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Collagen induction therapy
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| Collagen induction therapy | |
|---|---|
 Nurse performing collagen induction therapy for scar reduction using a microneedle stamping device |
Collagen induction therapy (CIT), also known as microneedling, dermarolling, or skin needling, is a cosmetic procedure that involves repeatedly puncturing the skin with tiny, sterile needles (microneedling the skin). It is important to distinguish CIT from other contexts in which microneedling devices are used on the skin (e.g., transdermal drug delivery, vaccination).
It is a technique for which research is ongoing, but has been used for a number of skin problems including scarring and acne.[1] Some studies have also shown that when combined with minoxidil treatment, microneedling is able to treat hair loss more effectively than minoxidil treatment alone.[2]
Combination with vampire facials
[edit]Platelet-rich plasma (PRP) can be combined with collagen induction therapy treatment in a form of dermatologic autologous blood therapy. PRP is derived from the patient's own blood and may contain growth factors that increase collagen production.[3] It can be applied topically to the entire treatment area during and after collagen induction therapy treatments or injected intradermally to scars. Efficacy of the combined treatments remains in question pending scientific studies.[4]
More serious safety concerns have been cited for these treatments, popularly known as vampire facials, when performed in non-medical settings by people untrained in infection control.[5][6] The New Mexico Department of Health issued a statement that at least one such business offering vampire facials "could potentially spread blood-borne infections such as HIV, hepatitis B and hepatitis C to clients".[5]
In April 2024, the CDC announced that three women who had been patients at the Albuquerque, New Mexico, VIP Spa had been diagnosed with HIV after getting "vampire facials" there. Another almost 200 former clients and their sexual partners were also tested but were found to not have HIV. No mention was made of any testing for other possible blood-borne infections.[7]
Notes
[edit]- ^ Cohen, BE; Elbuluk, N (5 November 2015). "Microneedling in skin of color: A review of uses and efficacy". Journal of the American Academy of Dermatology. 74 (2): 348–55. doi:10.1016/j.jaad.2015.09.024. PMID 26549251.
- ^ Dhurat R, Sukesh MS, Avhad G, Dandale A, Pal A, Pund P (January–March 2013). "A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study". Int J Trichology. 5 (1): 6–11. doi:10.4103/0974-7753.114700. PMC 3746236. PMID 23960389.
- ^ Abuaf OK, Yildiz H, Baloglu H, Bilgili ME, Simsek HA, Dogan B (December 2016). "Histologic Evidence of New Collagen Formulation Using Platelet Rich Plasma in Skin Rejuvenation: A Prospective Controlled Clinical Study". Ann Dermatol. 28 (6): 718–724. doi:10.5021/ad.2016.28.6.718. PMC 5125953. PMID 27904271.
- ^ Hall, Harriet (3 December 2018). "Vampire Facials". Skeptical Inquirer. CSI. Retrieved 14 January 2019.
- ^ a b Jennings, Rebecca (14 September 2018), ""Vampire facials" are massively popular. And – surprise! – potentially dangerous", Vox, retrieved 14 January 2019.
- ^ Robertson, Michelle (14 September 2018). "New Mexico officials urge 'vampire facial' spa clients to get HIV tests". San Francisco Chronicle. Retrieved 15 September 2018.
- ^ St. John, Alexa (29 April 2024), 'Vampire facials' were linked to cases of HIV. Here's what to know about the beauty treatment, Associated Press, retrieved 29 April 2024.
References
[edit]- Fabbrocini G, De Vita V, Pastore F, et al. (April 2012). "Collagen induction therapy for the treatment of upper lip wrinkles". J Dermatolog Treat. 23 (2): 144–52. doi:10.3109/09546634.2010.544709. PMID 21810012. S2CID 34680894.
- Doddaballapur S (July 2009). "Microneedling with dermaroller". J Cutan Aesthet Surg. 2 (2): 110–1. doi:10.4103/0974-2077.58529. PMC 2918341. PMID 20808602.
- Asif, M., Kanodia, S. and Singh, K. (2016), Combined autologous platelet‐rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split‐face study. J Cosmet Dermatol, 15: 434-443. doi:10.1111/jocd.12207
Collagen induction therapy
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Overview
Definition and principles
Collagen induction therapy (CIT), also known as microneedling, percutaneous collagen induction, dermarolling, or skin needling, is a minimally invasive dermatological procedure that involves the repetitive puncturing of the skin using fine, sterile needles to create controlled micro-injuries.[3][4] These micro-injuries penetrate the epidermis and reach into the dermis at a uniform depth, typically ranging from 0.5 to 2.5 mm, without causing significant thermal or ablative damage to surrounding tissues.[2] The procedure is designed to harness the skin's innate regenerative capacity, distinguishing it as a non-ablative alternative to more aggressive treatments like laser resurfacing or chemical peels.[5] The fundamental principle of CIT relies on inducing a localized wound healing response through these precise micro-traumas, which activate the release of growth factors and cytokines from damaged keratinocytes and fibroblasts.[6] This controlled injury stimulates fibroblast proliferation and migration, promoting the synthesis of new collagen (neocollagenesis) and elastin in the papillary dermis, thereby enhancing skin firmness, elasticity, and overall texture.[7] Unlike ablative methods that remove layers of skin and risk prolonged recovery, CIT preserves the epidermal barrier while targeting deeper dermal remodeling, resulting in gradual tissue rejuvenation over multiple sessions.[8] In essence, CIT operates on the biological premise that mechanical disruption of the dermal matrix initiates a cascade of repair processes, including the upregulation of collagen types I and III, without the need for exogenous substances or extensive downtime.[4] This approach leverages the skin's natural wound healing phases—briefly involving inflammation, proliferation, and remodeling—to achieve aesthetic improvements.[3]History and development
Collagen induction therapy (CIT), also known as microneedling, was invented in 1997 by South African plastic surgeon Dr. Desmond Fernandes, who initially used a tattoo gun-like device to create controlled micro-injuries for treating scars. This pioneering approach aimed to stimulate the skin's natural healing process by inducing collagen production without damaging the epidermis, marking a shift from more invasive resurfacing techniques prevalent at the time. Fernandes' early experiments focused on scar revision, laying the foundation for what would become a minimally invasive aesthetic procedure.[9] The therapy gained early traction in Europe during the early 2000s, particularly with the introduction of the dermaroller in 2000 by German inventor Horst Liebl, a handheld device featuring microneedles on a rotating drum that simplified the needling process for broader clinical use. This expansion facilitated its application beyond scars to wrinkles and skin laxity, with adoption accelerating among dermatologists and plastic surgeons in European clinics. A key milestone came in 2008, when a retrospective analysis by Aust et al., building on Fernandes' pioneering work, demonstrated efficacy in treating wrinkles and scars across 480 patients treated between 1997 and 2006, which helped validate the technique through clinical evidence and spurred further research.[10][11][9] In the 2010s, CIT evolved with the development of automated pen-like devices, such as the Dermapen introduced in 2010 by DermapenWorld, which offered adjustable needle depths and precise control, improving safety and consistency over manual tools. Regulatory advancements followed, including the U.S. Food and Drug Administration's classification of microneedling devices for aesthetic use as Class II medical devices in June 2018, enabling specific clearances like that for the SkinPen system, which further legitimized professional applications.[12][13] Post-2020, CIT experienced significant growth driven by the rise of at-home devices and integration with adjunct therapies like platelet-rich plasma, making it more accessible amid increased demand for non-surgical rejuvenation. Industry reports indicate that by 2025, over 2.1 million CIT procedures are performed annually worldwide, positioning it among the top non-surgical aesthetic treatments.[14]Mechanism of action
Wound healing response
Collagen induction therapy initiates a controlled wound healing response through the creation of micro-injuries in the skin, mimicking the body's natural repair mechanisms but in a targeted and accelerated manner.[3] This process unfolds in three distinct phases: inflammation, proliferation, and remodeling.[15] The inflammation phase begins immediately upon needling and typically lasts up to 48 hours, characterized by platelet activation and the release of cytokines and growth factors such as transforming growth factor-beta (TGF-β).[15] These events trigger an immune response that clears debris and initiates signaling for repair, with mild erythema and edema resolving quickly due to the superficial nature of the injuries.[15] In the proliferation phase, which starts concurrently or shortly after inflammation and peaks around 2 months, fibroblasts migrate to the site of injury, promoting the formation of new granulation tissue and the synthesis of type III collagen.[15] Micro-channels created by the needles, penetrating to depths of 0.5-2.5 mm, facilitate the deeper penetration of these growth factors like TGF-β, amplifying the healing cascade without causing full-thickness dermal damage.[3] The remodeling phase, extending over several months to a year, involves the reorganization and maturation of the extracellular matrix, where type III collagen transitions to the stronger type I collagen, enhancing skin tensile strength and elasticity.[15] This controlled injury depth limits excessive scarring by avoiding deep dermal disruption, resulting in an accelerated healing response that studies have shown can lead to a 400% increase in collagen production after 6 months.[16]Collagen and elastin stimulation
Collagen induction therapy stimulates fibroblasts in the dermis to produce new collagen through the upregulation of genes encoding pro-collagen types I and III, which are essential for structural integrity, while also promoting elastin synthesis to enhance skin elasticity.[17] This process is mediated by the release of growth factors such as platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-β), which activate fibroblast proliferation and differentiation, leading to neocollagenesis and neoelastinogenesis.[3] Histological studies have demonstrated that this stimulation results in an average 206% increase in collagen and elastin fiber formation within 6-8 weeks post-treatment.[17] The therapeutic mechanism begins with controlled micro-injuries that disrupt the existing dermal matrix, triggering a controlled wound healing response without excessive inflammation. This disruption prompts the deposition of glycosaminoglycans (GAGs) and hyaluronic acid (HA), which provide hydration and create a scaffold for new extracellular matrix (ECM) organization, supporting fibroblast migration and collagen fibril assembly.[17] Unlike acute inflammatory responses seen in deeper trauma, collagen induction therapy emphasizes ECM synthesis driven by TGF-β3, fostering organized tissue remodeling rather than scar formation.[17] Over the long term, the remodeling phase extends from 3 to 12 months, during which newly synthesized collagen matures and organizes into a denser, more parallel arrangement, resulting in a thicker dermis. Biopsy studies provide histological evidence of these changes, showing up to a 206% increase in collagen density and improved dermal thickness, with effects persisting beyond the initial healing stages.[17] The extent of stimulation exhibits a dose-response relationship influenced by needle density, typically ranging from 192 to 360 needles per cm², where higher densities correlate with greater fibroblast activation and ECM production without crossing into hypertrophic responses.[17]Procedure
Preparation and patient selection
Patient evaluation for collagen induction therapy begins with a thorough assessment of the individual's skin type using the Fitzpatrick scale, which helps determine suitability and appropriate needle depths to minimize risks such as post-inflammatory hyperpigmentation, especially in individuals with Fitzpatrick skin types III-VI.[7][1] Medical history is reviewed to identify conditions that may contraindicate the procedure, including a propensity for keloid scarring, active skin infections, or blood clotting disorders.[3] During the consultation process, the practitioner discusses the patient's expectations, outlines the typical treatment regimen of 3 to 6 sessions spaced 4 to 6 weeks apart to allow for skin recovery and collagen remodeling, and obtains informed consent detailing potential outcomes and risks.[18] This step ensures alignment on realistic improvements for concerns like fine lines or mild scarring. Skin preparation involves cleansing the treatment area to remove debris and reduce infection risk, followed by application of a topical numbing cream, such as lidocaine-based gel, 30 to 45 minutes prior to the procedure to minimize discomfort.[1] Patients are advised to avoid retinoids and excessive sun exposure for at least one week beforehand to prevent irritation or heightened sensitivity.[19] Ideal candidates include individuals with mild to moderate skin concerns, such as acne scars or early signs of aging, who are not pregnant or presenting with open wounds.[20]Techniques and devices
Collagen induction therapy, commonly performed via microneedling, employs both manual and automated techniques to create controlled micro-injuries in the skin, stimulating collagen production. Manual techniques utilize devices such as the dermaroller, a handheld rolling cylinder equipped with a drum of fine needles, typically numbering around 192, which is suitable for treating broad areas of the skin. In contrast, automated techniques involve pen-like devices, such as the dermapen, which feature 9 to 12 disposable needles and allow for precise application in targeted or irregular areas, offering adjustable depth and speed for customized treatments.[2] Needles in these devices are generally made from medical-grade stainless steel or silicon, with some advanced models using titanium for enhanced durability and reduced risk of allergic reactions. Needle lengths vary from 0.25 mm for superficial treatments to 3.0 mm for addressing deeper tissue concerns, enabling penetration into different skin layers to optimize collagen induction. At a depth of 0.5 mm, microneedling creates superficial micro-injuries that stimulate collagen and elastin production while boosting the absorption of topical products.[2][21] Motorized automated devices oscillate at frequencies ranging from 100 to 120 Hz, facilitating consistent and efficient micro-channel creation while minimizing trauma compared to manual rolling.[22][23] The procedure begins with marking the treatment area to ensure even coverage, followed by application of topical anesthesia if needed, and cleansing with an antiseptic solution.[2] The device is then applied in multiple passes, typically 4 to 10, using a cross-hatch pattern—combining horizontal, vertical, and diagonal directions—to achieve uniform micro-injuries, with the endpoint often being pinpoint bleeding for deeper treatments.[2] Sessions generally last 20 to 60 minutes, depending on the area size and depth, after which saline or soothing agents are applied to aid initial recovery.[2] Regulatory oversight ensures safety in professional settings, with devices like the SkinPen receiving FDA clearance in 2018 for improving the appearance of facial acne scars and subsequent expansions for wrinkles and abdominal scars, emphasizing sterility through single-use cartridges.[24][25] For at-home use, rollers are restricted to a maximum needle length of 0.5 mm to prevent excessive injury and infection risks, and should be used no more than twice weekly after proper sterilization, with consistent application every 1-2 weeks recommended for benefits such as improved skin texture. This shallower depth is safer with minimal downtime compared to deeper professional needling.[26][27][2][21]Medical uses
Skin rejuvenation and anti-aging
Collagen induction therapy, commonly performed via microneedling, is widely applied to address signs of photoaging by stimulating neocollagenesis in the dermis, thereby enhancing skin firmness and reducing fine lines and wrinkles. This treatment targets photoaged skin by inducing a controlled wound healing response that promotes the production of type I and III collagen, leading to improved elasticity and a more youthful appearance. Clinical studies have demonstrated its efficacy in treating mild to moderate wrinkles, with histological evidence showing up to a 400% increase in collagen and elastin density six months after a series of four sessions spaced one month apart. For skin laxity, the therapy tightens underlying structures without damaging the epidermis, making it suitable for addressing sagging in the face and neck regions. Improvements in skin texture, tone, and pore size are among the key benefits observed following collagen induction therapy, with visible changes often emerging after two to three sessions and reaching peak effects around six months post-treatment. In a clinical trial involving 48 participants aged 35 to 75, four automated microneedling sessions resulted in statistically significant enhancements, including a mean improvement score of 1.54 for skin texture and 1.09 for laxity on a standardized scale. These outcomes contribute to a smoother, more even complexion by remodeling the extracellular matrix and refining pore appearance through enhanced dermal support. At shallower depths such as 0.5 mm, microneedling creates controlled micro-injuries that stimulate collagen and elastin production, particularly benefiting skin texture, fine lines, and pore refinement, with consistent professional sessions spaced 3-8 weeks apart or more frequent at-home use every 1-2 weeks showing improvements in these areas and minimal downtime compared to deeper professional treatments, though it is less effective for deep scars.[2][21] When combined with topical agents such as vitamin C, collagen induction therapy effectively mitigates hyperpigmentation, promoting a more uniform skin tone by facilitating deeper penetration of antioxidants that inhibit melanin production. A split-face study of 15 participants with pigmentary disorders showed greater reduction in hyperpigmentation scores and improved elasticity on the side treated with microneedling plus a vitamin C and ferulic acid formulation compared to microneedling alone, with all subjects exhibiting enhanced complexion uniformity after three sessions. Another comparative trial confirmed superior clearance of melasma with vitamin C post-microneedling versus platelet-rich plasma, including significant reductions in epidermal and dermal melanin indices. Microneedling at 0.5 mm depth enhances topical absorption by creating microchannels that bypass the stratum corneum, allowing better delivery of active ingredients for rejuvenation.[21] The therapy is effective across all skin types, including darker Fitzpatrick types IV to VI, due to its non-thermal, minimally invasive nature that avoids post-inflammatory hyperpigmentation risks associated with laser treatments. Studies report wrinkle reductions of approximately 50% in mild cases following multiple sessions, with high patient satisfaction rates exceeding 90% for overall rejuvenation outcomes.Scar and stretch mark treatment
Collagen induction therapy, also known as microneedling (including dermarolling), is particularly effective for treating atrophic acne scars, such as ice pick, boxcar, and rolling types, by stimulating collagen production to fill in depressed areas and improve skin texture. Recent evidence from 2024-2025 reviews and studies confirms that microneedling is effective for improving atrophic acne scars via collagen stimulation and skin remodeling. It is safe and well-tolerated across skin types, yielding consistent improvements in scar appearance, texture, and patient satisfaction. Monotherapy is effective, but combinations (e.g., with lasers, PRP, or topicals) often yield superior results. As of February 2026, no major studies from 2026 are available.[28][29][30] For shallower rolling and boxcar scars, needle depths of 0.5 mm can be effective in promoting collagen induction and skin remodeling, though they are less impactful for deep pits like ice pick scars compared to deeper penetrations.[21] This process involves creating micro-injuries in the dermis that trigger a wound healing response, leading to neocollagenesis and remodeling of scar tissue, with clinical studies reporting improvement rates of 31% to 75% after multiple sessions.[31] Deeper needle penetration depths of 1.5 to 2.5 mm are typically used for these scars to reach the reticular dermis, enhancing the induction of types I and III collagen.[32] Advanced variants combining microneedling with radiofrequency (RF) energy, such as Morpheus8 and Vivace, have shown efficacy in improving skin texture and reducing the appearance of acne scars by delivering targeted heat to stimulate deeper collagen remodeling.[33][34] For surgical or traumatic scars, collagen induction therapy reduces the appearance by breaking down fibrotic tissue and promoting organized collagen remodeling, resulting in smoother texture and decreased visibility.[32] This approach is suitable for various scar types, though hypertrophic scars may show more modest responses compared to atrophic ones, with improvements noted in scar pliability and height after 3 to 6 sessions spaced 4 to 6 weeks apart.[32] Patient satisfaction is generally high, with over 80% reporting positive outcomes in clinical evaluations.[35] In the treatment of stretch marks, or striae, collagen induction therapy targets atrophic striae alba by inducing dermal thickening and elastin production, which helps narrow the width and improve the overall appearance of these linear scars.[36] Multiple sessions, typically 3 to 6 at 2- to 4-week intervals, are required, yielding 20% to 50% improvement in lesion severity based on physician and patient assessments.[35] Needle depths of 1.0 to 2.0 mm are commonly employed to stimulate the mid-dermis without excessive trauma.[32] The therapy is most effective for mature scars that are at least 6 months old, allowing initial healing to stabilize before intervention, and is contraindicated for active keloid formation due to the risk of exacerbating excessive collagen deposition.[32]Hair loss treatment
Collagen induction therapy, particularly through microneedling, is used for treating androgenetic alopecia by creating controlled micro-injuries in the scalp that activate growth factors such as VEGF, EGF, FGF, and PDGF, as well as stem cells and the Wnt/β-catenin pathway for follicle regeneration, while also promoting collagen production around hair follicles to enhance hair regrowth.[37][38] A randomized evaluator-blinded pilot study of 100 men aged 20-35 with mild to moderate androgenetic alopecia demonstrated that weekly microneedling sessions using a 1.5 mm dermaroller, combined with twice-daily 5% minoxidil, resulted in a mean hair count increase of 91.4 in a 1 cm² area after 12 weeks, compared to 22.2 with minoxidil alone.[39] Randomized studies, including a meta-analysis of 12 RCTs involving 631 patients, show dramatic improvement when combined with minoxidil versus minoxidil alone, with significantly greater increases in hair count (SMD 1.32) and diameter (SMD 0.34), enhancing topical absorption through microchannels created by the procedure.[40][41] In this study, new hair growth was noticeable around 6 weeks, with 82% of participants reporting more than 50% improvement. The typical frequency is once a week, though it may vary based on individual tolerance and needle length.Contraindications and risks
Patient contraindications
Collagen induction therapy (CIT), also known as microneedling, has specific patient contraindications to prevent adverse outcomes such as infection or impaired healing. These are categorized into absolute and relative contraindications, with additional considerations for systemic conditions that may compromise treatment safety.[2] Temporary eyebrow tint or dye is not listed as a contraindication in reliable medical sources, as it is a surface hair treatment rather than a skin-altering procedure like tattooing or microblading.Absolute Contraindications
Absolute contraindications are conditions where CIT is not recommended due to high risk of complications. These include:- Active skin infections, such as inflammatory acne, herpes labialis, or warts in the treatment area, as the procedure can exacerbate or spread infections.[2]
- Open wounds, which increase susceptibility to further infection and poor healing.[24]
- Blood clotting disorders, including hemophilia or use of anticoagulants like warfarin, due to risks of excessive bleeding and bruising.[24]
- Pregnancy or breastfeeding, as the safety of the procedure has not been established and potential risks to the fetus or infant are unknown.[24]
- History of keloid or hypertrophic scarring, due to risk of abnormal scar formation.[2]
- Recent use of isotretinoin (within 6 months), as it impairs skin healing.[24]
Relative Contraindications
Relative contraindications involve conditions where CIT may be considered with caution or after specialist evaluation, but often warrants avoidance. These encompass:- Moderate-to-severe chronic skin conditions like eczema or psoriasis, which can heighten skin sensitivity and infection risk.[2]
- Immunosuppression, such as from chemotherapy, which impairs wound healing and increases infection susceptibility.[2]
- Recent cosmetic procedures such as chemical peels, laser treatments, Botox injections, or dermal fillers, which typically require waiting periods of several weeks (commonly 2–6 weeks depending on the procedure) to allow skin recovery and minimize risks of prolonged irritation, poor healing, or other complications.
- Treatment over tattooed or microbladed areas, as microneedling can cause fading or alteration of pigment, and caution or avoidance is often advised in such cases.