Keywords
MicrodermabrasionHydro-dermabrasionFacialRough skinNon-invasiveExfoliationSun damageFine linesHydrofacial6.1 Microdermabrasion
Microdermabrasion, introduced in 1985, is a mechanical exfoliation treatment used to diminish the appearance of mild sun damage, uneven texture, discoloration, and acne. Microdermabrasion removes the stratum corneum, has a temporary effect on the lipid moisture layer of the skin, and has been shown to increase collagen stimulation (El-Domyati et al. 2016; Fak et al. 2018).
Microdermabrasion is a non-invasive procedure that produces subtle cosmetic effects. The benefits of its use have been studied to determine the level of improvement in visible skin appearance as well as the invisible benefits that occur in the deeper layers of skin (El-Domyati et al. 2016). In addition, microdermabrasion treatments can prepare the skin for different medical procedures such as intense pulsed light (IPL) or photodynamic therapy (PDT). Microdermabrasion performs just under fractional ablative laser treatment in the preparation of the skin for PDT and with significantly less pain, making microdermabrasion a reasonable pre-treatment modality (Bay et al. 2017).
Histologically, a decrease in the concentration of melanin, more uniform distribution of melanosomes, and increased collagen density with regular arrangement of collagen bundles are observed as a result of microdermabrasion treatment (El-Domyati et al. 2016). Clinically, microdermabrasion offers mild-to-moderate effects in the appearance of hyperpigmented lesions such as melasma, but in patients with photo-aging characteristics, the effect can be mild. Available evidence does not support adequate lightening of pigments from microdermabrasion but laser, peels, or medications are considered to be more beneficial (El-Domyati et al. 2016; Shim et al. 2001; Karimipour et al. 2010). Alternatively, worsening of acne lesions has been reported after microdermabrasion and so should be used with caution as treatment for acne; hence it might not be an appropriate indication for acne treatment (Karimipour et al. 2010).
Preparation of the skin with microdermabrasion immediately prior to an intense pulsed light (IPL) procedure is an additional option. Microdermabrasion can provide a more effective IPL treatment because the IPL light is thought to penetrate the skin more effectively due to the removal of superficial debris prior to IPL treatment. The combination treatment of microdermabrasion and IPL represents a synergistic approach to noninvasive skin rejuvenation (Strasswimmer and Grande 2006).
A series of microdermabrasion treatments is necessary to achieve optimal skin rejuvenation results although fine lines seem to be minimally amenable to its effects (Shim et al. 2001). Histologic improvements typically occur after just three microdermabrasion treatments but after six microdermabrasion treatments, the effects have demonstrated to be greater and included thickening of the dermis and new collagen and elastin formation (Freedman et al. 2001). A common interval for microdermabrasion is one treatment every 1–2 weeks for best results, and thereafter periodic maintenance treatments (Karimipour et al. 2010). Treatment effects and recommendations are important to convey to aesthetic patients. Apprising patients they are receiving benefits to their skin, although they might not be immediately visible, and they might require multiple treatments to achieve desired results, will assist in managing expectations.
6.2 Types of Microdermabrasion Devices
Depending on the model of the microdermabrasion device, there may be separate glass or plastic containers that simultaneously infuse water or serums onto the skin during treatment or others that use crystals. Currently, there are three common types of microdermabrasion machines, (a) those that blow fine crystals onto the skin during treatment, (b) those that do not use crystals, and (c) those that do not use crystals but infuse water or serums onto the skin during the treatment.
Example of crystal-free microdermabrasion device. Photo courtesy: Beth Haney, DNP, FNP-C, FAANP
The model of microdermabrasion device that does not use crystals, but uses a diamond treated tip of varying grit depending on the depth of skin ablation desired or the condition being treated, seems to be more effective in increasing collagen stimulation. Crystal-free microdermabrasion appears to cause an added benefit of increased extracellular matrix protein when compared to the effect of microdermabrasion that uses crystals (Kirkland and Hantash 2012a).
Example of hydro-microdermabrasion device. Photo courtesy: Beth Haney, DNP, FNP-C, FAANP
6.3 Considerations of Microdermabrasion
The level of skin ablation from the microdermabrasion procedure is determined by the strength of the flow of crystals (if crystals used), user speed of movement of the hand-piece, and the number of passes per site. Slow movement of the hand-piece and a higher number of passes increase the depth of microdermabrasion (Grimes 2005; Kirkland and Hantash 2012b). Careful technique is advised over bony prominences such as the brow, temple, malar, or nasal areas to avoid side effects such as increased redness, superficial lacerations, or abrasions (Shim et al. 2001). Lower vacuum settings are preferred over thin skinned areas such as eyelids to avoid purpura or ecchymosis (Karimipour et al. 2010). Skin testing in a small area with the recommended settings is necessary prior to beginning microdermabrasion treatment to assess skin reaction and patient tolerance.
The appropriate patient has slight discoloration, fine lines, and texture irregularities—significant photodamage, deep lines, and moderate hyperpigmentation are not the indications for microdermabrasion.
Advantages of microdermabrasion include minimal down time, few side effects, can be used on most skin types, and lower cost per treatment.
Disadvantages include the necessity for multiple treatments and less dramatic visible effects than other procedures such as IPL or laser.
Complications can include corneal irritation with using crystals, possible bruising, worsening of telangiectasia, superficial abrasions, and/or mild discomfort (Kirkland and Hantash 2012b).
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