Cosmetic vs. Medical Skin Needling: Understanding the Key Differences

The term ‘needling’ is used frequently within the industry. Understandably this may lead to confusion or misunderstanding if ‘Cosmetic’ and ‘Medical’ are not specified.

According to Dr Lance Setterfield, there is some overlap between the two treatments from a physiological perspective because all medical and the dermal needling involves the epidermis as well.

Below is an extract from his Manual – The Concise Guide to Dermal Needling – Third Medical Edition – Revised and Expanded. Dr Setterfield explains exactly how the various needle depths activate and stimulate the skin at a cellular level.

Traditionally, one of the benefits of microneedling is enhanced infusion of topical ingredients.

• From a clinical or practical standpoint, it is important to remember that systemic absorption of non-native ingredients will lead to an immune response that may manifest as allergic contact dermatitis or granuloma formation.
• Thus, ‘Cosmetic’ needling should be embraced for enhanced skincare absorption at home, while ‘Medical’ needling should be viewed as a treatment for stimulating growth factors and cytokines, or mechanical breakdown of scar tissue.

The benefits of infusing ingredients once a month in the clinic after ‘Medical’ needling are negligible and cannot be justified when weighed against the potential adverse outcomes.

• Substances that are applied as drugs for systemic use can be used with ‘Medical’ needling, e.g. δ-Aminolevulinic acid (ALA) – an endogenous non-proteinogenic amino acid.

• Typically, dermal needling is divided into ‘Cosmetic’ and ‘Medical’ needling based on the length of the needles and the depth reached in the skin.

This definition has more to do with providing a means for device classification in the industry and government agencies, as well as guidelines for legal considerations (scope of practice).

• Unfortunately, this ‘classification’ is not helpful when determining a treatment plan because practitioners become focused on the device specifications and lose sight of the patient.
• They tend to identify or associate a needle length with a particular condition.
• There are always exceptions to the rule when treating someone due to their uniqueness. It is essential to choose a needle length based on the depth of the problem being targeted in that particular individual, and not treat by numbers.
• Remember that it is the condition being treated that dictates whether it is ‘Cosmetic’ or ‘Medical’ and not the needle length.

Differences in needle size and their benefits

Cosmetic rollers (needle depth 0.2mm and 0.3mm) 

• Create micro-injury to the epidermis and stimulate keratinocytes to release growth factors and promote upregulation of epidermal growth factors (and many other growth factors and cytokines).
• Within this range of needles, rollers can be safely used by patients and trained skin therapists or aestheticians.

Medical rollers (needle depth 0.5mm-3.00mm)

• On the other hand, triggers the wound-healing cascade to stimulate keratinocytes and fibroblasts, with resulting of the upregulation of TGF-B3 and increased epidermal cell turnover, collagen, elastin and GAGs.
• This size of the roller is used by appropriately trained clinical aestheticians, dermal therapists, cosmetic nurses, and doctors.

Cosmetic needling: how does it work?

• Cosmetic needling achieves results through increased quantities and access of cell nutrients to the skin, thus optimising cell function.
• In addition, injury to the keratinocytes promotes epidermal growth factor (EGF) and increases cell turnover.
• The cosmetic roller and other home devices use very fine stainless-steel needles to make channels into the epidermis.
• This allows up to 80% more product in the skin compared to 7-10% with normal topical application), providing essential cell nutrients for stimulating your own collagen naturally.
• (Using 0.3mm needle size results in eightfold increased flux with hydrophilic substances and 0.2mm needle size fourfold).
• Needling, or any other treatment modality for that matter, will always deliver inferior results if not combined with the building blocks of topical nutrients with which the cell can work.

Effects in the epidermis

The epidermis is influenced by cosmetic needling in the following ways:

Micro-injury to the keratinocytes 

• This leads to the release of several growth factors, such as epidermal growth factor, which causes epidermal thickening and upregulation of cell function.

Cellular crosstalk between the healthy keratinocytes and melanocytes

• The result from dermal needling is improved, which leads to a better distribution of melanin pigment.
• It increases the delivery of the right ingredients to the depth of the keratinocytes and melanocytes.

Effects on the dermis

The dermis is influenced by cosmetic needling in the following ways:

• By cellular signalling from the keratinocytes through various growth factors and other molecules, which govern fibroblast response.
• By upregulation of collagen genes that influence fibroblasts.

Adding to this chapter Dr Setterfield provides further interesting information on the Dermal-Epidermal Junction – A new Frontier in which he explains how lower needling depth when used correctly can contribute to the upregulation of genes.

The Concise Guide to Dermal Needling – Third Medical Edition – Revised and Expanded is a comprehensive 283-page manual that covers the most up-to-date information on pathophysiology as well as protocols for treating a diverse range of skin conditions.

The book contains what ingredients to use and when contraindications and the most advanced protocols for achieving clinical results with dermal needling. It is considered the bible of skin needling.

Access your copy today!