OVERVIEW AND TECHNIQUE
Initially introduced in Italy in 1985, microdermabrasion (MDA) remains a popular cosmetic procedure today. The process involves rapid propulsion of abrasive microcrystals, usually aluminum oxide, at the skin through a handpiece. Other microcrystals used include magnesium oxide, sodium bicarbonate, and sodium chloride.1 The physical action of microcrystals on the epidermis generates the desired abrasive effect, and the attached vacuum removes the residual debris and microcrystals. Varying the number of passes, the rate of each pass, the size of crystals used, the force and speed of crystal flow, the angle of impact of the handpiece, and the vacuum pressure can produce different depths of skin ablation.2,3 Some units do not propel microcrystals at the epidermis. Rather, a handpiece impregnated with diamond studs (either external or recessed) produces the desired effect through movement over the epidermis (Figure 1A).4,5 Like their counterparts, these units also employ a vacuum to remove excess skin debris. This method is touted to offer greater precision and uniformity since crystals are not used. Furthermore, these units lack the ocular complications associated with stray crystals from comparable crystal-based units.6 Certain manufacturers offer different diamond grits, allowing the practitioner to customize the treatment to each patient skin type and quality, as well as to the desired degree of abrasion (Figure 1B).5
Most patients require repeat procedures every one to two weeks, for a total of at least six treatments.4 Unlike many other skin rejuvenation procedures, MDA does not require anesthesia. Additional advantages and disadvantages of MDA are discussed in Table 1. The procedure involves first having patients wash their faces with a gentle cleanser and water, followed by application of isopropyl alcohol to degrease the field of treatment. Patients should remove contact lenses to reduce the risk of corneal complications, and eyewash should be readily available during the procedure to remove stray microcrystals.
The practitioner then places gauze pads over the eyes for additional protection. Tension placed over the skin with the nondominant hand creates a level surface as the dominant hand treats with the handpiece (Figure 1C).5 Many practitioners use sequential passes in a horizontal, vertical, and oblique fashion. Posttreatment, patients once again wash their faces with a gentle cleanser and water and then apply a moisturizer or antibiotic ointment. Patients should also apply broad-spectrum sunscreens both before and after the procedure to reduce the risk of postinflammatory hyperpigmentation.4,7
Clinical Indications
Current indications for MDA include the treatment of photodamage, melasma, fine lines and wrinkles, dyschromia, acne scars, and skin texture irregularities.2,7,8 Some authors have also noted improvements in acne, milia, rosacea, seborrheic keratoses, and actinic keratoses.7 The clinical indications of MDA and supporting studies are summarized in Tables 2 and 3, respectively, with additional discussion below.2,7-14
Current indications for MDA include the treatment of photodamage, melasma, fine lines and wrinkles, dyschromia, acne scars, and skin texture irregularities.2,7,8 Some authors have also noted improvements in acne, milia, rosacea, seborrheic keratoses, and actinic keratoses.7 The clinical indications of MDA and supporting studies are summarized in Tables 2 and 3, respectively, with additional discussion below.2,7-14
Photoaging
In a report of 20 patients, Coimbra et al8 evaluated the effect of MDA on photodamage and fine rhytides. Investigators treated patients with a total of eight weekly treatments at a vacuum pressure of 30 kPa, which increased with each treatment to a maximum of 70 kPa. Digital photographs after each treatment session showed significant improvement in hyperchromia after five treatments as assessed by both plastic surgeons and lay observers. Only nonphysicians noted an improvement in fine rhytides.8 The authors performed histologic analysis of tissue in eight subjects and found epidermal thickness increased by approximately 43%. In addition, treatment led to increased levels of dermal collagen with greater organization.8 Unfortunately, the lack of reported clinical data and small sample size make it difficult to correlate these findings with clinical results.
In a report of 20 patients, Coimbra et al8 evaluated the effect of MDA on photodamage and fine rhytides. Investigators treated patients with a total of eight weekly treatments at a vacuum pressure of 30 kPa, which increased with each treatment to a maximum of 70 kPa. Digital photographs after each treatment session showed significant improvement in hyperchromia after five treatments as assessed by both plastic surgeons and lay observers. Only nonphysicians noted an improvement in fine rhytides.8 The authors performed histologic analysis of tissue in eight subjects and found epidermal thickness increased by approximately 43%. In addition, treatment led to increased levels of dermal collagen with greater organization.8 Unfortunately, the lack of reported clinical data and small sample size make it difficult to correlate these findings with clinical results.
