Before discussing the advantages of Dermapen I would like to touch on the history of needle dermabrasion and micro needling. Let’s start with history of micro needling..
The earliest forms of micro needling were reported by acupuncturists in China, centuries ago. The concept of using needles for the general health of individuals extended to other parts of the world, particularly France. Soon, both countries were using needles to stimulate specific acupuncture points to correct imbalances in the flow of natural energy through channels known as meridians. This same practice is the basis of acupuncture today. Micro needling is an age old, tried and true method that was basically being administered in ancient times but with motionless needles.
The concept of trying to get through the skin or trying ot get material through the skin return, return to needles was abrasion techniques which could be many different forms from dermabrasion where you’re using a wheel to take off layer of skin or a deep chemical peel. The first usage of resurfacing with abrasion with rotating wheel was in Germany in 1905 by chromayer. In the US, the concepts of using a needle was begun about 1995 by two brothers, two derms. Orantrek in Philly. They were using a bevel needle to release scars and wrinkles. They were not thinking of using it to make the skin better, but rather for subdermal releases in 1995. We now move to the modern era of micro needling. It’s defined as using either solid or hollow needle of the appropriate length and diameter to go through the skin epidermis/dermis and they were using these microneedles which really had to wait until technology caught up to make it because it’s so tiny, like 300 microns diameter. If you try to make a hollow needle that small, 0.3mm it’s impossible until you have the technology that can make it. so micro needling was really based on the ability to technologically make these needles that transferred it from a macro to a micro needle. To go through the epidermis, into the dermis for two reasons: the first reason, and this is a dry micro needling technique, you use the needle by itself and the needles can be a series of needles or a single needle, but you’re just puncturing the epidermis and relying upon the ability of the skin to respond to that by the normal wound healing efforts. You bring in the whole cascade of wound healing, all phases of normal healing, and therefore eyou make the skin better. that’s a dry needling technique.
That technique really was used in the early phases of micro needling and the early phases began in 1996. there was a derm, and I’ll send you this, but Dez Fernandez, who had a round platform stamp and in that stamp he embedded about 25 needles which protruded about 1-2mm from the surface. He stamped the patient under local. It was only used for skin rejuvenation based on the cascade of normal healing. A year later in 1997, a plastic from montreal used the needles not for making skin better but to treat scars. When you look at mature scars, they are white in color. When he used the micro needling technique, he brought in melanocytes to populate the scars to make them look as close to the surrounding skin. then he graduated to using the tattoo gun. He would use the gun like the regular tattoo artists and put pigments on the skin and drive in the pigments to try to blend the hypo pigmented scars to become more natural in color. He just used the tattoo gun without pigmentation, he found the scar became better in terms of color but also it’s other physical characteristics, being raised and angry looking.
It began with Chinese to French to dermabrasion, to subsicision with the needle under the skin to the early phases of what we call dry needling technique. Basically all they’re relying upon was the ability to generate the normal cascades of healing to make the skin better.
The modern era of needling began about 2000. there was a german by the name of hors libel. He trademarked what is now referred to as the derma roller. He used this which is like a wheel barrel, 2.5cm maybe across, and in this wheel barrel, he placed needles that were preset to certain depths that could not be changed. Under local, he would roll this wheel barrel which had the needles sticking out of them and was able to show in 2004 that the dermis became thicker and the epidermis became thicker, and thus there was rejuvenation. This was all dry technique, just reusing the wheel over the area. The 2 points here. One, the needles were preset in depth, you can’t change the depth of the needles, and you can’t really change the speed unless you wheeled it quickly or slowly. So there is some restrictions of the wheel barrel, there were parts that you can’t get to. But the idea was good because it did show rejuvenation of the skin, epidermis and dermis.
There was a fellow by dr. Schwartz in 2006 who used the same derma roller technique and called it collagen induction therapy, and all it was was an extension of the data that if you caused the cascade of wound healing to occur, collagen would be induced to form. There was about a 200% increase in collagen just by the penetration of the needles, according to his research. He made not only was there now an increase in the new collagen, but the collagen that was seen that was new was confined to the 500 micron level of the dermis, the upper third of the reticular dermis. If you went with deeper needles, like a 1.5mm needle or 2.5mm needle, the response of the collagen would only be in the upper third. So the area you saw improvement was in upper third of the dermis regardless of the depth of the needle.
We have a plastic in 2010 who showed about 140% increase in epidermal thickness and dermal thickness. All these studies that have been presented and published show epidermal improvement and dermal improvement about 150% to 200% baseline over time.
It’s just dry technique
Yes. Dry technique.
Now comes along Dermapen, which is a company concept that begin in Australia and brought to the US where the dist rights were given to Dermppen in Utah. It is FDA approved, it’s a class 1 device, FDA cleared, micro needling device. The difference with the dermapen from the other types of micro needling devices on the market is that it’s not a wheel barrel, it’s a pen. It’s like when you have a marker, a yellow marker that’s fat, that’s the size of it. It has 11 33 gauge needles embedded into a disposable applicator. All you do is take the applicator and the disposable so it’s a one time usage per patient, and you put it on the pen and the pen has an electric motor so it’s not battery powered, it’s electrical, and the motion of the needle is up and down like a stamping effect up and down, automated up and down. The reason that’s important is that a vertical intrusion into the skin, dermis, causes less trauma then when you’re wheel barreling it. when you wheel barrel you tear the opening. A stamp just goes up and down. The beauty of this device is that on the handpiece, the pen, you can adjust the needle depth from 0.25mm in depth up to 2.5mm in depth. 0.25mm is 250 microns. 2.5 is 2,500 microns. The epidermis is only about 100 microns in depth. The reticular dermis is about 2500 to 3000 microns in depth, so if you’re on the 2.5, that’s 2500 microns, when you’re using that setting you’re on the lower section of the reticular dermis. When you’re using the 0.25 you’re just in the upper part of the reticular dermis. There is variability in the needle depth, which is important when you’re doing facial work or non facial work because certain parts of the face like the upper lip or lower lip skin is thicker. Generally we like to work at the 1.5-2.5mm depth. If you go to the upper lip skin, you’re at the 2.5 level. If you use the wheel barrel, you’re stuck. There’s only one depth. You can vary the depth during the procedure, just by pushing it, it’s marked. But you can also vary the frequency. If you want to work slowly you work at one setting, it’s calibrated 1 setting frequency. If you want to work really fast you work at the 6-7 setting. The motion is as if you’re doing Microdermabrasion. So Microdermabrasion you just slip the device over the skin in a stamp-like fashion but you just have a sweeping motion across, and the frequency is so fast that it’s making these openings to the skin as you are sweeping the device across the skin.
SO what this really means, too, is that you have to have a slippage, the slippage is something you put on the skin that allows you to move the disposable head in the sweeping motion without it getting caught. In this case we would use hyuluronic acid.
Three things that are important about the Dermapen. One is that it’s disposable, there’s no cross-contaminating. How would you clean that wheel? You can vary the speed, you can vary the depth. You have the slippage.
This is all dry technique. If you use dry whether you do it on the face, off the face which we’ll get into, that’s all you need to do and you get the result because you’re relying on the normal cascade wound healing to introduce and stimulate collagen within the dermis of the skin.
Second concept, microneedling has also been used as a trans-dermal delivery system. That means if we can put something on the skin’s surface, and we can then make the openings, these are micro openings in the dermis—and remember this is a fractional device–then we have the opportunity of whatever we’re putting on the skin to get through eh pores, the channels you make, to get into the dermis where we want the action to be. Because the transdermal delivery system. That material can be non biological materials, cosmesueticals, pharmaceuticals, to biological materials such as biological bio active peptides or even cells such as platelets, PRP. When you’re using micro needling technique, if you believe the studies, which they look pretty good, the window of time you have to get the material is about 10-15 minutes. Because the pores, the channels close within that period of time.
Are you describing a situation where the material is painted on the skin and the needle or the Dermapen is waved over that area–
Waved over the area either with the delivery, what your trying to deliver is on the skin as you are doing the procedure or as soon as you finish making the dry pass, you put the material on.
Have you used this in your office?
Oh yeah, that’s why we’re investigating it.
Are you currently comparing the two techniques for anything in particular, what are you seeing so far?
Let me get to that a little later on. Remember when you’re doing transdermal delivery without a microneedle, the molecule has to be lypophyllic. Secondly, the molecule has to be like 500 daltons in dims, but TINY. The molecule needs to be very small and lypophyllic. They do this on skin, how in the world is this material getting through the in tact stratum cornium. It goes between the cells or they go through the normal pores o fhte skin, hair follicle, sebaceous gland. It becomes an inefficient way to get materials through the in tact stratum corrnieum. All of a sudden microneedling comes on board, and it’s making these little micro pore channels. Now we have conduits to get materials into the dermis. The other way was very, very difficult. They did all different methods, but they cost a lot of money. Microneedling doesn’t cost a lot of money.
There are also issues with consistent delivery before then based on the individual’s characteristics of skin
Exactly. Once you get involved with microneedling as a transdermal device, you can put in larger molecules, cells, they don’t have to be lypophyllic, you can get greater amounts in without worrying much about microbial penetration because the pores close withtin 10-15 minutes.
Because I’m an investigator for companies such as the Harvest company, which is the PRP, there are many companies but one that I work with, we are using a wet technique. We are using the microneedling as a dry technique then using platelets or cosmeceuticals or pharmaceuticals, etc, to boost up the original cascasde of wound healing. We are using the techniques in our office and these have to be at this time, we are involved in RV studies where we are using these to treat probably we hope better for wrinkles, fine lines, rejuvenation, superficial pigmentation’s, minimizing skin pores, improving stretch marks, crepey skin, surgical scars, acne scars and even hair growth. We use the platelets to stimulate dormant hair. Before we got involved in a microneedling technique.
We’re looking at this technique, micro needling, and investigating the combined treatments of the micro needling with cosmeceuticals and even with the platelets to see if we can use the platelets s a source of growth factors which they contain a lot of. We want to improve above and beyond what they did witht eh dry technique. This is all being done under IRB approval.
It’s an old technique, but a new technique. Dry to wet.
Are you seeing improvements or results that are noteworthy at this point?
We’ve been working with this concept for about 3 months now, we’ve done patients for acne scars, wrinkles, fine lines, pigmentation, stretch marks, hair growth stimulation, and the results are encouraging. They look sometimes as good as if we were doing in part fractional lasers, IPL. We don’t have to import technology.
And the cost is significantly less.
Significantly less. The bio tip, the one-time usage, it’s like $200 something like that. I don’t know what the cost is, but I know it’s not thousands of dollars.
And with this technology we can get into the upper lip skin, the lower lip, and running into the fine lines along the lip line.
Where are some places where you wouldn’t want to use Dermapen?
I think it’s more disease related than type of skin. you can use it on any type of skin. I’ve used it on atrophic hand skin on patients who are paper thin, including the thin skin inside the arm. The skin there is thin, but not like 69-year-old patient with paper thin skin where you just rub. You have to be careful where you have active infections like acne. Collagen, you have to work a a lower setting. But I don’t see any skin that woud not use it as but you have to alter technique from the primary disease problem or if there is an actual infection.
And it appears to be color blind. You can do it in type VIs, you can use it in type I.
Safety profile? How does that improve sales or perhaps how does it help ancillary staff?
Dermapen has two models. One is only to be used by the skin care aesthetician/medical assistant. They’re only to go down to certain micron depths. The medical will go up to 2.5 mm depth. Once you’re using cosmecuetials, the skin care people can use it with Dermapen.
Describe your most dramatic result that you’ve seen with this device
For fine lines around the upper and lower lip, very good. Acne scars, very good. Crepiness to the decolatage to the inner arm area. And general skin rejuvenation. We do Dermapen and isolated event and combine that with the medical skin care programs with LED Light sources. When the skin care people are doing this, we like to do this as it’s own benefit. in other words, talk about it using it by yourself and repeat every 3-4 weeks.
You used it with IPL?
Yes. You can use it with IPLs like think of the studies that have been done, but IPL was originally developed for vessels rosacea and for pigment. It wasn’t really developed for skin rejuvenation. But it happened because of the heating ability of it. this one has no heed to tit. The amount of collagen that you get from the derma pen is equiv to using the couch. We have started that,. the combined techniques since we know what they do in isolation. That’s something that parts on platelets which are just — that falls into my category.
What would one expect with IPL and Dermapen together?
you get a synergistic effect,