MicroNeedle at Home


I've had one professional microneedling session with an aesthetician, but the cost of $675 per session is beyond what my teacher salary permits, so I decided to find the device and use it at home.


I decided on the Dr. Pen, A1 model, which costs about $70.





This model plugs into an AC outlet, so if you want a rechargeable unit, select the Dr. Pen, A6 model, which costs about $105, and includes additional features. You can check out the links to see what's included with each. I also purchased replacement needle heads, which are shown in my picture above, but it comes with only two (2) 12-needle cartridges.


Other items I use:

Rubbing alcohol, cotton balls, antibiotic ointment, hyaluronic acid gel -- AND numbing cream.


I've purchased three different types of numbing cream, and the only one I've found that really works well enough for me is LMX numbing cream. I have the 4% now, but I'll buy 5% next time, even though it's for 'other' uses.





Preparation:

I follow the precautions and steps used at my derm's office, which are critically important for avoiding an infection!

1. Disinfect all equipment by soaking or wiping down with alcohol. My cartridges come in pre-sanitized packets, but they can be re-used up to four times, so I disinfect by soaking in 70% rubbing alcohol after each use and prior to the next use.
2. Thoroughly wash hands and cleanse face of sunscreen, makeup, etc.
3. Apply numbing cream and wait for 30+ minutes. Don't cheat here, or you'll regret it.
4. Remove numbing cream with water/damp cloth, and rewash hands
5. Donning rubber gloves now offers the most protection; either way, I'm cognizant of what I touch. Even touching my hair picks up bacteria that can transfer to the wound area
6. Disinfect facial skin with rubbing alcohol on a cotton ball. I do NOT skip this step.
7. Apply hyaluronic acid gel; this allows for easier movement of the device needles on the skin, but I always make sure my product is new (don't want any bacteria here); I use Swanson's Hyaluronic Acid Serum because it's simple without added ingredients
8. Determine the needle length for the section of face; a chart with this data accompanies the device.

Procedure:

1. I move in small, circular motions, reapplying gel and adjusting needle length as needed, as performed at my derm's office
2. I perform 4-6 rotations in each small section, which takes me about 20-30 minutes, or a bit more, to do most of my face. Note: I usually see small pins of blood every time. I do not stop or wipe off the blood; I just keep gently moving unless I need to adjust length or apply slip agent.
3. I use the .75mm on my cheeks and 1mm around my mouth. I usually can''t feel anything on my cheeks, but above my lip is more sensitive. Interestingly, my cheeks stay red longer, but around my mouth is usually just a bit pink.
4. Although the professional used the pen on my nose at the derm's office, I avoid that area because there are too many ridges that I am not proficient enough to do without injury. I could probably do the creases on the sides.
5. When I'm finished, I lightly cleanse the area with a moist cotton ball (and water)
6. Apply antibiotic ointment
7. I would apply sunscreen, but I always do this just before bed for the most healing time immediately afterward.

Other Serums:
Some people like to apply serums before the ointment, but I've read that it's not always safe. I wouldn't risk it since the skin is so vulnerable to infection at this stage. It's just not worth it to me.

How Often?
Several sources say to wait at least two weeks between sessions. Here's a quote from the DermaPen site, the makers of the device used by my derm's office: "The healing, inflammation, and collagenesis processes must take place for the benefits of microneedling to become evident.  Collagenesis peaks at 14 days after treatment.  Thus, a period of 14 – 30 days should elapse before a repeated microneedling treatment."

This picture is from day 2 after my most recent DIY microneedling with Dr. Pen: Cheeks look pink but they're fairly bright pink IRL; around my mouth is barely pink IRL and swollen. I also did my forehead, but you can't see it well here.


For more information on using Dr. Pen, there are videos online to observe the procedure performed by a trained aesthetician. I also recommend having a trained professional perform any procedure like this, at least once, those who want to try it.

The VI Peel

WHY?

I wanted to try the VI Peel because it's slightly different from the alpha- and betahydroxy acids (AHA and BHA) and TriChloroacetic Acid (TCA) chemical peels I normally perform at home--and it's the only one I haven't been able to find for at-home use. I turned 53 in February, so I think it's important to maintain cell turnover, which slows as we age.

So I went to a dermatologist to get the VI Peel.

Just after she applied the 2nd mixture.


WHO'S IT FOR?

Much of the information below is from a flyer provided by my dermatologist, though I do not use their words verbatim.

Those who want to positively affect acne, fine lines, wrinkles, scarring, malasma, hyperpigmentation, sun damage, signs of aging, rosacea, oil production, and/or overall skin tone.


All skin type and ethnicities can safely use this type of chemical peel.

And I would add from personal experience, it's for new-comers to peeling.

WHAT'S IN IT?

According to the same flyer provided by my dermatologist, the VI Peel contains a mixture of salicylic acid, TriChloroacetic Acid (TCA), tretinoic acid, phenol, vitamin C, and some other (unlisted) nutrients and minerals combined to work synergistically to remove the upper-most layer of the skin. This process, as with any peel, is touted to promote cellular turnover and collagen growth. It also refines the surface layer for smoother, clearer, firmer skin that has a more youthful and radiant appearance.

PROCEDURE

These are the procedures followed by the dermatologist I saw outside the Houston, TX area:

-Cleansed face with wipes
-Applied a numbing solution to sit for about 20 minutes
-Cleansed face again
-Disinfected face
-Applied two different peeling agents
-Did NOT remove peeling solution

POST PROCEDURE

I was told to

-Keep the solution on for the next five (5) hours
-Avoid the sun
-Use additional wipes provided that contained a low-level retin-a to continue the peeling
-Don't pick or peel skin
-Use sunscreen, which I do every day!

DOWN TIME

As with so many procedures, many providers tell us there's "little to no downtime," but that's like when repairing something: it always varies by person and takes longer than usually expected.

In my experience, the VI Peel has just as much downtime as a 25% TCA peel in terms of discoloration and peeling, though the depth and peeling are not as extreme, so this may be a better choice for first-time peelers, though I'd expect just as much downtime.

Click to enlarge


I was pink in some areas for days, primarily around my mouth, though this picture really doesn't do it justice, and the angle is weird--too close to my chin, though none of my pictures showed the red or yellow well. Use flash in the future!

It took about three (3) days to start peeling, and that lasted for another three, but it wasn't severe or in "sheets," so I would have been able to go out if I'd camouflaged, though I definitely would NOT want to go to work.

MY THOUGHTS

When I compare my experience with those who've posted information and pictures, I feel I didn't experience as deep a peel as others, though I attribute this to my regimen of at-home chemical peels: there wasn't much exfoliation needed.


I won't do this again. Would I recommend it? Maybe for someone who does not do at-home chemical peels or is a first-time peeler. It just doesn't seem any better than what I achieve as a MUCH lower cost at home!

My experiences may not reflect those of other consumers. This is not a recommendation to do at-home chemical peels.






Microneedling or CIT

Microneedling or CIT (Collagen Induction Therapy) doesn't necessarily involve chemicals, but it's an inexpensive method for treating fine lines and scars at home. I use a stamp and a roller.




There is much evidence that microneedling is effective for building collagen, which reduces wrinkles and scars, but research, research, research before any DIY procedure! I’ve included some clinical reports and research below (see references).

PROS:
  • Clinical evidence shows it works for wrinkles AND scars
  • Very Inexpensive
  • DIY
  • Down time is very short, much better than chemical peels
  • May help improve transdermal absorption of actives (questionable)

CONS:
  • Pain: it can hurt, but numbing cream helps
  • There's a little blood, but very small amounts from the pinpricks
  • Finding the best tools is challenging since not FDA approved for DIY
  • Expect slow results since collagen modeling takes time
  • Always a risk of infection with puncture wounds, so sterilize and sanitize
  • Not recommended for those with active acne lesions
My DIY Microneedling:
  1. I start with a high-quality instrument; I found the DermaRoller brand, which has titanium needles; I’ve read that poor tools may lead to breakage of needles in the skin or more damage in the skin than is necessary to induce collagen. My tools include a .5 mm stamp and a 1 mm roller. I use both, starting with the stamp, but I do not roll with the roller; I’ve found that just pressing like a stamp works better for me. I purchased my tools abroad as they’re not FDA approved.
  2. Always clean instrument(s) thoroughly with alcohol before and after each treatment and avoid touching the needles; I soak mine in alcohol for about 5 minutes each.
  3. I do my therapy before bed since I see a little blood and lots of redness. The redness lasts 24-48 hours for me, so doing this at night helps avoid having to apply concealer until some of the swelling subsides. I also see swelling for a couple of days.
  4. PAIN: I use lidocaine 5% prior to treatments to minimize pain, leaving it on for about 15-20 minutes and remove, wiping with alcohol before starting the treatment. I like the one linked because it’s non-oily and doesn’t cause breakouts for me. This treatment hurts, so it takes real commitment.
  5. After the therapy, I spray a DIY Vitamin C mixture on my face several times and follow with an antibacterial ointment. I make this DIY mixture just before treatment, so I don’t need preservatives, and I know bacteria growth should be minimal since I’m using distilled water (steam) and vitamin C powder.
  6. I’ve read that some people apply other actives following the treatment because the open channels in the dermis allow for deeper penetration, but I’ve read too many horror stories about infections arising from this practice, so I don’t use anything besides what’s listed above.
  7. I apply a good physical sunblock the morning after these treatments, which I apply daily anyway!
  8. I repeat every 3-5 weeks, depending upon needle size and aggressiveness
Google Images include many before and after photos that show much more detail than the photos I've taken with my phone.

Frequency

I've been doing the therapy about every 3-4 weeks for 4+ months now, so I'm not sure if there's any improvement, though theoretically, there must be some. It always looks great for the first couple of days afterward due to swelling, but that's temporary.

I've read that DIY'ers must be careful about doing the treatment too frequently since the collagen modeling can take 2-3 weeks to form after each treatment, so we risk damaging that repair process if we rush the treatments. I'm planning to do this regularly for the next year before I do anything else (besides my chemical peels) to see what kind of progress I can expect. I'd love to avoid plastic surgery, which all my friends seems to be having done. My sister just had a full face lift, and she's four years older than me. (I'll be 53 in Feb '17.)

A Brief History of Microneedling:
  • 1995 - Orentreich and Orentreich described subcision or dermal needling for scars
  • 1997 - Camirand and Doucet described needle dermabrasion using a "tattoo pistol" to treat scars
  • 2006 - Fernandes developed collagen induction therapy with the dermaroller
This book provides some interesting information, and if you have KindleUnlimited, it may be free. It has an interesting chapter that compares microneedling to lasers, chemical peels, dermabrasion, fillers, and IPL. There's also a chapter that addresses all the issues it may treat, though I haven't found clinical evidence supporting some of them.

References
1.            Orentreich DS, Orentreich N. “Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles.” Dermatological Surgery,  1995, Vol. 21. 
2.            Camirand A, Doucet J. Needle Dermabrasion. Aesthetic Plastic Surgery, 1997, Vol. 21, pp. 48-51. 
3.            Fernandes D. “Minimally invasive Percutaneous Collagen Induction.” Oral Maxillofacial Surgery, 2006, Issue 17, pp. 51-63. 
4.            Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. “Percutaneous collagen induction therapy: An alternative treatment for scars, wrinkles and skin laxity.” Plastic Reconstructive Surgery,  2008, Vol. 21.      
5.            Fernandes D, Signorini M. ‘Combating photoaging with percutaneous collagen induction.” Clinical Dermatology, 2008, Vol. 26. 
6.            Aust MC, Reimers K, Repenning C, Stahl F, j0 ahn S, Guggenheim M, et al. “Percutaneous collagen induction: Minimally invasive skin rejuvenation without risk of hyperpigmentation-fact or fiction.” Plastic Reconstructive Surgery,  2008, Vol. 122, Issue 15, pp. 53-63.













Significantly Reduce Redness and Downtime of Chemical Peels

I've been experimenting with a new topical that I'm really excited about using in conjunction with my TCA chemical peels, and I've detailed some of what I've found. 

If you've ever done a chemical peel, you know how erythema (red, hot, and inflamed skin) affects the downtime following a peel. One of the most challenging aspects of chemical peels is the DOWNTIME! I have to hide out in my house for 3-5 days, depending upon the peel. It becomes difficult to schedule around work, family, friends, and other community obligations--especially being a teacher. So anything that reduces the downtime, as long as it also contributes to healing and a positive outcome, is great!

THE RESEARCH

I'd been researching a topical to use for my rosacea. I found Azelex, which contains 20% azelaic acid. I have been using 50% TCA on on some age spots on my forehead, and had used the azelaic acid all over my face, but noticed that those treated spots were barely noticeable and healed very quickly, so I decided to it might be worth a try an an all-over treatment during a chemical peel.

After researching this ingredient, I found that it reduces post-inflammatory redness and hyperpigmentation--and it aids significantly in wound healing. Here's information on the Properties and Mode of Action.

According to the research, "Azelaic acid (AzA) has profound anti-inflammatory, antioxidative effects, and is bactericidal against a range of Gram-negative and Gram-positive microorganisms as well, including antibiotic-resistant bacterial strains. In addition, AzA's antikeratinizing effects are inhibitory toward comedones."

Yes, I know that the word ACID makes you do a double-take, but remember that in chemistry, it simply refers to a molecule or other entity that can donate a proton or accept an electron pair in reactions.

I was concerned though about mixing an "acid" with a chemical peel, so I continued my research and found this study where they combined glycolic acid and AzA. They saw a significant success, so that's what led me to finally try this.

One of my concerns was that a cream to help healing would cause a bad breakout (those antibacterial ointments and some lotions do that to me), but AzA is actually used to reduce acne, and it works great for me in that regard.

Here are a couple pictures so far; I’ll post again in a few days as I move through the healing process:

BEFORE: I have always focused chemical peels around my mouth because that's my problem area. I don't have any lines on my forehead or cheeks. I'll be 52 in February. 

Wearing physical sunscreen and powder

FROST
Yikes, it hurts! I applied 25% TCA in multiple layers (3 layers) with my fan brush for applying peels and let it sit for about 1 minute. Excuse my gaping mouth, but I've learned to apply it with my mouth open so that the solution can get to those tiny lines that are hidden or closed when my mouth is closed. I rinsed with copious amounts of cold water to neutralize. Basically, I just kept rinsing until the pain stopped.

Click on the image to enlarge.

Frost of 25% TCA Chemical Peel in 3 Layers

After rinsing to neutralize the TCA, I immediately applied my copper-peptide lotion, and then I applied 20% azelaic acid that I got as an Rx from my doctor in a medication called Azelex, and that's what I applied on top of the copper-peptide lotion. I left these on overnight since I did the peel at 6pm.

If you can't get an Rx, this serum is a great alternative. It contains Azelaic Acid,  Arbutin, and Hyaluronic Acid. Be careful not to order the one with vitamin C as this can burn if the pH level is too low. You can Contact this seller, and they'll make it without vitamin C and/or add/increase other ingredients since they create each batch as you order it. I think that's a great option--it's fresh and customized.

36 HOURS
Yesterday morning, I cleansed as usual and applied the copper-peptide lotion, Keys Solar Rx with zinc, and the 20% azeliac acid. I had to reapply the copper-peptide lotion several times during the day to keep the area moist, but I just dabbed it on top. Remember to use copper on the face ONLY when peeling and healing; this mineral is too strong for normal, healthy skin.

The pictures below are at 36 hours after the initial TCA application on Saturday evening.

You can see that the area is just starting to peel around the corners of my mouth, but what's really incredible is that the redness is so minimal. It's almost as if I didn't do a peel at all. This really seems to make the downtime tolerable. In fact, I went to the store! I never would have gone out before.

Click on the image to enlarge.


36 hours after 25% TCA peel: copper lotion + zinc sunscreen + azelaic acid

I included a whole-face picture here to show the lack of demarcation between my normal skin color and where I applied the TCA just 36 hours ago. There is so little difference that this is a game changer in downtime.

Click on the image to enlarge.
36 hours after 25% TCA application: copper lotion + zinc sunscreen + azelaic acid

48 HOURS:
There's still no significant redness, although I am starting to peel on the same schedule I usually experience. The area is a little pink, but I don't see the leathery, red or brown, irritated skin that I usually have at this point. There's no question that it would still be impossible to have an event scheduled this evening, but it's easier to not look like I've been using a blow torch on my face.

I tried to take a close-up picture to show more detail. Click on the image to enlarge.

48 hours after 25% TCA application: copper lotion + zinc sunscreen + azelaic acid

60 HOURS:
I woke up this morning and took this picture, so I'm really dry and afraid to move much before moisturizing in fear of cracking the skin. Still no significant redness or leathery look, but I'm continuing to peel. I expect much will peel today. Click on the image to enlarge.

60 hours after 25% TCA application - just woke up

66 hours after 25% TCA: copper lotion + zinc ss + AzA
This peeling should be done--or most of it--by 6pm, which is the end of day 3 or 72 hours after initial application, and I really didn't look hideous until last night/this morning. Looks like there's a 24-hour period of downtime for the peeling, which trims off at least a full day. Because there doesn't seem to be any major redness, I can still run errands and do other activities that won't require me to look presentable. I'm so excited to find a topical that makes downtime more tolerable. This truly changes the way I can perform TCA peels.

If you're interested in other ways to reduce downtime, look at this post on how to reduce swelling and inflammation


Use Caution when Combining some Supplements, Foods, and Medications with Chemical Peels

Those of us plagued with acne, even mild, have great results with chemical peels. Others choose oral prescription medications to control acne, and one common medication is Accutane, roaccutane, or isotretinoin.  Even doses as low as 10mg per day show incredible results for many people, but do NOT combine isotretinoin and chemical peels! Also, females taking isotretinoin are required in the United States to take two forms of birth control since this medication causes birth defects.

Even a low dose of only 10mg per day does not mix well with any type of chemical peel. The recommendations are to wait a minimum of 90 days after the final dose of isotretinoin before performing a light chemical peel, although six months is probably safer.

These photos show the results of combining 10mg per day of isotretinoin with a 70% glycolic acid peel:
 
10mg/day isotretinoin + 70% glycolic acid peel


The hyperpigmentation will require other treatments, such as corrective laser or chemical peels, although some fading can be achieved with a mild glycolic acid peel used 2-3 times per week in conjunction with a good physical sunscreen.

Typically, if a medication or supplement will cause increased sensitivity to UV rays, that's a red flag that it shouldn't be mixed with a chemical peel; however, I would ask my prescribing healthcare provider about doing a peel while taking medication. I never like to leave these details to anyone else, so I'd verify anything someone tells me--or thoroughly investigate it myself. 

Even some sunscreens increase UV sensitivity, so I would investigate other items I consumed and/or applied before a chemical peel. I would investigate medications, supplements, product ingredients, or even certain foods. 

Here's a list of items known to increase UV sensitivity, so I'd investigate further if I were considering a chemical peel:

  • Acne treatments: Creams and astringents with benzoyl peroxide. Prescription drugs including Accutane, doxycycline (an antibiotic), and Soriatane.
  • Antihistamines: Benadryl and other products with diphenhydramine.
  • Antibiotics: Tetracyclines, including Sumycin, Tetracyn, and Vibramycin (doxycycline). Sulfa drugs including Bactrim and Septra. Quinolones, including Cipro and Levaquin.
  • Antifungals: Griseofulvin, including Grifulvin V, Fulvicin P/G, and Gris-PEG.
  • Anti-inflammatories: Prescription and over-the-counter nonsteroidal anti-inflammatory pain relievers, including Celebrex, naproxen (Aleve), and ibuprofen (Motrin, Advil).
  • Chemotherapy drugs: Imatinib and dasatinib.
  • Cosmetic treatments: Microdermabrasion, chemical peels, laser treatments, exfoliating facial scrubs.
  • Diabetes: Sulfonylureas including Diabinese (chlorpropamide) and glyburide (Micronase, DiaBeta, Glynase).
  • Diuretics: Hydrochlorothiazide (HCTZ), used to treat high blood pressure. Lasix (furosemide). Combination drugs with HCTZ include Dyazide, Hyzaar, Maxide and Zestoretic.
  • Foods: Celery, citrus fruits (such as lime peel), dill, fennel, parsley, parsnips, and artificial sweeteners.
  • Heart medicines: Amiodarone (Cordarone), nifedipine (Procardia), quinidine (Quinaglute and Quinidex), and diltiazem (Cardize, Dilacor, and Tiazac).
  • Herbal remedies: Dong quai, St. John’s wort.
  • Perfumes: Lavendar, cedar, bergamot oil, sandalwood, rose bengal, musk, 6-methylcoumarine.
  • Psychiatric: Tricyclic antidepressants such as Norpramin and Tofranil; the antipsychotic medication chlorpromazine (Thorazine).
  • Skin care products: Check ingredients for alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), salicyclic acid, glycolic acids, Retin-A, and hydrocortisone.
  • Sunscreen: Benzophenones, dibenzoylmethane, oxybenzone, cyclohexanol, salicylates, cinnamate, and PABA (para-aminobenzoic acid).

List provided by WebMD. Photo from
"Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin" by Peter Arne Gerber,corresponding author Gabriela Kukova, Edwin Bölke, Bernhard Homey, and Evelyn Diedrichson.