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When and What to Use After Medical Microneedling

posted in Topical ingredients combined with microneedling by

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There is a question that keeps arising pertaining to “what to apply, and when, after medical microneedling”.

In my first book (2010), I talked about one of the functions of medical needling being for the purpose of “allowing” or “infusing” more skin care product ingredients into the skin.  This changed two weeks after publication of my Expanded Medical Edition in 2013 due to an abstract detailing 3 cases of granulomas which occurred after a medical microneedling treatment, (thought to be secondary to product ingredients applied “during” and “immediately” after treatment).

These patients became ill to the point of some requiring hospitalization.  Up until then, this was extremely rare.  (Perhaps there were more cases in the world that clinicians failed to diagnose because they did not connect the dots between the microneedling treatments and the presenting illness due to a lag period of several months.)  But having 3 cases reported in short succession (and there are now several other reported cases) is cause for concern, especially in light of the multitude of products used more and more frequently without regard to ingredients.

Here is one of the cases referred to me where histologically proven granulomas developed after a series of monthly microneedling treatments with a pen.

             jw1            jw4c

A skin lightening product was tattooed into the skin during treatments.  She developed a rash after the third treatment which required a dermatology consult and she was treated with hydrocortisone cream.  Two months later a fourth treatment was performed and these pictures illustrate the consequences that remained for several months, despite oral steroids, Doxycycline, Elidel and even methotrexate.

             jwh3            jw2d                  

Given the above, I believe when it comes to topical application during the procedure, it’s best to play it safe and perhaps only use sterile normal saline (or pure HA without inactive ingredients) to facilitate “glide” of needling devices, if required.  Also, wait 15 minutes after treatment before applying topicals.  Some studies show that the channels close within this time frame, so any dermal absorption of ingredients that may be responsible for triggering an immune response is minimized.  (When microneedling is done for “medical” reasons, such as melanocyte stem cell transplant or drug infusion, obviously the product needs to be applied within this window of opportunity.)

The skin is a highly immune-sensitive organ, and the long-term consequences of repeatedly testing the body’s immune system with “injected” ingredients are unknown.  At present, we ascertain that material that gets into the skin (dermis) that does not belong in the body triggers an immune response which may cause granulomas (scar tissue).  In view of this, it is no longer prudent to apply any cosmetic product after medical microneedling.  Forget about “absorption of product ingredients” as being a key function of medical microneedling.  This has now become a function of home rolling (or cosmetic needling).

Do not fret!  Realistically, when one is striving for “muscular tone”, significant improvement cannot be achieved by attending a gym once a month.  Similarly, infusing topicals “once a month” does very little.  It is “repetitive” micro-injury of the epidermis, along with increased absorption of topicals sustained over prolonged periods, that achieves optimum results.

Medical microneedling is becoming very popular and people don’t think twice about using their favorite cream afterwards.  In general, just because a skin care company sells a product to combine with needling does NOT mean it is safe to use.  There is an assumption that skin care companies will only provide products that have been specifically formulated to combine with microneedling and that they are safe, but this is incorrect.  The lack of regulatory oversight is an underlying weakness in measuring the true scope of the complications tied to products when combined with microneedling.

Anything applied “after” medical needling is now purely for the purpose of “sealing” the skin to prevent TEWL (Transepidermal Water Loss), and to replenish moisture that was lost as a result of the treatment.  Pure Hyaluronic Acid serves this purpose well because it is film-forming and is known to be safe to apply immediately afterward.  There is an abundance of scientific data pertaining to intradermal HA injections in the form of fillers.

Cosmetic products/cosmeceuticals, including sunscreen, should only be applied the following day. Theoretically, active ingredients are only needed on day 5 for the fibroblasts, since that is when these cells kick into high gear.  I have outlined protocols in my book on which active ingredients to add based on cellular needs at various stages of the wound healing cycle.  However, to create individualized post-treatment potions on this basis adds significantly to the burden of cost, so, unless there are actives in their normal creams that are highly irritating to their skin, (certain forms of Vitamin A), I allow patients to start back on their normal creams the following day.  (Keep in mind that the word “actives” is an over-simplification because it encompasses a multitude of ingredients.)  My answer above is in the broad sense, and, again, there are always exceptions to the rule.  As far as “when” to resume cosmetic rolling at home, it is “patient preference” once the skin feels comfortable.  Typically, this will only be around day 5-7.

Please keep in mind that there is no such thing as a perfect product.  I do not say this in a negative context.  It is impossible to formulate something that does not include an ingredient with the potential to trigger an immune response or affect cell physiology adversely.  In medicine, we are constantly weighing benefits against risks. Unfortunately, preservatives are an essential part of skin care products, as are many other ingredients.  Typically, these ingredients cause trouble based on dosage and frequency of use.  Microneedling increases the absorbed dose, so it is not surprising that side effects are magnified.  My recommendations are merely guidelines, and attempts to predict and avoid adverse reactions and complications based on probability and possibility.  Fragrance and preservatives are most likely to cause immediate and short-term problems, whereas emollients or emulsifiers, etc., may cause problems with prolonged use over years, or even decades.

In summary, keep it simple and keep it safe.

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16 Jun, 15

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There are 4 comments. on "When and What to Use After Medical Microneedling"

 

  • ***Microneedling – keep it simple and keep it safe! Keine kosmetischen Produkte und Cosmeceuticals bei Microneedling! | Dr. med. Jabs - Aesthetic Medicine*** says: posted on 16 Jun, 2015

    […] Lance Setterfield, einer der weltweit besten Experten für Microneedling warnt vor kosmetischen Produkten oder Cosmeceuticals während oder direkt nach Microneedling. Er empfiehlt einen Sicherheitsabstand von einem Tag! Denn es existieren keine kosmetischen Produkte die nicht Konservierungsstoffe und/oder Duftstoffe enthalten. Parfüme und Konservierungsmittel verursachen kurzfristig Immunreaktionen und Allergisierungen. Emolliants, Moiturizer und Emulgatoren sind für längerfristige Immunirritationen verantwortlich. Selbst Wirkstoffe wie Vitamin A verursacht eine Hautentzündung, wenn die Substanz in falscher Konzentration am falschen Wirkort der Haut angewendet wird. Es wird von Granulombildung längere Zeit nach Microneedling und Auslösung von schweren Immunreaktionen der Haut berichtet. In Kenntnis dieser Zusammenhänge müssen Microneedling-Kunden über diese Nebenwirkungen aufgeklärt und Behandlungsabläufe standardisiert werden: 1. Keine kosmetischen Produkte (Cosmeceuticals) während oder direkt nach dem Microneedling! 2. Als “Gleitmittel” beim Needling nur Kochsalzlösung oder reine Hyaluronsäure ohne Zusätze 3. Kosmetische Produkte frühestens am nächsten Tag nach Microneedling. https://www.needlingguide.com/when-and-what-to-use-after-medical-microneedling/ […]

    Reply
  • ***Gustavo*** says: posted on 16 Jun, 2015

    Hello, Dr. Lance. Very good article. Congratulations.
    Your article is intended for medical needling, using 0.5 mm needles or 1 mm followed this concept?

    Reply
    • ***Dr. Lance Setterfield*** says: posted on 16 Jun, 2015

      Hi Gustavo. This article pertains to any microneedling treatment involving the dermis, which on average is 0.5 mm or longer, depending on the area of the body being treated. (The skin below the eyes is thinner than on the neck, for example.)

      Reply
  • ***Williammr*** says: posted on 18 Jun, 2015

    Good way of explaining, and fastidious paragraph to obtain data on the topic of my presentation subject matter, which i am going to present in school.
    Legendario.

    Reply

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