In this video blog, Suneel Chilukuri, MD, discusses highlights from his lecture, What's in our Cosmetic Toolbox for the Medical Derm Provider , on November 8, 2024, 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

Dr. Chilukuri explains that technology has finally caught up with what pathology has long told us about scarring: driving a low-level cytokine, low-level inflammatory response — rather than a quick conversion from type III to type I collagen — appears to reduce hypertrophic and keloidal scars. He achieves this with smaller-needle microneedling (0.3–0.7 mm), exosomes to regulate inflammation, and polynucleotides/PDRN applied on day three or four, an approach he believes can change healing for surgical, traumatic, and acne scars alike. For acne, he tailors depth: 0.5 mm up to 2.0–2.5 mm in multiple layers to release tethered rolling, box, and ice-pick scars, and 0.7–1.2 mm (up to 1,200 microns) to affect the pathology of active acne, citing a study published in JDD a few months prior. He emphasizes how inexpensive these tools are — even an at-home 0.25 mm roller for about eight or nine dollars.

He also reflects on how he ended up in aesthetics — "a fluke" that grew out of reconstructive surgery and surgical scar work beginning in 1999. He encourages providers to reinvent themselves every five years and to identify the top three things they'd do even without pay. For hair loss, especially the trauma women face after pregnancy, traction alopecia, or illness, he now combines topicals, 0.5 mm microneedling with exosomes applied on top, in-office LED, and at-home devices like Viviscal Pro and the Revian LED cap (620 and 660 nm) that affect scalp nitric oxide. Despite frustrations like insurers denying a 70-year-old generic such as clobetasol, he sees endless possibility to change patients' lives.

  • Aim for low-level, controlled inflammation to slow the type III–to–type I collagen conversion and reduce hypertrophic and keloidal scarring.
  • Use smaller-needle microneedling (0.3–0.7 mm), exosomes to regulate inflammation, and polynucleotides/PDRN on day three or four to improve surgical, traumatic, and acne scar healing.
  • Match microneedling depth to the goal: 0.5–2.5 mm in layers to release tethered acne scars, and 0.7–1.2 mm to affect active acne pathology (per a recent JDD study).
  • These tools are remarkably affordable — even a home 0.25 mm roller costs about $8–9 and is swapped monthly.
  • For hair loss, combine topicals, 0.5 mm microneedling with exosomes and in-office LED, plus at-home options like Viviscal Pro and the Revian LED cap (620/660 nm) that modulate scalp nitric oxide.