Until now, laser resurfacing has been an effective way to rejuvenate facial skin. But why destroy the epidermis of the face to make it look smoother? Laser destroys the epidermis so that the tissues of the papillary and reticular dermis can be destroyed and thereby instigate the normal post traumatic inflammatory reaction. The extensive damage eventually leads to the dense production of collagen and elastin with subsequent skin tightening. There is no doubt that laser has made a lot of people happy… in the beginning. It is now time to look for a more physiological way of inducing collagen and elastin.

The epidermis is a complex highly specialized organ and while it is only 0.2 mm thick, it is our only protection from the environment. We should never, ever damage the epidermis unless the risk of leaving the epidermis intact is greater than removing it. Wrinkles are not a good excuse to destroy this wonderfully complex interface that we have with the environment.

To rejuvenate facial skin and look really young, we need a perfect epidermis. We need the horny layer to be intact and compact (as in a young skin). The stratum corneum is our main defense against UV rays as well as being the barrier protecting us from harmful chemicals. A thick stratum spinosum will add protection from UV rays. Basal keratinocytes must be as fresh and active as they can be with minimal deposition of excessive melanin. We need a thick layer of collagen in the papillary and reticular dermis and functional elastin with a good blood supply.

If you look at the skin of any photo-damaged person under the microscope, then you will see that each of these main points have been compromised by sun damage. Destruction of the epidermis is not the way to correct that problem. Topical applications of vitamin A and the antioxidant vitamins C, E, and carotenoids, on the other hand, are effective, safe and will largely restore the skin to a more youthful appearance.

Of course, the real problems of wrinkled, sagging skin lie in the dermis. The collagen has been damaged and the thick layer of collagen in the dermis has become thinner. Topical vitamin A will not produce dramatic changes in the elasticity of the dermis

Collagen Induction Therapy is designed specifically to meet this requirement.

Percutaneous induction of collagen results from the natural response to wounding the skin, even though the wound is miniscule. Each tiny wound goes through the three classic phases of wound healing:

1. Inflammation
2. Proliferation (tissue formation)
3. Tissue remodeling.

The needle only penetrates through the epidermis and does not remove it, so the epidermis is only cleft and will rapidly heal. This injury, minute as it might seem, does cause some localized damage and bleeding.
The needle pricks penetrate about 1.5 mm into the dermis and starts up the inflammation phase. Tiny blood vessels are ruptured so blood cells and serum get into the surrounding tissue.

A complex chemical cascade determines the formation of a clot, vascular permeability, the attraction for leucocytes, and fibroblasts are recruited into the wounded area. Platelets cause clotting and release chemotactic factors like Platelet Derived Growth Factor (PDGF), transforming growth factor, and Fibroblast growth factor (FGF) that initiate an invasion of other platelets, leucocytes and fibroblasts. The leucocytes remove debris and kill bacteria. This reaction is automatic and produces a surge of activity that inevitably leads to the fibroblasts being “instructed” to produce more collagen, and more elastin.

Tissue remodeling continues for months after the injury. By 5 days after the treatment, the fibronectin matrix is laid down along the axis in which fibroblasts are aligned, and along which collagen will also be laid down. Collagen type III is gradually replaced by Collagen I over a period of a year or more. This gives increased tensile strength. If we are looking at a single needle prick through the skin, then this is an un-important response. A completely different picture emerges when thousands of fine pricks are placed next to each other. The process can become virtually confluent, and a sheet of collagen will be laid down in the area just below the epidermis.
Collagen slowly shortens and so the tightening of the skin is progressive over the next few months. The results can mimic those obtained with a laser, but without destroying the epidermis. That is the great advantage of this system. It is believed that deeper penetration into the dermis produces better collagen and elastin deposition. After all, it’s only a pinprick!