Microdermabrasion                -------------------------------------------------------------------------------

Vol. 3 •Issue 2   HealthyAging

Scratching The Surface

 Microdermabrasion improves fine lines and wrinkles while increasing the effectiveness of other cosmetic procedures.

 By Helen Torok, MD, and Heather L. Funk

The roots of microdermabrasion date back to Ancient Egyptian times when rulers and members of their courts used abrasive masks made of alabaster particles to slough away the skin. They also used sour milk soaks, which contained lactic acid, to improve the skin's appearance.1

Microdermabrasion provides light abrasion to partially or completely remove the stratum corneum. Depending on the pressure applied, microdermabrasion also can abrade the epidermis. Over the centuries, practitioners have used various substances to accomplish this abrasion, including acids, minerals, plants and sandpaper.2

In the last decade, advances in microdermabrasion technologies have enhanced various methods to abrade the skin. Many physicians also use microdermabrasion as a precursor to chemical peels, photodynamic therapy and laser treatment to increase effectiveness of the procedures. These developments have made microdermabrasion one of the staples of cosmetic practices.

Technological Evolution

Microdermabrasion is the fourth most popular cosmetic procedure in the United States, with more than 1 million treatments performed annually. A typical U.S. medical spa can attribute 28 percent of its income to microdermabrasion.2

Given this growth and demand for the "lunch-time" peel, medical practices have several choices for micro-dermabrasion systems.

Particle microdermabrasion. The most common type of microdermabrasion machine uses particles, such as corundum and aluminum oxide, to abrade the skin. Some machines use other crystals as well, including sodium chloride, sodium bicarbonate and magnesium oxide crystals. These machines shoot fine particles of corundum and aluminum oxide onto the surface of the skin and then vacuum off the remaining particles and skin surface debris.

Generally, the operating protocol requires moving the handpiece over the treatment area in a single, smooth stroke and then repeating this step. The -practitioner must place tension on the skin and provide even pressure at all times. Otherwise, epidermal gouging may occur.

The procedure is painless and takes 30 to 45 minutes for the face and neck. To achieve optimal results, patients can come back for this procedure every two to four weeks for three to six sessions.

Particle-free microdermabrasion. Research has shown that aluminum oxide crystals in microdermabrasion treatment may be toxic to operators who have long-term exposure to the procedures.3 Aluminum has been implicated in the development of early dementia, but this connection has never been proven. Still, particle-free microdermabrasion has increased in popularity.

Using particle-free machines, operators don't breathe in potentially toxic aluminum oxide particles. Instead of using crystals, these machines have wands lined with diamond chips to exfoliate and abrade the skin. The wands come in fine, medium and coarse grades. A deep abrasion can be achieved using a coarse wand and applying heavy pressure, which can achieve similar results as true dermabrasion. However, the operator can still cause unnecessary epidermal damage if she applies too much pressure on fine, thin-skinned patients.

Patients generally like particle-free microdermabrasion because of the shorter procedure time. Practitioners also don't need to wipe residue from the skin, making it a less messy procedure.

Ultrasound microdermabrasion. Ultrasound technology exfoliates using water and ultrasound. The hand-held device is less expensive than a particle or particle-free machine. It is more efficient because an operator can perform the treatment in five to 10 minutes. It's also very quiet.

Patients with rosacea or ruddy complexions can especially benefit from this technology since it will not damage or disrupt capillaries. Ultrasound microdermabrasion is just as effective as particle and nonparticle systems. As an added benefit, practitioners can use ultrasound again to increase the penetration of antioxidants, vitamins, growth factors and other nutrients.4,5

Vibrating microdermabrasion. A newer development in microdermabrasion, the vibrating microdermabrasion system allows the physician to choose from different sizes of exfoliating paddles to gently abrade the skin. The practitioner generally buys the kit with vibrating nonimbedded, single-layered, abrasive stainless steel paddles. The paddles can be re-used as well. The physician also can use these paddles with a topical cream that increases penetration. One benefit of this system is that it can treat larger areas, such as the back and neck in 20 minutes.

Home-use microdermabrasion kits. In response to the boom in microdermabrasion treatments, home-based microdermabrasion kits also have become popular. These kits use the same crystals as the particle machines with hand-held battery powered sponges. More than 24 different models are on the market. Although these devices are less expensive and more convenient for the patient, they may not be as safe or effective as the clinical methods. However, patients may use these home devices to maintain clinical benefits from the office.

In Combination

As microdermabrasion use has grown, clinicians have started to combine multiple modalities to enhance the overall results of cosmetic procedures. This approach targets specific concerns, such as photodamage, enlarged pores, rosacea, wrinkles, acne and acne scars.

Research shows that microderma-brasion stimulates collagen formation.6 Thus, it's ideal to incorporate microdermabrasion before chemical peels to treat photodamage, enlarged pores, rosacea, fine lines and wrinkles. Manually exfoliating the stratum corneum allows for a uniform and deeper peel. The combination is ideal with any peeling agent, including glycolic, salicylic acid, lactic, trichloroacetic and Jessner's. The clinician can perform the peel in the same manner as a stand-alone treatment, performing the peel directly after microdermabrasion.

Practitioners also can use microdermabrasion before photodynamic therapy with aminolevulinic acid (ALA). The ALA is left on the abraded skin for 60 minutes. The face is then exposed to intense pulsed light and blue light. This approach can effectively treat heavy photodamage, acne or actinic keratoses.7,8

The number of treatments required varies and depends on the degree of photodamage, as well as the amount of facial redness and broken blood vessels. Usually three to five sessions four weeks apart will produce dramatic results in patients with heavy damage. Lighter damage generally responds within two to four sessions.

Use microdermabrasion before any cosmetic or laser treatment because it will enhance the results of the procedure. It also can ease the pain of laser treatments since it can enhance penetration of the topical anesthetic.

Patient Selection

Proper patient selection is imperative for microdermabrasion, which is most effective with superficial skin conditions, such as early photoaging, fine lines and superficial scarring.

All Fitzpatrick skin types may be treated safely with microdermabrasion. However, be careful with types IV through VI. People with these skin types may be at risk of developing hyperpigmentation or hypopigmentation, especially if practitioners apply excessive pressure during the microdermabrasion treatment. Thus, use ultrasound microdermabrasion or the light wand of a particle-free system for these skin types.

Be certain the patient's expectations are realistic. Because microdermabrasion is a superficial skin care treatment, the results are limited. Microdermabrasion can improve the overall texture and tone of the skin. It's also effective in reducing enlarged pores, fine lines and wrinkles and superficial scars. However, microdermabrasion will not be effective in treating deep scars, pigmentation problems, broken blood vessels or deep wrinkles. The great advantage of microderma-brasion is its lack of complications. Any erythema usually resolves within hours after the treatment, and patients can resume their normal activities immediately. It's relatively painless and can be repeated in short intervals.

However, microdermabrasion shares similar contraindications as other resurfacing procedures. Patients with active herpes infection, active bacterial infection, active fungal infection, active psoriasis and other inflammatory conditions should not have this procedure. In addition, those who use Accutane or have used it for three months are not candidates for microdermabrasion.

Make sure you get a proper consent form signed and review all the indications and contraindications. If possible, take digital pictures to document any facial lesions or irregularities before the procedure. Remember to use sunscreen (SPF 30) with a good UVA/UVB blocker to protect sun-sensitive skin.

Microdermabrasion is a popular procedure, billed as a "lunchtime" peel at spas and physician offices across the globe. Its lack of complications, ease of use and its potential to be combined with other treatments make it an ideal and useful tool for any cosmetic practice.