As a Derm, This is My Favorite Skin Treatment for Firmer Skin | Dr. Sam Ellis — Transcript

Full transcript

1. 0:00Microneedling is one of the most popular
2. 0:01skin rejuvenating treatments in my
3. 0:03office and I have had it done many, many
4. 0:06times myself, but I find there are so
5. 0:08many questions floating out there about
6. 0:11microneedling at home versus in-office
7. 0:13treatments, radio frequency versus
8. 0:15traditional, are we using PRP, are we
9. 0:16adding exosomes? So, you can think of
10. 0:18today as your comprehensive guide to
11. 0:21microneedling.
12. 0:27I'm Dr. Sam Ellis. I'm a board-certified
13. 0:29dermatologist practicing in the San
14. 0:30Francisco Bay Area and this channel is
15. 0:33here to help you make better decisions
16. 0:34about how you take care of your skin.
17. 0:36It's an extension of the conversations I
18. 0:38have every day in my clinic with my
19. 0:40patients. So, if you like that type of
20. 0:42content, make sure you give this video a
21. 0:43thumbs up and you are subscribed to the
22. 0:45channel. Let's start with the basics,
23. 0:46which is what is microneedling?
24. 0:48Microneedling is also known as collagen
25. 0:50induction therapy and it works on this
26. 0:53very simple principle of creating
27. 0:54micro-injuries within the skin with very
28. 0:57tiny sterile needles in order to
29. 0:59stimulate a wound healing cascade that
30. 1:02helps you create more collagen and
31. 1:04elastin in the skin. And as you may
32. 1:05already know, collagen and elastin are
33. 1:07the main structural support proteins
34. 1:09within your skin. It's what gives your
35. 1:11skin integrity, gives it bounce, and
36. 1:13what keeps your skin tight. So, who
37. 1:16wouldn't want more of that going on
38. 1:18within their skin? And for those
39. 1:19reasons, microneedling can be very
40. 1:21helpful with addressing a variety of
41. 1:23skin concerns, but I find that my
42. 1:24patients use it the most to help with
43. 1:27fine lines, irregular texture, and
44. 1:29enlarged pores. And microneedling isn't
45. 1:31just for the face. In my practice, I use
46. 1:33it all the time on the neck and on the
47. 1:35chest to help with things like sleep
48. 1:37creases and crepiness and those
49. 1:39horizontal necklace lines. It's also one
50. 1:41of the few resurfacing procedures that
51. 1:43is safe for all skin tones because it
52. 1:45doesn't use heat. And heat is one of
53. 1:47those things that can induce irregular
54. 1:49pigmentation, especially in those who
55. 1:51have more melanin-rich skin tones. So,
56. 1:53the fact that microneedling can be done
57. 1:55without heat makes it a safer option for
58. 1:57everybody. And although most people are
59. 1:59a good candidate for micro needling,
60. 2:01there are a handful of instances where I
61. 2:03wouldn't recommend these, so I do want
62. 2:04to briefly go over that. I wouldn't get
63. 2:06micro needling done if you have active
64. 2:08acne. Typically, we are doing micro
65. 2:10needling for a cosmetic correction, but
66. 2:12if you have ongoing breakouts, I would
67. 2:14argue that getting your acne under
68. 2:16control is a much bigger cosmetic
69. 2:18priority. Also, if you are micro
70. 2:20needling over active acne, you risk
71. 2:22spreading bacteria and exacerbating the
72. 2:23problem, which of course nobody wants.
73. 2:25Sometimes when people hear me say that
74. 2:27you can't have micro needling done if
75. 2:28you have active acne, they sort of lump
76. 2:30rosacea into that as well, but if you
77. 2:33have decently well-controlled rosacea,
78. 2:34micro needling can actually be
79. 2:36beneficial for you. It's one of the many
80. 2:38reasons that I get micro needling done
81. 2:39myself. You also don't want to have
82. 2:41micro needling done if you have any open
83. 2:43irritation or sores on the skin,
84. 2:44including an active cold sore. Now, it's
85. 2:46totally fine if you have a history of
86. 2:48cold sores, we'll just put you on an
87. 2:49antiviral medication, usually the day
88. 2:51before you have your micro needling
89. 2:53treatments done, and we usually have you
90. 2:54take that for a week. But if you have an
91. 2:56active cold sore, we would ask you to
92. 2:57reschedule because we don't want to risk
93. 2:59exacerbating that. And when I mentioned
94. 3:01not getting micro needling done if you
95. 3:03have irritation on your skin, that can
96. 3:05be a temporary form of irritation, like
97. 3:07maybe you tried a new skin care product
98. 3:08and your skin got really inflamed, not
99. 3:10the best time to do micro needling. But
100. 3:11also, if you have a flare of your eczema
101. 3:13or your psoriasis, that is not the time
102. 3:15to have a treatment like this. Lastly,
103. 3:17if you have a history of true keloid
104. 3:19scars, I would not have micro needling
105. 3:21done. And I say true keloid scars
106. 3:23because a lot of people think they have
107. 3:24keloids, actually have something called
108. 3:26hypertrophic scars, which is not a
109. 3:28contraindication to having micro
110. 3:30needling done, and while I never expect
111. 3:32my patients to know the difference, the
112. 3:34person assessing you for your micro
113. 3:36needling candidacy should be able to
114. 3:38tell the difference. And if they can't,
115. 3:40that's a red flag. I always like to get
116. 3:42a very thorough medical history on
117. 3:44anyone that I'm delivering a cosmetic
118. 3:45treatment for because I need context,
119. 3:48and there might be changes to the the or
120. 3:50the plan or the aftercare based on that.
121. 3:53So, I always want to make sure that I'm
122. 3:54treating my patient appropriately and
123. 3:57safely. So, let's say you decide, "Hey,
124. 3:58I'm interested in microneedling because
125. 4:00I have some early texture. I have some
126. 4:02enlarged pores. I want to be doing
127. 4:04something to nudge my skin towards being
128. 4:06better." What does that look like when
129. 4:08you are in a cosmetic office? First of
130. 4:10all, I would say if you are getting
131. 4:11assessed for microneedling, you should
132. 4:12go somewhere that offers more than just
133. 4:15microneedling because if all they have
134. 4:17is a microneedling device, guess what
135. 4:18they're going to recommend to you.
136. 4:20Versus if they have lasers and peels and
137. 4:23injectables, they will give you a much
138. 4:25more comprehensive assessment and
139. 4:27microneedling might be something you're
140. 4:28interested in, but there might be
141. 4:30something that's actually better for the
142. 4:31concerns that you have. And like I sort
143. 4:33of mentioned before, a lot of people can
144. 4:35be a good candidate for microneedling
145. 4:37because it's a really easy way to nudge
146. 4:39your skin towards being healthier and
147. 4:40creating more collagen and it's safe for
148. 4:43all skin types. So, I recommend it often
149. 4:45for my patients who are in their 30s or
150. 4:4740s or 50s and maybe don't have the
151. 4:49downtime for really aggressive laser
152. 4:51resurfacing or even moderately
153. 4:53aggressive laser resurfacing like
154. 4:54Fraxels or Halo lasers, but they want a
155. 4:57little more oomph than say my more
156. 4:59gentle resurfacing lasers or a chemical
157. 5:01peel. Microneedling kind of sits right
158. 5:03in the middle where you're getting
159. 5:04meaningful collagen stimulation with
160. 5:06each treatment, but not a ton of
161. 5:08downtime and an excellent risk profile.
162. 5:10One question I'll often get during a
163. 5:11consultation is, "Well, how deep do you
164. 5:13go with the microneedling?" And it
165. 5:15really depends. I want to get into what
166. 5:17we call the papillary and reticular
167. 5:19dermis, which is below the epidermis or
168. 5:21the top layers of the skin because that
169. 5:23is where I have the greatest potential
170. 5:25to induce collagen, but that depth is
171. 5:27really going to depend on your unique
172. 5:29skin and what areas of your face or neck
173. 5:31or chest that I'm treating. For example,
174. 5:33around the eyes, I'm usually under a
175. 5:35millimeter of depth, but as we go to the
176. 5:37cheeks and the chin and the perioral
177. 5:39area, we can go up to 2 and 1/2 mm deep.
178. 5:42So, over the course of a treatment, we
179. 5:43might change the depth of the needles a
180. 5:45bunch of times in order to give you the
181. 5:47most tailored and effective treatment. I
182. 5:49also think you should always get proper
183. 5:50pain control if you're going to have
184. 5:52microneedling. Sometimes I have patients
185. 5:54come in and they tell me they've had
186. 5:55microneedling before with zero numbing
187. 5:57and that it was painful and yeah, of
188. 5:59course it was. You had thousands of tiny
189. 6:01needles poking you in the face with no
190. 6:03numbing. So, I like to give my patients
191. 6:04somewhere between 45 and 60 minutes of
192. 6:07numbing so the treatment is incredibly
193. 6:08comfortable. I always tell them on a
194. 6:10zero to 10 pain scale, you should be
195. 6:12sitting at a two or less. someone's
196. 6:14having a procedure done in my office,
197. 6:15they would come in, marinate in their
198. 6:17topical numbing for anywhere from 45 to
199. 6:1960 minutes, get fully cleansed and
200. 6:21sterilized, and then have their
201. 6:22treatment done, which can take anywhere
202. 6:24from 15 minutes to 45 minutes depending
203. 6:27on how much surface area we're covering.
204. 6:28When you're having professional
205. 6:29microneedling done, we are typically
206. 6:31using a microneedling pen that has a
207. 6:33sterile head attached to it that can
208. 6:35have anywhere from six to 36 needles.
209. 6:38And with that pen, you don't just have
210. 6:39the ability to turn it on, but you can
211. 6:41also change the frequency of the needle
212. 6:43oscillation because they're kind of
213. 6:44going in and out of the skin, but also
214. 6:46the depth at which those needles are
215. 6:48penetrating. And of course, everyone
216. 6:49will have a slightly different
217. 6:50technique, but we are typically slowly
218. 6:53moving that pen over the surface of the
219. 6:55face either in a back-and-forth,
220. 6:57up-and-down motion, or sometimes in
221. 6:58little circles depending on what we're
222. 7:00trying to achieve. And if you're
223. 7:01appropriately numbed, it shouldn't feel
224. 7:03sharp at all. It just feels like a buzzy
225. 7:04vibration. So, typically right after you
226. 7:06have your microneedling procedure,
227. 7:08you're going to feel like you have a bit
228. 7:09of a sunburn or a windburn, and for most
229. 7:11people that uncomfortable situation
230. 7:14naturally subsides over the course of
231. 7:16one to two hours. And you're also going
232. 7:17to look quite red and maybe even notice
233. 7:20some pinpoint bleeding in certain areas.
234. 7:22And then over the course of the next few
235. 7:23days, that redness is going to fade to a
236. 7:25mild pink. You will notice maybe some
237. 7:27sandpaper texture to your skin, and most
238. 7:30people are healed between three and
239. 7:32seven days. It really just depends on
240. 7:34their unique skin and how aggressive the
241. 7:35treatment was. I find with myself in the
242. 7:37settings I use, post-treatment day
243. 7:40three, I look pretty normal to the
244. 7:42average person, but there have been many
245. 7:43times where I go to clinic the very next
246. 7:45day after having microneedling done and
247. 7:48at least no one says anything. I always
248. 7:49tell my patients if it's their first
249. 7:50microneedling session to give themselves
250. 7:52some extra days to recover, not plan any
251. 7:54big social events or work presentations.
252. 7:57And once they get a sense of their
253. 7:58unique recovery journey, they can decide
254. 7:59moving forward how much downtime they
255. 8:01need to a lot for themselves. In terms
256. 8:03of when you'll see results, about 1 week
257. 8:05after your microneedling session, most
258. 8:06people notice that their skin just looks
259. 8:08more plump and juicy and glowy, but it's
260. 8:10really over the course of the next
261. 8:12several weeks that you're going to get
262. 8:14that collagen stimulation. And I always
263. 8:15remind my patients microneedling is a
264. 8:17fairly gentle treatment, and you need to
265. 8:19do it repeatedly to see the most
266. 8:21exciting clinical results. Most of the
267. 8:23clinical trials do microneedling four to
268. 8:26six sessions, four to six weeks apart.
269. 8:28So, really doing a series is where
270. 8:30you're going to see meaningful changes
271. 8:32in your skin that last. I always tell my
272. 8:34patients when it comes to treatments
273. 8:35that require multiple sessions to see
274. 8:37exciting results, one is a treat, four
275. 8:40or five is a treatment. And then once
276. 8:42you complete that initial microneedling
277. 8:43series, which I often refer to as
278. 8:45bootcamp, then you can go into more of a
279. 8:47maintenance mode. A lot of patients will
280. 8:49get microneedling done every six to nine
281. 8:52months as just like a little reminder or
282. 8:53a nudge to their skin to continue to
283. 8:55produce collagen. But, I also have
284. 8:56patients who prefer to stack their
285. 8:58treatments where every fall they do two
286. 9:00or three treatments back to back, kind
287. 9:02of like a mini series. And that just
288. 9:03comes down to personal preference. Now,
289. 9:05I do want to talk a little bit about
290. 9:06radiofrequency microneedling because it
291. 9:08gets a lot of hype and hate on social
292. 9:10media, and I just want to provide some
293. 9:11clarity here. Unlike traditional
294. 9:13microneedling, which is completely
295. 9:15heatless, radiofrequency microneedling
296. 9:17combines heat with that microneedling
297. 9:20treatment to get a more robust collagen
298. 9:22stimulating response from the skin.
299. 9:24Morpheus 8 is probably the most popular
300. 9:26brand name of radiofrequency
301. 9:27microneedling, but there are a ton of
302. 9:29other devices. In my office, we have
303. 9:31something called Potenza. And really
304. 9:32radiofrequency microneedling treats all
305. 9:34the same things as traditional
306. 9:36microneedling in terms of improving skin
307. 9:38texture, helping with fine lines, acne
308. 9:40scarring, but radiofrequency has also
309. 9:42been touted to tighten the skin, and I
310. 9:45want to push back on that a little bit.
311. 9:46I find that when people come in asking
312. 9:48about radiofrequency microneedling
313. 9:49treatments, they're hoping that it's
314. 9:51going to lift and tighten their lower
315. 9:52face or their jowls, but it doesn't
316. 9:55induce enough collagen stimulation to do
317. 9:57that in a really exciting way. And in
318. 9:59fact, there are now many reports of
319. 10:01radiofrequency microneedling being used
320. 10:03over aggressively to try and tighten the
321. 10:05skin and inducing things like scarring
322. 10:07or fat melting. And I don't say those
323. 10:09things to scare people off from this
324. 10:10procedure. I'm obviously a proponent of
325. 10:12it. I have a device in my office, but it
326. 10:14is so key that if you're going to pursue
327. 10:17radiofrequency microneedling, you have
328. 10:19it done by an experienced provider. And
329. 10:21where radiofrequency microneedling
330. 10:23really fits in my practice is for my
331. 10:25patients who maybe have a deeper skin
332. 10:27tone, so they're not a great candidate
333. 10:28for more aggressive laser resurfacing,
334. 10:31but they do want to get a more robust
335. 10:33collagen stimulating response than what
336. 10:35traditional microneedling offers. So
337. 10:37usually it's deeper skin tones and more
338. 10:39mature skin. But for a lot of my
339. 10:40patients who are coming in in their 30s,
340. 10:42and 40s, and 50s, we can get away with
341. 10:44traditional microneedling, which is less
342. 10:46uncomfortable and way more affordable.
343. 10:48The other thing patients will often
344. 10:49inquire about is adding on something
345. 10:51like platelet-rich plasma or exosomes to
346. 10:54their microneedling treatment in order
347. 10:55to enhance their results. PRP is
348. 10:57platelet-rich plasma, which is where we
349. 10:59draw your blood in the office, spin it
350. 11:01super fast so we can separate out the
351. 11:03plasma component of your blood, which is
352. 11:05really rich in nourishing growth
353. 11:07factors. And in my practice, we often
354. 11:08use it to help with hair growth, but it
355. 11:10also can be used on top of a
356. 11:12microneedling session when you have all
357. 11:13of those open channels in the skin to
358. 11:16help you heal faster and get a more
359. 11:17robust response. Now the best data we
360. 11:19have for microneedling with PRP is in
361. 11:21those with acne scars, and the data very
362. 11:24clearly shows that if you have acne
363. 11:25scars and you add PRP to your
364. 11:27microneedling treatment, you will have a
365. 11:29more robust result. Whether those PRP
366. 11:32benefits apply to those who don't have
367. 11:34acne scarring is less clear, but I have
368. 11:36many patients who opt to include PRP
369. 11:38with their treatment because they want
370. 11:39to have the best chance of having the
371. 11:41most exciting result. Now, when it comes
372. 11:42to other things that can be added on
373. 11:44with PRP like PDGF, platelet-derived
374. 11:46growth factors, or exosomes, it's not
375. 11:49something I offer in my office because
376. 11:51the data just really isn't there yet,
377. 11:53but I know other people swear by them,
378. 11:55but because I don't see the robust
379. 11:57clinical trials showing that they add
380. 11:59benefit with a strong safety profile,
381. 12:02it's not something I recommend to my own
382. 12:03patients. And this sentiment really
383. 12:05carries over to how I feel about at-home
384. 12:07microneedling treatments. Those
385. 12:09treatments that you do at home are quite
386. 12:11superficial, and although they may do
387. 12:13something nice for the skin, we just
388. 12:14don't have the same robust clinical data
389. 12:17to support their efficacy. So, I'm
390. 12:18certainly not against them. It just has
391. 12:20a much less predictable clinical
392. 12:22outcome. Plus, you have these risks of
393. 12:24things like infection or causing
394. 12:25granulomatous reactions, all things that
395. 12:28are risks with in-office treatments as
396. 12:30well, but it's a much more uncontrolled
397. 12:32environment when you are microneedling
398. 12:34yourself at home. If you are going to do
399. 12:36facial microneedling at home, make sure
400. 12:37your face is really clean, you're using
401. 12:39fresh needles, and rather than using
402. 12:41something like a derma roller, which can
403. 12:43drag and tear the skin, I much prefer
404. 12:45something that's more of an in and out
405. 12:47stamping motion. You just have to keep
406. 12:48in mind when you are doing manual
407. 12:50stamping of your skin, you're creating
408. 12:52very, very few channels in the skin
409. 12:54compared to having an oscillating
410. 12:56microneedling device performed on you in
411. 12:58the office. And no matter what type of
412. 12:59microneedling you're having done, it's
413. 13:01really important that you take care of
414. 13:03your skin properly afterward. Now, I
415. 13:05will always defer to your provider and
416. 13:07what they recommend to your skin, but I
417. 13:08can tell you what I have my patients do.
418. 13:10After the procedure is done, and
419. 13:11especially if they have also gotten
420. 13:13topical PRP, I don't want them to wash
421. 13:15their face for at least 4 hours. So, I
422. 13:17usually just say, "Leave your face alone
423. 13:19until you're getting ready for bed."
424. 13:20When you're doing that first night of
425. 13:22skin care, I'm going to have you use a
426. 13:24really gentle cleanser. I often
427. 13:25recommend my Prequel cleanser. And then,
428. 13:27you are going to do a very thin layer of
429. 13:30ointment. That could be Aquaphor, it
430. 13:31could be Vaseline, something that you
431. 13:33know your skin tolerates well, and you
432. 13:35don't have to goop it on. But, the way I
433. 13:37think of it, we've just made a ton of
434. 13:38little wounds in your skin, and the same
435. 13:41way if you got a cut or a scrape, I
436. 13:42would want you to put ointment on it to
437. 13:44help it heal faster. The same goes for
438. 13:46your face after microneedling. Because
439. 13:47those channels are so tiny, they're
440. 13:49essentially closed after that first
441. 13:51night. So, if you don't want to continue
442. 13:52to put ointment on your face after day
443. 13:54one, totally fine. In the subsequent
444. 13:56days while you're still healing, you're
445. 13:57going to wash your face a couple of
446. 13:59times a day. You're going to apply some
447. 14:00type of moisturizer or ointment, and
448. 14:02during the day, I want you to apply
449. 14:04sunscreen if you're going to be outside.
450. 14:06While you're healing, I have you hold
451. 14:07off on using any of your actives,
452. 14:09whether that's vitamin C, peptides,
453. 14:10retinoids, exfoliants. And you'll really
454. 14:13know when you're done healing because
455. 14:14your face won't feel sandpapery or tight
456. 14:16anymore. And then you can go back to
457. 14:18your normal skin care regimen.
458. 14:20Microneedling, when done well, is one of
459. 14:21the most versatile skin rejuvenating
460. 14:24treatments out there. So, I really hope
461. 14:25this answered a lot of your questions. I
462. 14:27would love to hear in the comments your
463. 14:29experiences with microneedling. Are you
464. 14:30thinking about it? Have you had it done?
465. 14:32What did you like? What did you not
466. 14:34like? Give us the tea. Other people read
467. 14:36the comments besides just me, and I love
468. 14:38that we can learn from each other in
469. 14:39this community. Thank you as always for
470. 14:41being here. Don't forget to like this
471. 14:42video and subscribe to the channel, and
472. 14:44I will catch you next time.
473. 14:53>> [music]