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Microneedling | Medical or Cosmetic Treatment ?

Written by Dr Lance Setterfield on February 23rd, 2015.      0 comments

Dr Lance Setterfield with Florence Barrett-Hill from Pastiche Training SpaBeauty NZ Dr Lance Setterfield training with
Florence Barrett-Hill from
Pastiche Resources & Training.
I am writing this post because of my grave concern over some of the current actions and statements made by those in the microneedling industry and/or those who are microneedling treatment providers. While I respect and appreciate the passion and sincerity of those who wish to contribute to the health and well-being of others suffering from damaged or aging skin, at the same time there has often been an over-zealousness that has prompted some to cross the line into areas that, in the long run, may damage or even cause grave injury. Remember, our first obligation is to do no harm.

Medical microneedling is just as it says...a "medical" treatment, not merely a service on a menu.
Before one even brings this treatment into one's practice, serious foundational knowledge and training MUST be acquired...and I do not mean training that comes on the instruction leaflet accompanying a needling device, or from the device company on how to use their device, and especially NOT going on Facebook and asking a group what one should do for a particular problem their client has before they show up for their medical microneedling appointment, and sometimes without having been seen beforehand.

Imagine a doctor going on Facebook and asking his "friends" what he should do for a patient who is coming in for high blood pressure or for cancer. This analogy only applies in the respect that, as I said, medical microneedling is a MEDICAL treatment, and not some sort of intensive facial.
Just because estheticians are currently allowed to do these treatments does not detract from the fact that this is serious. One must know "what" is involved when dealing with the underlying causes of skin ailments and the "whys" and "hows" to connect the dots before ever attempting to treat someone with this very invasive treatment.

If, and ONLY if, estheticians have this basic foundational knowledge pertaining to needling specifically, then I am all for them continuing to perform this treatment.

Medical microneedling penetrates the dermis, and the application of substances (within the first 24 hours) which could be contaminated is never an option. This could cause infection or an immune response where the risks can be extraordinarily severe.

(I refer to an article from the
Daily Mail Online).

Dr Lance Setterfield Microneedling Expert SpaBeauty NZ Articles
To apply the latest cream or "recipe" from someone's blog because it "sounds" good, or because there are pictures that show improvement, is malpractice. Medical needling has serious complications and we have to work within strict guidelines or this will be taken away from estheticians.

I have concerns about education & training in microneedling that focus only on the "How's", and NOT the "If's, When's, or Why's". Judging by some of the comments that ensued, there seems to be some uncertainty about “scope of practice” with microneedling. According to the Health Professionals Act in Canada, members of a regulated profession are granted specific authority to do invasive or higher risk activities based on their education, experience, and demonstrated competence. In most parts of the world, each jurisdiction has laws, licensing bodies, and regulations that describe requirement for education and training, and define scope of practice.

Perhaps the greatest misunderstanding in all of this is assuming that because estheticians in some Countries or States are permitted to use microneedling devices up to a length of 0.5 mm, they are automatically working within their scope of practice. Being allowed to perform a treatment is one thing. Being able to do it is quite another.

First, while needling is classified according to needle length, for the most part it is "not the length of needles" that makes this high risk, it is enhanced penetration of "inappropriate product ingredients" that trigger an immune response in some people. Does the practitioner have specific education pertaining to product ingredients in the context of microneedling?

Second, at present, 0.5 mm devices are a gray area. Medical = dermal treatments. Cosmetic = epidermal treatments. The border between the dermis and the epidermis undulates, so when the wave curves up towards the surface, the needle enters the dermis. When the wave curves down, the needle is in the epidermis. It is impossible to say what percentage of the treatment involves the dermis. It could be argued that the majority of the time a 0.5 mm is only entering the epidermis, given the fact that most electronic devices are too weak to penetrate to the set depth of 0.5 mm. Hence, estheticians are allowed to do these treatments in many parts of the world. However, this is "living on the edge". If (when) they cross the line (into the dermis), does the practitioner have specific education to deal with whatever may be involved at this unintended level of treatment? (Infection control, recognizing complications, etc.)

Third, while much of an esthetician’s training pertaining to skin can be extrapolated to microneedling, this treatment modality has some specific “quirks” that are not taught at colleges and not even at medical schools. Does the practitioner have specific education pertaining to these “quirks”? There are also several techniques involved from a practical hands-on perspective. Does the practitioner have adequate experience and have they demonstrated competency with practical hands-on techniques?

If the answer to any of the above questions is "no", then that person is not practicing within their scope. This applies to all practitioners (doctors, nurses, etc.), not just estheticians.

Finally, from a legal perspective, when things go wrong, expert witnesses (your peers) are called upon to decide whether or not your treatments fall within the realm of "accepted standard practice". While patients may demand a holistic approach to care, "unorthodox" treatments (depending on the laws governing your jurisdiction) may invariably make you liable in a clinical setting.
Canadian Skin treatment specialist Dr Lance Setterfield is researching the effects of dermal rolling of the epidermis (cosmetic needling) and dermis (medical needling) combined with pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients.
The goal of the research is to narrow down the variables (e.g. depth of needles, frequency of treatment, topical ingredients and timing of their application, natural hindrances, synergistic modalities and timing of use) to facilitate optimum results.

Dr Lance Setterfield is an International Authority & Educator on Microneedling & Author of
The Concise Guide to Dermal Needling.

Dr Setterfield is the Medical Director of Acacia Dermacare: 

Join Dr Lance on Facebook here.
Dr Lance Setterfield SpaBeauty NZ Experts




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