|Needling has come a long way since 1995 when skin needling came onto the scene after Andre Camirand first published his experience about making scars less visible by “dry needling”. When I extended the concept to rejuvenating skin in 1997, doctors ridiculed the idea that a simple pinprick could have such powers. Like Camirand, I started by using a tattoo artist’s device with a flat array of four needles that could penetrate 1- 2 mm into the skin.
I had previously been trained by the doyen of tattoo artists so I could adapt that skill to safely needle patients’ faces but I learned that intensive needling put the patients out of social circuit for up to 10 days and the procedure took a long time to do. I also noticed that thick scars didn't change sufficiently. I reasoned that if one could use a roller with 3 mm needles, one could needle deeper and probably faster and because there would be fewer holes, the skin would return to a normal appearance sooner. Intensive treatments this way looked almost the same as using a tattoo gun but the healing time was reduced to 5 -7 days.
By 1999 I had a sufficient number of clinical results to make a presentation at the International Plastic, Reconstructive and Aesthetic Society conference in San Francisco. The lecture theatre was packed with standing room only and one prescient comment was that my lecture was the most provocative and exciting idea for the coming century. I believed the clinical results indicated that there was regeneration of tissue and in particular restoration of the normal lattice arrangement of the fibres in the dermis. Regeneration had never before been described as a result of any intervention and I ended up explaining this in a long interview on Channel 5 TV. The first publication of skin needling was in the Hot Topics section of Aesthetic Surgery journal.
However, there was no proof of this until Aust took up the challenge to study skin needling and his team discovered that the release of the TGF-beta growth factors in simple wounding and in skin needling were diametrically different.  In skin wounds, TGF-beta 1, 2 and 3 are all released but the TGF-beta-3 fades away within 24 hours and TGF-beta 1 and 2 persist for a week or two. In skin needling the reverse situation applies and this has been confirmed in repeated tests: TGF-beta 3 persists at raised levels for up to two weeks whereas TGF-beta 1 and 2 fade away within 24 hours. This detail provoked the idea that needling again a week later would increase the effects of TGF-beta-3 and produce results that were superior to needling at longer intervals.
However, in order to do needling as intensively we needed to fully anaesthetise the skin and that requires sedation because it can be very uncomfortable just to get good anaesthesia of the face and neck. The question then arose about how to make needling easier for the patient and also make it less dramatic in appearance.
By using rollers with needles that protruded only 1.0 mm we could do skin needling under simple topical anaesthesia. That made needling more accessible and because we worked less intensively the clinical and social sequelae would be easier to tolerate. I assumed that with an intensive needling one makes about five times more holes in the skin than we could by using topical anaesthesia so I recommended six treatments done at weekly intervals. After several months I realised that this regime produced results very similar to one intensive treatment but more conservatively minded people worried that frequent treatments would negate the benefits of needling.
Indeed, some “authorities” condemned weekly treatments even though they had no clinical evidence at all. Aust and colleagues doubted that needling at weekly intervals had any value but fortunately researched this and discovered that needling at weekly intervals gave far superior results. They also showed without doubt that topical vitamin A, and they used Environ vitamin ACE oil in their studies, virtually doubled the benefits of needling. There is no clinical doubt and scientific investigation has proved that the best way to induce changes by needling is to use topical vitamin A and repeat the needling within 7 days.
I believe that the reason for this is that one builds up the concentrations of TGF-beta-3 to levels unattainable by even the most intensive needling because each needling experience adds to the previous levels of TGF-beta-3.
The challenge now is to optimise needling and I believe that using well-selected peptides can enhance our results. My clinical research shows dramatically better results when I add a special cocktail of peptides. I believe we should not use growth factors themselves, but rather molecules that will induce the natural balance of growth factors. I am currently researching needling every second or third day and the indications are that this regime gives the greatest tightening of skin that I have ever seen. Needling does something clinicians have craved for centuries: it causes regeneration and rejuvenation and we will learn to harness its powers more effectively in the coming years.
- Camirand, A. and J. Doucet, Needle dermabrasion. Aesthetic Plast Surg, 1997. 21(1): p. 48-51.
- Fernandes, D., Percutaneous collagen induction: an alternative to laser resurfacing. Aesthet Surg J, 2002. 22(3): p. 307-9.
- Ferguson, M.W. and S. O'Kane, Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos Trans R Soc Lond B Biol Sci, 2004. 359(1445): p. 839-50.
- Aust, M.C., et al., Percutaneous collagen induction-regeneration in place of cicatrisation? J Plast Reconstr Aesthet Surg, 2010.Zeitter, S., et al., Microneedling: Matching the results of medical needling and repetitive treatments to maximize potential for skin regeneration. Burns : journal of the International Society for Burn Injuries, 2014. 40(5): p. 966-73
Dr Des Fernandes in NZ
|There are not many people who can claim to be true pioneers, but Dr Des Fernandes is one such man. Dr Fernandes has become an internationally recognised figure in the worlds of anti-ageing skincare, medical aesthetics and cosmetic surgery. One of the champions of the use of vitamin A in skincare and a leader in the field of medical needling, he has a list of prestigious published papers under his belt and lectures around the world.
Dr Des recently made Insignia’s “Top 10 Plastic Surgeons in the World” list, a nod to his pioneering techniques in the cosmetic surgery field. He is also the creator of the world-famous DF Machine, which was the first machine to combine pulsed Iontophoresis and Sonophoresis in a cosmetic application.
In recent years the use of medical rollers as a skin rejuvenation technique has grown in popularity but Dr Fernandes was the first to develop a device for this type of skin needling – the Roll-CITTM. “Originally the Roll-CITTM was designed purely for medical use but over the years Dr Fernandes has devised rollers for salon and home use.
In 2015, Environ celebrates its 25 year milestone and PSB is pleased to announce that Dr Fernandes will be in Auckland on Monday 29th of June. Dr Des will conduct a hands-on needling demonstration for stockists, followed by an open to the industry session in the afternoon. He will also perform a private needling session the following day for winners of the Environ Incentive.
For more information please contact: firstname.lastname@example.org
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