Aesthetic Surgery Journal Advance Access published August 16, 2016
Cosmetic Medicine
Commentary
Commentary on: Micro-Needling Depth
Penetration, Presence of Pigment Particles, and
Fluorescein-Stained Platelets: Clinical Usage
for Aesthetic Concerns
Julius W. Few, MD; and Alec Semersky
Accepted for publication July 6, 2016.
Micro-needling is a relatively novel technique that uses
needles ranging from 0.5 mm to 2.5 mm in order to create
micro-wounds or channels in the skin. The microneedles
are designed to penetrate the stratum corneum without
traveling into the nerve fibers of the skin. In doing so,
micro-needling can create micro channels in the skin rela-
tively painlessly. The channels allow for delivery of macro-
molecules through the skin, and, while healing, promote
collagen production in the skin. As a result, micro-needling
is an effective tool for treating aesthetic skin concerns such
as wrinkling, as well as delivering transdermal medications
and vaccines.
The author aimed to determine average depth penetra-
tion of microneedles, as well as the optimal time of topical
application to achieve maximum depth of macromolecule
dissemination through the skin after micro-needling treat-
ment.1 In studies I, II, and III, the study utilized low sample
sizes of only facial skin excised from Caucasian patients
aged 72, 73, and 62, respectively. The use of only these pre-
auricular skin strips from a narrow ethnic background limits
the study’s broader applications. It would be advantageous
to examine needle penetration depth and time-dependent
dissemination of macromolecules after micro-needling on
skin excised from different areas of the body, and on skin of
different age and ethnicity. The author did increase the
sample size by examining five sections within each 1 × 1
cm2 section of excised skin, though a larger selection of skin
samples is still required for a complete study.
Size indeed may not matter for micro-needling. Despite
a small sample size, the varying penetration depths of dif-
ferent needle lengths provide meaningful information. The
Aesthetic Surgery Journal
2016, 1–2
© 2016 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
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DOI: 10.1093/asj/sjw133
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author found that the level of needle penetration was con-
sistent between 0.5 to 1.5 mm, validated by histology and
tissue marking. When the investigators used needle lengths
of 1.5, 2, and 2.5 mm, the results were less consistent and
the level of penetration was greater for the 2 mm than the
2.5 mm. They appropriate indicate the need for additional
research for greater length applications and we concluded
that outcomes were impressive across varying lengths of
penetration, making 1 to 1.5 mm needles an optimal choice
for the described indication.
The findings related to the time-dependent dissemina-
tion of macromolecules through the skin are of particular
importance. With an increased sample size, the massage
times of topical products into the skin post-treatment indi-
cated by the study could serve as a guideline for doctors
who employ these topical products after treatment.2,3 The
study results suggest that the optimal time of skin penetra-
tion is at 5 minutes and the window of tissue access starts
to close drastically after 30 minutes, making a truly essen-
tial contribution to the literature.
Dr Few is a Clinical Professor of Surgery, School of Medicine,
University of Chicago Pritzker School of Medicine, Chicago, IL; and
Cosmetic Medicine Section Editor of Aesthetic Surgery Journal.
Mr Semersky is a pre-medical student, University of North Carolina,
Chapel Hill, NC.
Corresponding Author:
Dr Julius W. Few, 875 N. Michigan Avenue, Suite 3850, Chicago,
IL 60611, USA.
E-mail: drj@fewinstitute.com
2 Aesthetic Surgery Journal
The author achieved excellent results in treating aged
skin, wrinkling, laxity, alopecia, atrophic acne scars, and
striae with micro-needling. Both patients and observers
unanimously reported aesthetic improvements twelve
months after completing micro-needling treatment for
every aforementioned category. The minimally invasive
nature of micro-needling is enticing for both patients and
for healthcare professionals because of its efficacy, low
complication rate, and relative simplicity. For patients, the
minimal pain of the microneedles is also an alluring benefit
over more invasive alternatives.4
At the senior author’s ( JWF) practice, micro-needling is
used to treat aesthetic concerns ranging from static wrin-
kles, atrophic acne scars, to a wide range of other scars.
Occasionally, micro-needling will also be utilized for
re-pigmenting skin. Patients opt for micro-needling to treat
these aesthetic concerns because of its positive results as
well as its relative painlessness. Our results from 100 pa-
tients sampled, who underwent micro-needling, have been
overwhelmingly positive. Like the study, we encountered
few complications other than prolonged erythema and oc-
casional swelling. Aesthetically, our patients also experi-
enced consistent improvement and demand for retreatment
has been high. To improve results, the author of the study
employed topical platelet rich plasma (PRP) after micro-
needling. While the results are significant, we would have
liked to see a head to head, blinded comparison between
the use of PRP vs placebo. Given the use of microneedles
release a variety of growth factors, including platelet
derived growth factor, PRP may not add statistically signifi-
cant benefit.5-8
We congratulate the author for presenting a very
elegant, well controlled study on a powerful tool in cosmet-
ic medicine. We believe this study validates the importance
of adjunct cosmetic procedures in the plastic surgery
patient, as the results shown could not be achieved by
surgery alone. Micro-needling shows promise as an effec-
tive, minimally invasive tool for long-lasting improvements
in skin appearance. The data found on micro-needling
depth penetration and time-dependent dissemination of
macromolecules are an important step in the advancement
of micro-needling for use in other applications such as vac-
cines and delivery of medication impermeable to the skin.
Disclosures
Dr Few serves on an advisory board for Allergan, Inc., (Irvine,
CA) and Mentor (Santa Barbara, CA); as a remunerated consul-
tant for Allergan, Inc., Medicis (Scottsdale, Arizona), Palomar
(Westford, MA), Ulthera (Mesa, Arizona), and Venus Concept
(Toronto, Ontario Canada); as a remunerated speaker for
Allergan, Inc., Ulthera, and Venus Concepts; and has received re-
search grants as an investigator for Allergan, Inc. and Medicis. Mr
Semersky declared no potential conflicts of interest with respect
to the research, authorship, and publication of this article.
Funding
The authors received no financial support for the research,
authorship, and publication of this article.
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Downloaded from http://asj.oxfordjournals.org/ by guest on August 16, 2016
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