The Point Is: Everything in Beauty Treatments Using Needles and Needling

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu, and I'm excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is The Point Is: Everything in Beauty Treatments Using Needles and Needling. Dr. Bass, most of us think of plastic surgery as involving the operating room, incisions, stitches, and recovery. What are surgeons doing with needles that are enough of a big deal to put it into the mix with surgery?

Lawrence Bass (00:37):
Well, let's back up for a second and talk about definitions. Just so we lay out the playing field in which needle treatments and needling treatments are taking place, there are treatments that are invasive, like surgery where there are open incisions, and as you said, stitches and recovery time. There are minimally invasive procedures. These typically involve very small incisions, maybe like a big needle puncture or like a small incision of an inch or something like that. Like endoscopic surgery and arthroscopic surgery and laparoscopic surgery that allows surgery to be done inside. Often very substantial surgery just through very small incisions. And then there are other minimally invasive things like liposuction, which use very small incisions. A lot of things are happening on the inside, but the surgical impact is much less. Then there are microinvasive treatments, things essentially that are done with needle punctures. And sometimes those needle punctures are big needles, like even as big as a millimeter or slightly bigger two millimeters. And sometimes those are the tiniest needles that are out there and everywhere in between. And then there are noninvasive treatments, things that don't break the skin surface at all, and they're the least invasive category.

Doreen Wu (02:36):
Now let's get to the bottom line. Will these treatments really give me major results and allow me to avoid the recovery and downtime of surgery?

Lawrence Bass (02:45):
That's a great question, and I already alluded to the issue of recovery. So minimally invasive procedures sometimes still have major recovery or they might not have time when you're flat on your back in bed, but there's some work and social downtime. So that's the first thing to talk about. It's important to understand very clearly no matter how minimal the treatment sounds like, what the recovery is really going to be like, even if the treatment is minimally invasive, to make sure that fits with your desires and lifestyle requirements. Some treatments have little to no recovery, but there's always some kind of risk lurking in the background of more recovery. So an example of that is a Botox injection. Usually there's no recovery. It's literally a lunchtime treatment only takes a few minutes and you can go right back to work or almost any activity, but there's always that risk of a bruise.

(04:01):
Any time you break the skin with a needle, there's some risk of a bruise. You just have to keep that in the back of your mind. If you do the treatment enough times and things like Botox are recurrent treatments, sooner or later you're going to get unlucky and have a bruise and a little disruption in your social schedule. There are ways to minimize that. You know, if you avoid aspirin, alcohol, non-steroidal, anti-inflammatory medicines like ibuprofen, Naprosyn that minimizes the risk and how you behave afterwards. Everyone has different rules, but I ask people to avoid sports spending, lifting, consuming any alcohol for a few hours afterwards, again, to help minimize the risk of bruising.

Doreen Wu (04:55):
What about the results? Are they comparable to the surgical results?

Lawrence Bass (04:59):
In terms of results, and that's really the bottom line in in all treatments, you know, we're undertaking it to look better in a way that's obvious and visible. There's an awful lot of variation in this very large playing field of treatments, and particularly on the energy based side of it. There's not a lot of data. So most of the treatments with needles are either recurrent treatments or treatments that are done in a series, so three or five treatments or sometimes more or required to get a meaningful result. And as I said, there's not a lot of outcome data about that. So it's really critical to understand what the goal of the treatment is. And a lot of treatments that work in a very similar way and look almost almost identical can be more focused on either skin laxity or skin smoothing or skin surface changes.

(06:10):
And so if that matches up with what your goal is, that's a good fit for you. But just because it's a hot device or it's supposed to make the skin better, if it's not matched up with your goal, then it may not be the right choice for your individual needs. Now some of the technologies have parameter flexibility. They can expose at different depths in the skin so they can hit more than one clinical application area within the skin. But not all of the devices have that capability. So it's important to know the details or be working with a plastic surgeon who's very knowledgeable and experienced with these kinds of devices.

Doreen Wu (06:59):
Okay, so now that we have an overview, let's talk about the various needle puncture procedures. What are the main categories of needle treatments?

Lawrence Bass (07:07):
Well, the first thing is injectable treatments. So a treatment where you're trying to inject something under the skin or into the skin using a needle and filler treatments like wrestling, Juvederm and the others are examples of this where you are injecting a essentially mechanical filler or shape changer Botox treatments where you're injecting a medication that has a specific pharmacologic effect of blocking the nerve signal and relaxing muscles that therefore relaxes wrinkles or creates another change in the skin. There are needling treatments. So these are treatments that use many tiny sterile needles to create tiny punctures in the skin to a predetermined or to a variable depth depending on the capabilities of the technology. Creating a lot of punctures in the skin is little microtrauma that the body recognizes and responds to biologically. So it creates biostimulatory effects such as neogenesis, the formation of new collagen in the skin and neovascularization. And when you create the little punctures, you also release small amounts of blood into the skin. And that may be one of the ways that the biostimulatory effect takes place, because a number of elements in the blood do have biostimulatory effects in and of themselves.

(08:59):
Needling treatments in which a material is injected are also used using multiple small needles to make many tiny punctures, but also introduce a little bit of medicine into the skin. And in, in the United States print principally that's platelet rich plasma or PrP, which is harvested by drawing a large tube or sometimes two tubes of blood from, from the patient. And then preparing the fraction within the blood that's platelet rich by spinning the blood in a centrifuge the material can then be re-injected into the skin using the microneedling devices. Finally there's energy based microneedling, basically using radio frequency energy to expose the superficial or the deep layers of the skin or even just beneath the skin with little bits of energy to create a controlled injury that during healing amplifies the neocollagenesis and other effects. And as we age, you know, the amount of collagen and our skin diminishes, the organization diminishes our skin thins and the blood supply to the skin diminishes. So creating new collagen, restoring or creating new micro circulation to the skin are important to keep the skin looking and behaving like younger skin. And depending on what application you're looking at, this energy based microneedling can have the principal effect, as I mentioned earlier, of skin surface correction, skin quality issues that are seen on the surface of the skin or scar and wrinkle reduction or even laxity reduction.

Doreen Wu (11:01):
Which brings me to the age old question of which device is best. What are some factors that we should consider when making this decision?

Lawrence Bass (11:10):
There are so many devices right now and many of them are excellent. It's best to understand what feature specifically is going to be addressed, how many treatments that's going to require to see a meaningful result and how much downtime is involved. I also think it's important to understand how much discomfort the treatment itself is likely to have and in the first few hours of recovery, because there's a lot of variation device to device, some of the devices are minimally uncomfortable and others, the area really needs to be completely injected with local anesthesia to be numb in order for the treatment to be tolerable. So that's a broad range and you want to know where in that range you're signing up for in a given treatment. Energy based microneedling, I think the biggest role is in skin quality more than laxity reduction or wrinkle reduction. But there's a role in all of those things for these devices particularly for certain individuals who have a degree of a feature but not a severe degree.

Doreen Wu (12:40):
Let's just circle back to injectables for a moment. We talked about this extensively in previous episodes, but can you remind us what are the goals of injectables and who is it for?

Lawrence Bass (12:51):
So injectables play a major role at most stages of aging and the principle role in the first few decades of facial aging facial volume and smoothing of dynamic wrinkles mild shape enhancements to maximize facial harmony and allure is really the principle focus of these sorts of treatments.

Doreen Wu (13:23):
Lastly, before we conclude Dr. Bass, can you share some important takeaways for our listeners?

Lawrence Bass (13:29):
It's important to understand the level of invasiveness where we started out in this episode, and more important, the recovery time and social downtime of any treatment. So have that clearly in mind to make sure it's going to fit with your lifestyle and you don't get caught out with of some disruptive downtime that you weren't expecting. Many treatments are recurrent, so important to understand what's going to be needed to maintain a result, how often it's typically performed so you can assess what you're getting into and how to get the most out of the treatment. The nice thing about recurrent treatments are they're easy to try and see if you like them. And if you think they're great and have a big impact on your appearance, you keep doing them. And if you don't think they contribute a lot at this stage of the game, you just stop doing them and leave it aside. Other treatments are part of a series, so there you need to understand the number and frequency of treatments that are typically needed to get worthwhile results or that your plastic surgeon tells you are probably going to be required for you as an individual given your current stage of aging.

(15:03):
As I said earlier, make sure the capabilities of the treatment match your aesthetic issue and goals and that the treatment is being used for what it's intended for. You know, most treatments can give something really useful and really satisfying if they're being used for a problem that they're designed to solve. And if you're trying to use them in a backhanded way to solve another problem, typically the results are not very satisfying and potentially the risks are greater. Finally, make sure you're at the right stage of aging to really get benefit from the treatment selected. It's very appealing to do a non-invasive or a minimally invasive or microinvasive treatment, which is what most of the needle treatments are microinvasive. But at some stages your skin is not really likely to respond in a substantial way or the degree of correction required is not likely to be that which a microinvasive treatment and needling treatment can give you. Other times it's just a question of amount. You know, if you're 35 years old, you may need a little bit of filler. If you're 65 years old, you're going to need more than a little bit to look your best. If you're 85, it's going to be more.

Doreen Wu (16:33):
Thank you Dr. Bass for sharing your insight and expertise with us. And thank you to all of our listeners for joining us today to hear about the ever expanding role of needling treatments in aesthetic care. I hope you found this episode as intriguing and informative as I did. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in an upcoming episode, please reach out by email or Instagram. We'll see you next time. This is Doreen Wu thanking you for joining Dr. Bass and me for this discussion of how needles play an important role in beauty treatments and plastic surgery. Be sure to tune in next time and don't forget to subscribe to our podcast to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (17:13):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast. Consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.