And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started.
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Hi, my name is Dr. Shelly Goldstein. Welcome to the American Acupuncture Council. Thank you so much for having me here today. And today’s topic is going to be Treating Facial Wrinkles with Intradermal Needling. So let’s get started. We think of wrinkles on our face and we think of them as just wrinkles.
But in fact, there are many, types of wrinkles on the face, and they come from many different sources. We can get wrinkles from. Bone changes and over time, all of these changes occur on many different levels. So from the deepest level bone, as we age, bone resource, or starts to break down, bone is the underlying structure of our face.
And so when the bone starts to break down, so do the overlaying structures, including the skin or the surface, which is where the wrinkles. We can get wrinkles from muscle changes over time. We say muscles attenuate, which means they, they get stiff and stagnant and then they create different peaks and values increases in the face.
We can get wrinkles from fat changes. Over time, fat starts to break down and move primarily into the nasal labial fold, or that fold between the edge of the nose and the corner of the mouth and accentuates different types of wrinkling. And then of course, all of those wrinkles show up on the skin. So on top of the wrinkles that occur from the skin level.
Are those deeper wrinkles? So today we’re gonna focus on the wrinkles that we see that appear on the skin from skin changes. The skin is part of the Anta system. The anta system consists of that fat layer, the subcutaneous of the hypodermis. And then on top of that is, Dermal layer, which is the true health of the skin.
Skin cells start at the bottom of the dermis, make their way up to the epidermis, above the dermis, and then they float to the top and they come off. So the true health of the skin and the visible health of the skin reside in the epidermis and the dermal layer, and that is the layer that we’re going to talk about when we talk about intradermal needling.
Intradermal needling is one of many different types of needlings that occur when you go get an injection or a hypodermic shot if they go into the muscle. It’s called intramuscular need. If it’s at the slide slightly into the, that subcutaneous level that’s called subcutaneous needling, intravenous, lev needling goes right into the bloodstream, and then there is the intradermal needling, which goes between the.
Into the dermal layer. So we see on needling too deep is that it misses that middle dermis layer. If you needle too shallow, it stays too superficial at the epidermal level into, if it’s inserted properly, it goes into the dermis and you can actually see it creates a little swelling at the surface.
And that’s how you know if you are into the intradermal needling because you can actually see the surface of the skin popping. Why, intradermal needling into the dermal layer? What’s going on? Basically, and in a nutshell, we’re working in the connective tissue portion of the dermal layer. There are two types of connective tissue in the dermal layer of the tissue.
There’s the papillary layer. Which is that loose mesh work that we can see on the right, and this primarily provides the nutrients to the skin, and then there’s the rec particular level below, which is much thicker, and it provides the density of the tissue or density of that layer, the structure of that layer.
When we think about connective tissue, what are we talking about? The primary components that make up connective tissue are collagen. Collagen is the support system. It’s like the mattress that you lie on. It’s the firm structure that has enough balance in it to allow you to lie comfortably. But it also.
Has enough resilience and tension so that you have support. That’s collagen. It’s the mattress of the germal layer of the tissue and the mattress of connective tissue. In addition to connective tissue and collagen, we have elastic fibers. And as you can see in this slide, it’s a very thin vertical.
Structure and that’s gonna allow the snap or the ability for that dermal or the connective tissue to bounce back. So you lie on the mattress, it sinks in, you get up, it pops back up, and that’s due to the elastin fiber within the connect. Tissue and then also in the connective tissue. We have fibroblast cells.
And fibroblast cells are what stimulate the production of collagen, and then we, It’s all embedded in this aqueous solution of hyaluronic acid. And hyaluronic acid provides the moisture and the ability for cells to float around and receive the nutrients that they need to grow healthy. It’s also what keeps our skin nice and hydrated and moist.
Now as we age, what happens? We age, we start to lose the ability for the cells to mo migrate from the base of the germal layer up through the epidermis, and they lose their vitality. We start to lose the integrity of the collagen and the elastin in those layers. They begin to get disorganized or not line up properly.
We start to lose the VAs, the blood vessels that iva that area and nourish the, area as well. When all of this happens, we start to lose that plumpness, the plumpness of the. The connective tissue and the dermal layer itself. When it starts to, when we lose the integrity of that it starts to dry out, we start losing hyaluronic acid in within that area.
And then we start to see not only as it dries out, but that dermal layer in that epidermal layer start to thin and separate. Creates more dryness. And then as we lose that suppleness of disorganization of collagen, an elastin, we start to see pitting. And you can actually see in this image, you can see the surface of the skin starting to pit.
Sometimes we call that wrinkle. Sometimes we call it skin pitting. For our purposes, There are multiple types of wrinkles. There are fine lines are primarily due. They’re not wrinkles. They’re due to the loss of hyaluronic acid in the tissue or dehydration. And the key is to just drink more water.
We are apply more hyaluronic acid or hydration to the surface of your skin. For our purposes, we are going to look today at shallow wrinkles. Shallow wrinkles, you’ll see in a moment are very superficial wrinkles. When the collagen starts to move up and down, or the elastin starts to snap back we, lose the creases.
So the creases come when we’re activating our muscles or textures of the skin, and then they relax as they, as the shallow wrinkles become more sedentary, they move into deep wrinkle. And this is when we are actually start to see changes in the architecture and integrity of collagen in the skin tissue and, also lattin so it becomes more visible when the faces at Russ and then static wrinkles are are a different type of wrinkle.
They’re actually. Deep wrinkles that have been around for a while. And in this situation actually starts to create damage into the tissue via the loss of elasticity within an elastin within that skin tissue. And then again, this too is visible at when the faces rest. And then we have dynamic wrinkles.
And these have more to do with muscle as opposed to skin create, although they may. Static wrinkles and deep wrinkles and cello wrinkles. When you treat dynamic wrinkles, you actually have to treat the muscle as opposed to the skin. So here’s an example. Here’s shallow wrinkles are on the left. And as you can see in this image, the person on the left or the figure on the left is probably in her thirties.
The middle is probably in there, her fifties and sixties. And then the on the right is, older. Most shallow wrinkles occur earlier in. And as you can see, say particularly in this image starting at the nasal labial full dot full between the edge of the nose and the corner of the Mac, you start to see the creasing there.
You’ll start to see it in between the eyebrows, Ella creasing, and possibly across the forehead. As they move into deeper wrinkles, you can start to see the changes of the architectural changes in the face. You can start to see a deeper creasing between the eyebrows, the nasal labial, fo maybe around the mouth, starting to see a change in the mental crease, which is between.
The chin and the lower lips and the marionette lines, which are between the corner of the mouth and the jaw area. And then as they move into more static wrinkles, they create a number of changes in the architecture of the face. And you can see the visible difference here. In fact, it’s just a progression from left to right and most of it has to do with age and lifestyle.
And diet. What’s interesting about needling at different layers of the tissue, particularly at the epidermal level and the germal level, is the references to it that we’ve seen in the classics, notably the ling shoe over time. In the classics, they talk about numerous, there are numerous discussions about needling guidelines specific to the layers of the face, the skin, the flesh.
The channels around the muscles, and then at the layer of the bone. So there are constant references throughout time about different ways and the importance of kneeling at all of those different levels. Also in the Ling shoe, in chapter one, it says The skin, the flesh, the muscles, the tendons and the meridians occupy different places in the body and that different diseases respond to different methods of treatment.
In chapter seven, it talks about the illnesses. If illness is superficial and needling is deep, it will penetrate and injure the good flesh. If illness is deep and needling is superficial, results will not be obtained. So again, there’s the references to the changes, the importance of needling at different different layers, and then the results that can be obtained when properly kneeling into those different levels.
Intradermal needles is superficial needling, obviously, and it’s sim very similar to Japanese needling technique. We know in Japanese needling technique that the insertion is superficial, that the manipulation, if there is any manipulation occurs at the surface of the skin. We’re not needling for Dutch.
And the needle gauges. The needles themselves are different. They’re very thin, and the length varies, say between a very short needle and say a 30 millimeter, which is like an inch long. When we are needling for the purpose of intradermal needling, what’s going on? There are multiple theories as to why this works.
One that’s the most popular and actually the foundation of say Derma rolling or microneedling, is the fact that when you insert a needle into the surface of the skin, it actually creates a little wound. Wound healing results. When you put something in or you damage the surface of the skin fibroblasts, circle that area and immediately start to stimulate the production of collagen and elastin within that tissue to actually heal the wound from the inside.
This was what we called a wound healing cascade, and which case again? We insert the needle, it creates a micro damage into the surface of the skin or under the surface of the skin. Fibroblasts come in, they stimulate the production of collagen. Collagen starts to line up, as well as elastin into the dermal layer of the skin.
And you can actually see in this image, In the first image, you see where the damage was created, and then you start to see the abundance of fibroblasts building collagen and elastin at the dermal and epidermal layer to start to thicken and to heal this microtrauma. Another theory is in doing so, what we’re doing is actually enhancing not just the collagen, but also the elasticity as well.
So we’re building collagen, building elastin under the skin, stimulated by the trauma that was created by inserting a needle into the surface of the skin. And there’s also something else that’s going on, and that’s called Paso Electric. Collagen is the primary component in connective tissue, which we just learned, and it also is capable of transmitting electrical signals throughout the bottom.
So it has an electric energy, call it, she call it electro Paso. Call it whatever you want, but it creates a vibration or an electricity. that then signals throughout surrounding area. And it’s both mechanical. So inserting in the needle stimulates this Paso electricity. It creates both the mechanical and electrical properties that vibrate out into the surface and connect with other systems.
So when. Insert the needle as a form of an external influence. The electrical current in that tissue created by the collagen radiates out into neighboring structure. It’s a, it’s somewhat the foundation of acupuncture in our culture is creating some type of an energetic that then spreads, not just stays at the center where we’re need.
It begins to spread out throughout surrounding tissue. And in our world, the meridians that, that connected these points. So we need and put the needle in. Intradermal needling, it stimulates that wound healing cascade. It excites that collagen Paso electricity. And it also releases fascial tension, which is the tension that is created by holding that tissue in this stagnant place now for so long.
The slide in this presentation or in this PowerPoint is histological slide. So they take pieces of skin or where there are wrinkles, they put ’em on the slide and, they put them they put a little piece of glass on top of it and they slide it under a microscope and, then you actually get an, a larger image or a magnified image of what’s going on.
So here we see a wrinkle. And it looks like a little divot like this. This is another slide. The wrinkle is actually very, shallow. This would be considered a shallow wrinkle. This is very minor or more minimal wrinkle, moving into a deeper wrinkle. Here’s a deeper wrinkle. You can see it’s not just a, dip or, but more of a plummet, a little deep area.
So that’s a different kind of wrinkle. So as you can see, we’re going to see all different types of wrinkles, and we’re gonna needle them differently as well, depending upon the. The, wrinkle itself. So we can’t really look at a magnifying glass in our practice. We’re not gonna take a slide and put it under my magnifying glass.
So you have to start to train your eye to see what does a wrinkle look like? Is it very shallow? Does it look a little bit deeper? Does it look like it’s petted? And then we’re going to decide how to needle it, and we’re gonna decide which type of needles to. Most of the intradermal needles today are either the straight intradermal needles, the Japanese one, or the press tax.
And they’re good. They don’t give you a lot of flexibility if you, they’re very tiny. You have to use a pair of tweezers if you’re using an intradermal needle and just slide it in. And you get a very short distance of, being able of insertion the press tax. There’s only one way to needle it and it’s down.
So that is somewhat limiting. EUS is a new serum needle and I think it’s a really good needle, and it’s ones that I choose to use. They’re stainless steel needles. They’re triple polished. They’re similar to serum needles. They’re high. The, quality of them is great. They come in a bolt pack of four.
They’re really easy to use and they’re a little bit longer. Some, they range between they’re all about seven millimeters, but then the thickness of them is varies. Different sizes. So depending upon the type of needle you choose you can affect different types of wrinkles. All of them work. It’s just a matter of personal preference.
So I’m gonna show you these slides. So this is a shallow wrinkle, which means it’s going to show up and then disappear. So when the model lifts her eyebrows and cringes her forehead, then you’re gonna start to see them. And I’ve actually had her do this in this image. And so we’re gonna look at these needles.
It’s pretty good. It’s a little blurry, but basically she doesn’t have a lot of wrinkles. And the wrinkles that she does have moose. One way to find out whether it’s a shallow wrinkle list, actually, to have your patient lift their eyebrows, drop them further eyebrows, and see what stays, and see what goes away.
So in this situation, what I’m gonna do is I’m actually gonna spread. The tissue and needle very shallowly into the needle. So in this situation, when you’re spreading the needle it’s a very shallow insertion at the upper level of the dermal level. You open the wrinkle, slide the needle into the surface, and you can line them up because most of these are fairly long needles.
So this is a good technique to use if you’re doing, if you’re treating a very shallow. Let’s see. This is more of a deeper ecstatic wrinkle, and this is the nasal labial fold right here. It’s the different, it’s from the corner of the nose to the sock corner of the mouth. A lot of it has to do with tissue that has fat that has moved down, or gravity muscle attenuation.
Has some effect in it. But in this situation, you’re gonna actually treat the wrinkle itself. Now, it’s hard to spread this because it’s a deeper wrinkle and it’s static. You can see it, it will stay there whether the person is smiling or frowning or either or making any other muscle expression. So rather than trying to spread this, wrinkle, what you’re gonna do is you’re gonna actually grab.
Like this and pinch, and then slide the needle into the crease. So let’s take a look at this. So I’m pinching, it, and slide. Okay. I’ll show you. This is a closer version of it. This is a, and it’s a little bit blurry, but I think you get the image. You’re gonna pinch and slide. Okay. It takes little practice.
It’s almost as if you want to take that area, start further out, pinch it, and let’s do this one more time so that you can see it. You’re pinching, you’re starting f pretty far out. In order to pop it, pop the tissue up so that the only thing that you can actually see is the wrinkle. Perfect. Let’s keep going.
Okay. Now, we’re gonna talk about deep wrinkles for a moment. On top of the changes of the architecture that occur within the derma layer, when A wrinkle has been around for a long time, it starts to affect the tissue around it very similar to that of a. Scar tissue is composed of the same collagen protein as healthy skin tissue similar to this, but because of the trauma or because of the static nature of the wrinkle, the tissue around it starts to change.
So similar to a scar where during tissue healing, the collagen cells group together. Like this and bunch up. This is sometimes what a deep wrinkle looks like. We’re gonna look at one in a minute. The way to treat this is not to slide the needle in because that’s not gonna really break up the tissue is and not to pop it and go into.
Base, but actually to go into the wall of the tissue to start to break up the fibrous tissue that is starting to develop, to create this, that stagnant nature, that depth of, the wrinkle itself. So here we go. Take a look. This is, if you look at the, let’s look up here. This is what we’re gonna treat.
This where the red arrow is. But if you look at, and it’s right here on the large image. Now look at this wrinkle. This wrinkle starts at the, in the lip. It starts at the base of the bottom lip and actually projects all the way down, but right. This is the depth of the wrinkle. This is probably where it started, began to spread.
So here’s where the damage is. Here’s where potential scar damage is, what we’re calling scar damage, but it’s really not a scar. It’s basically tissue that has been in one position for a very, long time. So in order to affect this, we actually need to break this, tissue up and around it. So we’re gonna take.
And I’m gonna needle into the wall. You can either needle from the outside in or you can needle from the inside out, but the object is to actually get into the wall of that wrinkle as opposed to the base of the wrinkle itself.
So just as a recap, we have fine lines. Fine lines are basically due to creases in the skin surface caused by dehydration. And the way to treat it is to enhance water consumption or to apply it or both. We have shallow wrinkles, which have to do with creases that are just beginning, and they change so they’re not stagnant.
Over time, you spread the wrinkles and needle into the crease. We have deep wrinkles where the crease is caused by the beginning of. In a lack of integrity of collagen and elastin in the tissue itself, and they stma, they’re starting to show up and stay there, stay at the face, or stay visible when the face is at rest.
And then we have static wrinkles. And these result from a loss of elasticity, tissue damage, we see that build up or the change in the architecture of collagen elastin around those needle wrinkles. And the treatment is to, the intradermal, kneeling treatment is to needle into the crease of the wall. And then we have dynamic wrinkles, often known as ride tides.
And these develop from repeated facial movements, in which case we need to treat the muscle as well as the. So thank you for today’s presentation. If you have any other questions or want to know more about facial acupuncture or cosmetic facial acupuncture you can visit firstname.lastname@example.org, my website.
You can email email@example.com or follow me on Instagram at Shellie underscore Goldstein. So thank you again everyone. Thank you, the American Acupuncture Council. It’s always a pleasure to be with you and next week stay tuned for Chen Yen she’s very exciting and a wonderful lecture. I’m sure you’ll enjoy her presentation as well.