Conventional topical techniques such as lasers, dermabrasion, chemical peels for the treatment of facial scars, pigmentation, stretch marks on the tummy cause injury and damage to the epidermis, which is the largest, highly specialised skin organ that offers a complex barrier to the outside world. How can we rejuvenate not only the skin of the face but also the hands, arms, trunk and legs and still maintain the epidermis intact? How can we induce new collagen formation for all skin types including darker skin types IV-VI without the fear of post-inflammatory pigmentation?

Percutaneous Collagen Induction Therapy [P-CIT] is a medical microneedling technique that lends itself to achieve collagen induction by causing micro-trauma to the epidermis and dermis thereby inducing an inflammatory response to injury that heals with further deposition of collagen. The needles penetrate through the epidermis but do not remove it, so the epidermis is only punctured and will rapidly heal. The hallmark of this novel technique is maintaining an intact epidermis and undamaged dermal papillae coupled with the initiation of a fibroblastic response to wound healing resulting in the synthesis of new collagen and elastin fibers within the reticular dermis without the adverse effects of thinning the epidermis and post-inflammatory hyperpigmentation or PIH.

Indications for Percutaneous Collagen Induction Therapy using microneedles include:

1. To restore skin texture and firmness in the early stages of facial aging. The skin tightening results from increased collagen and elastin deposition within the deeper layers of the dermis. Other areas that can be treated include the neck, arms, abdomen, thighs, areas between the breasts and buttocks.
2. Fine wrinkles around the eyes, lower eyelids, forehead and upper lips.
3. Photodamaged skin with pigmentation.
4. Acne scarring.
5. Reducing stretch marks and tightening loose skin after childbirth.
6. Laxity of skin in the arms and tummy after liposuction and Thermage.
7. Accelerate transdermal penetration of medically recommended topical cosmeceuticals.
8. Scars following accidents and burns.

Most patients seeking skin rejuvenation have physical signs of photoaging from ultraviolet sun damage. Others have pigment scars after acne remission and epidermal thinning from previous skin peels and laser treatments. Priming of the skin epidermis with topical Vitamin A and C prior to medical epidermal microneedling is advised. Vitamin A is believed to promote normal cellular function, proliferation, and differentiation of cells and Vitamin C promotes new collagen formation and is a powerful antioxidant. Improved skin health promotes a more sustained response to microneedling. Vitamin A is essential for the normal physiology of skin and it is destroyed by daily exposure to sunlight thereby diminishing its important influence on skin metabolism.

The inflammatory response of the skin epidermis and dermis following microneedling results in increased cellular proliferation involving various blood cells such as neutrophils, leucocytes, monocytes, keratinocytes, and dermal fibroblasts which in turn continue to influence and be influenced by the release of growth factors. Recent studies on wound healing have shown the influence of Transforming growth factor (TGF)-b in the induction of angiogenesis or new blood vessel formation following injury to the skin with increased extracellular matrix protein production. Keratinocytes stimulate growth of the epidermis and dermal fibroblast proliferation results in increased collagen deposition which in turn results in healthier, smoother skin that is firm in texture with improved natural colour.

Post P-CIT management involves daily topical application of vitamin A and transdermal delivery of Provitamin C using iontophoresis technology. This allows maximum penetration of these essential vitamins as well as other liposomal serums for new cell growth, elastin and collagen production. P-CIT can be repeated, if required, until the desired aesthetic result is obtained.

Microneedling Facts:

• Minimal risks
• Cost effective
• Short healing period within weeks
• No ablation of the epidermis
• Out-patient treatment
• Can be repeated without any restriction
• All skin types can be treated

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