Skin needling for treating wrinkled upper lips and difficult scars. - An alternative to laser resurfacing.

By Dr. Des Fernandes

Welcome to some ideas from Cape Town South Africa. My name is Des Fernandes and I am a plastic surgeon concentrating on head and neck surgery. I might be in the minority position right now, but I believe that we have to look for alternatives to laser re-surfacing of the skin. I'd like to present my 2-year experience of an alternative method to laser re-surfacing and dermabrasion. Those techniques destroy the epidermis in order to create denser fibrosis in the dermis. The technique that I will describe preserves the epidermis, and stimulates collagen deposition in the dermis.

I was impressed by the publication of Camirand to make scars less obvious by using a tattoo gun to "needle abrade" the scars. As I understand it, this technique works because the needles break old collagen strands that are tethering the bed of the scar, and the damage also creates more collagen immediately under the epidermis.

Because the needle only penetrates through the epidermis and does not remove it, the epidermis is only cleft and will rapidly heal. As the skin swells, the holes are closed and the edges of the epidermis are approximated. The needle prick injures the upper 1 - 2 mm of the dermis. This injury, minute as it might seem, does cause some localised damage and bleeding. This will promote the normal post-traumatic infiltration of fibroblasts and the release of growth factors. Ultimately, collagen is laid down in the papillary and upper reticular dermis. This is an un-important response if we are looking at a single needle prick through the skin. A completely different picture emerges when one has thousands of fine pricks next to each other. The process can become virtually confluent, and as a result, may mimic the results obtained with a laser, but without destroying the epidermis. It may be that with deeper penetration into the dermis, better collagen and elastin deposition will be obtained.

The Technique
I use a tattoo-artist's gun with 4/5 needles in a straight row. The skin must be held tightly and the excursion should be sufficient to penetrate skin. It is usually easier to work in the Langer's line but I also work in a contrary direction as well.

Healing
The skin is crimson coloured immediately after the treatment but bleeding is minimal and stops pretty soon. After all this is only a pin-prick.! I have treated the skin with granulflex, with Tegaderm or simply leaving the skin exposed and covered only with a vitamin A and antioxidant vitamin gel. My impression is that healing is better when the skin is left exposed and covered with Vitamin A Gel

By day 4 to 5 the skin has returned to a moderate pink flush which is usually easily covered with make-up. The oedema of the face rapidly becomes un-noticeable, though one may notice "water-bags" for up to three months on the malars after treating the lower eyelids. At the same time collagen and elastin are building up and the skin gradually tightens up. The process can be repeated at anytime after the epidermis has healed completely.