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Microneedling, in one form or another, has been around for years. The term ‘microneedling’ encompasses a large and quite varied number of devices, ranging from rollers to stamps to microneedling pens. The thought process behind all of them is the same, regardless of the device– creating microchannels and a micro injury in the skin that initiates the wound healing cascade and breaks up thicker collagen fibers.
As a female plastic surgeon in Seattle, I understand first-hand the importance of effective scar treatments and the impact they have on the lives of my patients. Scars are an inevitable part of surgery, as there are no “scar-less” procedures (unless you are a fetus). Thus, the goal becomes trying to create the nicest looking scar possible. Particularly with Plastic Surgery procedures, scars can be the tell-tale sign that a person has had “work done”, so their emotional and psychological impact on patients cannot be understated. There are a host of strategies we employ in order to create the perfect scar– thin, light, flat and soft. In this article, we will explore the science behind microneedling as it relates to post-surgical scar treatment, its benefits, and the treatment protocols for optimal results.
Normal Scar Formation
Before delving into microneedling as a scar treatment, it's essential to understand the process of scar formation. Scarring occurs as a natural part of the healing process when the skin experiences injury or trauma. The body responds to the injury in three phases: inflammatory phase, fibroproliferative phase and the remodeling phase. The inflammatory phase lasts the first week, and is marked by a cellular cascade meant to “clean up” the area. Your body begins building blood vessels to the area which will ultimately transport the body’s machinery needed to build scar tissue. The fibroproliferative phase is the second stage of healing where the body starts producing collagen (the building block of skin) in high volumes. This collagen, however, is immature and unorganized. During the third and final phase of wound healing, beginning around one month post injury and lasting up to one year, the immature collagen is slowly replaced by mature, organized collagen. This stage, in effect, will serve to soften and flatten a scar. You will also see a decrease in redness of the scar as the blood vessels that were originally built to the area to help bring in supplies are removed by the body. It is a pretty miraculous process but most certainly not quick. Hence, is not just hyperbole when your Plastic Surgeon tells you it truly takes an entire year for your scars to fully heal. The silver lining of a scar’s long remodeling phase is that it gives us ample opportunity to intervene.
The Science Behind Microneedling and Scar Treatment
Microneedling, also known as collagen induction therapy, is a minimally invasive cosmetic procedure that has gained popularity for its ability to improve the appearance of scars. I personally prefer the SkinPen device, which is the only FDA approved device on the market. This pen has a tip containing multiple rows of small needles that produces depth-controlled “micro channels”. These micro channels serve a few important purposes. First, they create a controlled injury to the skin which, as a result, signals the body to produce the building blocks of skin– collagen and elastin. Tissue studies post-treatment show a thickened epidermis (or outer layer of skin) and increased dermal collagen and elastin, while also showing the upregulation of signaling molecules and growth factors responsible for collagen production, maturation, and the formation of new blood vessels. The result is skin remodeling, smoothing of scars. Improved texture and reduced scar visibility.
Another unique feature to microneedling that makes it a great tool for scar treatments comes from the microchannels that the device itself creates. Those microchannels are the perfect way to get topical treatments directly into the level of the dermis. These treatments can include those that are commonly injected into scars such as steroids or 5-Fluorouracil, or they can include topical agents commonly employed in skin rejuvenation such as hyaluronic acid, exosomes or Platelet Rich Plasma (commonly referred to as PRP).
What To Expect For Treatment
There are a couple of key questions that your Plastic Surgeon (or Aesthetician, Nurse Injector) must shake out, namely when to start microneedling treatments and how frequently to get them.
Since there is no established, singular treatment protocol as well as a multitude of devices for use, each Plastic Surgeon may have a different preferred regimen for treatment. There are a couple of key variables to consider, however. First, the scar must be mature enough to withstand micro injury. Generally, this will take a few months to occur, as the tensile strength of scars reach a maximum of about 80% compared to normal, uninjured skin, at approximately 2 months post injury. It's essential to allow adequate time for the scar to stabilize and for any inflammation to subside before starting microneedling treatment.
Microneedling procedures can be done in a clinic setting and usually require only a topical numbing medication to be placed on the area of treatment prior to. Once numb, patients usually only experience the sensation of pressure as the device makes contact with the skin. After treatment, redness and some punctate bleeding are likely for a few days but pain and discomfort will be minimal if not absent. Moisture to the skin is critical, as is avoiding irritating scrubs, soaps, and sun exposure during that time.
The frequency of microneedling treatments for scar reduction typically ranges from 4 to 6 weeks apart. This interval allows the skin to go through its natural healing and collagen production processes. Multiple treatments may be needed to achieve the desired improvement in scar appearance. Ultimately, treatment frequency and duration will be based on how your scars respond to treatment.
In Summary
It’s important to remember that scar formation is multifactorial, and the best plan of action for scar care is often multimodal. Microneedling is a great tool that will initiate the body’s natural healing cascade, break up thickened scars, and can introduce topical materials into the dermis for accelerated healing. Microneedling should always be combined with a daily scar care routine. In my Plastic Surgery practice, I overwhelmingly recommend silicone gel sheets to my patients for daily use. The addition of other scar-reducing modalities such as laser therapy and injections (5-fluorouracil, corticosteroids) can act synergistically to enhance progress and improve results. In the end, all scars are slightly different as will be their treatments.
Dr. Megan Dreveskracht is a Female Plastic Surgeon in Seattle, Washington who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.
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