The use of dermal fillers, as well as the effects of dermal needling on the skin, have been studied and confirmed to stimulate neocollagenesis. In this article, the author discusses the combination of these the two concepts in one technique to offer superior outcomes. The article supports the notion that hyaluronic acid (HA) stimulates collagen in the skin and uses evidence to suggest that specific techniques and instruments can greatly enhance the durability of results. Based on the controlled injury theory in which type I and type III collagen production occur at accelerated rates post trauma, the technique uses a sharp needle to create a modest subcuticular undermining effect. This controlled trauma disrupts fragmented collagen strands and replaces them with purposeful, elongated strands of promoted neocollagenesis. Controlled injury begins the wound healing cascade and creates new, non-fragmented collagen, providing improvement in the appearance and health of ageing skin. When neocollagenesis is increased, the duration of the desired outcome also increases. Type I and III collagen have been shown to last 4–7 years, creating an aesthetic result lasting long after the duration of the HA filler itself.
