Inventing Modern Microneedling and Defining the Future of Skin Regeneration

Nearly 3 decades ago, Des Fernandes, MBBCh, FRCS (Edin), a plastic surgeon, researcher, and founder of Environ Skin Care, transformed a niche concept into one of today’s most widely adopted modalities for scar revision, photoaging, and skin regeneration. His pioneering work helped codify microneedling as a predictable, minimally invasive, collagen-inducing therapy long before the aesthetic market recognized its potential. In an exclusive, in-depth conversation with Dermatology Times, Fernandes reflects on how the technique evolved, the essential role of topical vitamins, and the next era of regeneration-focused aesthetic dermatology.

Early Days of Microneedling Techniques

Fernandes traces the modern technique back to 1994, when he began “horizontal” needling of upper-lip rhytids using a thick needle. The improvement was promising, but complications such as bruising and nodularity made the procedure impractical. A turning point came 3 years later at an International Society of Aesthetic Plastic Surgery meeting in São Paulo, Brazil, where he encountered the work of Andre Camirand, MD, on dry needling for facelift scars.

Already familiar with tattooing techniques from earlier training, Fernandes recognized the potential. He began treating upper-lip lines using a tattoo device; it was slow, inflammatory, and far from elegant, but effective enough to spark deeper investigation. After several rounds of treatment on early patients, he noticed meaningful improvement and expanded to photoaged skin, acne scarring, and burns.

Still, the limitations were obvious. “It was laborious, slow, and caused a lot of inflammation,” he noted. “I soon decided that the holes were too close to each other.” Convinced that deeper penetration was required, he began designing his own 3-mm rollers and stampers, eventually discovering that puncture-induced signaling was driving far more than controlled injury—it was stimulating regeneration.

Histology confirmed that, unlike most resurfacing modalities, microneedling did not induce scar tissue formation. It instead restored more normal architecture. This foundational insight led Fernandes to collaborate with Matthias Aust, MD, whose laboratory work would later establish microneedling’s cytokine- and growth factor–mediated mechanisms, including modulation of IL-10, melanocyte-stimulating hormone, and TGF-β family signaling.

Their findings also dispelled long-held fears about inducing postinflammatory hyperpigmentation. With IL-10 upregulated and melanocyte-stimulating hormone suppressed, Fernandes found the procedure to be safe across all Fitzpatrick skin types. “I have tried needling on virtually all colors of skin, and I have only seen benefit,” Fernandes emphasized.

Combating Myths and Misconceptions

When Fernandes first pioneered this procedure, he recognized the difficulty in convincing his peers that skin needling was an efficacious way to treat acne, burn scars, and photoaging.

“Their attitude was that my concept of needling was a bloody, sadistic type of treatment,” he said.

One of the biggest misconceptions among both patients and clinicians today, Fernandes says, is the belief that more invasive treatments automatically deliver better results. Ablative lasers, deep chemical peels, and some energy-based devices create controlled scarring and tightening. Needling, on the other hand, is the only procedure that helps remove scars and promotes the regeneration of normal skin.

For best results, he recommends a periodic series of 4 to 6 treatments to keep skin in optimal condition. Still, outcomes vary. A potential area of research he hopes to explore is platelet count, as he believes this may be an underrecognized factor influencing individual response.

“I always underpromise because we must accept that not everyone gets the best possible results,” Fernandes noted. “The worst complication is that the patient may not be satisfied with the degree of improvement. And the solution to that problem is very simple: Just do more needling.”

Vitamins and Antioxidants Are Nonnegotiable

To Fernandes, the synergy between microneedling and topical vitamins is not optional—it is the scientific core of the procedure. Since his first case, every patient has been pretreated with topical vitamin A, vitamin C, and antioxidants. Vitamin A’s role in epidermal differentiation, collagen synthesis, and fibroblast modulation is well documented, and Fernandes believed early on that it amplified the wound-healing pathways triggered by needling. Vitamin C was equally essential, he notes, given its central role in collagen cross-linking.

Findings from Aust’s subsequent research confirmed the hypothesis. Topical vitamins alone increased epidermal thickness by 20% but combining vitamins with microneedling nearly quadrupled collagen deposition and skin thickening compared with untreated controls.¹ His work also introduced weekly 1.0-mm needling to sustain elevated TGF-β3.

“Vitamin A and C are not just an option, but essential to create the best result. The science is very clear and well demonstrated,” Fernandes said. “I refuse to do needling on any patient who will not use topical vitamin A, C, and peptides.”

Looking Forward to the Regenerative Future

Fernandes predicts a continued rise in the global adoption of microneedling, not as a budget alternative to energy-based devices, but as a primary regenerative therapy with unmatched safety and versatility.

His ongoing innovations at Environ Skin Care, including cosmetic rollers, low-frequency sonophoresis, and electrosonic treatments, reflect his lifelong commitment to what he calls “future proofing” the skin. And according to Fernandes, new pioneering concepts are already in development.

“We are forever evolving as the science of skin care grows, and we are working on some new ideas that we believe will be pioneering changes in skin care,” he added.

Over 27 years later, modern microneedling continues to validate the vision he first had in a tattoo studio—one grounded not in injury, but in regeneration. Fernandes, who has personally had over 90 episodes of needling on his face, concluded with this remark: “I certainly look much fresher than my colleagues, who mocked me when I started the idea of skin care and needling.”

Reference

Fernandes D. Commentary on: Micro-needling depth penetration, presence of pigment particles, and fluorescein-stained platelets: clinical usage for aesthetic concerns. Aesthet Surg J. 2017;37(1):86-88. doi:10.1093/asj/sjw151