Introduction to Acne Scars:
Ice Pick Scars:
- Deep pits (usually less than 2mm across).
- Extend into the skin, giving the skin an appearance of having been punctured by an ice pick.
Boxcar Scars:
- Angular scars with sharp vertical edges
- May be shallow or deep
- Most often found on the cheeks and temples.
Rolling Scars:
- Caused by damage under the surface of the skin
- Give the skin a wave-like appearance.
- Tend to be wide and shallow.
Mechanism of Action:
- Mechanically breaks down scar tissue.
- Activates cellular enzymes known as matrix metalloproteinases, or MMPs.
- Remodels scar tissue through the proper deposition of collagen and elastin.
- Addresses the red and purple discoloration associated with acne scars by increasing blood flow.
- Addresses the brown discolorations, or post inflammatory hyperpigmentation (PIH), associated with acne scars by stimulating the skin’s natural growth factors.
BEFORE
AFTER
Female | Procedures: 6 Photos courtesy of: Cathy A. Presnick, Licensed Aesthetician; A Perfect Complexion, LLC, Melbourne, FL
SkinPen® Precision and Enlarged Pores
Introduction to Enlarged Pores:
- Enlarged skin pores refer to conditions that present with visible topographic changes of skin surfaces.
Although not a medical concern, enlarged pores are a cosmetic concern for a large number of individuals - Clinical causes of enlarged pores
-
- High sebum excretion,
- Decreased elasticity around pores
- Increased hair follicle volume.
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- Other contributing factors chronic recurrent acne, sex hormones, and skin care regimen.
Crown Clinic, Mona Alqam, MD.
Mechanism of Action:
- Reorganization of old collagen fibres and laying down of new collagen, elastin, and capillaries leading to the effect of skin tightening
- Thickening of Epidermis
- Increase in levels of type I, III and VII, newly synthesized collagen and tropoelastin
BEFORE
AFTER
Female | Procedures: 4. Crown Clinic, Mona Alqam, MD.
SkinPen® Precision and Fine Lines and Wrinkles
Introduction to Fine Lines and Wrinkles:
- Considered a part of the aging process of the skin
- This aging process is accompanied with structural and functional changes in extracellular matrix components such as collagen and elastin which can result in the appearance of fine lines and wrinkles.
Zhang, S., & Duan, E. (2018). Fighting against Skin Aging: The Way from Bench to Bedside. Cell transplantation, 27(5), 729–738. https://doi.org/10.1177/0963689717725755 7
Mechanism of Action:
- Inducing the wound healing process and stimulating the skin’s natural growth factors
- Increasing the epidermal thickness and tropoelastin content
- Conducting dermal collagen types I, III, and VII
BEFORE
AFTER
Female | Age: 66 | Procedures: 2.
Photos courtesy of Christina Clarke, Registered Nurse Bio-Health & Aesthetics, Mount Pleasant, SC
SkinPen® Precision and Mottled Hyperpigmented Lesions/Patches
Introduction to Mottled Hyperpigmented Lesions/Patches:
- Common skin condition with unknown pathogenesis
- Associated with solar and hormonallystimulated melanocytes (increasing melanocyte stimulation hormone, MSH) causing uneven increases in facial melanin.
- More commonly found in races with higher pigmentation but can occur in all skin types.
V. Sheth et al, JAAD (2010) https://doi.org/10.1016/j.jaad.2010.12.046
Mechanism of Action:
- Induce keratinocyte turnover and “restore” the normal pigment activity of melanocytes in over pigmented areas.
- This occurs at the dermal-epidermal junction (DEJ).
- This DEJ-shallow dermis area is the target depth to microneedle. See arrows where microchannels are formed
Epidermal melanin density in melasma before procedure
Reduction in epidermal melanin density 1 week after microneedling procedure
Cassiano et al., Indian Journal of Dermatology, Venereology and Leprology | Volume 85 | Issue 6 | November-December 2019
SkinPen® Precision and Pigmentation Conditions
Introduction to Pigmentation Conditions:
Solar lentigines occur due to excessive production of melanin pigment which results from overexposure to UV rays from the sunlight or tanning beds
Crown Aesthetics, data on file ; Global Aesthetic Improvement Scale (GAIS)
Mechanism of Action:
- Induce keratinocyte turnover and “restore” the normal pigment activity of melanocytes in over pigmented areas.
- This occurs at the dermal-epidermal junction (DEJ).
- This DEJ-shallow dermis area is the target depth to microneedle. See arrows where microchannels are formed
Courtesy of Rosenpark Research, Dr. Sonja Sattler
SkinPen® Precision and Stretch Marks
Introduction to Stretch Marks:
Stretch marks can be caused by an overextension of the skin. Can be found on men and women but 2x more frequent on women. There is little evidence for avoidance other than well moisturized skin. Stretch marks tend to start as red discoloration and age to atrophic white stretch marks
Mechanism of Action:
- Promotes removal of old damaged collagen
- Induces keratinocytes proliferation that releases growth factors to promote collagen deposition by the fibroblasts and elastin deposition
- Modulates the expression of several genes in the skin (vascular endothelial growth factor, fibroblast growth factor, epidermal growth factor, collagen type I and III) that promote extracellular matrix remodeling
BEFORE
AFTER
Kui Young Park et al. Dermatol Surg 2012;38:1823–1828
SkinPen® Precision and Surgical Scars
Introduction to Surgical Scars:
“Each year in the developed world 100 million patients acquire scars, some of which cause considerable problems, as a result of 55 million elective operations and 25 million operations after trauma. There are an estimated 11 million keloid scars and four million burn scars, 70% of which occur in children.”. There are 3 main types of scars:
Hypertrophic Scars:
- Excessive collagen deposits appear raised, but not to the degree observed with keloids
Keloid Scars:
- Can appear as a firm, rubbery lesion or shiny, fibrous nodules
Contracture Scars:
- Are characterized by extremely tight skin that can restrict your ability to move
Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003;326(7380):88-92. doi:10.1136/bmj.326.7380.88 https://www.providencefacialplastic.com/scar-revision philadelphia/
Claytor, R. Brannon M.D.; Sheck, Casey Gene D.O.; Chopra, Vinod M.D.. Microneedling Outcomes in Early Postsurgical Scars. Plastic and Reconstructive Surgery: September 2022 – Volume 150 – Issue 3 – p 557e-561e doi: 10.1097/PRS.0000000000009466
Mechanism of Action:
- Mechanically breaks down scar tissue.
- Activates cellular enzymes known as matrix metalloproteinases, or MMPs.
- Remodels scar tissue through the proper deposition of collagen and elastin.
Alster, Tina S. M.D.; Li, Monica Ka Yi M.D. Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up, Plastic and Reconstructive Surgery: February 2020 – Volume 145 – Issue 2 – p 358-364 doi: 10.1097/PRS.0000000000006462
BEFORE
AFTER
Surgical scar on the nose before (left) and 6 months after (right) two microneedling treatments. Global Assessment Score = 4.
SkinPen® Precision and Hypopigmented patches
Introduction to Hypopigmented patches:
- Hypopigmented patches occurs when pigment-producing cells (melanocytes) die or stop producing melanin.
- The involved patches of skin become lighter or white. It’s unclear exactly what causes these pigment cells to fail or die.
- It may be related to:
- A disorder of the immune system (autoimmune condition)
- Family history (heredity)
- A trigger event, such as stress, severe sunburn or skin trauma, such as contact with a chemical
Mechanism of Action:
- Induce the activation, migration, and/or proliferation of melanocytes into hypopigmented areas at the dermal-epidermal(DEJ). This shallow dermis area is the target depth.
- Also, mechanical trauma stimulates the melanocytes migration from the pigmented areas to unpigmented areas.
- Microneedling may increase the number of pigment cells and stimulate more pigment production
- Studies in literature indicate that 6 or more treatments may be necessary to begin to see improvement
Ebrahim et al. J Cosmet Dermatol. 2020;00:1–8.
Microchannels provide space for melanocytes to migrate into non-pigment areas
Fernandes, D. OralL, maxillofacial Surg Clin 2005; 17:51-63