Question: I would appreciate your thoughts. We have introduced medical microneedling into our Clinic in the last three months, however, some clients have commented they feel their wrinkles are more noticeable.
Answer: Firstly, is this based on perception or reality? What do the before-and-after pictures demonstrate? One cannot go on “feelings”, and patients are notorious for not recalling the previous state of their skin, especially when changes are gradual and incremental. One needs to manage expectations in that noticeable improvement after only three months will not always be dramatic, and in some cases can take from 6 months to a year.
Secondly, if results are not as expected, one should revisit the patient history, exam, and diagnosis to ensure that an underlying cause, such as hypothyroidism, has not been overlooked. One also needs to consider lifestyle influences, such as alcohol or caffeine that act as diuretics. There are several other considerations when establishing underlying causes of rhytides , but too numerous for this discussion.
Thirdly, it would call into question the products being used in combination with microneedling. Some products include the needed “active” ingredients for the sake of making a label claim, but the concentration is inadequate (“angel-dusting”).
There are other possibilities that can lead to increased wrinkling after medical microneedling.
In the short term, lines can appear worse for the first few days after a treatment due to transepidermal water loss (TEWL). You can reassure your clients that any wrinkle that develops quickly is not due to loss of structural integrity and it is temporary.
In the long term, wrinkles that get progressively worse over months most likely have glycation as the underlying cause. (See page 126 of my book The Concise Guide To Dermal Needling-Expanded Medical Edition: Q/A section: “Will needling help with the visible effects of glycation?”)
Be sure to include the fact that wrinkles may worsen after microneedling in your “Informed Consent” for litigation purposes.[wp_ad_camp_3]