Ideal Needling Depths by Daniel Clary, VP of AnteAGE Education
What is the ideal depth of needle penetration with professional microneedling treatments to yield maximum results and mitigate adverse outcomes?
One of the most discussed topics within the professional aesthetic space is how to properly perform a microneedling treatment. With the surge in these professionals posting their treatment videos on social media, it has become quite evident that there is a significant disconnect between what professionals (including medical providers) think a microneedling session should look like, and what the science actually tells us. This is predominantly surrounding the topic of how deep a treatment needs to be in order to achieve efficacy, with efficacy being measured as an improvement in skin texture and a reduction of fine lines/wrinkles. While the majority of professionals are trained in the basics of how to perform the treatment (usually by the manufacturer of the device they are using), what is lacking in those educational efforts is a deeper understanding and exploration of skin physiology, cellular/molecular biology, and a modern day look at wound healing, especially in the aesthetic context. What seems to be dogma in the aesthetic community is that microneedling requires deep needle penetration, a release of massive amounts of blood and blood-derived molecules, and that mass destruction leads to maximum results. This is, for the majority of clients seeking out this treatment for anti-aging purposes, unequivocally false. In fact, utilizing this approach as the standard, can lead to unintended consequences, and at worst, leave a client worse off than they were before they started treatments. Microneedling is a wonderful tool for facial rejuvenation, but without a grasp on the science that explains why and how this modality is so unique compared to all the rest, you will never be able to tap into the true regenerative power it yields.
The “deeper is better” mindset is rooted in the idea that in order to stimulate collagen production in the skin, the skin must be injured, burned, inflammation triggered, and that the cells that produce the collagen (the fibroblasts) must be directly targeted and damaged. While yes, skin after being injured does produce collagen (we will discuss what type of collagen this is later), the idea that this is a prerequisite really defies all physiological logic. That would mean that a child, with all that abundant youthful collagen in their skin, is being bombarded with constant injury in order to get that collagen. Silly thought, right? The Fibroblast cell, the most dominant cell in all connective tissue, is a very intelligent, but extremely defensive cell, by nature. The quality and quantity of protein (collagen, elastin) it produces, all depends on the “instructions” or message it has been given. Collagen comes in many forms, and it is the ones with tensile strength we are looking for, not the vulnerable ones produced when excess damage occurs. It is a fact that the amount of collagen these cells produce (naturally) starts to decline in our early twenties, and the goal in anti-aging is to get them to produce more of it as we age, but depending on how we approach this, we are talking about the difference between healthy, youthful collagen production, and warped/inflexible collagen production (scar tissue). Microneedling, when performed correctly, empowers the skin, and the Fibroblasts, to produce and deposit the type of collagen we had in our youth, and that leads to healthy, radiant skin long term. This all has to do with the way your skin cells talk to one another.
The entire AnteAGE brand was founded on the science of cell signaling, or the ability your cells have to communicate with each other. They are literally exchanging dialogue with each other all day, everyday. This “language” that your cells use are known as growth factors & cytokines, tiny messenger protein molecules acting as “text messages” between cells. It is a well-established fact that all biological activity that happens in your body, between your cells, is mediated and controlled by these molecules. One thing to remember is that while the cells produce hundreds of these proteins, not all are created equal. Some are highly inflammatory, and some are extremely anti-inflammatory. Our topical products are formulated with these potent biological signals (the good anti-inflammatory ones), to effectively allow the cells in your skin to start “talking to each other” like they did in our youth. And this is exactly what microneedling can achieve, and what it was fundamentally designed to do, IF you perform the procedure correctly. So what exactly does that look like?
Let’s first start with the approach to this treatment I mentioned above. Why do professionals go deep into the skin with these needles (usually 1mm+ deep, often going to 1.5-2mm)? As I stated before, they are under the impression that you have to both injure the fibroblast directly (this is located deeper in our skin at the dermal level), and trigger the release of blood and blood derived molecules to get “results”. Have you ever seen those professional microneedling videos where the clients face is dripping with blood? Are you cringing like we are? What happens when this level of damage is created in the skin? In the simplest explanation, inflammation is what happens. And a ton of it! Inflammation is actually pro-aging, and we know that healing in the presence of inflammation, in all tissues, is pro-fibrotic. That is scar tissue. The growth factors and cytokines that are contained in your blood (inside the platelets), are extremely inflammatory. So the more you release, the more inflammation is present. So while yes, they are messenger molecules, they aren’t the ones we want in order to achieve youthful skin. Remember when I mentioned that there are good and bad growth factors? Blood contains the bad ones, at least for anti-aging. And then because you are directly damaging the fibroblast cell, it will respond defensively, pumping out that wound collagen mentioned earlier, which, because of the inflammatory environment you have now created, will become fibrotic (scar) tissue. Is any of this sounding appetizing?
So why do they keep doing this? I am sure most don’t have the deeper knowledge I am providing, and the reality is that, unfortunately, this approach CAN lead to a temporary cosmetic benefit. What do I mean? When your skin is that inflamed, it can lead to inflammation-mediated edema (swelling), that can “seemingly” make your wrinkles disappear for a period of time. Once that initial inflammation goes down, the underlying skin will reveal the true damage, and the wrinkles you thought were gone can present themselves again, often worse than they were before. So, you are left with skin that is looking older than it should, and underlying fibrotic collagen that is, in all honesty, not pretty to look at as we get older. The long term impact this approach to microneedling has on the health of your skin needs to be taken into consideration.
But if we do not go that deep, and there is no blood, will we get the results we are looking for? If the fibroblast is not directly injured, how will they produce collagen? This is where the science of cell signaling comes into play, and this is why microneedling, as opposed to all other advanced skin rejuvenation modalities, is the only technology that effectively enhances healthy cell signaling for true regenerative benefits in the skin. It is not only the Fibroblast cell in your skin that can communicate, but all the cells in your skin (outside of your surface corneocytes) have the ability to “talk” to every other cell. In fact, it is the epidermal keratinocyte that is truly king in this context. They are the MASTER communicating cells in your skin. And it is THIS cell that we are trying to target when we microneedle the skin. Specifically, the target site for the majority of microneedling procedures performed, is the dermal-epidermal junction, or DEJ. This is the basement of your epidermis, where the epidermis and dermis meet. The basal keratinocytes that reside here, when pierced with the needles, will release their own growth factors and cytokines, which will then travel to ALL the other cells in the skin, including the dermal fibroblast, coordinating their behavior and activity. That means that yes, you will get collagen produced when you perform this procedure in this way! Those growth factors that you released will attach to those fibroblasts, telling them to produce collagen. Not by forcing/injuring them (wound, warped collagen), but by empowering them via natural physiological processes (youth collagen). This approach is not only substantiated by the science, but it leads to the most positive clinical outcomes for the client, while reducing the dangers of deep needling.
So what depth does the DEJ reside in? On any given area of the face, with age and skin thickness taken into consideration, the DEJ is anywhere between 0.5mm to 1mm MAX. That means that you are mostly working in the 0.5-0.7mm range, with 1mm depths utilized on thicker parts of the face like the cheeks. In fact, the most exciting data shows us that when you needle in these depths, you maximize the amount of collagen-promoting growth factor release, all while, get this, actually REDUCING inflammation and inflammatory pathways. That is an incredibly intelligent modality that no other technology can come close to. This is regeneration at its finest, that, unfortunately, will go away the minute you enter into deeper territory. As a side note, those deeper depths are not completely off limits, especially when it comes to treating scar tissue. Mechanical breakage of that deep seated fibrotic network is needed, but perfectly timed with the right topical adjuvants to minimize more scarring from happening. That is where topically applied growth factors come into play, for all microneedling treatments. Microneedling on its own, can only get you so far. But when you add the right topical growth factors to the skin to add to the ones the cells released when needled, that cell communication gets amplified to a magnitude of unimaginable proportions. This leads to the best possible clinical outcomes and results for your clients.
Microneedling, as I mentioned, is a significantly advanced tool for anti-aging aesthetic objectives. It not only respects the skin barrier (needles are entered in a sort of a fractional way, leaving the barrier intact), but will yield amazing regenerative power when performed correctly. It is not always easy going against the status-quo, but when it comes to science and safety, the best approach is a well-informed and educated approach. Microneedling can work FOR your skin, not AGAINST it, only if you allow it to.