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Figure 1.1 Original microneedling roller created by Dr. Desmond Fernandes in 2001. Fixed needle length of 3.0 mm multiuse roller; designed for reuse on a single patient for approximately six treatment sessions. The original rollers were not able to be autoclaved at that time. They were sterilized by soaking in instrument cleaning fluid.

      Source: Dr. Desmond Fernandes.

      In 1996, skin needling using a roller device was introduced by Fernandes at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei [2]. In 1997, Camirand and Doucet introduced dry tattooing without pigment as needle dermabrasion and proposed it as a technique to improve the appearance of scars [3].

Fernandes, in 2001, developed the original percutaneous collage induction dermaroller with needles. His pilot roller device was a drum‐shaped tool, with a cylinder and 3 mm needles that reach the fibroblasts deep in the reticular layer (see Figure 1.1).

      Zeitter et al. confirmed Fernandes’s findings and made a modified roller. They concluded that 1 mm needles show similar results to 3 mm needles, with the advantage of less downtime, swelling, and pain [3, 4].

Mechanism of action

The mechanism of action is thought to be a disruption of the epidermis and dermis. Micropunctures are created using microneedles, which produce a controlled skin injury without damaging the epidermis. The mechanical microinjury results in the classic wound‐healing cascade and stimulates cellular proliferation and migration through the stimulation of growth factors (see Figure 1.2).

These microinjuries lead to minimal superficial bleeding and set up a wound‐healing cascade with release of various growth factors, such as platelet‐derived growth factor (PDGF), transforming growth factor alpha and beta (TGFα and TGFβ), connective tissue activating protein, connective tissue growth factor, and fibroblast growth factor (FGF) [5]. The needles also break down the scar strands and allow them to revascularize. Neovascularization and neocollagenesis are initiated by migration and proliferation of fibroblasts and laying down of an intercellular matrix [6, 7]. A fibronectin matrix forms five days after injury and determines the deposition of collagen, resulting in skin tightening persisting for five to seven years in the form of collagen III. The depth of neocollagenesis has been found to be 5–600 μm with a 1.5 mm length needle. Histological examination of the skin treated with four microneedling sessions one month apart shows up to 400% increase in collagen and elastin deposition at six months postoperatively, with a thickened stratum spinosum and normal rete ridges at one year postoperatively [8]. Collagen fiber bundles appear to have a normal lattice pattern rather than parallel bundles as in scar tissue [9].