shutterstock_230184487Microneedling or percutaneous collagen induction therapy is here to stay, according to experts speaking at the annual meeting of the American Academy of Dermatology in San Francisco.

In fact, Tina Alster, MD, director at Washington Institute of Dermatologic Laser Surgery in Washington, and clinical professor at Georgetown University Medical Center in Washington, DC, performs microneedling daily. She chooses it frequently for the treatment of perioral lines because it is not only effective, but also much less expensive than lasers.

Technique is fundamental to a superior outcome with microneedling, Alster says.

Topical lidocaine is first applied, followed by a 30-minute delay. Next comes Hyaluronic acid to enable the microneedling device to glide over the skin smoothly, Alster says. Refrain from applying vitamin C preparations prior to performing microneedling, for these preparations can irritate the skin, she adds. Pinpoint bleeding is relieved by dabbing the skin and applying ice and/or soothing balms.

“I go back and forth over an area, north and south, east and west, and diagonally,” she explains. “It can be performed around the eyes as well (to address crow’s feet).”

Post-treatment, patients appear pink in areas that have been exposed to microneedling, she says.

Microneedling for melasma?

Microneedling can be used in darker skin types, unlike many lasers, and can be a treatment for hyperpigmentation and melasma, adds Doris J. Day, MD, an associate professor of dermatology at New York University/Langone Medical Center and director at Day Cosmetic, Laser and Comprehensive Dermatology.

“You are promoting skin cell turnover and helping drive the melanocytes up and out of the skin, without creating heat,” Day tells Plastic Surgery Practice. “It makes sense to use Hylauronic acid because it’s a humectant and is organic to the skin,” Day says. “It glides well, and if it penetrates through the skin, then there is an added benefit.”

Alternatively, clinicians can use a topical agent like ultrasound gel or any agent that is inert and water-based before microneedling, Day says.

“Microneedling is coming back in vogue,” says Seth Matarasso MD, a clinical professor of dermatology at the University Of California School of Medicine in San Francisco, who acted as course director. “You get rid of a lot of cutaneous defects.” Patients with recent skin infection, shingles, or HSV (herpes simplex virus) outbreak are not candidates for microneedling.

To be extra safe, Matarrasso might take the added step of pretreating patients with an antiviral agent if they have had fever blisters in the past.