CosBeauty Magazine #74

Skin
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 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 in the UK. The
first publication of skin needling was
in the Hot Topics section of Aesthetic
Surgery Journal.
At that stage I presumed the reason
for regeneration was from plateletderived
growth factors released after
puncturing tiny vessels in the dermis.
Almost at the same time Mark
Ferguson in the UK was studying
TGF-beta-3 in preventing the
formation of scars. In time I realised
that since TGF-beta-3 was released
from platelets, it was the most likely
cause of tissue regeneration and scar
reduction when needling skin.
However, there was no proof of
this until Matthias 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: TGFbeta
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 superior to
needling at longer intervals.
However, in order to do needling
as intensively, we needed to fully
anaesthetise the skin and that
required 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 1.0mm 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,
the best way to induce changes by
needling is to use topical Vitamin
A and repeat the needling within 7
days. I believe the reason for this is
the concentrations of TGF-beta-3
build up to levels unattainable by
even the most intensive needling
because each needling experience
adds to the previous levels of TGFbeta-3.
The challenge now is to optimise
needling and I believe using wellselected
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. CBM
www.cosbeauty.com.au 41