Interview with Dr. Lance Setterfield June 06 2014

Dermal needling treatments have been successfully used in skin care to address multiple issues, including acne scars and anti-aging. I have had tremendous success integrating dermal needling into my practice, and I have to credit Dr. Lance Setterfield for adding to my knowledge and enthusiasm about this results driven technique.

I felt extremely honored that Dr. Setterfield agreed to take the time to sit down with me for an interview!

Wandering Aesthetic: How did you discover, and later decide to study needling so comprehensively?

Dr. Lance Setterfield: Having grown up in South Africa, I have significant photo-damage, including skin cancer.  While researching options to treat myself, I came across dermal needling.  Initially I was skeptical, but became convinced when, after dermal needling one of my patients with a genetic connective tissue disorder, she responded  positively; theoretically she ought not to have.

This inspired further studies.

WA: What's the history of needling?

DLS: Initially, in the late 1990’s Dr Camirand noticed overall skin improvement in his patients that were treated with cosmetic tattooing for hypopigmentation and scars.  It was also noted that some of the normal pigment returned. Since then, various devices in the form of rollers, stamps and electronic pens have been created to facilitate skin rejuvenation. 

WA: Who’s the best candidate for this type of procedure?

DLS: Medical (in-clinic) microneedling works best for anti-aging (wrinkles and brown spots), and scars (surgical, acne, trauma, burns).  It may be effective for hair restoration and stretch marks, but results are more variable in these patients depending on underlying causes and other factors.

WA: What are your thoughts on using the patients blood,ie Vampire facials, versus topical vitamins and peptides?

DLS: Platelets are "envelopes" found in blood containing chemical messages that are released at the time of emergency (crisis after wounding) to facilitate repair.  Think of these molecules as the smoke that sets off the smoke alarm.  The molecules are designed to trigger inflammation which in turn draws other cells to the region with this call for help, e.g. white cells to kill bacteria that enter the wound, or fibroblasts, which are the cells in skin that make collagen and elastin.  In theory, the more molecules there are to call for help, the more fibroblasts, the more collagen.  So how could this not be a good thing?  This brings us to quality versus quantity.  The fibroblasts called to an area of crisis are called myofibroblasts, and they are designed for quantity to fill a hole.  As a result, the collagen fibres are formed parallel to each other, which is known as scar collagen.  Normal skin has these fibres woven together like a basket to give ideal strength and flexibility.

Instead of focusing on the message system that platelets provide, there is more benefit to focusing on what the various skin cells need to support "optimum" repair and function.  Although Vitamins A and C have been around forever, they play an essential role in cell physiology.  There are several ingredients to consider in this phase of treatment, besides vitamins, but the scope of that discussion is immense and cannot be covered here.

In summary, platelets therapy promotes scar collagen, whereas vitamin therapy combined with needling produces normal collagen, and therefore skin that will function optimally over time.

WA: How then, is needling different to platelet therapy, after all, the process releases these same molecules from platelets with injury during treatment?

DLS: Platelets contain molecules that are predominantly inflammatory.  This is where the balance of nature comes in.  Needling stimulates other cells to release chemicals that are anti-inflammatory, and the molecule most credited with this action is TGF-B3.  It is thought to be the off-switch for the alarm that allows the white cells to go home when the coast is clear (once the hole is closed and there is no longer chance of bad bacteria getting in).  TGF-B3 is associated with normal basket weave collagen production which is found in normal skin.

WA: What are the benefits of needling vs. lasers.

DLS: Laser and other heat inducing treatments cause an injury in skin via increased heat.  Temperatures above 43 degrees Celsius produce heat shock protein 47 that is associated with an increase in collagen production.  Temperatures greater than 45 degrees lead to shrinkage and denaturing of collagen which gives a tightening effect, as well as collagen production due to the inflammatory response.  So isn't this everyone's dream in the anti-aging department?  The unanswered question is what will the skin look like, and will it function optimally in (5-10)15-20 years from now?  With needling, this anti-inflammatory response is averted, thanks to TGF-B3.  The other "plus" with needling is that any protein molecules needed for repair are not damaged in the heating process, as is the case with the other treatments mentioned above. Finally, darker skin absorbs more heat, just as a black car compared to a white one.  This heat damages, or excites, the cells that make pigment, or worse still, results in a burn and possible scarring.  Thus, needling is safe to use in all skin types if no other influencing factors are present.  To keep things in perspective, laser may still be needed to treat blood vessels and brown spots, but then the negatives can be countered by doing a needling treatment 2 weeks later.

WA:  How does needling improve scars?

DLS: Needling improves scars in three ways.  Firstly, it physically breaks down scar tissue.  Secondly, enzymes are triggered that dissolve or remodel the scar.  Thirdly, microneedling triggers new collagen growth to fill things in.

WA: What should a patient expect post treatment?

DLS: Patients typically look as though they have severe sunburn after treatment, and they will feel flushed and hot in the region treated.  LED immediately after microneedling helps reduce the redness and calms the inflammation.  Occasionally, mild bruising and swelling may occur.  The skin feels tight for about 3 days.  Flaking is the major feature for about five days and this is easily hidden with the correct products for adequate moisturizing.  Makeup also allows return to normal life in a day or two.

I hope you enjoyed!


- The Wandering Aesthetic