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The Power of Microneedling and Antioxidants · The Science of Skin

• 0:00
  SPEAKER_01: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
• 0:08
  SPEAKER_01: To learn more, visit www.skinseuticals.com.
• 0:22
  SPEAKER_02: Hello and welcome to Skincare Confidential, the podcast supporting the Science of Skincare Summit, an annual educational conference occurring September 5th through the 7th, 2025, in Austin, Texas.
• 0:35
  SPEAKER_02: It is 7 o'clock in the morning in Austin, but much later than that in Seoul, South Korea.
• 0:41
  SPEAKER_02: And I am so excited to introduce my guest today, who is Dr.
• 0:47
  SPEAKER_02: Jihee Kim.
• 0:48
  SPEAKER_02: Dr.
• 0:49
  SPEAKER_02: Kim is a professor in the Department of Dermatology at Yonsei University in or around Seoul, South Korea.
• 0:57
  SPEAKER_02: Dr.
• 0:58
  SPEAKER_02: Kim has done some incredible work in dermatology, in particular combining topical dermocosmetics or cosmoceuticals with laser or energy-based procedures.
• 1:11
  SPEAKER_02: And because of that, she has worked extensively with skin seuticals and has two abstracts that will be presented at the American Academy of Dermatology meeting in March of 2025.
• 1:24
  SPEAKER_02: And we will be focusing on the results of those two abstracts.
• 1:27
  SPEAKER_02: Dr.
• 1:28
  SPEAKER_02: Kim, thank you so much for joining us.
• 1:30
  SPEAKER_00: Hi, Dr.
• 1:31
  SPEAKER_00: Lane.
• 1:32
  SPEAKER_00: So nice to be here, and I'm looking forward to our conversation today.
• 1:36
  SPEAKER_02: Wonderful.
• 1:37
  SPEAKER_02: Well, let's jump into this, Dr.
• 1:39
  SPEAKER_02: Kim, because you are such an expert and you've produced such amazing data.
• 1:43
  SPEAKER_02: There were two abstracts that are being presented at the AAD.
• 1:48
  SPEAKER_02: Interestingly, they are on the same group of patients.
• 1:52
  SPEAKER_02: You treated the patients on their face with one type of treatment and on their neck with another, which I think is just brilliant because it really is efficient.
• 2:02
  SPEAKER_02: Could you please go through this group of patients and just talk about the demographics of this study group?
• 2:09
  SPEAKER_00: So our study looked at how combining microneedling or microneedle radial frequency with an antioxidant serum combined containing vitamin C, E, and ferrolic acid could enhance skin rejuvenation.
• 2:23
  SPEAKER_00: And we already know that microneedling is great for boosting collagen and improving skin texture.
• 2:30
  SPEAKER_00: And also C.
• 2:31
  SPEAKER_00: ferolic is one of the most well-studied antioxidants to help the photo damage.
• 2:36
  SPEAKER_00: But we wanted to see if using them together could create the kind of synergistic effect, and basically whether the serum could enhance or even prolong the benefits of the treatment.
• 2:48
  SPEAKER_00: And it turns out it really does.
• 2:51
  SPEAKER_00: And how we recruited the patient is we treat the patients for the face, we did microneedling only, and for the neck, we did microneedling radio frequency.
• 3:05
  SPEAKER_00: And we chose different methodology because I think many patients could use microneedle as a home care procedure instead of visiting the clinic every time.
• 3:17
  SPEAKER_00: So we try to use different modalities in the same patient group.
• 3:22
  SPEAKER_02: Well, that's brilliant, actually.
• 3:23
  SPEAKER_02: So exactly correct, right?
• 3:25
  SPEAKER_02: The microneedling procedure, we we know that people can buy microneedle rollers, for example, or microneedling stamps.
• 3:32
  SPEAKER_02: They are readily available and can really do this at home on a regular basis.
• 3:37
  SPEAKER_02: Just to back up though, Dr.
• 3:39
  SPEAKER_02: Kim, if you were talking with one of your patients who is interested in performing microneedling at home, how frequently would you recommend them doing the procedure on themselves?
• 3:51
  SPEAKER_00: I would recommend repeating the procedure at with at least three or four weeks apart because the home devices are usually one millimeter to up to 1.2 or 1.5, depending on the regulations.
• 4:09
  SPEAKER_00: But if it's too frequent, it might harm the regular skin turnover interval.
• 4:17
  SPEAKER_00: So I would recommend a monthly treatment or somewhat longer than that.
• 4:22
  SPEAKER_02: Okay, great.
• 4:23
  SPEAKER_02: And of course, because you are producing an injury in the skin and the needles are penetrating through the epidermis into the dermal layer, you'll want to make sure that your skin is thoroughly cleansed before performing any procedure.
• 4:37
  SPEAKER_02: Absolutely.
• 4:39
  SPEAKER_02: Yeah, and after you've used a microneedling roller or stamp, my recommendation, and Dr.
• 4:45
  SPEAKER_02: Kim, I'm I'm probably I'm pretty sure you'll agree with me, is to throw that away because that is now not sterile at all, and and reusing it could introduce infection.
• 4:56
  SPEAKER_02: And so it's time to get another device for your next treatment, which I totally agree.
• 5:02
  SPEAKER_02: One month, four to six weeks apart is probably the right interval.
• 5:06
  SPEAKER_02: Dr.
• 5:06
  SPEAKER_02: Kim, in your study with the microneedling on the face, how deep did the needles go with the microneedling device that you used?
• 5:16
  SPEAKER_00: So it varied from 1.2 millimeter to 1.5 millimeters.
• 5:21
  SPEAKER_00: And because we were doing a procedure in the clinic, we did the procedure after applying the topical anesthetic cream.
• 5:29
  SPEAKER_00: So we could have gone deeper, but we tried to stick in with a routine home care depth.
• 5:35
  SPEAKER_00: So I used 1.2 to 1.5 millimeter.
• 5:39
  SPEAKER_02: Okay.
• 5:39
  SPEAKER_02: Again, mimicking what a consumer can do at home.
• 5:42
  SPEAKER_02: So you did the procedure twice, Dr.
• 5:44
  SPEAKER_02: Kim, right?
• 5:45
  SPEAKER_02: At baseline?
• 5:46
  SPEAKER_00: Yes.
• 5:46
  SPEAKER_00: At baseline at four weeks.
• 5:49
  SPEAKER_02: Four weeks, okay.
• 5:51
  SPEAKER_02: And can you explain how the CE ferrulic serum was applied?
• 5:57
  SPEAKER_00: So I've actually got an idea from the study by Dr.
• 6:01
  SPEAKER_00: Weibel many years ago using C.
• 6:03
  SPEAKER_00: ferolic after fractional CO2 laser.
• 6:06
  SPEAKER_00: And because from her study, applying C.
• 6:09
  SPEAKER_00: ferolic after ablative laser procedure did not cause any erystema or irritation, we were quite confident that we could use immediately after the procedure.
• 6:20
  SPEAKER_00: So in our clinical study, C.
• 6:23
  SPEAKER_00: ferolic was applied immediately after the microneedle procedure.
• 6:28
  SPEAKER_02: And it was a split face study, right, Dr.
• 6:30
  SPEAKER_02: Kim?
• 6:31
  SPEAKER_00: Right, it was.
• 6:32
  SPEAKER_00: So we randomized the the split side of the face.
• 6:37
  SPEAKER_00: So patients didn't know which side was getting the C phralic and which side was getting the placebo because the placebo that we used was a exactly the same formulation with C-ferolic, just without the antioxidants.
• 6:52
  SPEAKER_00: So one side our clinical nurse coordinator applied C-ferolic, and the other side the placebo serum was applied.
• 7:00
  SPEAKER_02: Okay.
• 7:01
  SPEAKER_02: And then the patient was instructed to continue application at home?
• 7:05
  SPEAKER_00: Yes, they used it once daily for 12 weeks.
• 7:10
  SPEAKER_02: Okay.
• 7:10
  SPEAKER_02: Was the patient blinded as to what serum they were using on each side of their face?
• 7:16
  SPEAKER_00: Yes.
• 7:17
  SPEAKER_00: So to be honest with you, like the placebo serum was a very good formulation.
• 7:22
  SPEAKER_00: So some patients didn't recognize which one was the actual test product.
• 7:27
  SPEAKER_00: So we were glad that the result turned out that CE ferlic has superior results.
• 7:32
  SPEAKER_00: So I think it was well blinded.
• 7:34
  SPEAKER_02: Okay, good.
• 7:35
  SPEAKER_02: And because your Norse co your Norse nurse coordinator up uh performed the procedure and applied the first application of CE ferolic, the principal investigator was blinded as well, I was I assume.
• 7:47
  SPEAKER_00: Yes, I was blinded.
• 7:49
  SPEAKER_00: So in in our regulations, actually it was me who performed the microneedle and for the face.
• 7:58
  SPEAKER_00: So I moved out and she continued the application, and then I went back to do the procedure for the neck.
• 8:06
  SPEAKER_02: Okay, so right.
• 8:08
  SPEAKER_02: So so remember we're talking about two different protocols on the same patient, one on the face with the microneedling, one on the neck with the radio frequency microneedling.
• 8:17
  SPEAKER_02: You performed the procedures, then you left the room, and the nurse coordinator applied the serums to the randomized side of the face that got active versus vehicle.
• 8:28
  SPEAKER_00: Exactly.
• 8:29
  SPEAKER_02: Okay, okay.
• 8:30
  SPEAKER_02: I'm understanding now.
• 8:31
  SPEAKER_02: That's a really brilliant protocol development.
• 8:33
  SPEAKER_02: Honestly, Dr.
• 8:34
  SPEAKER_02: Kim.
• 8:34
  SPEAKER_02: It's so efficient, and I think I'm going to use that.
• 8:38
  SPEAKER_00: Thank you for the compliment.
• 8:39
  SPEAKER_02: Absolutely.
• 8:40
  SPEAKER_02: So the patients applied, you had two procedures.
• 8:44
  SPEAKER_02: The patients applied the CE for Rulec from day zero through day through week four.
• 8:50
  SPEAKER_02: Did they continue applying the CE for Ruleic after week four?
• 8:53
  SPEAKER_00: Uh yes, they did.
• 8:54
  SPEAKER_00: So they continued applying up to 12 weeks, and it was used throughout the study.
• 9:01
  SPEAKER_02: And the primary efficacy endpoint was measured at 12 weeks.
• 9:05
  SPEAKER_00: Well, we had some different primary and secondary endpoints, but the main primary endpoint was at 12 weeks, and what that was the modified Griffith scale.
• 9:17
  SPEAKER_02: Okay.
• 9:17
  SPEAKER_02: Okay.
• 9:18
  SPEAKER_02: And can you explain the modified Griffith scale to our audience?
• 9:22
  SPEAKER_00: The modified griffith scale is one of the best used clinical scales to measure photodamage of the skin.
• 9:29
  SPEAKER_00: It has attributes of fine wrinkles to coarse wrinkles and skin texture and skin tones.
• 9:34
  SPEAKER_00: So it could address like various aging features such as pigmentations to skin roughness.
• 9:42
  SPEAKER_00: So we recruited the patients showing mild to moderate degree of modified griffith scale, and then we repeated the measurement at four weeks and 12 weeks.
• 9:54
  SPEAKER_02: Okay, great.
• 9:56
  SPEAKER_02: And so you you did the microneedling on the face, so we understand that procedure.
• 10:01
  SPEAKER_02: Let's go to the neck.
• 10:02
  SPEAKER_02: Before we get into the results of both, I'm keeping everybody on the edge of their seat here.
• 10:06
  SPEAKER_02: But before we go to the results, let's talk about how you did the neck.
• 10:10
  SPEAKER_02: So this was radio frequency microneedling.
• 10:13
  SPEAKER_02: Do you do you mind Dr.
• 10:14
  SPEAKER_02: Kim just explaining that procedure and how it differs from microneedling?
• 10:19
  SPEAKER_00: So the applicator is basically the same, but the difference is when we use it for microneedling, we turn off the radio frequency energy and just use the microneedle itself.
• 10:32
  SPEAKER_00: But when we use it as a microneedle radio frequency, we turn on the electricity on.
• 10:38
  SPEAKER_00: So for the neck, we use the needle depth for 1.5 to 1.8 millimeters.
• 10:45
  SPEAKER_00: And there were energy in every single microneedle pin, which was about 20 to 30 joules per pin.
• 10:53
  SPEAKER_00: And it was done by a stamping procedure with a single overlapping passes.
• 10:59
  SPEAKER_02: Okay, great.
• 11:00
  SPEAKER_02: So now we understand.
• 11:01
  SPEAKER_02: On the face, no radio frequency energy was applied through the needles.
• 11:05
  SPEAKER_02: The exact same needles were used on the neck, going a little bit deeper with radio frequency energy applied.
• 11:12
  SPEAKER_02: Exactly.
• 11:13
  SPEAKER_02: And Dr.
• 11:13
  SPEAKER_02: Kim, can you explain to us why are we using radio frequency energy with microneedling?
• 11:19
  SPEAKER_02: I I suppose what goal are we trying to achieve with the radio frequency microneedling?
• 11:24
  SPEAKER_00: That's a great question.
• 11:26
  SPEAKER_00: Because the neck wrinkles are rather coarser than the facial fine wrinkles.
• 11:32
  SPEAKER_00: And we we could still use microneedle for the neck, but still we wanted the slight difference because for the neck we tried to have a deeper collagen stimulation and regeneration of elastic fiber.
• 11:46
  SPEAKER_00: So by using microneedle radiofrequency, we could deliver the radio frequency energy directly to the dermal level, and we could bypass the epidermis, which has a higher risk of post-inflammatory hyperpigmentation or burns.
• 12:03
  SPEAKER_00: So I think micro radio microneedal radio frequency is one of the efficient methods to treat the collagen remodeling and also enhance elasticity.
• 12:16
  SPEAKER_02: All of your patients in the study were Korean, correct?
• 12:20
  SPEAKER_00: Right.
• 12:20
  SPEAKER_00: So we they were 28 patients and they were all Koreans.
• 12:26
  SPEAKER_02: And you know, it's well known that people of Asian descent have skin that can react to energy-based devices or even non-energy-based devices differently than people of Caucasian descent or African-American descent, for example.
• 12:42
  SPEAKER_02: So in my training, at least, we were trained to be very careful with people of Asian descent with their skin.
• 12:49
  SPEAKER_02: Was there any pretreatment that was performed for the study in terms of did you pretreat with hydroquinone or anything that that might help reduce the occurrence of hyperpigmentation with these treatments?
• 13:02
  SPEAKER_00: So that's a very good point because if it was not a clinical study, I would routinely prescribe patients for pre-treatment before any kind of procedure.
• 13:13
  SPEAKER_00: But because this was a clinical study, we had to ask them to stop using any active ingredients or even retinoids for two or three months before the study.
• 13:25
  SPEAKER_00: So in this study, there were no pretreatment.
• 13:29
  SPEAKER_02: Okay.
• 13:30
  SPEAKER_02: So there was no pretreatment.
• 13:32
  SPEAKER_02: And as you said, in clinical in your clinic, on a regular basis, you would pretreat to prevent hyperpigmentation.
• 13:39
  SPEAKER_00: Yes, I did.
• 13:41
  SPEAKER_02: So we haven't used anything to prevent hyperpigmentation, and pigmentation is part of the Griffith scale, as you mentioned.
• 13:48
  SPEAKER_00: Yep, agree.
• 13:51
  SPEAKER_01: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
• 14:00
  SPEAKER_01: To learn more, visit www.skinseuticals.com.
• 14:06
  SPEAKER_02: So now's the time where I think we should start talking about the results, right?
• 14:10
  SPEAKER_02: Because I think they're actually kind of incredible.
• 14:12
  SPEAKER_02: Um, so let's talk about the face first, Dr.
• 14:15
  SPEAKER_02: Kim.
• 14:16
  SPEAKER_02: Okay.
• 14:16
  SPEAKER_02: So can you review the results of the facial uh treatment with the two microneedling treatments?
• 14:25
  SPEAKER_02: Remember, they were performed at baseline in week four, and they were there was a split face application of CE frulic that was used immediately after the procedure at baseline, daily by the patient until week four, procedure performed again.
• 14:40
  SPEAKER_02: Steve Ruleic applied immediately after the procedure again at week four, and then daily through week 12.
• 14:46
  SPEAKER_02: So we've set the stage.
• 14:48
  SPEAKER_02: I think everybody understands who these patients are, what you did, and let's go through the results if you don't mind.
• 14:55
  SPEAKER_00: So if I start from the microneedle phase study, yes.
• 15:00
  SPEAKER_00: So starting from four weeks, the CE phreolic treated site showed increase in skin elastic elasticity, and the way we measured is there is a device called skin elastiometer, which is a device using to used to measure the skin resilience by the elasticity values, and that difference kept increasing by week 12, and the difference was statistically significant at the point starting from the week 4 and also at the week 12.
• 15:36
  SPEAKER_00: And another interesting result was there were some differences in the skin melanin levels from the microneedling.
• 15:45
  SPEAKER_00: So after 12 weeks, the level of melanin content measured by maxameter showed decrease on the facials on the side treated with C e frulic.
• 15:58
  SPEAKER_02: And on the side not treated with C e fruic, did the melanin index increase compared to baseline at week twelve?
• 16:04
  SPEAKER_00: It slightly increased because we were getting into the summer when we were almost completing the study.
• 16:11
  SPEAKER_00: So there was a slight increase, but it was not significant.
• 16:15
  SPEAKER_00: However, the difference between the C e fruitic treated group and non-treated group showed some significant difference.
• 16:23
  SPEAKER_02: Okay.
• 16:24
  SPEAKER_02: So just to summarize, we saw an increased elasticity of the skin measured objectively with a with a ketometer, and that was not only increased at week four after one treatment, but at week eight after two treatments, and continued to increase at week 12.
• 16:45
  SPEAKER_02: Am I correct?
• 16:46
  SPEAKER_00: Yep, that was also very interesting for us because we we do expect like there should be increase at week four because both sides were treated with microneedle.
• 16:58
  SPEAKER_00: But the difference between the feralic treated site and placebo site, there were significant differences between two sites.
• 17:08
  SPEAKER_00: So in general, it was increased overall because we did the microneedling procedure, but the gap between two groups were more more were further increased in C ferrulic sites.
• 17:21
  SPEAKER_02: And that's that's it right there, right?
• 17:24
  SPEAKER_02: That that's the the whole purpose of the study is to show that you can augment the results of a of a treatment to the face like microneedling with the use of integrated skin care.
• 17:36
  SPEAKER_02: And the only product used was CE ferulic, which is a combination of three very strong antioxidants, right?
• 17:43
  SPEAKER_02: Dr.
• 17:44
  SPEAKER_02: Kim, vitamin C, vitamin E, and ferulic acid, all developed by uh under the the the Sheldon Pennell um Duke parameters that where he found the correct percentage of the antioxidants in the correct acidic buffer so that the the uh they were the most biologically active.
• 18:07
  SPEAKER_02: And I think we should talk a little bit about the product itself, Dr.
• 18:11
  SPEAKER_02: Kim, because it is acidic, right?
• 18:14
  SPEAKER_00: Yep, it is acidic.
• 18:16
  SPEAKER_00: And people are very concerned about whether it could be irritating by applying immediately after the procedure.
• 18:24
  SPEAKER_00: But we so when we first applied C serum, we kept the patients in the clinic for up to 30 minutes to see if they are really okay.
• 18:37
  SPEAKER_00: But the C e frulic applied site didn't show any sign of irritation or prolonged erysema.
• 18:44
  SPEAKER_00: So it was considered safe using as immediate application post-procedurally.
• 18:51
  SPEAKER_02: Dr.
• 18:52
  SPEAKER_02: Kim, besides the vehicle and the CE frulic, were any other products applied to the face?
• 18:59
  SPEAKER_00: Well, we we used the the real moisturizer by Large Posey, which was supported by the Korean skin pseudocals teams.
• 19:10
  SPEAKER_00: So from the sunscreen and skin cleansers, and even the moisturizer were all controlled for for the test the placebo and C ferolic site.
• 19:22
  SPEAKER_02: Okay, so the patients used either vehicle or CE ferrulic to one side of the face, but the moisturizer sunscreen cleanser was the same for both sides of the face.
• 19:33
  SPEAKER_00: Exactly.
• 19:35
  SPEAKER_02: Okay.
• 19:35
  SPEAKER_02: Now we also mentioned the Griffith scale, Dr.
• 19:38
  SPEAKER_02: Kim.
• 19:38
  SPEAKER_02: Can you can you review just the results of the the Griffith scale uh that you used at baseline in week four, eight, and twelve?
• 19:47
  SPEAKER_00: So we used the overall photo damage scale scale for the modified griffith scale, and we are still analyzing the features from the each attributes, but when we add up the whole score, the the modified Griffith scale, which scored higher in the baseline, showed decrease after 12 weeks.
• 20:09
  SPEAKER_00: And the difference between two groups, C.
• 20:11
  SPEAKER_00: Feralic and placebo, were also significantly different.
• 20:15
  SPEAKER_00: So C Fraudic site showed further decrease in modified Griffith scale.
• 20:20
  SPEAKER_02: Okay.
• 20:21
  SPEAKER_02: Okay, amazing.
• 20:22
  SPEAKER_02: So just to reiterate, before we go to the neck, because this is truly an amazing study, uh, the more I learn about it, the more I'm I'm impressed.
• 20:30
  SPEAKER_02: Uh there was no pre-treatment for these patients who have a risk of hyperpigmentation anyway because of their skin type and because of the treatment that was being used.
• 20:38
  SPEAKER_02: So it was gutsy to do this without pre-treatment, right?
• 20:43
  SPEAKER_02: Um two treatments were done between one to one point two, I believe, millimeters in depth with the with the microneedling device.
• 20:52
  SPEAKER_02: Um split face comparison, vehicle versus CE ferulic.
• 20:56
  SPEAKER_02: That was the only active that was used on the skin.
• 20:59
  SPEAKER_02: The rest were bland moisturizer, sunscreen, and cleansers.
• 21:02
  SPEAKER_00: Exactly.
• 21:03
  SPEAKER_02: Um patients used the skincare through 12 weeks, even though there were only two treatments done at baseline and week four.
• 21:10
  SPEAKER_02: And what you found was the elastic component to the skin improved, the elasticity of the skin improved, not only compared to baseline in both sides, which is not surprising, right?
• 21:24
  SPEAKER_02: You would imagine would improve elasticity by itself.
• 21:27
  SPEAKER_02: So that's that's totally not surprising and expected.
• 21:30
  SPEAKER_02: But what is maybe not surprising, but it it may engender some raising of eyebrows from our listeners to know that the CE ferulic applied to one side actually increased elasticity through week 12 compared to the vehicle.
• 21:51
  SPEAKER_02: Everybody every both sides got microneedling, but the CE ferlic improved elasticity statistically significantly greater than the vehicle side.
• 22:00
  SPEAKER_02: And we we are anxiously awaiting the results of the modified Griffith scale on photo aging, which I'm sure will be published to see which of those attributes also improved with the CE frulixide versus a vehicle in a statistically significant manner.
• 22:14
  SPEAKER_02: Is that fair?
• 22:16
  SPEAKER_00: Yeah, that's fair.
• 22:17
  SPEAKER_00: And actually I was quite surprised because like we, as you mentioned before, like before because we did the very powerful treatment, microneedle and microneedle RF, it is very natural and expected to see increase in in skin elasticity, but the sustained increase was very interesting for us.
• 22:40
  SPEAKER_00: And what I also want to mention is from the study on the neck, I think it it is very well demonstrated because on the study from the neck, the skin elasticity increased at time at four weeks, but it started to decrease from eight weeks on the placebo side.
• 23:02
  SPEAKER_00: However, on the C ferlic treated side, there were sustained increase up to 12 weeks.
• 23:09
  SPEAKER_00: But still comparing baseline and 12 weeks, the overall values are increased in both groups.
• 23:17
  SPEAKER_00: But in this placebo group, there was a the peak at four weeks, but which become toward the down point after the treatment effect was gone, but still see ferol it could induce sustained increase in skin elastic fiber.
• 23:35
  SPEAKER_02: Great.
• 23:36
  SPEAKER_02: Thank you for that segue.
• 23:37
  SPEAKER_02: Let's talk about the neck now.
• 23:39
  SPEAKER_02: I think we've we've kind of completed our analysis of the study microneedling to the face.
• 23:44
  SPEAKER_02: Let's talk about microneedling, radio frequency microneedling to the neck.
• 23:48
  SPEAKER_02: So a much different procedure, honestly, because of the application of that energy, which is applied, as you mentioned, to the dermal layer, the deep dermal layer.
• 23:58
  SPEAKER_02: And not only does it enhance the effect of the microneedling in my experience, but it also can cause some tightening of the fascia, for example, and just a reformulation of the collagen to be much younger in its activity.
• 24:15
  SPEAKER_02: So as a more aggressive procedure where the procedure probably does more by itself than microneedling, I wondered how much effect CE ferrulic would have with the procedure that does a lot by itself.
• 24:32
  SPEAKER_02: And indeed, as you mentioned, the CE ferrulic as an integrated skincare is absolutely synergistic with this procedure.
• 24:41
  SPEAKER_00: That's a very critical point because the way we set the energy point for the microneedal radio frequency is considered moderate or even slightly lower than the moderate values.
• 24:56
  SPEAKER_00: But because we didn't do any pre-procedural skincare, we tried to go for rather safe and moderate procedure protocols.
• 25:06
  SPEAKER_00: So the depth-wise 1.5 to 1.8 millimeter is rather usual parameter used for neck rejuvenation.
• 25:15
  SPEAKER_00: However, the energy level was somewhat in the intermediate, 20 to 30 joules, depending on the skin type.
• 25:22
  SPEAKER_00: It is not considered as the most aggressive parameter.
• 25:26
  SPEAKER_00: But because I was treating the the patients with the Fitzpatrick skin type 3 or even 4, I had to be more careful using a higher energy level.
• 25:39
  SPEAKER_00: And to address to your point on the fascia tightening, I wish I could achieve the deeper level of skin tightening with the procedure.
• 25:52
  SPEAKER_00: However, I think the fractional microneedle radio frequency, it might be a little bit difficult to achieve deeper penetration on the neck because the neck is not a very stiff anatomical structure compared to the face.
• 26:06
  SPEAKER_00: So when we do the procedure, there is some kind of repelling back of the needles.
• 26:12
  SPEAKER_00: So there's always a risk of the focused electrical damage on the epidermal side.
• 26:18
  SPEAKER_00: So that was the reason why we had to use the moderate parameters for the neck.
• 26:24
  SPEAKER_00: But I totally agree with your point.
• 26:26
  SPEAKER_00: So probably like combining C-ferolic with maybe monopolar radio frequency or bipolar radio frequency with a high energy would be a very interesting result.
• 26:38
  SPEAKER_02: Okay.
• 26:39
  SPEAKER_02: And you is the same idea, C e frulic to one side of the neck, uh vehicle to the other side of the neck, once daily for 12 weeks, two treatments of baseline and week four.
• 26:50
  SPEAKER_02: And let's go through the results just for the neck now.
• 26:54
  SPEAKER_02: And I think you mentioned this before, but the the elastometer measurement of elasticity of the skin was significant, not only compared to baseline, but actually between the two sides, right?
• 27:06
  SPEAKER_00: Yep, correct.
• 27:07
  SPEAKER_00: And on the placebo side, there was some decreasing trend after four weeks, but there were sustained increase on the C ferlic side.
• 27:19
  SPEAKER_02: And I mean, elasticity of the skin on the neck is so important, right?
• 27:23
  SPEAKER_02: Because so many of our patients come in complaining of sagging of the neck, deepening of the horizontal lines of the neck.
• 27:32
  SPEAKER_02: And so if we can use a product like CE ferulic, which is, you know, it's so easy to apply and enhance elasticity, that is incredible uh in and of itself.
• 27:45
  SPEAKER_02: And then let's talk at the about them the maxameter um ratings uh in terms of pigmentation.
• 27:52
  SPEAKER_00: So for the neck, we didn't have any interesting data on maximum.
• 27:57
  SPEAKER_00: There were no difference between the placebo and seafrail group.
• 28:01
  SPEAKER_00: Yep.
• 28:02
  SPEAKER_02: Okay, great.
• 28:02
  SPEAKER_02: So it certainly didn't cause hyperpigmentation, which again is something I would be worried about with the addition of the energy.
• 28:09
  SPEAKER_00: Right.
• 28:09
  SPEAKER_02: Um, so really important to talk about that in my view.
• 28:13
  SPEAKER_02: And and then as we think about the uh modified Griffith sale again, I'm I'm assuming those data are not available yet.
• 28:20
  SPEAKER_00: So we try to apply modified Griffith scale, but because it has pigmentation component, we thought it was not one of the most appropriate skills, scales maybe for the neck rejuvenation.
• 28:33
  SPEAKER_00: So instead, we did the investigator rating.
• 28:37
  SPEAKER_00: I didn't, including me, there were three independent dermatologists who measured the clinical grading in five five scales, like maximum improvement, moderate improvement.
• 28:50
  SPEAKER_00: Okay.
• 28:50
  SPEAKER_00: And there were some statistical differences between the C Frallic and placebo group, but still I think the measurement data seems more interesting for the for the poster presentation.
• 29:04
  SPEAKER_00: But it is also included in the results.
• 29:07
  SPEAKER_02: Okay.
• 29:07
  SPEAKER_02: Okay, great.
• 29:08
  SPEAKER_02: So the elasticity of the skin is really what we're focusing on here.
• 29:13
  SPEAKER_02: And if we think about the mechanism of action of CE ferulic as a strong antioxidant, how can we make that leap between preventing reactive oxygen species species damage and enhanced elasticity or enhanced elastin production in the skin?
• 29:32
  SPEAKER_02: How how in your mind, how do you make that connection?
• 29:36
  SPEAKER_00: So before the study, I myself was even more focusing on the collagen as a thermal rejuvenation.
• 29:45
  SPEAKER_00: But I think from our study we could have like a slight shift from collagen to elastic fiber because collagen acts as a main structural protein and it could be rejuvenated by procedure itself.
• 30:02
  SPEAKER_00: However, the regeneration of elastic fibers are quite less compared to collagen after the procedural change.
• 30:12
  SPEAKER_00: And if we look into the product a little bit, I think the antioxidant vitamin C itself could promote collagen synthesis by providing the scaffold by the vitamin C.
• 30:26
  SPEAKER_00: And the vitamin E and ferrulic acid could help with the elastic fiber because it could reduce the oxidation of elastic fiber and degradation.
• 30:38
  SPEAKER_00: So probably by using a combination antioxidant could enhance the elastic fiber regeneration, which was first stimulated by the procedure, and probably applying it regularly could enhance the production of elastic fiber after even the procedure role effect is done.
• 31:04
  SPEAKER_02: So you're really taking the biology of vitamin C and the way vitamin E and frulic acid work synergistically with vitamin C and applying it to not only the uh effect on collagen, but also the idea that the collagen can act as a scaffold for elastin to grow.
• 31:20
  SPEAKER_02: Which um Dr.
• 31:22
  SPEAKER_02: Kim, I think that's brilliant as well.
• 31:23
  SPEAKER_02: I never thought of it that way.
• 31:25
  SPEAKER_02: So um thank you for that.
• 31:26
  SPEAKER_02: Uh, I always learn something when I speak with Dr.
• 31:29
  SPEAKER_02: Kim.
• 31:29
  SPEAKER_02: So um we have we have unbelievably run out of time already, Dr.
• 31:35
  SPEAKER_02: Kim, but I just want to thank you so much, not only for walking us through the data, but also having the idea to perform these studies and developing such an interesting protocol for both the neck and the face, uh, and and really showing the power of integrated skincare.
• 31:52
  SPEAKER_02: I think we talk about it a lot, and there are studies on it, but this is such a well-controlled, well-performed study with uh really significant objective grading that's used as primary endpoints, along with subjective photo damage scales and IGA scoring.
• 32:10
  SPEAKER_02: But when you see this objective data, you really cannot argue with the fact that the CE Ferrulic application after both microneedling and microneedling and radio frequency microneedling enhances the efficacy of these uh procedures.
• 32:24
  SPEAKER_02: So uh thank you again, Dr.
• 32:26
  SPEAKER_02: Kim.
• 32:26
  SPEAKER_02: I look forward to seeing you perhaps at the AAD.
• 32:28
  SPEAKER_02: Will you be there?
• 32:30
  SPEAKER_00: Unfortunately, not for this year, but I'll try to attend next year.
• 32:35
  SPEAKER_02: Okay.
• 32:36
  SPEAKER_02: Okay, well, we will miss you, but certainly your data will be presented, and that's incredibly important.
• 32:42
  SPEAKER_02: Uh, my name is Dr.
• 32:43
  SPEAKER_02: Ted Lane.
• 32:44
  SPEAKER_02: I am your host for today's episode of Skin Care Confidential.
• 32:47
  SPEAKER_02: I would like to thank my guest, Dr.
• 32:49
  SPEAKER_02: Jihe Kim from South Korea.
• 32:52
  SPEAKER_02: Uh, please, if you like the episode, give us a five-star rating, subscribe, and please tell your friends about the podcast as well.
• 32:59
  SPEAKER_02: Thank you so much.
• 33:00
  SPEAKER_01: This episode is brought to you by Skin Pseuticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
• 33:09
  SPEAKER_01: To learn more, visit www.skinseuticals.com.