Editor's Note: Last month's part one of this article ended with the advantages of combining the treatments of acupuncture and microneedling; this month we will look at protocols and contraindications.

Protocols & treatment Timing

• A course of treatments should be performed over a period of 12 weeks if possible.
• Microneedling should be performed once every two weeks.
  It takes two weeks for the levels of collegenease produced in the skin to peak and it is only after this that another treatment should be performed.⁹
• Acupuncture should be performed once every two weeks on alternate weeks to the microneedling. It is better if microneedling and acupuncture are not performed in the same session as the skin can become very sensitive and the it is not ideal to overload the healing response of the skin in a small area.

Microneedling Protocol

• Cleanse the skin using an appropriate organic cleanser. Remember this step is important as the microneedling will increase the absorption of any products still on the skin.
• At this stage I apply a green tea oil blend to the skin. Green tea oil has been shown to benefit scars and moisturizes the skin reducing the skin dryness associated with microneedling.¹⁰
• A short massage can be applied at this stage using a jade roller, such as gua sha or tui na.
• For acne scars and smaller scars I select a 0.75mm roller. If assisting very large or deep scars elsewhere on the body a 1.5mm roller can be applied. Keep in mind that a 0.75mm roller is the longest length that can be used relatively painlessly. Patients should be warned of possible discomfort if you are planning to use a 1.5mm roller.
• Roll across the skin in an upwards and out wards direction to lift and smooth the skin. The facial rolling techniques are usually the most difficult due to the more complex contours of the face. For those familiar with other forms of Chinese facial massage such as the jade roller the directions followed are very similar.
• Roll across each area approximately 15-20 times.
• After the treatments don't use any products other than the green tea oil for at least eight hours as absorption through the skin is still increased during this time.
• If possible between treatments ask the patient to apply green tea oil to their face once or twice a day. As green tea oil is quite expensive six drops can be combined with a little water on the hands and massaged into the skin.

Acupuncture Protocol

• Follow the skin preparation and aftercare instructions listed in micro needling protocol.
• Choose appropriate acupuncture needle lengths based on the size of the scar.
• Locate the border of the scar and then needle one to two fen outside this broader.
• Guide the needle under the scar towards the center of the scar.
• Lift and thrust the needle several times in the area to help separate the scar tissue before allowing the needle to rest.
• The number of needles used on a scar depends on the size of the scar. Up to seven needles can be used on larger scars.
• When treating smaller acne scars it is often not possible to treat all scars in a single session. If the scars are very small one to two half cun needles inserted correctly can be sufficient per scar.
• Retain the needles for 28 minutes.

Contraindications

• Any open skin wounds, rashes, psoriasis, eczema, pustular or nodular rosacea and fungal infections should all be avoided.
• Raised moles, warts or moles that have changed shape or color and unidentified skin growths should be examined by a physician before being treating.
• Cold sores must be avoided if present or they may be spread. If there is a history of cold sores it is often best to begin taking any cold sore medicine before beginning microneedling as any form of skin needling can activate the immune system and cause an outbreak of cold sores.
• Pustular acne spots should be avoided. This is important when treating acne scars where there is still acne in the area.
• Keloid scars are a strict contraindication as needling in the area can increase their growth.
• Patients taking anticoagulant medication should be treated with caution.
  Acupuncture and microneedling can complement each other to create an effective treatment for a variety of scars.

References

9. Kingston A. Holistic Microneedling: The Manual of Natural Skin Needling. London: New Generation, 2012.

10. Chen L. "Use of single component Camellia oil for treatment of scald with no scar left." Famiing Zhuanli Shenqing Gongkai Shuomingshu Peop. Rep. China, 2005; 4.

Anthony Kingston studied acupuncture and herbal medicine in Sydney, completing a masters of Health Science. After extensive further study in Asia, he founded White Lotus Anti Aging. He is the author of the international best selling book, Holistic Microneedling and is the expert skin needling advisor to BABTAC, the largest beauty organization in Britain. Visit www.whitelotusantiaging.com to learn more.