The Art and Science of Microneedling: A Vistapen Journey
Let me tell you a story about a procedure that, when done with care and deep understanding, becomes not just a treatment but a partnership between clinician and skin. The heart of our tale begins with a question that arises in every aesthetic practice: what is the most effective way to use numbing cream for microneedling?
For cosmetic procedures, BLT cream has proven more effective than the commonly used 5% lidocaine. The 5% lidocaine requires 30 to 60 minutes with an occlusive dressing, tying up a room and often providing inadequate pain control. BLT, on the other hand, works within 10 to 15 minutes. But here is the critical point: microneedling increases the uptake of anything applied to the skin by about 80 percent. Since lidocaine is a medication, toxicity is a real concern. Therefore, the numbing agent must be removed completely before the procedure begins.
Preparation: The Foundation of Success
The patient's skin has been numbed for 25 to 30 minutes. The numbing cream has been thoroughly removed. The skin has been prepped through a gentle exfoliation to remove dry, dead skin cells, followed by a mild cleanser. This prepares a clean canvas for the work ahead.
The tool of choice is the Vistapen, a device capable of creating 1,300 microchannels per second. It features a depth gauge ranging from zero to 2.5 millimeters and a speed gauge. The needle cartridge is a sterile disposable. On the back bar, we have 100% hyaluronic acid, which serves as both a glide and a sealant. We also have human epidermal growth factor, which presents fibroblasts and assists with collagen induction.
The Question of Speed
When asked about which speed to use, there is a straightforward answer: always use the fastest speed. The slower the rotation, the more the patient feels it. Higher speeds create a more painless procedure. Two key factors create discomfort during microneedling: a dull needle and a slow motor. Always use the fastest pen on the fastest speed, and always use a fresh needle.
These are 33-gauge needles. After treating a face, or a face and neck, the needles become dull. Cheap counterfeit needles purchased on the open market are a serious risk. They come batched from China with a different cut on the stainless steel. A recent study using electron micrographs revealed some needles did not even come to a point. They had hooks on the ends and flakes of metal. Such needles rip the face rather than creating clean channels, potentially causing more scar tissue. Reputable manufacturing is essential.
The Product Line: Each Tool Has Its Place
Immediately after the procedure, Vitamin C Repair is applied. It is an excellent antioxidant for post-care. Because thousands of microchannels have been created in the skin, whatever is applied must be designed specifically for that environment. Most topicals from a bathroom cabinet contain perfumes and unnecessary elements that should not penetrate deep into the skin.
The Bio 5 Peptide Neuro Extender contains five bio-identical peptides. It helps prolong the effects of Botox by up to 45 days. The Sensitive Cleanser is used after exfoliation to prepare the skin. The Brightening Veil contains Hexaresorcinol and hydroquinone to lighten the skin by inhibiting melanin development. It is useful for smoothing the skin tone.
There are two post-procedure masks. The Cryo Mask is a simple cooling mask. Once the microneedling is complete, the face is hot. This cooling effect is the last thing the patient remembers when they walk out the door, and it often brings them back. The other is a growth factor-infused mask.
Post-Procedure Care: The First 24 Hours
Patients should wait 24 hours before applying makeup or their regular skincare regimen. Ideally, the only thing that should be applied topically immediately after the procedure is high molecular weight hyaluronic acid, stem cells, or PRP. Sunblock should wait until the next day. Patients should wear a hat if they need to be in a sunny area. Avoid hot water, as the skin is much like a sunburn.
Contraindications include pustular rosacea. If a patient is having an eruption, wait for it to subside. The heat of the procedure can inflame the condition further. Microneedling is effective for acne because it reduces bacteria count, but caution is necessary with active inflammation.
The Procedure Begins: Setting Up the Pen
The sterile needle cartridge is inserted into the pen. A protective sheath covers the needles to prevent cross-contamination. The cartridge has a separate chamber that prevents topical products from entering the needle mechanism. The sheath protects against any external product that might travel down the side of the needle. The infection risk is zero. Cross-contamination risk comes from handling the base of the pen with gloves, as the pen is not autoclavable. Wiping it down with a bacteriostatic cleanser is sufficient.
Always use a corded pen. The only advantage of a battery-powered pen is convenience. As soon as a lithium battery drops to 80 percent power, the motor slows. Remember the lesson about a slow motor. A corded pen provides consistent power every day. The cord is never on the patient's face. It can be placed behind the neck and clamped. It never gets in the way.
The Application of Products
A tiny cup is filled with several squirts of hyaluronic acid. A vial of human epidermal growth factor is added. The 4-milliliter vial is sufficient for a treatment area the size of a piece of paper, such as a full face and neck. For additional areas like the abdomen or décolleté, more than one vial may be needed. The hyaluronic acid molecule is too large to penetrate the skin. It acts as a glide during the procedure and as a film sealant at the end. The growth factor is microneedled into the skin. After pouring, the vial should be capped and left upside down to collect the remaining milliliter that works its way down the side of the glass tube.
The Technique: Sequencing and Motion
Start with the forehead. The biggest areas of patient discomfort are the forehead and the upper lip. If you begin there, the hardest part is over first, and the rest of the procedure feels downhill. The pen should follow the contours of the face. The patient's head can be passively turned to the position needed. This prevents uneven cuts from lifting the edge of the needle.
There is no written rule about a specific depth for a specific area. Everyone's skin is different. A patient may have thicker skin on one side of the face because they drive to work every morning with the sun beating down on that side, and then the sun hits the other side on the drive home. One side might need 0.5 millimeters, while the other requires 1.0 millimeter for the same result. Asymmetry is normal. Pain is also subjective. Some patients, even with numbing, react strongly. It may be necessary to start very shallow and gradually increase from 0.25 to 0.5 as they become more accustomed to the sensation.
The average skin thickness on the face is about 1.5 millimeters. For anti-aging microneedling, the depth is usually one millimeter or less. Going deeper than 1.5 millimeters enters the subcutaneous tissue. This depth may be used for medical microneedling of scars or tattoos, but for general rejuvenation, staying below one millimeter is best to avoid inducing collagen scar formation without benefit.
The ideal result is pinpoint bleeding. This indicates microchannels have been created. Three passes are made in several different directions. No excessive downward pressure is needed. The pen should be kept flush against the skin surface.
Navigating the Face: Forehead to Periorbital
After completing the forehead, move to the periorbital area. The same 0.5 millimeter depth is often suitable. Use the left hand to stretch the skin and use the infraorbital ridge as counterpressure. If a client bruises easily, a small blood bruise may appear, but it subsides within a few days. Move from the nose outward. Moving from the cheek toward the nose can lead to venous pulling and blood blisters. Milk the skin away from the midline.
The crow's feet and cheeks require a depth of 1.0 to 1.5 millimeters. The skin in these areas is thicker due to squinting. Blow the cheek out to create a smoother surface. This is a common area for acne scarring, which may require even deeper penetration. Multiple passes in multiple directions are essential. For deep acne scarring, subcision can be performed first to break up fibers, followed by microneedling.
Do not try to cover the entire area in one pass. Work one section, then another, and always assess where you have missed. Even a proficient trainer may sometimes forget an area like the crow's feet. Look at the final product. Touch up any spots that have been missed.
Shifting the Paradigm: What Cell Are You Treating?
The old model asked how deep to go for wrinkles. The new question is: what cell are you treating? The three main cells targeted in microneedling are keratinocytes (epidermal cells), melanocytes (at the dermal-epidermal border), and fibroblasts (in the dermis). Microneedling improves communication between these cells. Dry, flaky skin is a keratinocyte problem, so deep penetration is not needed. Melanocytes are about 0.5 millimeters deep, so hyperpigmentation does not require deep needling. In fact, going deeper than 1.5 millimeters as a routine creates heat that can activate melanocytes and worsen hyperpigmentation.
For years, clinicians chased fibroblasts, believing deep injury was needed to stimulate the wound cascade. New research shows keratinocytes themselves can stimulate collagen. Studies found that even when going to a depth of 1.5 millimeters, collagen regeneration only occurred to a depth of 0.5 to 0.6 millimeters. The deeper collagen did not seem to be sensitive to microneedling. The good work may be done on the way down, not at the endpoint.
Wrinkles are considered a scar at the dermal-epidermal border. They represent the separation of the epidermis from the dermis, forming a disruption in the barrier. A depth of 0.5 millimeters is effective for this. Deeper needling releases multiple growth factors, some of which are fibrosis-inducing. The non-fibrotic growth factors come from keratinocytes. Going very deep as a routine may stimulate scar collagen that looks good now due to inflammation and edema, but in 20 years, the damage may become apparent. There is even a thought that deep microneedling performed routinely may one day be considered negligence.
Timing and Contraindications
For men who shave or individuals who have had laser hair removal, microneedling can be done the same day as shaving. The best time is immediately after shaving, when stubble is minimal. Laser hair removal works best when the hair is below the skin surface, as stubble increases the risk of burns. Wait about three to four weeks between microneedling and procedures like laser, HIFU, or radiofrequency. Package treatments carefully to set a time frame. Generally, perform radiofrequency or laser at the front end, as you have to wait three to four weeks to do them after microneedling.
If a patient is prone to ingrown hairs, remove the hair before the procedure. The micro-needling will assist healing, but a foreign body like an ingrown hair creates inflammation. Inflammation is the enemy of good healing. In every other organ system, inflammation is associated with negative outcomes. The question in aesthetics is whether we are creating a chronic inflammatory reaction with our treatments. This perspective drives the trend toward shallower needling and careful selection of topical chemistry.
The Final Steps: Masking and Nourishment
Upon completion of the face, apply a cooling mask. A growth factor-infused mask is excellent. Keep fingers constantly moving on the face. Patients enjoy the cooling sensation. The mask absorbs the heat. It can be turned over to access more product. The mask should stay on for five to eight minutes.
While the mask is on the face, move to the neck and chest. The skin in these areas is thicker and less sensitive, so the needle may be slightly duller from the face without causing discomfort. Stay on one side of the center of the esophagus. The patient looks up to access the neck.
Allergies, Immunity, and History
Allergic reactions to the products are rare. These stem cell products originated for burn patients, including pediatric burn patients. The main problems come from fragrances and excipients in other products. These are well-tolerated. For immunocompromised patients, such as those with HIV or undergoing chemotherapy, the concern is not the product itself but the fact that any procedure creating a wound draws on the immune system. The immune system must divert attention from fighting other things to heal the wound. If a patient comes in with a cold or is fragile, wait. If they are stable, it is safe.
The medical history should inquire about allergies to pain medications, dental pain history, infectious diseases, herpes infections (which may require valtrex as a preventative), and blood-borne risks like HIV or hepatitis C. These are clean procedures, not sterile procedures. There is a risk of aerosolized blood. In at-risk populations, the clinician should wear glasses and a mask. The FDA lists cross-contamination between patients as a risk for microneedling, specifically mentioning hepatitis C and HIV. Always use a new needle for each patient. A needle is good for one face, neck, and chest. If the abdomen were included, it would be time to change the needle.
Hydration and the Take-Home Kit
After removing the mask, hydration is key. Any leftover hyaluronic acid is rubbed in. The absorption rate is extremely high through the open channels. Blood is not wiped away. It is rubbed back into the skin. Blood contains excellent stem cells. It is good stuff.
Each patient receives a take-home kit containing a lipid spray and a silicone spray. The lipids are applied first to nourish the skin. The silicone spray creates a barrier against exterior dirt. In a four- to six-treatment regimen, this kit lasts the entire time. Patients use it for two to three days post-procedure, then store it for their next visit.
When the patient sits up, they are done. The skin has been treated with respect, understanding, and precision. That is the art and science of microneedling.