Microneedling Course Manual PDF

MICRONEEDLING ALL ABOUT THE SKIN MENTORING ACADEMY [email protected]  Microneedling My name is Katerina Angellotti, I’d like to welcome you to All About The Skin Academy. I am a Medical Aesthetician, Wife, Mother and also the Founder and Director. I s...

MICRONEEDLING ALL ABOUT THE SKIN MENTORING ACADEMY [email protected]  Microneedling My name is Katerina Angellotti, I’d like to welcome you to All About The Skin Academy. I am a Medical Aesthetician, Wife, Mother and also the Founder and Director. I started this mentoring academy to empower students and to teach you to take P.R.I.D.E in yourself. We Are Powerful! We Are Resilient! We Are Independent! We Are Determined! We Are Entrepreneurs! In this industry I have worn many different hats, I have been an educator, a sales representative, medical office manager and medical aesthetician. My passion is to share everything I have learned in these roles in this course. Whether you would like to become a sales representative, medical aesthetician, expand your skillset or grow your own business you have come to the right place. Let’s get started. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 2  Microneedling Course Scheduling 6 Hour Theory & Practical In-Clinic Setting Evaluations Theory 2 Practical Evaluations 1 Written Test Passing Requirements Student must successfully complete the practical evaluations ad achieve an overall average of 80%+ to successfully complete this course. Course Materials Manual Starter Kit Online Resources Optional: E-Pen Microneedling Device All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 3  Microneedling Course Description This comprehensive training program is designed to expand the options for aestheticians aiming to grow a successful business. Microneedling, also known as collagen induction therapy, has been utilized for many years. This technique stimulates the body’s natural healing process, resulting in increased cell turnover, collagen and elastin production, which enhances skin rejuvenation. This course is designed with theoretical and practical training. Students will study the history of microneedling and its effect on the beauty industry, an in-depth analysis of the skin, and the applications of treatment. Students will learn the safety protocols involved with microneedling. Throughout the course the students will learn to assess the client’s needs, demonstrate complete consultations, facilitate appropriate treatments, and perform microneedling treatments with the E-Pen. Within a clinical setting the student will focus on hands on treatments that are in line with the current industry demands and standards. Upon completion of the course the students will be able to provide clients with thorough knowledge of microneedling and its effectiveness of treatment. Students will explain the benefits, treatment processes, indications, and contraindications for the most effective results as desired by each individual client. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 4  Microneedling COURSE OBJECTIVES: Theory:  Identify the layers of the skin and recognize skin irregularities  Recognize the aging skin process and discuss effective treatments at each stage  Recall professionalism techniques, client care, station set up and client draping  Know the importance of a complete consultation for the safety of the treatment  Explain client care, skin analysis, effective recommendations  Skin typing and classifications  Discuss client consultations, pre and post treatment, and charting of client’s progress  Manage client files and discuss follow-up protocols Practical:  Facilitate effective application of client care, greeting, consultations, and skin analysis  Demonstrate proper station set up, client draping, and ongoing client care  Explain the indications and contraindications associated with microneedling treatments  Prepare client for treatment  Discuss the various skin concerns treated by microneedling as fine lines, wrinkles, acne scars, redness, pigmentation concerns  Communicate effectively with client throughout treatment process  Complete client treatment and follow up with service and product recommendations  Complete and review client files and provide ongoing follow up with each procedure MARKING BREAKDOWN Written Test – 20% Practical #1 – 40% Practical #2 – 40% All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 5  Microneedling Clinic Rules and Regulations The overall success of each student relies on full cooperation within the All About The Skin Inc. clinic. Rules are outlined to have a safe, reliable and effective learning environment for each student and those who are instructing the classroom.  Respectful of everyone in the clinic  Follow proper protocols and directions as outlined  Complete all assessments as instructed  Be punctual and prepared for learning  Remove outdoor footwear  Use time management effectively  Professional attire, communication both verbal and non-verbal  Follow health and safety as outlined by your instructors  Follow the privacy rules of the clinic as instructed which includes respect of other professional visitors, language and communication boundaries  Student are responsible to review all written material and be prepared ahead of the practical process within the clinic. Students will have access to instructions through email and within a class environment for questions and ongoing clarification. Questions will be answered throughout the course for your better understanding of the course content, please feel free to take notes. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 6  Microneedling WELCOME TO ALL ABOUT THE SKIN ACADEMY THINKING ABOUT BECOMING AN AESTHETICIAN? Microneedling is a skincare treatment that creates deliberate wounds on the skin with tiny needles to stimulate collagen production with the use of an E-Pen. Through monthly treatments, Microneedling can improve the appearance of fine lines and wrinkles, hyperpigmentation, and scarring, while also firming and brightening the complexion. Microneedling is such a great asset to your business, we know you are going to love it! You only need to look around to see that it is one of the hottest beauty trends right now around the world – and not just for models and celebrities! More and more people are making Microneedling treatments a part of their beauty regime. In this manual you will learn:  The practical skills needed to perform treatments safely and effectively  Benefits that treatments can provide to your clients  Indications and contraindications for treatment  Anatomy & Physiology  Step by step procedure  Practical  Theory  And much more Want to be your own boss? JOIN THE LARGEST AND GROWING PROFESSION AS AN AESTHETICIAN All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 7  Microneedling TABLE OF CONTENTS MODULE ONE........................................................................................................................... 12 INTRODUCTION TO MICRONEEDLING.................................................................................. 13 WHY STUDY MICRONEEDLING?........................................................................................ 13 WHAT IS MICRONEEDLING?..................................................................................................... 13 MICRONEEDLING.................................................................................................................. 15 MODULE TWO.......................................................................................................................... 16 HOW IT WORKS..................................................................................................................... 17 WHAT ARE THE MOST EFFECTIVE USES OF MICRONEEDLING?............................................ 18 WRINKLES.......................................................................................................................... 18 ACNE SCARS....................................................................................................................... 18 STRETCH MARKS................................................................................................................ 18 ROSACEA........................................................................................................................... 19 PIGMENTATION................................................................................................................. 19 MODULE THREE........................................................................................................................ 20 MICRONEEDLING FAQ’S........................................................................................................ 21 WHAT IS THE PROCESS INVOLVED IN CARRYING OUT MICRONEEDLING?....................... 21 WHAT IS THE MICRONEEDLING RECOVERY TIME AND WHAT DOES RECOVERY ENTAIL? 21 WHAT ARE THE BENEFITS OF MICRONEEDLING?............................................................. 22 MICRONEEDLING VS LASERS VS CHEMICALS.................................................................... 22 WHICH SERUMS TO USE WITH MICRONEEDLING?........................................................... 22 ARE THERE ANY SIDE EFFECTS FROM MICRONEEDLING?................................................. 23 IS MICRONEEDLING UNDER EYES SAFE? IS MICRONEEDLING LIPS RECOMMENDED?..... 23 WHAT ARE MICRONEEDLING RESULTS AFTER ONE TREATMENT? HOW OFTEN SHOULD MICRONEEDLING BE DONE?............................................................................................. 23 BENEFITS OF MICRONEEDLING......................................................................................... 23 MODULE FOUR......................................................................................................................... 25 HISTORY OF MICRONEEDLING.............................................................................................. 26 MODULE FIVE........................................................................................................................... 29 All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 8  Microneedling DEVICES..................................................................................................................................... 30 MICRONEEDLING FREQUENCY.......................................................................................... 30 SERUMS.................................................................................................................................... 31 THE BEST SERUMS TO USE WITH MICRONEEDLING......................................................... 31 HYALURONIC ACID............................................................................................................ 31 PEPTIDES............................................................................................................................ 32 CERAMIDES........................................................................................................................ 32 EGF..................................................................................................................................... 32 MODULE SIX.............................................................................................................................. 34 ANESTHETIC.......................................................................................................................... 35 CLIENT NUMBING.............................................................................................................. 37 MODULE SEVEN........................................................................................................................ 38 E-PEN TREATMENT................................................................................................................ 39 MICRONEEDLING DEVICE INSTRUCTIONS FOR USE.......................................................... 39 INTENDED USE................................................................................................................... 39 CONTRAINDICATIONS........................................................................................................ 39 WARNINGS........................................................................................................................ 39 PRECAUTIONS.................................................................................................................... 40 CONSENT FORM SAMPLE...................................................................................................... 42 TREATMENT LOG SAMPLE.................................................................................................... 43 CHARGING......................................................................................................................... 44 PRE-APPOINTMENT........................................................................................................... 44 PRE-PROCEDURE PRECAUTIONS....................................................................................... 44 QUICK PROCEDURE INSTRUCTIONS.................................................................................. 45 PROCEDURE DEPTH (SUGGESTED GUIDELINES)............................................................... 48 AFTER PROCEDURE............................................................................................................ 49 HOW TO REMOVE THE SLEEVE AND CLEAN THE E-PEN DEVICE....................................... 50 E-PEN CLEANING............................................................................................................... 51 MODULE EIGHT......................................................................................................................... 52 PREPARATION....................................................................................................................... 53 All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 9  Microneedling CLIENT PREPARATION....................................................................................................... 53 TREATMENT CHECKLIST.................................................................................................... 53 CLIENT PREPARATION....................................................................................................... 54 GENERAL SAFETY RULES.................................................................................................... 54 MODULE NINE.......................................................................................................................... 55 TREATMENT AREAS & DEPTH............................................................................................... 56 ACNE SCARS....................................................................................................................... 56 SCARS ON THE NOSE......................................................................................................... 56 ENLARGED PORES.............................................................................................................. 56 WRINKLES.......................................................................................................................... 56 NASOLABIAL FOLDS........................................................................................................... 56 UNEVEN SKIN TEXTURE AND SKIN TONE WITH NO SCARS............................................... 56 STRETCH MARKS................................................................................................................ 57 LONG SURGICAL SCARS OR OTHER LONG SCARS.............................................................. 57 SHORT SURGICAL SCARS OR OTHER SHORT SCARS.......................................................... 57 MANY SCARS ON A LARGE AREA OF THE BODY................................................................ 57 SCARS ON THE WRIST........................................................................................................ 57 LOST ELASTICITY / SUN DAMAGED SKIN........................................................................... 57 SERIOUS BURN SCARS....................................................................................................... 58 CELLULITE.......................................................................................................................... 58 THINNING HAIR................................................................................................................. 58 MELASMA.......................................................................................................................... 58 PIGMENTATION................................................................................................................. 58 HYPOPIGMENTATION........................................................................................................ 59 MODULE TEN............................................................................................................................ 60 MICRONEEDLING INSTRUCTIONS FOR INDIVIDUAL AREAS OF THE BODY........................... 61 FACIAL REJUVENATION..................................................................................................... 61 UPPER ARM TREATMENT.................................................................................................. 62 HAND REJUVENATION....................................................................................................... 62 ABDOMEN......................................................................................................................... 63 All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 10  Microneedling THIGH AREA....................................................................................................................... 63 NECK AND DÉCOLLETAGE.................................................................................................. 64 HAIR LOSS.......................................................................................................................... 64 STORAGE................................................................................................................................... 65 MODULE ELEVEN...................................................................................................................... 66 AFTERCARE............................................................................................................................ 67 Keep the new skin clean and moisturized; no makeup for 3-7 days................................ 67 WHAT TO EXPECT AFTERWARDS...................................................................................... 67 AFTERCARE ADVICE........................................................................................................... 68 DO NOT EXPOSE YOURSELF TO THE SUN.......................................................................... 68 DO NOT USE ANY “ACTIVE INGREDIENT” SKIN PRODUCTS.............................................. 68 USE COLLAGEN STIMULATING PEPTIDES.......................................................................... 68 AVOID THE USE OF MAKEUP AFTER TREATMENT............................................................. 68 USE A COOLING FACE MASK............................................................................................. 68 USE AN ANTIOXIDANT SERUM.......................................................................................... 68 AVOID SWEATING.............................................................................................................. 69 DRINK WATER.................................................................................................................... 69 REVIEW QUESTIONS................................................................................................................. 70 CONTACT US............................................................................................................................. 72 All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 11  Microneedling MODULE ONE  Introduction to Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 12  Microneedling INTRODUCTION TO MICRONEEDLING Microneedling can make a big difference in the way skin looks and in the way a client feels about his or her appearance. Besides being a minimally invasive facial treatment, it can offer many improvements to the appearance of the skin. It can make aging skin look smoother, firmer, and less wrinkled. A combination of good salon facial treatments and effective individualized home care will show visible results. WHY STUDY MICRONEEDLING? Aestheticians should study and have a thorough understanding of microneedling because:  Providing skin care services to clients is extremely rewarding, helps improve their appearance, and helps them feel better about themselves  Knowing the basics of skin analysis and in-depth knowledge about microneedling will enable the aesthetician to offer clients advice when they ask for it.  Although a skin disease cannot be treated, the aesthetician must be able to recognize adverse skin conditions and refer clients to seek medical advice from a physician.  Learning the basic techniques of microneedling will give a good overview of, and an ability to perform, these foundational services  The aesthetician may enjoy this category of services and may consider specializing in microneedling. This study will create a perfect basis for making that decision. WHAT IS MICRONEEDLING? Microneedling is a minimally invasive skin rejuvenation procedure that involves the use of a device that contains fine needles. Microneedling has recently attained popularity because of media coverage and the fact that it can be used safely with minimal training. During the microneedling treatment, slim, fine needles push below the surface of the skin and create what is called a micro-wound or micro-channel. This method is a simple yet exciting procedure for all ages and skin types. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 13  Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 14  Microneedling MICRONEEDLING The procedure aims to give facial skin a smooth, youthful, and radiant appearance. As well as smoother skin, proponents claim that microneedling can help with acne scars, dry skin, sun-damaged skin, fine wrinkles, stretch marks and minimize the appearance of scars. E-Pen and multiple other devices are used for microneedling. These other devices usually have shorter needles and provide significantly less penetration and injury, and therefore may be less effective. Many clients who want younger looking skin or who want to treat the imperfections on their face or other exposed skin are turning to this treatment because it has several advantages over other types of procedures that treat the same issues. When these wounds are created, the body’s natural defenses are triggered, and it begins to produce new skin cells, capillaries, and collagen to repair the damage. This natural repair process caused by microneedling eventually leads to younger-looking skin which is also firmer and plumper. Microneedling may also be referred to as:  E-Pen  Skin Needling  Medical Microneedling  Dermaroller/stamp  Dermapen  Collagen Induction Therapy (CIT)  Percutaneous Collagen Induction (PCI) Microneedling Client Applications:  Skin Rejuvenation  Fine Lines & Moderate Wrinkles  Skin Laxity  Acne Scars  Diminished Texture, Tone, Colour  Stretch Marks  Traumatic Scars  Photo Aging & Sun Damage  Hyperpigmentation and Hypopigmentation All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 15  Microneedling MODULE TWO  How It Works All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 16  Microneedling HOW IT WORKS Microneedling relies on the principle that growth factors are released once the needle pierces the stratum corneum (the outermost layer of the epidermis). These growth factors are believed to be responsible for the treatment of various skin conditions. At a microscopic level, proliferated skin cells, such as fibroblasts, migrate to the point of injury and transform into collagen fibers, resulting in increased fiber strength and elasticity. This treatment improves your skin by increasing the production of collagen, facilitating natural repair and growth, and making the skin stronger and thicker. The new collagen fills depressed scars and wrinkles from the bottom up, lifting the depression so they are level with the surrounding skin. This process takes two to three months to produce visible results, and can also help thicken thinner, fine skin types. Microneedling leads to three major phases of natural wound healing which results in enhanced stimulation of new healthy skin:  Phase 1 (1 to 3 days) Inflammation: Activated by piercing the dermal tissue, platelets release cytokines and growth factors which act as signals for the body’s immune system. White blood cells (neutrophils and macrophages) are sent in to disinfect the wounds, clear the debris, increase the blood supply, and begin the creation of fresh, new skin.  Phase 2 (3 to 5 days) Proliferation: In this phase, the fibroblasts, keratinocytes, and epidermal cells continue to divide to populate the areas of damage and secrete growth factors and extracellular matrices, such as elastin and collagen, will be laid down and deposited with new tissue formation.  Phase 3 (6 to 30 days) Remodeling: During this phase, collagen and elastin producing fibroblasts proliferate in the puncture wounds formed by the microneedles and migrate. The collagen in the newly formed tissue is now replaced with even stronger collagen and the dermis contracts to create a youthful firm, but supple texture to the skin. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 17  Microneedling WHAT ARE THE MOST EFFECTIVE USES OF MICRONEEDLING? Microneedling can be used to treat and improve the following skin conditions. WRINKLES Aging skin droops and develops wrinkles, lines, and furrows. The severity of these changes in an individual depends on the genetic tendency, skin type and exposure to environmental factors. Wrinkles occur when the skin loses suppleness and tightness as it ages. It is seen more commonly in areas of skin which are stretched regularly such as around the eyes (crow’s feet), forehead and mouth. By renewing the production of collagen, the skin becomes plumped out, thicker and retains its elasticity. ACNE SCARS A significant proportion of acne sufferers will have some form of scarring to show for it. Medical studies suggest that between 30% and 95% of clients with acne develop some form of scarring. Importantly, seeking early treatment for acne helps to reduce the risk and severity of acne scarring. Microneedling mechanically breaks down existing scarring and stimulates the production of collagen and elastin, vital components of healthy skin. This has the effect of smoothing out the skin due to the reduction of the size and depth of acne scars. Clients usually have an immediate glow to the skin, but the visible changes develop over a course of several days and weeks. Results can continue to improve for up to 6 months after the treatment as collagen production continues. Not all acne scars are well suited to be treated by microneedling. In particular, microneedling is not well suited to treat keloid scars as there is mixed evidence of its effectiveness. Keloid scars are formed when scar tissue forms on the skin in excess, because of excess collagen production. Clients with keloids scars should consider alternative treatments such as the use of steroid injections. STRETCH MARKS Stretch marks are caused by prolonged skin distension due to pregnancy and weight gain. It can also be caused by prolonged use of oral and topical corticosteroids which hinder the formation of collagen and elastin fibers. There is no effective treatment to correct stretch marks as the epidermis in stretch marks is weakened and the support structure beneath it is compromised. Microneedling will improve the density of the epidermis by stimulating epidermal growth factors, but it is important not to overpromise results. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 18  Microneedling ROSACEA Rosacea is most commonly seen after age 30 and may initially resemble a simple sunburn or a mysterious redness. Early treatment is key. Rosacea cannot be cured but it can be controlled. Microneedling can help control rosacea by stimulating the epidermal growth factor which increases the density of the epidermis. This lessens the appearance of vessels beneath the skin and the overall redness. It strengths collagen in both vessel walls and connective tissue that supports the vessels. It also increases the availability of cell nutrients and antioxidants. PIGMENTATION Pigmentation occurs in two different forms: passive and inflammatory. Inflammatory pigmentation occurs as a result of the activation of our skin’s natural defense mechanisms. Melanin moves up to defend against trauma caused by factors such as sun exposure, poor products, or injury. Passive pigmentation results from an internal imbalance which stimulates the melanin stimulating hormone. These imbalances can be caused by pregnancy, hormonal imbalances, the contraceptive pill, and various medications. Microneedling can correct pigmentation by increasing the availability of skin lightening actives. It also normalizes the cell signaling function which when overstimulated, causes overproduction of pigment. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 19  Microneedling MODULE THREE  Microneedling FAQ’s All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 20  Microneedling MICRONEEDLING FAQ’S WHAT IS THE PROCESS INVOLVED IN CARRYING OUT MICRONEEDLING? The first step is to cleanse the client’s face to ensure the skin is entirely makeup and dirt free. Microneedling is usually performed under the influence of a topical anesthetic cream which is applied for a minimum of 30 minutes before the procedure is started. After 30 minutes, the area to be treated is washed and then cleansed with 70% alcohol to ensure all oils are removed and skin is sterile, preventing risk of infection. The depth of penetration, the number of passes, and degree of overlap is highly dependent on the underlying condition, the area being treated, the brand of device used, and the length and frequency of the needle insertion. For treating acne and other scars, the needle length should be selected on the basis of the depth of the scars. A needle length of 1.5–2 mm is usually used for acne and other scars. To treat aging and wrinkles, 0.5–1.0 mm needles are usually recommended. Once the microneedling is complete, hyaluronic acid serum is applied. WHAT IS THE MICRONEEDLING RECOVERY TIME AND WHAT DOES RECOVERY ENTAIL? The recovery is not more than 7 days and for most clients typically around 3–4 days. The recovery process entails avoiding direct sun exposure, using active skincare ingredients (acids and Vitamin A, C & E) and no hot showers. A day after the treatment it is recommended to use sunscreen, tinted sunscreen may be worn to cover the redness and to also assist healing. For a few days, clients should avoid chlorinated swimming pools and activities that cause excessive perspiration. Immediately post-treatment, there is a redness to the skin resembling a mild sunburn. A puffy facial appearance or slight bruising is common on day 1. For the first 3–5 days, the skin may feel dry and tight. By days 4– 6, there is minimal swelling, and any bruising is close to disappearing. Skin flaking is common at this point. By day 7, there are very little visible signs of the procedure and clients can appear in public with confidence. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 21  Microneedling WHAT ARE THE BENEFITS OF MICRONEEDLING? Microneedling is becoming a very popular treatment as it has a number of benefits:  The micro-channels created by microneedling increase the absorption rate of serums, increasing their overall efficacy. Medical studies have shown that microneedling can increase serum absorption by as much as 1,000 times. It can be performed on all skin types and most areas on the body.  Microneedling can be combined with other treatments like chemical peels, microdermabrasion and fractional resurfacing giving maximum benefits. It leads to regenerative healing, as opposed to cicatricial healing (with a risk of scar tissue formation) like most other alternative treatments.  It is more affordable than laser resurfacing and does not have the associated risks. 4-6 sessions every 4 weeks is generally sufficient. Treatment plans can be easily personalized by going deeper in some areas where skin damage requires a more aggressive approach. MICRONEEDLING VS LASERS VS CHEMICALS Treatments such as laser resurfacing or dermabrasion, offer a significant improvement in facial scars but are invariably associated with considerable downtime and longer recovery time. This interferes with the clients’ daily activities. Treatments with microdermabrasion and non- ablative lasers are associated with minimal downtime but do not show the same level of efficacy as microneedling. Microneedling can be used on areas that chemical peels or laser resurfacing cannot, such as around the eyes. With a lower risk of hyperpigmentation and scarring, it’s safer for darker skin tones than lasers. Deep chemical peeling used for the treatment for scars may render the skin more sensitive to photo damage and dyschromia. In contrast, microneedling preserves and thickens the epidermis over time. WHICH SERUMS TO USE WITH MICRONEEDLING? As stated earlier, the micro-channels created by microneedling increase the absorption rate of serums, increasing their overall efficacy. It is recommended to use serums containing Vitamin A and C to help in collagen formation. Without Vitamin C, collagen fails to produce triple helixes, resulting in weak connective tissues. The weak tissue may interfere with wound healing and accelerate the aging process. Vitamin C also protects Vitamin from oxidation. Studies show that sun-protected skin, more so than sun-exposed skin, treated with Vitamin A, results in increased collagen. Hyaluronic acid can also be used as it helps in keeping the skin hydrated. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 22  Microneedling ARE THERE ANY SIDE EFFECTS FROM MICRONEEDLING? The common side effects from microneedling are stinging, dryness and flaking up to 5 days after the treatment. The biggest challenge is the pain resulting from aggressive treatments with needles that are 2-3 mm. It is important to have adequate anesthesia to alleviate the pain. Another disadvantage is that microneedling takes time and money to see the results. It is recommended for most clients to receive between 4-6 treatments spaced approximately 4 weeks apart. IS MICRONEEDLING UNDER EYES SAFE? IS MICRONEEDLING LIPS RECOMMENDED? Yes, microneedling under eyes is safe, and we recommend always treating below the eyes as this is the first area to show signs of loss of structural integrity. However, this is not useful for treating dark circles or puffiness under the eyes. On the other hand, microneedling lips is very painful and will not plump your lips. Lips produce much less collagen and will not show the similar collagen build-up to facial skin. WHAT ARE MICRONEEDLING RESULTS AFTER ONE TREATMENT? HOW OFTEN SHOULD MICRONEEDLING BE DONE? Microneedling should not be performed any sooner than every 30 days. The number of treatments depends on the severity of the skin condition which is being treated. 6 treatments are recommended for acne and body scars and anti-aging treatments. The response to Microneedling treatments is highly individualized, and it is challenging to predict what the results will be after just one treatment. There is no limit to the number of procedures. Following a series of treatments, maintenance is recommended between 3-4 months along with adequate skincare to maintain results. BENEFITS OF MICRONEEDLING  Stimulates the production of collagen and  Stimulates lymphatic drainage elastin in the dermis  Lightens sun and age spots  Reduces wrinkles  Diminishes the appearance of large pores  Improves skin firmness  Evens skin colour and texture  Minimizes acne, ice pick, and chickenpox scars  Softens stretch marks and surgical scars  Breaks up and reduces the appearance of cellulite  Improves skin circulation All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 23  Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 24  Microneedling MODULE FOUR  History of Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 25  Microneedling HISTORY OF MICRONEEDLING The earliest form of microneedling, acupuncture, traces its roots to the Chinese centuries ago. Micro-needling, commonly called collagen induction therapy or CIT, is quickly becoming one of the most sought-after methods for skin rejuvenation. Micro- needling is a procedure used to create a controlled wound response without abrading the epidermis. A controlled wound response means to stimulate a wound response to improve the appearance of the skin. The motivation for the wound response is to essentially thicken the skin. Dr. Des Fernandes, the pioneer of collagen induction therapy, stated, “if we are trying to thicken the skin then why are we removing the superficial layers?” It was a question and challenge both, and as aesthetic treatments have evolved, the use of fractional modalities have become favored by many providers due to the reduction in downtime and lowered chance of complications. Skin needling for skin rejuvenation was originally discovered by Dr. Orentreich in 1995 with the use of 18–20-gauge single needles to reduce the depressions in scars and deep wrinkles. This individual needling technique showed great improvement for these lesions but also showed rejuvenation in the surrounding skin. In 1996, Dr. Fernandes developed a stamp-like device to cover a larger area by inserting multiple needles at a time. In 1997 Dr. Andre Camirand published his experience using a tattoo gun without ink on hypochromic scars. Like Dr. Orentreich, Camirand also discovered improvements in the appearance of the skin around the treated scars. The first dermaroller, released in 2004 by a German inventor named Horst Lieble, was called (simply enough) the Dermaroller, and it led to the development of percutaneous collagen induction therapy by Dr. Fernandes. Other companies soon followed, boosting micro-needling’s status as one of the most popular skin rejuvenation techniques. There are several methods for skin needling available, including stamps, rollers, and automated devices. The stamps are not as frequently used but can be more cost- effective as they are simply made of a plastic handle with needles on the end. The rollers have a higher price point, for the simple reason that more goes into making them and they can average 200 needles per device. The rolling method seems to be the most commonly used, due to its easy accessibility to providers and clients alike, although new modalities are constantly being developed. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 26  Microneedling As the roller showed great improvement in the appearance of the skin, companies have found ways to make the treatment safer and more effective. The most recent development is the use of an automated needling device (more commonly known as the E-Pen) a “pen.” Automated needling is aimed at providing the user with more consistent needling, using vertical insertion to reduce the risk of tearing the skin. Needling devices have other benefits as well, including ease of use with an ergonomically comfortable device and the ability to alter the needle depth during treatment. This new technology is changing the scary thought of a provider using a drum-like rolling device aggressively over the skin (some say it resembles a meat tenderizer). The rollers can be painful, produce excessive bleeding on the skin, and leave the skin with prolonged erythema. The automated needling is performed in a controlled manner making side effects less probable and results more profound. The important milestones in the development of microneedling are:  Among the earliest proponents was Michael Pistor, the French doctor who is credited with having developed Mesotherapy in 1952.  Dr Philippe Simonin, a Swiss French dermatologist, published the results of his Electroridopuncture (ERP) technique in 1994. His study examined 600 clients, split into two client groups — Skin Aging and Old Scars. After 10 treatments on all clients, 40% of the Skin Aging group showed significant improvement and 22% moderate improvement. In the client group with Old Scars, 60% improved with 5–6 treatments. The best results were obtained for old fibrous and depressed scars.  Dr Des Fernandes, a plastic surgeon, and founder of the Environ skin care range introduced skin needling using a roller for treating wrinkles at the International Society of Aesthetic Plastic Surgery (ISAPS) congress in Taipei in 1996.  In 1997, Andrea Camirand, a Canadian surgeon, used tattoo-guns to treat scars caused by plastic surgery. He reported surprising improvement in texture and color of facial scars after camouflage tattooing done on scars. The insertion of tattoo gun needles led to the breakdown of scar collagen tissue and stimulated the synthesis of new healthy collagen leading to improvement of scar texture. This microneedling technique soon disappeared from the operation rooms because it was tedious.  The German inventor Professor Horst Liebl sought a new and considerably faster way of microneedling. He integrated nearly 200 non-traumatic micro needles of medical grade into a drum shaped device. Now the previous “static” needling was transformed into a “dynamic” needling process to treat larger All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 27  Microneedling skin areas in lesser time. He called his invention Dermaroller and patented and trademarked it in the year 2000.  In 2006, Dr Des Fernandes developed Percutaneous Collagen Induction (PCI) therapy with the Dermaroller. Dermarollers gained popularity in the treatment of acne scars, stretch marks, and post-surgery scars. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 28  Microneedling MODULE FIVE  Devices  Serums All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 29  Microneedling DEVICES TYPES OF MICRONEEDLING DEVICES There are so many different kinds of microneedling devices with different product names available, it’s impossible to list all of them. Here is a summary of the more popular microneedling devices you need to know about:  Dermarollers resemble small manual paint rollers with a round, rotating cylinder that has up to 200 tiny needles protruding from it and a handle for moving around it your face. These are sold for at-home use. Yes, they puncture hundreds of tiny holes in the skin. Thankfully these rarely break the skin—but using such tools at home is probably not a good idea due to the risk of infection and lack of sanitization at home.  E-Pens look like a pen, with a circular head studded with tiny needles. The motor-driven needles move in and out of the skin, piercing it with thousands of tiny punctures. The concentration of the needles in a tiny point is helpful for small, dented acne scars, improving fine lines and skin integirty. These are meant for a medical setting.  Dermastamps resemble E-Pens but have a larger head with more needles protruding from it for use on larger areas. Dermastamps may be motorized or manual and work exactly as the name implies: Rather than rolling needles over the skin the needles are systematically stamped into skin. Microneedling devices used with light emitting diodes (LED) is a process of using a microneedling device with an LED device. LED light has been shown to have benefit for skin rejuvenation. However, published research about this combination doesn’t exist at this time except from companies promoting it. MICRONEEDLING FREQUENCY  0.2 or 0.25mm long needles can be used every 2nd day on the same skin area.  0.5mm long needles can be used 1,2 or 3 times a week on the same skin area.  1mm can be used every 10 to 14 days on the same skin area.  1.5mm can only be used once every 3-4 weeks on the same skin area.  2mm can only be used once every five weeks on the same skin area, and only if you have the knowledge to judge which part of the skin is thick enough to safely use this needle length as it may cause more harm than good. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 30  Microneedling SERUMS THE BEST SERUMS TO USE WITH MICRONEEDLING Microneedling is a skincare treatment where an E-Pen is used to create deliberate wounds on the skin with tiny needles to stimulate collagen production. Through monthly treatments, E-Pen can improve the appearance of fine lines and wrinkles, hyperpigmentation, and scarring, while also firming and brightening the complexion. There are a couple reasons for why microneedling is beneficial with the use of a serum. By pairing treatments with serums, the client may find it more comfortable during the actual treatment, as the serums will help your device glide over the skin more smoothly. Secondly, it also improves product absorption by up to 300%, helping the clients get the most out of the serum ingredients and resulting in a brighter complexion! Please keep in mind that not all serums are suitable for microneedling. Some may cause irritation and should be avoided! Please patch test all serums before use. With any skincare concerns, please contact a health professional for advice before use. It is best to apply the serum within 5 minutes of finishing the procedure, as this is the time in which the micro-channels will still be open. HYALURONIC ACID Once again, hyaluronic acid is your best friend! It is an extremely popular skincare ingredient which features in many moisturizers and serums, hyaluronic acid is also an amazing serum for microneedling. Hyaluronic acid is a hydrating ingredient which replenishes skin, and the micro- channels created during the microneedling process will optimize product absorption to maximize the benefits of any hyaluronic acid-based serum applied post-needling. It's best to ensure hyaluronic acid is the main player in the serum of choice, and the formula is fragrance free to minimize the risk of irritation. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 31  Microneedling PEPTIDES Peptides help the skin remain intact by keeping the skin firm, reducing the appearance of wrinkles, and boosting overall texture and tone. Therefore, by applying a peptide infused serum while microneedling, it will concentrate their effectiveness and vastly improved absorption. As with hyaluronic acid, always choose a fragrance-free formula to avoid any potentially reactive ingredients. CERAMIDES Ceramides make up 50% of the uppermost layer of your skin and are the fatty acids which help keep the skin barrier intact and hold onto moisture. Needling with ceramides will assist with speedy healing through restoration and hydration, essential for during and after your treatment when your skin is feeling tight and flaky from the deliberate trauma. EGF EGF (epidermal growth factor) is used in medicine to speed up wound recovery, and also has multiple benefits for skin, including reducing the appearance of wrinkles, improving hydration, and preventing hyperpigmentation. EGF is stimulated at a cellular level to help heal and restore damaged skin. It works by binding to cells and signaling them to behave like young, healthy cells, to grow, repair, and survive. This basically means cells will heal quicker and stronger. When noticing signs of aging, dry skin, and uneven skin tone from hyperpigmentation, scarring and blemishes, EGF will help stimulate collagen and elastin to improve skin texture and elasticity. With new cells, the skins barrier is strengthened, which means it can hold onto moisture and prevent melanin production during wound healing, reducing red marks left behind from breakouts. Our bodies naturally produce EGF, but as with all good things, the production decreases with age, which slows down the speed at which the skin can repair itself. With noticeable signs of aging in the skin, it is probably a good time to start incorporating EGF into a skincare routine. Clients might want to do so earlier if they find their skin experiences scarring or red marks after breakouts. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 32  Microneedling Apply EGF serum during and after needling, and as mentioned before, ensure the product doesn't contain any fragrances or active ingredients which may cause irritation. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 33  Microneedling MODULE SIX  Anesthetic All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 34  Microneedling ANESTHETIC Anesthetic can be used not only to make the client more comfortable during their procedure. Topical anesthetic should generally be applied before treatment for maximum efficacy, depending on whether it is suitable. It is also important to let the client know that they may still feel discomfort, although it will be greatly reduced. The amount of anesthetic that will be needed is dependent on the individual. Clients with higher metabolisms, for example may process the anesthetic more quickly and therefore require more of it throughout the procedure. It is incredibly important that the aesthetician is aware of the national guidelines regarding the use of anesthetics, and any use of prescription anesthetic deemed to be used inappropriately or illegally will result in prosecution. USE OF TOPICAL ANESTETIC If choosing to use topical anesthetic creams to numb the area, they should be applied 30 minutes before commencement of treatment. Below is a quick guide on how to use a product (always follow manufacturers recommendations). Zensa Cream usually usually applied thickly to treatment area and covered with cling film. It can take 30-60 minutes for this cream to effectively numb the area. Zensa contains a medication called lidocaine and falls under the ‘local anesthetics’ category. Other local anesthetics include Emla and Dr. Numb. Application of these creams will reduce pain on the skin; however, the client may still experience feelings of pressure, touch and mild discomfort. It is common for the skin to look paler for a short time following the application of Zensa cream, some people may experience erythema and slight swelling. Numbing cream should not be used if allergic to any of the following ingredients:  Lidocaine  Prilocaine  Polyoxymethylene hydrogenated castor oil  Carbomer 974P  Sodium hydroxide  Purified water All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 35  Microneedling Physician permission should be sought before use on the following clients suffering with:  Anemia  Rare inherited illness called glucose-6-phosphate dehydrogenase deficiency  Methemoglobinemia (affects blood pigment levels)  Atopic dermatitis Or using the following medications:  Sulphonamides (a large group of synthetic bacteriostatic drugs that are effective in treating infections caused by many gram-negative and gram- positive microorganisms. They are used in treating many urinary tract infections)  Other local anesthetics  Mexiletine or amiodarone (treatment for uneven heartbeat) The above information should be checked at the consultation stage of treatment. Zensa cream is not recommended for use in the orbital rim and never during any eye procedure. If using around the mouth, ensure ingestion of product does not take place.  Swelling (oedema) of the skin in the treated area  Itching of the skin in the treated area  Blistering of the skin at the site of application may occur very rarely. If this happens the gel should be removed from the skin immediately If any of these reactions occur the use of Ametop as a topical anesthesia is not recommended as not only, will it cause a skin irritation, it may also inhibit the effectiveness of treatment. ASPIRIN AND NSAIDS Clients are often tempted to take pain reducing medication before treatment. Aspirin and NSAIDS have anti-coagulant properties and therefore will affect clotting mechanisms in the blood, therefore cause more bleeding than necessary. This will cause more trauma and increase the risk of bleeding or bruising during treatment. Clients may take Tylenol (acetaminophen) instead before treatments if needed. Please note the aesthetician CANNOT administer ANY medications to the client. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 36  Microneedling CLIENT NUMBING If microneedling is too painful for the client, here are some options as the aesthetician:  Numb the area with icepacks prior to microneedling. It greatly reduces pain. Keep ice packs clean by washing them with hot water and soap.  Use a topical anesthetic such as Zensa. Apply a generous layer of cream, cover with plastic wrap and leave it for 30 minutes. Wipe it off just before the procedure. It will numb the skin for about 30 minutes. Use according to instructions. DO NOT USE TOPICAL ANESTHETICS ON LARGE AREAS OF SKIN DUE TO RISK OF TOXICITY AND NEVER MICRONEEDLE ON SKIN THAT STILL HAS NUMBING CREAM ON IT. WIPE THE NUMBING CREAM OFF BEFORE THE TREATMENT. DO NOT USE TOPICAL ANESTHETICS WHEN PREGNANT OR BREASTFEEDING. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 37  Microneedling MODULE SEVEN  E-Pen Treatment All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 38  Microneedling E-PEN TREATMENT MICRONEEDLING DEVICE INSTRUCTIONS FOR USE Always follow the instructions the company provides for the chosen device. This section is for your reference and a general guideline only. E-Pen is an automated, non-surgical microneedling device designed for use by certified aestheticians. The device incorporates a sterile microneedle cartridge and sleeves for single use only. INTENDED USE The E-Pen is a microneedling device intended to be used as a treatment to improve the appearance of facial acne scars, fine lines and overall skin texture. CONTRAINDICATIONS Are there any reasons why a client should not receive E-Pen treatments? The use of the E-Pen should not be used on clients who:  Have active skin cancer in the treatment area(s)  Have open wounds, sores, or irritated skin in the treatment area(s)  Have an allergy to stainless steel or anesthetics  Have a hemorrhagic (bleeding) disorder/hemostatic (bleeding) dysfunction  Are pregnant or nursing  Are currently taking drugs with the ingredient isotretinoin (Accutane) NOTE: This product is not intended for transdermal (under the skin) delivery of topical products such as cosmetics, drugs, or biologics. WARNINGS Do not use any equipment not designed specifically for E-Pen as to avoid interference with the device’s intended performance. Use of this equipment adjacent to or stacked with other equipment should be avoided because it could result in improper operation. Use of accessories other than those specified or provided by the manufacturer of this equipment could result in increased electromagnetic emissions or decreased electromagnetic immunity of this equipment and result in improper operation. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 39  Microneedling PRECAUTIONS What precautions should clients be advised about? Safety and Effectiveness for settings greater than 2 mm has not been evaluated. Universal precautions and sanitization before during and after the treatment are necessary during microneedling. Microneedling should not be used within the orbital rim of the eye, such as the eyelids. The E-Pen has not been evaluated in the following client populations (i.e., clients with the following conditions or taking the following medications):  actinic (solar) keratosis; active acne  collagen vascular diseases or cardiac abnormalities  diabetes  eczema, psoriasis and other chronic conditions in the treatment area or on other areas of the body  immunosuppressive therapy  history of contact dermatitis  raised moles in the treatment area  rosacea;  active bacterial, fungal, or viral infections (i.e. herpes, warts)  keloid scars (a scar that grows outside of the boundaries of an original scar)  clients on anticoagulants  scars and stretch marks less than one year old  scleroderma; and wound healing deficiencies All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 40  Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 41  Microneedling CONSENT FORM SAMPLE All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 42  Microneedling TREATMENT LOG SAMPLE All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 43  Microneedling CHARGING This device comes with 2 batteries and a charging cable. Ensure one battery is charged sufficiently while the other is attached to the device. Each battery will give 4 hours of continuous charge. The E-Pen is a wireless device making it very convenient to use. IMPORTANT: Keep dry. PRE-APPOINTMENT  Do not use Retin- A or other exfoliating creams 24-72 hours (1-3 days) prior to the treatment. Avoid sun tanning or tanning creams/sprays for at least a week before treatment  Clients must NOT have recently had laser surgery or treatments  Clients who have had a recent chemical peel or other skin procedure, such as collagen injections, should wait 2-3 weeks before undergoing microneedling  Prospective clients should also refrain from waxing the desired treatment area for 2 weeks prior to the microneedling treatment  Wash the face and neck with a non-oily, non-soap based cleanser before each scheduled treatment  Must not have used Accutane in the last 6 months PRE-PROCEDURE PRECAUTIONS  Avoid excessive sun exposure/burns 24 hours prior to procedure.  Discontinue use of topical retinoids 24 hours prior to procedure.  Avoid treatment on clients with active breakouts or open lesions.  Allow at least 24 hours after autoimmune therapies before a treatment.  Wait six months following oral isotretinoin use.  Although not seen in the clinical study, in Fitzpatrick IV–VI, pigment may darken prior to lightening. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 44  Microneedling QUICK PROCEDURE INSTRUCTIONS 1. Have client complete consent form. 2. Explain the microneedling procedure to the client and set expectations. 3. Cleanse client’s face with a gentle cleansing complex to effectively remove makeup, sunscreen, and surface oils. 4. Take “before” pictures of the procedure area. 5. Apply single use, non-latex gloves and a face mask. 6. Apply numbing cream. 7. Open the E-Pen Kit and remove all contents. 8. Apply the disposable sleeve to the E-Pen. 9. Install the cartridge onto the E-Pen. 10. Once the numbing cream has been applied for at least 30 minutes, it must be removed from the skin with an antiseptic cleanser, followed by 70% alcohol prior to the microneedling procedure. 11. Apply a thin layer of hyaluronic acid to protect the skin against abrasion and friction during the treatment. If the layer is too thick the microneedle cartridge may become clogged. 12. Ensure the needle is set to “0” before starting a new procedure. 13. Power on by pressing and holding the on/off button on the front of E-Pen for two seconds. 14. Adjust needle depth settings on the E-Pen device by rotating the dial to the desired depth. 15. Select depth is based on client needs. Start at a depth setting of 0.25mm. Increase in increments of 0.25 mm or 0.5mm until desired erythema is reached, with a maximum depth of 1.5 mm on the face. Lower to 0.25-0.5 mm to perform procedure around orbital rim, nose and forehead. *Note: treatment can be performed around but not within the orbital rim* 16. Divide the face into four quadrants. Start with the right cheek, move to the chin/perioral/ nose, then to left cheek, and finish with forehead. 17. Hold the skin taut and glide the pen in controlled horizontal motions. Repeat with vertical motions in the same area. Then repeat in a one- directional controlled circular motion. Repeat the pattern if the erythema endpoint is not reached. Depth may be increased within guidelines if necessary. 18. For additional treatment of scar tissue, such as facial acne scars, a needle depth of 1.5mm may be used on the face. RN and MD can go up to 3mm depth if required. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 45  Microneedling 19. Apply a thin layer of hyaluronic acid or desired serum once the treatment is completed. 20. Remove needle cartridge and dispose in sharps container. 21. Remove gloves first, and then face mask. 22. Give post-care instructions. 23. Discard remaining disposables in the garbage and sanitize equipment, device and surfaces. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 46  Microneedling All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 47  Microneedling PROCEDURE DEPTH (SUGGESTED GUIDELINES)  Forehead (0.25-1.0 mm)  Nose (0.25-0.75 mm)  Around the Orbital Rim* (0.25-0.5 mm)  Facial Scars (up to 1.5 mm) The E-Pen device allows for incremental increase in settings of up to 2 mm to allow for the variability in thickness of healthy skin and acne scar tissue. However, the device has not been clinically evaluated at cartridge settings of greater than 1.5 mm. As there are fine structures (ex. nerve branches and accompanying blood vessels) that run under the skin and are essential to proper tissue function, it is not recommended to treat at needle depths greater than 1.5mm. It is essential that the thickness of the client’s skin in each anatomical area to be treated is assessed by a qualified clinician to address any potential risk of injuring these structures. Such structures include (but are not limited to) the supraorbital nerve (the terminal branch of the frontal nerve that provides the sensory innervations for the skin of the forehead, mucosa of frontal sinus, and the skin of the upper eyelid) and the temporal, buccal and marginal mandibular branches of the facial nerve (motor nerve that controls facial muscle movement). NOTE: Microneedling should not be used within the orbital rim, such as the eyelids. IMPORTANT: Micro-channels created during the procedure may remain open up to 24 hours. NOTE: This product is not intended for transdermal (under the skin) delivery of cosmetics, drugs, or biologics. Unexpected complications may occur when products not proven safe for use with microneedling are applied post-procedure. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 48  Microneedling AFTER PROCEDURE 1. Apply a generous layer of hyaluronic acid after the procedure. 2. Selected serums may be applied additionally the day of the procedure to prevent the skin from drying out post procedure. The client can re-apply, as needed, up to 24 hours post procedure. 3. Advise client to avoid sweaty exercise and sun exposure for 72 hours post- procedure. 4. It is recommended to avoid other facial aesthetic treatments the month following the E-Pen treatment. 5. Schedule next appointment in 4 weeks. 6. Take “after” pictures during the next appointment. Vitamin C is water-soluble, and any oils will prevent its penetration into the skin. Therefore, gently remove any creams from the skin with an oil-free cleanser, then apply a vitamin C serum and about half an hour later apply Infadolan. Use very little Infadolan, no need to get greasy skin. Slightly oily is enough because the oil-base does not get absorbed (however, the vitamins in it do). DO NOT EXPOSE THE SKIN TO EXCESSIVE LEVELS OF UV LIGHT AT LEAST 1 WEEK BEFORE, AND 2 WEEKS AFTER MICRONEEDLING. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 49  Microneedling HOW TO REMOVE THE SLEEVE AND CLEAN THE E-PEN DEVICE  Hold the E-Pen perpendicular to the floor, or with the cartridge attachment tip pointing downwards. Use one hand to remove the cartridge and dispose of the cartridge in a sharps container.  Continue to hold the E-Pen device perpendicular to the floor, with the cartridge tip pointed downwards, and pull apart the adhesive strip of the sleeve.  Remove the sleeve by carefully rolling it down the E-Pen to prevent soiling the handpiece.  Dispose of the sleeve in the garbage. Sleeves are not intended to be reused.  Disinfection of the E-Pen should be completed with the use of Sani-wipes.  After removal of the sleeve and disinfection of the device and all surfaces with sani-wipes is performed, users’ gloves should be removed, hands cleaned, and a new pair of clean gloves worn before proceeding to the next client. NOTE: Soiled gloves should always be disposed of in the garbage. Do not reuse disposable gloves. NOTE: The purpose of a sleeve is to provide a covering that helps prevent the transmission of pathogens from one client to another. HOW TO INSTALL/UNINSTALL DISPOSABLE E-PEN CARTRIDGE  Ensure E-Pen is powered off.  Open the cartridge package by holding it right-side up and pulling back the protective covering at the sealed chevron.  Align the lock and key mechanism on the E-Pen microneedling cartridge and the device.  Rotate the cartridge to lock it in place. The E-Pen cartridge is now secure.  To remove the cartridge, rotate until the cartridge is removed.  The E-Pen cartridge is designed for single use.  Dispose of used cartridge in a sharps container. *If the E-Pen becomes inadvertently contaminated before or during installation (i.e., Dropped on floor, open/broken package, needles subjected to possible contamination), discard, and obtain new cartridge. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 50  Microneedling E-PEN CLEANING  Ensure the E-Pen device is powered off before cleaning.  The device should be cleaned while holding the E-Pen facing straight down while wiping the rotary area. Do not clean directly inside the device.  Sani-Cloth wipes should be used to clean the E-Pen after each procedure. Sani- Cloth wipes may also be used to clean the battery and charging cable. Sani-Cloth wipes should be used to carefully wipe the E-Pen, according to their directions for use, found on the Sani-Cloth labelling. Attention should be paid to clean areas such as crevices, seams, and areas around where the cartridge attaches to the device.  Sani-Cloth Directions for use: Special Instructions for Cleaning & Decontamination against HIV-1 and HBV of surfaces/objects soiled with blood/body fluids: Personal Protection: Specific barrier protection items to be used when handling items soiled with blood or body fluids are disposable latex gloves, gowns, masks, or eye coverings.  CLEANING PROCEDURE: Blood and other body fluids must be thoroughly cleaned from surfaces and objects before application of the disinfectant.  DISPOSAL OF INFECTIOUS MATERIALS: Blood and other body fluids should be autoclaved and disposed of according to federal, state, and local regulations for infectious waste disposal.  CONTACT TIME: Leave surfaces wet for 30 seconds and 10 minutes for HIV- 1 and HBV, respectively. Use the 10-minute contact time to mitigate other viruses, bacteria and fungi listed on the label.  Do not immerse in liquids.  Do not use solvents to clean device. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 51  Microneedling MODULE EIGHT Preparation All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 52  Microneedling PREPARATION The treatment time varies depending on the individual client. It is important to wear disposable gloves (latex or vinyl) when carrying out a treatment, because the removed hairs may have body fluid on them, and you are possibly working with chemicals. CLIENT PREPARATION Follow basic sanitation procedures:  Fill out Client Record card and discuss treatment.  Have client remove contact lenses.  Place client in a partially reclining position in the facial chair.  Cleanse the face thoroughly with a non-oily cleanser and dry.  Complete client consultation sheet  Position client comfortably  Take a before photograph  Protect client’s hair with a head band or and drape a towel over the client’s upper body to protect clothing  Sanitize hands  Remove any traces of make up using an oil free make up remover and a clean cotton pad TROLLEY CHECKLIST Trolley set up should ensure that the surface is wiped according to the approved guidelines and a clean dental bib is placed on top. On the working trolley ONLY include disposable single use consumables for microneedling, including gauze, alcohol wipes, gloves, the cartridge and sleeve (out of their box in preparation). Any other components of the treatment should be covered in disposable plastic sheeting or be stainless steel such as tweezers and scissors and be fully sterilizable, preferably sonically cleaned and then disinfected. As a rule, keep the trolley clear of anything that is actually not needed during the procedure. Creams and pigments including approved anesthetics can be decanted into disposable pigment cups prior to beginning the procedure. Next to the work station, have a sharps bin, an approved disinfectant within reach. TREATMENT CHECKLIST  Hands must be washed before and after treatment using antibacterial soap  Any cuts or abrasions on hands should be covered with sterile dressing and gloves All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 53  Microneedling  Any equipment coming into contact with the skin should be sterile/sterilized before use  Check all electrical safety precautions and machine settings follow manufacturer's instructions  Working area must be prepared to meet all legislation requirements  PPE in place for client and the aesthetician - gloves, mask and apron/scrubs/lab coat should be worn by the aesthetician  Bed protected with disinfection, covered with disposable paper roll CLIENT PREPARATION Following the consultation and full explanation of the treatment procedure the client should be instructed with the following guidelines before treatment commences:  Client will need to remove piercings if obstructing treatment site area  Their hair will need to be pulled back with a disposable headband  The client should be positioned at the head of the treatment bed ensuring good access to the procedure area GENERAL SAFETY RULES  Always inspect the devices before every use (ideally use a 12× magnifying glass)  Do not use a microneedling instrument on infected or diseased skin such as severe active acne, herpes, blood clotting problems, poor healing, eczema, psoriasis, fungal infection, wounds, moles, etc.  Disinfect the skin and the E-Pen before every treatment.  Buy an alcohol-based disinfectant in the pharmacy for skin disinfection. It is usually a mixture with around 50 to 70% Alcohol. Betadine can also be used. Do not use Betadine when pregnant or breastfeeding. Wipe the Betadine off BEFORE microneedling since it can pigment the skin.  Do not store the instruments or devices close to possible sources of contamination such as a toilet or sink. Keep the E-Pen in a closed container.  The E-Pen can be used on all areas of skin, except for the eyelids. Be extra careful around the eyes. The skin around the eyes is very thin, so do not apply too much pressure.  After microneedling with needles longer than 0.5mm try to avoid the sun for a week and use a sunscreen lotion with high SPF.  Wait one day before applying makeup.  Avoid microneedling for 6 months after taking the last dose of Accutane. Always do a small test patch first to see how it heals. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 54  Microneedling MODULE NINE  Treatment Areas & Depth All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 55  Microneedling TREATMENT AREAS & DEPTH ACNE SCARS Using a 1.5 mm depth E-Pen is very effective, especially if scars are on a rather large area on the body. Dermastamping can be used in addition to E-Pen device. It is more targeted. Both can be used in the same session. For post-acne pigmentation/spots or to help preventing acne formation, use a 0.5 mm depth. For shallow scars, use a 1mm depth. SCARS ON THE NOSE All invasive skin treatments on the nose are risky because this area reacts and heals unpredictable, and it can end up worse. Try a 1mm depth but never perform any aggressive stamping here. Start slowly and try one small area first. ENLARGED PORES E-Pen works very effectively on acne scars, however pores are not scarring. Pores are ducts in the skin and their size is genetically determined. A depth of 0.2mm to 0.5mm will thicken the epidermis. A thickened epidermis could make pores look smaller because the pore size is the smallest on the skin’s surface and as you go deeper into the skin, the pore channel widens. A 0.5mm dermastamp may also be used. WRINKLES Wrinkles around the eyes and lips can be treated with a 0.5-1mm depth E-Pen. For general rejuvenation of the entire face use 0.5mm-1.5mm depth. For the neck, use a 1mm depth, but avoid the Adams’ apple. NASOLABIAL FOLDS The deepening of skin folds is caused by:  Loosening of ligament attachments that attach the skin to the underlying tissues and to the bone  Loss of skin elasticity  Loss of fat gravitational forces Microneedling can improve skin elasticity and trigger collagen, but it cannot solve the other causes so there are no miraculous results expected for the nasolabial folds. Stamp the fold densely with a 1.5mm depth. UNEVEN SKIN TEXTURE AND SKIN TONE WITH NO SCARS 0.5mm-1mm depth. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 56  Microneedling STRETCH MARKS Stretch marks are not just marks; they are in fact very deep scars in the skin. Generally, use a 1.5mm-2mm depth. The skin on the upper arms is thin and microneedling sometimes causes bruising. Use a 1mm-1.5mm depth on the upper arms. The best results with stretch marks and surgical scars are achieved when keeping the pricked scars occluded with an oily ointment. To avoid greasy clothing from the ointment, a white paper napkin, handkerchief or towelette on the area and put the clothes over it. LONG SURGICAL SCARS OR OTHER LONG SCARS (tummy tuck, caesarean etc.) 1.5mm-2mm depth. SHORT SURGICAL SCARS OR OTHER SHORT SCARS (liposuction, vaccination etc.) 1.5mm-2mm depth. MANY SCARS ON A LARGE AREA OF THE BODY 1.5mm-2mm depth. SCARS ON THE WRIST This area has thin skin, use a 1mm depth. LOST ELASTICITY / SUN DAMAGED SKIN The best results for crepey/sagging skin is microneedling in combination with peels. This speeds up the cell turnover of the skin and forms new collagen and elastin. A 0.5mm- 1mm depth is recommended every 4 weeks. This should also help with age/sunspots. Do not expect miracles though. The biggest problem of aging skin is that the subcutaneous fat that makes the skin nicely plumped is disappearing. Microneedling cannot trigger fat production; it can only affect the skin and slightly thicken and tighten it. HANDS If there are have visible veins at the back of the hands, do not push the device deeply. Use a 0.5-1mm depth. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 57  Microneedling SERIOUS BURN SCARS 2mm depth. CELLULITE Microneedling has a limited effect on cellulite. 1.5mm-2mm depth will help thicken the skin. THINNING HAIR Use a 0.2mm depth for product penetration. Microneedling greatly enhances the penetration of skin or hair products, so do not apply too much product in the beginning. High percentages of ingredients may cause rare but potentially dangerous side effects. Slowly increase the application and treated skin surface. Use a 0.5mm depth to enhance blood flow to the hair follicles. MELASMA The honest answer is, Melasma can both improve and worsen after microneedling because Melasma is a very unpredictable condition. Any skin procedure or any “intervention” onto the skin (very cold, very hot, strong wind, certain creams, massage etc.) can theoretically make Melasma worse because the skin may react to it by producing more pigment. Everybody reacts differently and what worsens Melasma in one person can improve it or do nothing for the other. Clients with Melasma should avoid sun exposure as much as possible. A 0.2mm depth microneedling treatment can be very useful in enhancing the absorption of Hydroquinone or other lightening products in to deep skin layers, but it should only be done for three months and then a one-month break. A 0.5mm-1mm depth may also be beneficial (it reaches the dermis part of the skin where dermal Melasma resides) in combination with skin lightening products (three months on, one month off and so on). Do a small test area first and leave it for at least 3 weeks to see how the skin reacts. PIGMENTATION If the client has red skin due to dilated veins, microneedling will not help. Try vascular laser for this. Standard pigmentation is caused by the overproduction or uneven distribution of the pigment Melanin. Melanin is normally present in the skin, and it is our natural protection against ultraviolet radiation from the sun. The darker the skin, the more Melanin it contains. Sun exposure triggers Melanin production but the skin also produces Melanin as a reaction to certain stimuli, such as long-term inflammation (acne) or certain types of skin injury (burns). Often, the reason for the All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 58  Microneedling excessive or uneven distribution of Melanin is unknown. The response of pigmentation to microneedling depends on how deep the pigmentation is. The shallower it is, the easier it is to address. Microneedling speeds up the turnover of skin cells and that improves pigmentation. Use either a 0.5mm-1mm depth once a month. For sun damaged, pigmented skin on fore-arms or legs, give the skin a good scrub with a pumice stone prior to the treatment. Microneedle when the pumice scrub has healed. Application of skin lightening products right after treatment will greatly increase the likelihood for improvement of sun/age spots, melasma and brownish pigmentation. Apply for 3 months, then take a one month break, then repeat. HYPOPIGMENTATION Skin pigment (Melanin) is produced by melanocyte cells. They are at the bottom of the epidermis, which thickness is 0.1–0.3mm. When they produce too much Melanin in a certain area, it causes hyperpigmentation. And when they do not produce enough or are destroyed or damaged, it causes hypopigmentation. Scar tissue differs from normal skin and one of the differences is that it has no, or badly functioning pigmentation processes. Microneedling often triggers the activity of melanocytes (pigment producing cells) or “wakes up” existing dormant melanocytes. In some cases, the colour turns completely back to normal (especially if there is hypopigmentation but no scar tissue, such as in Vitiligo) and in some cases the color improves but the scars still remain lighter than the surrounding skin. If the client hypopigmented patches, treat them every 4 weeks with a 1 mm depth. If you have a hypopigmented, hardened scar or if it is on an area with thick skin (such as the knees), use a 1.5 mm depth. Treat the hypopigmented patches and also treat slightly outside of its borders to enable the migration of melanocytes from the surrounding normal skin into the hypopigmented areas. Ideally, combine microneedling with stamping of the most hypopigmented patches. When the skin is healed from microneedling, expose the hypopigmentation to the sun because Melanin is produced as a reaction to UV (provided there are melanocyte cells in the area to produce it). All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 59  Microneedling MODULE TEN  Individual Areas of the Body All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 60  Microneedling MICRONEEDLING INSTRUCTIONS FOR INDIVIDUAL AREAS OF THE BODY FACIAL REJUVENATION 1. Begin on one side of the face and cover it thoroughly before proceeding to the other side. It is better to start on the right side and then do the left side. 2. Needle outwards from the middle of the chin toward the lower ear horizontally. 3. Place the E-Pen slightly higher up the cheek and repeat, gradually working further up the face until the entire half has been covered. Resist the urge to roll over the eye socket area. If the client has eye wrinkles that should be treated, gently pull this skin downward over the cheek and roll it there to avoid damaging the eye. The skin around and under the eye is extremely thin, caution is advised. Do not use excessive pressure and glide gently. 4. Ensure 3 passes are completed in each facial quadrant before moving to the next section (vertical, horizontal and circular motion passes). All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 61  Microneedling UPPER ARM TREATMENT Microneedling can help sagging or wrinkled skin in the upper arm area. 1. Before beginning, massage the upper arm, working upward in the direction of the chest. 2. Then start microneedling upward toward the chest on the right arm, moving across to the back while continuing an upward stroke. 3. Then cover the same area with perpendicular passes. 4. Repeat the entire process on the left arm and follow with Vitamin C serum. HAND REJUVENATION Just as microneedling can stimulate collagen production and thicken the skin on the face, it has a similar effect on the hands. 1. After cleaning the hands thoroughly, start with the tip of the right thumb and needle up the thumb and down the back with short strokes. 2. Do this on each finger, being sure to microneedle up across the back of the hand. 3. Then needle across the back of each hand, perpendicular to the fingers before repeating the entire process on the left hand 4. Needles longer than 1mm are not recommended for hand treatments. Do not use excessive pressure. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 62  Microneedling ABDOMEN 1. Start in the middle of the abdomen and roll upwards. 2. Make repeated strokes toward the right side, then move back to the center and work outward to the left side. 3. Cover each area 10 to 15 times. 4. Apply Vitamin C serum and use caution when going out in the sun. Keep in mind that a 1.5mm depth might be better for severe scarring, while 0.75mm can be enough for smaller scars. 1.0mm is the sweet spot. THIGH AREA 1. It is important to only work upwards towards the trunk, to allow venous drainage and not damage the valves in the veins which cause blood to pool in the limbs. This is the one area where it recommends applying a little more pressure, as clinical experience suggests, achieving quicker results. 2. Avoiding the sun is usually easier on the thighs than the face and hands and direct sunlight should still be avoided for at least 24 hours. All About The Skin Inc. Confidential & Proprietary - Copyright © 2021, All Rights Reserved Worldwide 63  Microneedling NECK AND DÉCOLLETAGE If the client has loose skin in the neck area, microneedling can help tighten it, while also reducing the appearance of aging and sun damage. 1. As always, clean the skin first. 2. Start from the base of the neck in the center and move up the neck until the jaw is reached. 3. Start each subsequent glide slightly higher up until the entire area has been covered, then do the right side and the left side. 4. Keep in mind that the skin on the neck is extremely sensitive, so caution is advised. It is important to roll gently, try to avoid any significant redness or discomfort. HAIR LOSS Typically, pattern hair loss occurs on