Microneedling: Percutaneous Collagen Induction (PCI) Therapy for Management of Scars and Photoaged Skin—Scientific Evidence and Review of the Literature

Abstract

Demand for safe, less aggressive and cost-efficient treatment modality to improve skin quality and appearance following scarring or photoaging is increasing steadily. A treatment modality that preserves the epidermis while promoting regeneration rather than cicatrization would be ideal. Percutaneous collagen induction (PCI) therapy or microneedling is claimed to approach this ideal objective. The current comprehensive literature review is intended to analyze the scientific basis supporting this therapeutic modality and to evaluate the efficacy of PCI microneedling therapy versus no treatment of patients with photoaged skin and scars of various etiologies on aesthetic skin rejuvenation, skin tightening and scar quality in prospective, retrospective and experimental studies. Twenty-five published studies were identified and included in this review. Four publications are experimental animal studies; most clinical reports are case series or small cohort non-randomized studies or trials lacking methodological unity with a heterogenous mix of scars, wrinkles and skin laxity being treated. The majority are studies about management of scars of various etiologies while only 4 specifically investigated the effect of PCI on wrinkles and aging skin. One study compared burn scar erythema in the treated area to the untreated area, and 5 studies included histologic evaluation of biopsies. Despite PCI promising therapeutic benefits and its increasing cosmetic applications, the current literature review unfortunately revealed a limited number of high-quality studies mostly experimental. Data and conclusions of clinical studies must be carefully interpreted before translating the evidence presented into clinical recommendations.

Collagen in Wound Healing

“…In 1995, a method called subcision was introduced as a minimally invasive way to treat scars using extremely fine needles to disrupt dermal collagen to trigger dermal remodeling and skin resurfacing [ 120 , 121 , 122 ]. This method is now known as microneedling or percutaneous collagen induction (PCI).…”

“…in small cohort clinical studies. A recent review of the evidence available on PCI techniques for scar treatment identified benefits such as little to no side effects and versatility of application [ 120 ]. However, this and other reviews have pointed out the lack of high-quality studies with sufficient numbers of patients following a standardized outcome protocol [ 121 , 122 ].…”

Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study

“…Percutaneous collagen induction therapy, commonly known as microneedling, has proven to be a well-tolerated, minimally invasive office procedure with a minimal downtime, considerable suitability for different skin types with minimal side effects and hence high degree of patient satisfaction. This technique acts through creating micro-channels/wounds inducing a wound healing cascade followed by deposition of newly formed collagen and elastic fibers and clinically evident as more tightened skin [ 4 ].…”

Facial Anti-Aging Treatments with Soft Peeling and Microneedling Technique

“…The study demonstrated the therapeutic efficacy of the combined needling-peeling treatment in different types of wrinkles (Figures 1-4). The maintenance of the integrity of the epidermal layer associated with the deep damage and the restriction of this damage to the area delimited by the microchannel, sparing the surrounding tissues, determines a good therapeutic result, with a low risk of side effects and complications [32,33].…”