Hello Mr. Liebl,
In my quest to learn more about your DermaRoller and CIT process I have read through your website and found it very informative. However, I am a little uncertain about a few issues concerning the treatment protocol with the 1.5 mm size, and hope you can share some additional details with me.
I understand that the entire process of how the Dermaroller works is based on the wound-healing cycle and that a cascade of actions is stimulated by the micro-injuries created by the DermaRoller in the dermis. I’ve read several articles that describe the three phases of wound healing (Inflammation, Proliferation, Maturation). However, I am not clear on one issue. When a new sheet of collagen is laid down just above the dermis and is populating with Collagen Type III for approximately 21 days from the onset of the “injury”, it then slowly converts from Type III to Type I. From that point on, the collagen fibers composed of Type I begin to strengthen and the greatest effects of skin remodeling take place and continue to do so for upwards of a year (or longer).
Based on this, I am wondering how it is possible to tell so early on after an initial DermaRoller treatment if you require another treatment (or more) 4 to 6 weeks later. The Maturation phase extends beyond 4 to 6 weeks and this is when the greatest results are developing and become more visable….right?
Essentially how can you ‘see’ results that haven’t had a chance to mature yet?
I am also wondering why just 3 treatments instead of 4 or 6, etc., should additional treatments be deemed necessary. Is the Maturation phase interrupted in some way by incorporating additional treatments with the 1.5 mm too close together? Some other ‘experts’ are claiming that the 1.5 mm size can be used several times a week for an indefinite period of time. But this just does not make ANY sense to me based on the wound-healing cascade and life cycle.
I am truly hoping that you can help me understand the reasoning behind the different Treatment Instructions for the 1.5 mm and why they should be stopped after 3 procedures during the first year of using the DermaRoller.
Thank you so much for your time and help. I look forward to hearing back from you.
Regards,
Lorraine
(Quote from website) “According to the individual skin condition, 1 to 3 procedures, separated by 4 to 6 weeks, are sufficient to resurface the skin. As aging continues, we recommend one refresher-CIT every year. Between the CITs and after the last one, you can support the results of the CIT by using the Home Care Dermaroller in combination with high-end peptide serums.”
Dear Lorraine,
Thank you very much indeed for your thoughtful mail. I have received thousands, but never such a detailed concern. Let me explain what we know so far. It is widely believed that skin reacts to needling by the wound healing cascade. But if one looks closer and goes more in cell biology than the picture suddenly changes dramatically. First we have to answer the question what is an injury? The best definition would be: The disruption of tissue integrity. Now the next question would be: Does a fine, precisely tooled, non traumatic needle cause an injury? Yes and no. Certainly cells may be damaged and capillaries may be punctured. A wound can only heal, when certain skin cells are stimulated by signals be become active. If there is a bleeding wound, naturally TGF (transmitted Growth Factors), usually transported by blood platelets, would send signals to various cells to become active, and in the end fibroblasts would transform into collagen fibers for wound closure. This we would call wound repair by fibrosis. Until this point school of thoughts is clear.
But if we have a closer look at needling that does not go further the average thickness of the dermis of about 1,5 mm, the picture changes dramatically. Although needles may puncture some capillaries, that are “emptied” by visible petechiae on the surface, their TGF amount would not be sufficient to trigger wound healing. Matter of fact, if skin cells receive injury signals transmitted by nerve cells (about 200 per square centimeter just below the basal membrane), they release also TGF. Unfortunately this is widely unknown.
We made experiments for years with MatTek and Biosciences in he USA in order to find out what causes new collagen formation in the dermis. We used cultured skin cells (without blood vessels, and therefore without TGF that derivate from platelets)) and needled it in various depths. By measuring the electrical skin resistance first we could see a significant change in electrical conductivity between intra- and extra cellular signal exchange. We clearly could harvest new collagen fibers after needling. Why they differ in amount – we do not know (yet).
The needling interval is a good question and we do not have yet the right answer. But if one looks at the fast response to needling of acne scars, we know that an interval of about 6 weeks is sufficient. Personally I am more on your side and I would like to see longer intervals. But at present, in so called modern times, we have a problem: people are impatient and they “want it now”. Although you should not forget, many physicians are often pushed for fast results. They actually should be the protagonists and tell people to be patient. However, why should a new cell formation influence the previous needle induced ones?
As all cases are different we only can give guidelines, but patient and physician in the end must decide. Also do not forget one point: The average knowledge of physiology. People are impatient and most of them are not interested in what happens in their body. We live in competitive times of individuals, and each one wants to be the first and best looking. This is the reason behind why we publish only fractions of medical knowledge.
Even for physicians needling and its mechanism of action is widely unknown. I just came back from a lecture and workshop and only after the lecture, they suddenly stood up and admitted that “they did not know how cell biology works”.
I hope that this answers your questions to some extent. If you have more, please do not hesitate to contact me again. Then I shall guide to to the right articles to get a closer picture.
Last but not least. To any ablative, cutting or cell damaging procedure the body will respond with its repair mechanism – fibrosis, an unformatted bundle like collagen. To micro needling (provided the right needles are used) the body responds with cell regeneration and new collagen that integrates into the existing collagen formation and its cross linked pattern. It is as simply as that.
Best regards
Horst Liebl
Dear Dr. Liebl,
Congratulations on the new website and this wonderful blog. It is very informative and a great help to patients like me who have been struggling for years because of acne scars.
I have been a follower of your old website, carefully reading about articles on this procedure dermarolling.
This is a relatively new procedure in the Philippines and I am quite happy to know that many clinics are now offering it. I am fully aware (thru information from the old website) that your medical rollers are for one patient and SINGLE use only. However, my dermatologist insisted that it can be used up to six times (She is using the MF8, 1.5mm). Is is me, or is my understanding of english is poor, as label of the container says that it is a SINGLE USE, DISPOSABLE INSTRUMENT. Please shed us light on this issue.
Janice