Dr. Setterfield graduated from the University of Stellenbosch, Cape Town, South Africa, in 1983. He completed a further five years of post-graduate training in various disciplines of Medicine before immigrating to Canada to begin Family Practice in 1988. Dermatology comprised a considerable percentage of his practice in rural Canada, and personal experience with skin cancer led to a special interest in the field of anti-aging and cancer treatments.
In September 2000, he moved to Victoria, British Columbia to start a Family Practice. He joined a Laser Clinic in nearby Nanaimo as Co-Medical Director in 2003 and was the Co-Founder and Co-Medical Director of a Laser Clinic in Victoria until February 2005. He subsequently ended his family practice to concentrate his efforts in the area of skin health and started his own clinic to research the effects of dermal needling, combined with pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients.
Dr. Setterfield was one of the first physicians in Canada to incorporate medical needling into his practice, and consequently supports clinics in many parts of the world as a consultant. At the time of writing the first edition of this book, he was working with a nanotechnology company in California to develop protocols for new medical needling devices and was also conducting trials on new skin lighteners for US-International joint venture companies.
What started out as an exercise to consolidate information in the form of a manual for the clinics I train and support, ended up as a journey through a world of embryology, physiology, biochemistry, histology, pathology, immunology, genetics, and statistics. The irony in this is that I hated all of these subjects with a passion at medical school. Another surprise was that I started with a set of presuppositions and had to rewrite sections of the book as I uncovered pieces of the puzzle. The more I discovered, the more I realized I had barely scratched the surface (excuse the pun).
In 2003, I embraced the opportunity to combine the broad base of knowledge my years of general practice had provided with the exciting new developments in anti-aging medicine. Frankly, I was burned out and needed a new challenge. I rushed forward, trusting all the information fed to me by the industry. It was shortly after the 2004 ASLMS Conference in Dallas that I began to question things. Thermage and Levulan with PDT were the buzz words back then. The concept of Fraxel was honoured as the most innovative presentation with the greatest potential. We were the 4th clinic in Canada to get a Blue-U, and I had several treatments for my AK’s. Initial results seemed promising, but it did not take long before the lesions returned. Around the same time, reports from colleagues regarding Thermage were discouraging. Non-responders in my own patients with IPL were more frequent than I was led to believe by the company selling the equipment. Results with creams were also disappointing.
In 2005, I decided to retreat. I downsized and purchased some equipment to allow my own evaluation of what worked and what did not. With my own photodamage to contend with, I went through many different products and eventually found something that was effective. Co-incidentally, the roller was part of that skin care line. Initially, the cost of a roller was $850.00 US. I was not about to recommend these without knowing that they worked. My first roller patient was a woman in her early 30’s with Ehlers-Danlos syndrome. After discussing options, she wanted to try it, even though theoretically her genetic code precluded improvement. Surprisingly, she responded to treatment with improved wrinkles and UV scores.
In 2005, I attended a training session by Dr. Fernandes in Vancouver for CIT (collagen induction therapy) with medical needling, using a 3 mm roller. The dental blocks and topical anaesthetic were inadequate and I decided not to pursue this. I did incorporate the cosmetic rollers into my practice, however, and was surprised by the results in some patients. As time went by, I saw that this was not just a flash in the pan. It was obvious that, combined with the correct creams, this treatment was every bit as effective as laser or Fraxel, etc., if not better in some cases.
While the rollers play a role, I believe I can attribute much of the success I have seen in my patients to implementation of a system called Advanced Skin Analysis. This was developed by Florence Barrett-Hill, one of the world’s leading technical educators in the field of professional skin treatment therapies. It establishes underlying cause, and links product composition to skin condition. She presents her immense experience in cell physiology and cosmetic chemistry in a logical manner, and with this as my foundation, I was prompted to explore the science behind the obvious success in my patients.
Like most, I initially believed that in order to stimulate collagen, the target in rejuvenation was the fibroblast. However, all the evidence points to the keratinocyte as being the key to success. It is an established fact that ablative therapy, while associated with more side effects, has better results than isolated dermal injury in so-called “non-ablative” treatments.
If the fibroblast is the target, this contradiction, in itself, should raise eyebrows. All the growth factors isolated in needling studies that are known to be associated with the positive features of scarless wound healing in embryos involve the keratinocytes.
Combining these facts with results in some of my patients that are beyond expectation and do not involve any injury to the depth of fibroblasts, I am led to believe that a possible explanation is that needling not only spares the epidermis, but strengthens it. Repeated injury of healthy keratinocytes leads to release of anti-fibrotic growth factors and optimizes cell-to-cell communication between keratinocytes, melanocytes, and fibroblasts. When these signals are boosted, fibroblasts differentiate to form normal collagen and greater amounts of hyaluronic acid, as seen in the ideal situation of embryo wound healing. It is amazing that, with the wealth of information available, this still remains a mystery in 2014. If the above theory is correct, it would open up a whole new world to the industry, and the possibility of healthy skin would be attainable for the many, instead of the few.