue overlies a wound
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Microneedling Meets All Goals
Optimize cell function Preserve integrity of the epidermis Strengthen dermal/epidermal junction Preserve dermal papillae Break down scar tissue Release epidermal growth factors Increase natural collagen: transforming growth factor (TGF ß3) ß3 Induce regenerative healing
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Ablative vs. Non-Ablative Treatments
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Comparison with Other Treatments
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Introducing SkinPen
2013: SkinPen modernizes microneedling
• Stainless steel, cordless design • • Single, use disposable Advanced Microneedle Cartridge Minimizes epidermal destruction while delivering over 1400 microchannels per second • Ideal for clinical practice Fine lines or moderate wrinkles Diminished skin texture, tone and color Atrophic acne scars Stretch marks Traumatic scars Photo aging
Dr. Des Fernandes – Topical A & C
Pre-treats patients with topical A and C three weeks to three month prior to needling.
• Vitamin A is essential for the normal physiology of the skin and for
collagen preservation; maximizes collagen production
and the skin will heal as rapidly as possible • Vitamin C needs to replaced daily to ensure for natural protection and repair of DNA;
essential for the production of normal collagen
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Microchannel Formation
For dermal rollers, the number of microchannels increases as a function of the number of passes made 1 pass 3 passes 5 passes 10 passes 15 passes
*Figure from: The AAPS Journal, Vol. 13, No. 3, September 2011
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Microchannel Formation
For SkinPen, the number of microchannels depends on how quickly you move the SkinPen across the surface of the skin.
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Needles cycle at 142 Hz or 142 “stamps”/second, potentially creating 1704 microchannels/second when moving the skin pen
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Slower movement at a rate of 1 cm/second, you can create roughly 4858 microchannels/ cm2 of skin*
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Faster movement at a rate of 3 cm/second, you can create roughly 1621 microchannels/ cm2 of skin*
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The SkinPen produces significantly more microchannels with one pass than created by a dermal rollers after many passes!
*Needles are ~1 mm apart (1000 microns) and the cartridge head has a diameter of 3.5 mm
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Recommended Needle Depth
Needle depth is contingent on:
Thickness of dermis in area to be treated:
The dermis of the face is variable, typically no deeper than 1.5 mm Dermis in other areas of the body may be thicker or thinner, with the dermis of the back typically the thickest (~3 mm)
Reason for Treatment:
Facial rejuvenation for improvement of skin texture of fine lines will require less penetration Improvement of scar tissue will require a more aggressive treatment and therefore deeper penetration Fabbrocini G, et al.. J Dermatolog Treat. 2012 Dec 8. [Epub ahead of print].
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Recommended Needle Depth
Average Skin Thickness Measurements Site
Upper lip Lower lip Philtrum Chin Upper eyelid Lower eyelid Forehead Right cheek
AVG ABC
0.83 ± 0.17
0.82 ± 0.15
0.83 ± 0.10
1.15 ± 0.11
0.38 ± 0.09
0.82 ± 0.21
1.03 ± 0.15
1.07 ± 0.09
Plast Reconstr Surg. 2005 May;115(6):1769-73
Site
Left cheek Malar eminence Submental Nasal tip Nasal dorsum Right neck Left neck
AVG ABC
1.17 ± 0.08
1.05 ± 0.45
0.89 ± 0.19
1.22 ± 0.15
1.15 ± 0.11
0.52 ± 0.23
0.54 ± 0.20
Why SkinPen?
• Stainless steel, cordless design • The
most advanced microneedle cartridge on the market
: Bio-Sleeve technology eliminates cross-contamination and protect the pen 12 medical grade steel, 32 gauge needles to reduce epidermal destruction for superior results and positive patient experience Exhaust port to reduce suction and risk of broken capillaries
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Treating Hyperpigmentation
5 intervention points:
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Block UV radiation Block Melanin Stimulating Hormone (MSH) before it stimulates the kertinocytes and melanocytes Inhibit tyrosinase, the enzyme needed to form melanin in the melanosome Interfere with L-Dopa, the building blocks for pigment in the melanosomes Interfere with transfer of pigment from the melanosome to the keratinocyte
Topicals: Increase collagen synthesis
• Amino acids such as Proline and Lysine • Copper peptides • Peptides such as palmitoyl oligopeptide, Matrixyl 3000, palmitoyl tetrapeptide 7, kinetin • Zinc • Bioflavinoids: plant-derived antioxidants such as grape seed extract/resveratrol, green tea extract • Stem cells • Omega 3 & 6
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Clinical Study: Scars
Microneedling offers a simple and safe modality to improve the appearance of acne scars without risk of dyspigmentation in patient of all skin types
60 patients of skin types phototype I to VI were treated with microneedling for treatment of acne scars Three treatments at monthly intervals.
Evaluated by using a Global Aesthetic Improvement Scale (GAIS), and analyzed statistically by computerized image analysis of the patients ’ photographs.
Average reduction of 31% of scarring.
No short- or long-term dyschromia was observed.
Fabbrocini G, et al.. J Dermatolog Treat. 2012 Dec 8. [Epub ahead of print].
Stretch Marks
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Difficult to treat
• Epidermis is atrophied and support structure beneath it is compromised • Melanocytes are sparse or absent, distance to cover is too great for migration •
Needling:
• Improves density of the epidermis through release of epidermal growth factor • Considered to be the most effective solution for stretch marks •
Important to not overpromise and under-deliver results
Clinical Study: Stretch Marks
Treatment of striae distensae using needling therapy: a pilot study.
• 16 Korean volunteers • 3 microneedling treatments at 4-week intervals • Assessed by pre and post-treatment clinical photographs, skin biopsies, and patient satisfaction scores.
Dermatological Surgery 2012 Nov:38(11): 1823-8
Clinical Study: Stretch Marks
Results:
7 patients (43.8%): marked to excellent improvement 9 patients: minimal to moderate improvement
Patient Satisfaction Scores:
6 patients (37.5%): highly satisfied 8 patients (50%): somewhat satisfied 2 patients (12.5%): unsatisfied No significant side effects except mild pain, erythema, and spotty bleeding.
Dermatological Surgery 2012 Nov:38(11): 1823-8
Rosacea
• Stimulates EGF (epidermal growth factor) to increase density of epidermis, lessening appearance of vessels under the skin and overall redness • Strengthens collagen in vessel walls and connective tissue that supports the vessels • Increases Platelet GF which attracts monocytes into the wound which release interleukin 10 (anti-inflammatory cytokine) • Increases availability of cell nutrients and antioxidants