The Environ® Medical Roll-CIT™ is a revolutionary and unique design. It is a patent pending instrument designed by Dr. Des Fernandes, a leading South African plastic surgeon and founder of the International Environ® range of skin care products and treatments.

BACKGROUND

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

 

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

 

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

 

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

 

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

 

The Environ® Medical ROLL-CITTM (Collagen Induction Therapy) instrument is designed specifically to meet this requirement. The instrument makes needling of the skin easy and quick to do. It is a small hand-instrument, easy to use, store and post. The instrument is packed in surgical packets and is exposed to gamma irradiation.

THE PRODUCT

Environ® Medical ROLL-CITTM

 

  • The Environ® Medical ROLL-CITTM is a roller with needles for the natural induction of collagen.
  • It is used by professionals such as medical practitioners and appropriately qualified and insured aestheticians..

PRINCIPLE

How does Percutaneous Collagen Induction work?

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

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

The needle only penetrates through the epidermis and does not remove it, so the epidermis is only cleft and will rapidly heal. This injury, minute as it might seem, does cause some localised damage and bleeding.

The needle pricks penetrate into the dermis and starts up the inflammation phase. Tiny blood vessels are ruptured so blood cells and serum get into the surrounding tissue. A complex chemical cascade determines the formation of a clot, vascular permeability, the attraction for leucocytes, and fibroblasts are recruited into the wounded area. Platelets cause clotting and release chemotactic factors like Platelet Derived Growth Factor (PDGF), transforming growth factor, and Fibroblast growth factor (FGF) that initiate an invasion of other platelets, leucocytes and fibroblasts.

The leucocytes, particularly Neutrophils act on the damaged tissue, remove debris and kill bacteria. This reaction is automatic and produces a surge of activity that inevitably leads to the fibroblasts being “instructed” to produce more collagen, and more elastin. Re-epithelialisation occurs within a few hours after needling and is really due to keratinocyte migration rather than proliferation. When the keratinocytes have joined together they start producing all the components to re-establish the basement membrane with laminin, and collagen types IV and VII. One or two days after injury the keratinocytes start proliferating and thicken the epidermis.

Fibroblasts migrate into the wound and produce collagen, proteoglycans, elastin and other matrix proteins. Initially after needle damage, the disruption of the blood vessels causes a moderate amount of hypoxia. The low oxygen tension stimulates the fibroblast to produce more TGF-, PDGF, and endothelial growth factor (VEGF). Procollagen mRNA is also up regulated, but this cannot cause collagen formation because oxygen is required and that only occurs when re-vascularisation occurs.

Prevascularisation occurs quite soon after needling. TGF- is a powerful chemotaxic agent for fibroblasts, which migrate into the wound at about 48 hours after injury and starts producing collagen I and III, elastin, glycoseaminoglycans and proteoglycans. Collagen type III is the dominant form of collagen in the early wound healing phase and becomes maximal by 5 — 7 days after injury. This collagen is laid down in the upper dermis just below the basal layer of the epidermis.

Tissue remodelling continues for months after the injury and is mainly done by the fibroblast. By 5 days after injury, the fibronectin matrix is laid down along the axis in which fibroblasts are aligned, and along which collagen will also be laid down. TGF- and other growth factors play an important part in the formation of this matrix.

Collagen type III is gradually replaced by Collagen I over a period of a year or more. (Collagen I is the type produced in infants.) This gives increased tensile strength. The metallo-proteinases are essential for the conversion process.

If we are looking at a single needle prick through the skin, then this is an un-important response. A completely different picture emerges when thousands of fine pricks are placed next to each other. The process can become virtually confluent, and a sheet of collagen will be laid down in the area just below the epidermis.

Collagen slowly shortens after a few months and so the tightening of the skin is progressive over the next few months. The results can mimic those obtained with a laser, but without destroying the epidermis. That is the great advantage of this system. It is believed that deeper penetration into the dermis produces better collagen and elastin deposition.

After all this is only a pinprick!

 

INDICATIONS FOR SKIN NEEDLING ARE:

  1. To restore skin tightness in the early stages of ageing. This is a relatively minor procedure and can safely be recommended. In some cases it has been found that patients who were worried about having a face-lift were satisfied with the result of simple needling of the skin. Great results in the skin above the eyes have been achieved, as the elevation of eyebrows is a natural result of healing. To avoid laser especially in people with thin skin who cannot have laser resurfacing with safety.
  2. Acne scarring. Great success with needling for acne scars. The results are superior to dermabrasion.
  3. For the reduction of fine lines.
  4. As described by Camirand, scars are improved and if they are discoloured white, they may return to a more natural colour after needling.

ADVANTAGES OF SKIN NEEDLING ARE:

  • The first advantage is that this procedure does not permanently damage the skin. The skin actually becomes thicker.
  • The healing phase is short.
  • The procedure is not painful due to the anaesthesia (topical only required for 1mm depth needling); there is also no post operative pain.
  • It is not as expensive as laser resurfacing.
  • Sun-sensitivity is a major and enduring problem in laser resurfacing, whereas after needling of the skin, the horny layer rapidly returns to its original thickness and the skin is not sun sensitive.
  • A major advantage is that this needling can be done on people who have had laser resurfacing, or those with very thin skin.
  • A very gratifying change occurs in dilated blood vessels, which may disappear.
  • The other advantage is that this does not really have to be done by a plastic surgeon or dermatologist. The technique is easy to master because it does not require the artistic skills that are imperative in a tattoo artist.
  • If the result after the percutaneous collagen induction is not satisfactory to the patient, it can be repeated without any risk.

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