Wrinkles are lines, folds, or ridges in the skin caused by aging, sun damage, poor hydration and nutrition, and smoking. Wrinkles form where elastin is decreased and subdermal fat is reduced. Matrix metalloproteinases (MPPs) have been implicated as they increase in concentration with age. The MMPs include collagenases (cleaves fibrillar collagen), gelatinases (cleaves IV collagen and gelatin), and stromelysins (cleaves extracellular matrix proteins). With age, the balance between creation and destruction of dermal proteins shifts to destruction.
The treatment of wrinkles has historically taken three paths:
- Take off the peaks – through surgical or laser dermabrasion, now a largely abandoned practice.
- Elevate the troughs – by adding dermal volume either endogenously by Dermapen treatment or exogenously by injecting dermal fillers.
- Change the tension – through surgical lifts or botox.
Both Dermapen and dermal fillers have been used for fine lines and wrinkles. Both treatments elevate the troughs of wrinkles. Dermapen is used for both dynamic and static wrinkles; fillers are generally reserved for static wrinkles. (Botox is used for dynamic wrinkles.)
|Indications for Use||Fine lines and wrinkles||Fine lines and wrinkles|
|Mechanism of Action||Micro-injuries to the dermis causes the body to produce its own collagen||Volume filler injected into the skin|
|Onset of Effect||30 days||Immediate|
|Duration of Effect||> 2 years||3- 18 months|
|Cost||$200 to $800||$800 to $4K|
|Downtime||1 day||1 day|
|Expected Side Effects||Erythema||Lumpiness
|Skin testing 28 days prior||Not required||Required for bovine collagen (Zyderm), porcine collagen (Evolence), PPLA (Sculptura)|
|Operator training||Operator independent by engineering and Needlelogics Certification||Operator dependent. Some filler companies require certification.|
Dermapen produces controlled micro-injuries that reengage the healing cascade and produce collagen and elastin in the dermis. The body’s own collagen adds volume to the dermis (Aust et al., 2008). Histological examination reveals a thickening of the dermis by 50% and an increase collagen and elastin deposition. The collagen has the normal basket weave structure. Dermal fillers generally thicken the dermis by the physical volume of the introduced substance. There are exceptions, however. Calcium Hydroxyapatite (Radiesse) provides a scaffold for the body’s collagen. Polylactic Acid (Sculptura) stimulates collagen production as the particles degrade. Because exogenous substances are injected into the skin, irritant and allergic reactions are possible with dermal fillers.
The onset of the dermal thickening effect depends on the mechanism of action. Dermapen uses the body’s healing to produce collagen and dermal thickening, like the fractional laser, it takes time for the patient to see the effects of treatment. Collagen production continues for 60-90 days (Aust et al., 2008; Aust et al., 2010). The dermal thickening effect for most dermal fillers is immediate (except for PPLA and Calcium Hydroxylapatite).
Patients will be impressed with the Dermapen treatment in 30 days, so the clinician must tailor the expectations, perhaps by marketing a multiple treatment package. The delayed results are similar to fractional laser or RF treatments.
|Type of Dermal Filler||Trade Name Examples||Specific Side Effects|
|Collagen||Zyderm (bovine)Evolence (porcine)||Allergic reactions 3%
Requires skin testing 28 days prior to treatment
|Polylactic Acid (PPLA)||Sculptura||GranulomaBumpiness* Thickening is produced by collagen production stimulated by degradation of PPLA particles, results seen in 4-6 weeks|
|Calcium Hydroxylapatite||Radiesse||* Provides a scaffold for collagen deposition, delayed results|
The side effects of Dermapen are predictable and mild. The down time after therapy is a matter of just a few hours and consists of mild erythema with a subjective feeling of tightness – like that of a sunburn. With careful selection of topical solutions, the incidence of allergic reactions is minimal. The actual filler effect is provided by the body’s own collagen, so reactions due to chronic exposure don’t exist.
The side effects from dermal fillers are composition specific. They include allergic reactions, granuloma formation, and abscesses.
The Dermapen is engineered to be operator independent. With the Needlelogics Certification, results are optimized and forseeable
Results from dermal fillers are operator specific. It is critical to distribute the filler effectively without producing lumps or bumps. There are anecdotal reports of Dermapen being used to correct the lumps and bumps left by dermal fillers.
Aust MC, Knobloch K, Reimers K, Redeker J, Ipacktchi R, Altitas MA, Gohriz A, Swaiger N, Vogt PM (2010) Percutaneous collagen induction therapy: An alternative treatment for burn scars. Bruns 36: 836-843
Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM (2008) Percutaneous collagen induction therapy: An alternative treatment for scars, wrinkles, and skin laxity. Plast and Reconstruct Surg 121: 1421-1429.