Poking holes in the skin to allow ingredients to seep in seems barbaric. But doctors are now embracing both low- and high-tech methods of doing just that to treat fine lines, rough skin, large pores, and acne scars.

Needling devices—originally stamps covered in pins—have existed since the 1980s but were not in wide use among physicians. Lately, more dermatologists are adopting the technology, and rollers are also sold for home use. When a doctor is doing the poking, the treatment is called percutaneous collagen induction therapy (PCIT).

Here’s how it works: One of Epi Center MedSpa medical treatment providers will sponge a teaspoon of an anti-aging ingredient, such as hyaluronic acid, on the patient’s face or chest. (Numbing the area first is preferable; otherwise, the needles feel “like tiny pinpricks,” says Dr. Patrick Bitter, Sr. , Epi dermatologist and Co-Owner.) Then the medical treatment provider moves a needling device over the skin (called the micropen), rolling or pressing it like a rubber stamp. The fine, short needles make microscopic entry channels (a.k.a. holes) for the anti-aging ingredient.

Needling can cause minor bleeding depending on the depth of the holes. At the end of a session, the patient’s skin is deep pink. Even if no serum is used, “the injury caused by needling alone builds collagen and elastin through the body’s innate wound-repair mechanisms,” says Bitter. There are no studies yet quantifying how much better the results are with a serum than without. After 48 to 72 hours, the skin starts to improve. And after four or five treatments spaced a few weeks apart, improvements in skin tone and texture can be seen in photos and with the naked eye. “Microneedling is especially good for smokers’ wrinkles around the mouth, large pores on the nose, and neck lines,” says Lisa Szady, Epi Center MedSpa, Nurse Practitioner, who also uses a topical wash of diluted Botox to tighten the neck and around the eyes.

A more intense way to breach the skin barrier is now becoming available. Here at Epi Center we offer a treatment called Fractora. Our medical providers use this fractional laser technique to create deeper channels in the skin to deliver ingredients, which can double the benefits of any substance applied, whether it’s a drug or a cosmeceutical. Once the top layer of the skin, which acts as a barrier, is vaporized by the laser, “it is an open door for ingredients to get through,” says PA, Shilpa Vichare, who has researched this new combination therapy. On its own, “the heat of the laser stimulates collagen, helps decrease brown spots, tightens skin, and reduces wrinkles.” (Be prepared for several days of redness, swelling, and a little scabbing.) It is too early to know which drugs and cosmeceuticals are most effective with Fractora, but we are trying everything for the patients optimal results: Sculptra, hyaluronic acid, Retin-A, vitamin C, SkinCeuticals C E Ferulic serum, and even Botox.