Dermapen vs. Laser
What makes Dermapen Different:
The closest technology to the Dermapen is a fractional laser. A fractional laser “drills holes” in the skin to create a wound healing response and leaves normal tissue around the holes to be a reservoir for fibroblasts and stem cells to migrate into the holes. Fractional radio frequency devices work on a similar principle and have many of the same side effects as fractional lasers (Yeung et al., 2012). Dermapen also makes holes in the skin to create a wound healing response and leaves normal tissue around the holes. These technologies have similar results, but achieve them in very different ways, and result in very different side effects profiles. The laser uses light to char and obliterate epidermis to produce small pits which vary in diameter and depth, depending on the laser type (Erbium, YAG, CO2; nonablative vs ablative) and manufacturer. Dermapen produces reproducible and consistent holes in the skin.
Side effects differ between technologies. Most fractional lasers leave erythema and edema up to 48 hours after treatment. Resultant down time is approximately 3-4 days for fractional laser treatments (Gold, 2010). Dermapen treatments result in erythema without edema for about 24 hours. Dermapen has none of the side effects specific to fractional lasers, such as:
- Pain (higher in dark skined patients (Mahmoud et al., 2010)
- Persistent erythema (Gold 2010)
- Infections (viral and bacterial). Facial herpes reported in 10.6% of patients in spite of antiviral prophylaxis (Naouri et al., 2011)
- Post inflammatory hyperpigmentation in up to 18% (Vaiyavatjamai and Wattanakrai, 2011; Chan et al., 2010; Mahmoud et al., 2010; Yeung et al., 2012)
- Post inflammatory hypopigmentation – seen in patients up to two years after a laser treatment. Occurs in up to 20% of patients with photo-aged skin (Gold 2001).
Light based therapy is not for all skin types. For example, the indications for use cleared by the FDA may put limits on the skin types that may be treated with a fractional laser. For example, the indications for use may prohibit the use of the laser on Fitzpatrick 4, 5 , and 6 (darker skin colors), for example: “The EXELO2 with the fractional scanning unit is indicated for ablative skin resurfacing in people with skin types 1, 2 or 3 based on Fitzpatrick skin type scale.” K090639. The fractional holes “drilled” by the laser are a function of skin type, skin thickness, and vascularity. Dermapen is not affected by skin type as it does not rely on skin color to turn light into heat.
A major complication from light based therapy includes Postinflamatory Hyperpigmentation (PIH) in Oriental, Mediterranean, and African skin types (Yeung et al., 2012; Metelitsa and Alster 2010; Chan et al., 2007). PIH presents as symmetric hyperpigmented macules and patches on the face. PIH is one of the most common and distressing pigmentary disorders seen in dermatology clinics. It is notably difficult to treat and may relapse. Of course, Dermapen has not reported PIH complications and thus is safe for darker skin (Fabbrocini et al., 2009).
Micro Needling vs Dermal Rolling
The dermal roller is the precursor to Dermapen—it’s a simple mechanical device whose primary use is percutaneous collagen induction (PCI) therapy. A rolling drum on a handle is festooned with thin surgical steel needles of a specific length and rolled across the skin to create numerous perforations as it is moved. Needle length may vary between rollers but stay generally within the neighborhood of 1.5 mm. Results are noteworthy, to say the least.
The problem is that while the microneedle concept is simply and elegantly executed with dermal rollers, it is not ideally executed. Compared to Dermapen it is quite painful, and any post-treatment erythema and/or edema tend to last about four days, creating unwanted (if somewhat minimal) downtime. The character of the microwounds seen with the dermal roller is much more traumatic to the skin; instead of a rapid vertical needle insertion and withdrawal, dermal rollers dig into the skin and create more of a tearing wound, and may be responsible for the longer downtime.
A study presented at an Australian medical conference [Chu 2012] compared Dermapen and dermal roller technology head-to-head for atrophic acne scarring. Subjects (n=60) presented with predominantly rolling acne scars and had each been previously treated at least once with a dermal roller, suggesting familiarity with the procedure. Although the physician and his staff had successfully treated more than 1000 patients with the dermal roller in this manner, Dermapen won hands down. Users found it quite easy to operate, and objective evaluation via digital scan technology with software analysis revealed greater reduction in scar depth with Dermapen. Additionally, patients rated Dermapen treatment to be less painful with shorter downtime and better clinical outcomes.
There is also marked potential for variability between operators using dermal roller technology. The nature of the rolling drum requires some small amount of pressure during rolling to ensure proper microneedle penetration. This pressure can never be the same between individual users—or between individual treatments by the same user, no matter how experienced—so depth of penetration will be inconsistent to some degree. With Dermapen the device does the work; the user exerts force in a lateral motion perpendicular to the skin’s surface, taking the user out of the proverbial picture. This is an issue because the subject of microneedle therapy is a matter of microscopic differences measured in tenths of a millimeter. Theoretically, different penetration depths have different therapeutic effects, so the ability to create consistent perforation patterns may hold the key to therapeutic value and versatility.
From a practice standpoint ensuring sterility is essential, and with Dermapen it is accomplished with the simple swapping of inexpensive disposable tips. A dermal roller must be manually sterilized between users, which is not a complicated or expensive process but is time consuming and relatively less reliable. Also, the relatively small size of the Dermapen tip makes it capable of treating areas such as the upper lip which a dermal roller cannot easily reach.