Q&A: Des Fernandes, MB. BCH, FRCS, on Pioneering Modern Microneedling

Nearly 3 decades ago, Des Fernandes, MB. BCH, FRCS, the pioneer of modern microneedling and founder of Environ Skin Care, transformed an emerging concept into a rigorously studied, globally adopted modality for scar revision, photoaging, and regenerative skin therapy. In this exclusive interview with Dermatology Times, he discusses the foundation of his work, the crucial role of topical vitamins in this technique, and the future of skin regeneration.

Dermatology Times: How did you discover and perfect modern microneedling?

Fernandes: I had started “horizontal” needling of the upper lip grooves with a thick needle in 1994, but the problem was bruising and even some nodules that developed. So, by 1997, when I went to the International Society of Aesthetic Plastic Surgery (ISAPS) meeting in São Paulo, Brazil, I was receptive to a paper by Andre Camirand, MD, where he spoke about dry needling or needle abrasion to convert white face-lift scars into unnoticeable skin-colored scars. Apparently, tattoo artists have long known about “dry needling”. Since I had trained with a tattoo artist in 1985, the concept was easy for me to understand, and when I returned home, I started treating a patient with upper lip lines with the standard tattoo device.

At the end of the first month, I could see improvement but was dissatisfied. So I did another treatment, which brought a better result but still not enough. So I did a third treatment. In two months, she had three needling treatments, and the result was now good. I then did whole faces for photoaging, acne scars, and even some burn patients. It was laborious, slow, and caused a lot of inflammation. I soon decided that the holes were too close to each other. This is what you need if you are pigmenting skin but not for what I was doing. I also felt the needles needed to penetrate much deeper. I then designed a 3 mm long needle roller, stamper, and “rocker” which I submitted for patenting. My cousin, who worked for the European Patent Authority in Munich, however, informed me that a rolling device had been patented by French doctor Michel Pistor, the founder of mesotherapy, in the 1950s. I looked at my results and I concluded that needling must induce growth factors that cause regeneration.

Histology of my patients showed no evidence of scars post-procedure. We were causing regeneration and that gave me an impetus to do more. Fortunately, I met a young doctor, Matthias Aust, MD, who was looking for a research project, and I suggested that he explore skin needling and find out if and why we were causing regeneration of the skin. In the early days, I felt confident only to treat lighter skin shades. I am a Fitzpatrick III and on me, I had no problems with pigmentation. But I was worried that the inflammation would cause pigmentation. I had one Indian patient who desperately wanted her pigmented chicken pox scars improved. I did a small patch with a roller on her wrist and that caused no pigmentation, so I did her whole face with a lovely result. Aust showed in his experiments that besides causing regeneration of tissue for the first time in medical history, needling with a roller up-regulated IL-10 and down-regulated melanocyte-stimulating hormone, which explained why pigmentation is not a complication. I have tried needling on virtually all colors of skin, and I have only seen benefit. However, the real problem lay in convincing my peers that skin needling was a wonderful way to treat acne, burn scars, and photoaging. Their attitude was that my concept of needling was a bloody, sadistic type of treatment.

Dermatology Times: What is the benefit of combining the procedure with topical vitamin A and antioxidants?

Fernandes: Right from the very first case of needling, my patients were first put on topical vitamin A, C, and antioxidants. I knew that vitamin A was important for stimulating collagen, elastin, and hyaluronic acid, and made faster healing of any wound, amongst thousands of other essential actions that vitamin A has on growth, differentiation, and maturation of cells. I thought it would be synergistic with needling because by then, I already understood that topical vitamin A promoted the action of growth factors. At the same time, I reckoned that if we were stimulating collagen formation, then we would need extra vitamin C because it is essential for normal collagen formation. I have worked with peptides in formulating cosmetic products since about 1996 and soon I realized that peptides that promote skin matrix would be ideal to use with skin needling. At the same time, I also did trials on patients of not only needling but enhancing the activity of vitamin A, C, and peptides by using a combination of these actives in daily skin care regimens and also doing weekly treatments with a special machine that I developed in 1998 to use low-frequency-sonophoresis and iontophoresis. By doing this, we were able to show significant lifting effects in my patients.

Because I thought that needling automatically causes some degree of inflammation, I figured that antioxidants would help to soothe the skin. My ideas were proved right by Aust in his laboratory work, where he showed that by simply using vitamins A and C, the skin became 20% thicker and healthier. By adding needling to vitamins A and C, we could almost quadruple the thickening of the skin and increase in collagen, compared to skin that was not treated with vitamin A before and after needling. I believe in litigious societies, that patients may sue their doctors if they omit to use topical vitamin A, C, and antioxidants before and after skin needling. In various aspects of his research, Aust and his team showed that there were surprising changes in the TGF-beta cytokines. After surgery or accidental lacerations, TGF-beta-1 and TGF-beta-2 are raised and remain raised for a prolonged period. TGF-beta-3, on the other hand, makes a transient appearance and disappears by 24 hours. In needling, exactly the opposite occurs: TGF-beta-1 and 2 make only a transient appearance and disappear by 24 hours, whereas TGF-beta-3 remains elevated for about 2 weeks. IL-10 also remains elevated for a longer period than after any cut to the skin, which may account for why some people develop pigmentation in their scars.

The fact that TGF-beta-3 is raised for about 2 weeks made me consider a way of maximizing skin needling by doing 1.0 mm needling once a week. That met with considerable opposition. There was an idea that I would reverse the effects of needling and not promote greater levels of TGF-beta-3. Fortunately, Aust and team explored this and confirmed my findings. We were getting very much better results than expected. With the roller, I found my patients could return to work the next day and just look as though they spent time in the sun. No bruising, despite significant bleeding during the procedure. No discomfort and only mild sensitivity. By day 6, they were looking good, and then we did the next treatment. I did a trial of measuring growth factors by tape stripping the skin a few days after needling and the preliminary results showed progressive elevation of growth factors. These results, which were part of a master’s thesis, were never submitted for publication.

Dermatology Times: What is the most common misconception or mistake patients or clinicians make about microneedling treatments?

Fernandes: Patients don't easily understand what value needling has for them and that is why I wrote a book for patients to read that tries to explain in simple terms exactly what needling is, how it’s done, and the result one can anticipate. Many patients and clinicians believe that more invasive treatments will give better results. They don’t understand that every other skin treatment causes scarring to various degrees, and the scarring helps to tighten skin. Needling helps to remove scars and causes regeneration of normal skin. It's the only procedure that does that. With needling for acne scars, we get about 60 to 70% improvement after one series of needling and after repeated treatments, scars become nearly invisible. I always under-promise because we must accept that not everyone gets the best possible results. I theorize that the results are heavily dependent on the blood platelet count. For example, I have a relatively low platelet count, and I feel I don't get as good results as my assistant nurse, who has a high platelet count and seems to get much more impressive results on her skin compared to mine. Photoaging treatments not only tighten and smooth the skin but also lighten pigmentation marks, reduce pore size, and make skin appear younger. For the best results, I recommend that people periodically do a series of 4 to 6 treatments to keep their skin in optimal condition. I have had over 90 episodes of needling of my face in the past 27 years...I certainly look much fresher than my colleagues, who mocked me when I started the idea of skin care and skin needling.

Dermatology Times: What were some key pearls you shared at the recent ICOPLAST 2025 World Congress that you think are critical for our audience to know?

Fernandes: I tried to show how skin needling developed in Cape Town 27 years ago, only a short distance away from where we were having the congress. I tried to impress on the audience that vitamin A and C are not just an option, but essential to create the best result: the science is very clear and well demonstrated. I refuse to do needling on any patient who will not use topical vitamin A, C, and peptides. I believe I gave a well-illustrated talk showing how we have refined the treatments and the management after needling. The use of low-frequency sonophoresis has also magnified the results that can be achieved, and I showed some independent results from other doctors. The use of red/infrared LED immediately before and after needling also promotes better results. Another little tip is to ask the patient to wear a face-supporting mask as often as possible and certainly every night for a week or two, which I believe helps to tighten the matrix network of the skin.

Dermatology Times: How do you see microneedling and regenerative skin care evolving in the future?

Fernandes: I think even more people should understand that the simple treatment is affordable and gives results often comparable to those achieved by expensive machines. It is not only a “third-world” solution. It is probably the safest procedure ever described, and one does not put questionable products on the skin. 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.

Environ Skin Care, from the onset 35 years ago, has always been involved in the regeneration of skin and in our search for “futureproofing” the skin. We have pioneered ways to enhance penetration to help active ingredients work more efficiently. My pioneering work on medical skin needling led to the Cosmetic Roller with needles only 0.1 or 0.2 mm long. That research started in 2000, and an engineer hacked my idea and put the roller on the market before I had completed my clinical research. Environ also pioneered the use of Low Frequency Sonophoresis in its skin care professional treatments, which remains one of the most effective machines in the world today. This principle has been employed in the Environ DF machine Electro-Sonic treatments. This is also used in the Environ DF Mobile, which allows clients to focus on special areas of concern. 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.

[Transcript has been edited for clarity.]