Microdermabrasion Treatment & Management

The results achieved with microdermabrasion can be enhanced with medical therapies in the form of topical skin treatments. Common adjuncts to microdermabrasion include tretinoin, alpha-hydroxy acids, retinoic acid, and topical vitamin C. In patients being treated for hyperpigmentation, the application of hydroquinone between treatments can be useful. Liberal use of sunscreen and moisturizers is also beneficial. Postoperatively, these products serve to address exfoliation and photosensitization. Long-term benefits include reduction of sun damage and photoaging and improved skin moisture.

A variety of microdermabraders are available on the market. Several components are common to all systems and include a pump that generates a high-pressure stream of aluminum oxide or salt crystals, a connecting tube that delivers the crystals to the handpiece, a handpiece, and a vacuum to remove the crystals and exfoliated skin. The crystals are then discarded. Handpieces are available in disposable and reusable types. The reusable handpieces must be resterilized after each use. Microdermabrasion can be performed by a physician, nurse, or licensed aesthetician.

The most commonly treated area is the face, but microdermabrasion can be used effectively on the neck, hands, and chest. The depth of the treatment depends on the strength of flow of the crystals, the rate of movement of the handpiece against the skin, and the number of passes over the treatment area. Slower movement of the handpiece (allowing longer contact of the abrasive crystals with the skin) and more passes achieves deeper abrasion.

No premedication is necessary, unless desired. Prior to the procedure, the skin is cleaned of all makeup and oil. No topical or local anesthetic is necessary, although its use is not precluded. Contact lenses are removed, and eye protection is placed to prevent injury from stray particles.

The technical key to microdermabrasion is placing the skin under tension so that an effective vacuum is achieved. Typically, stretching the treatment area with the nondominant hand and using the dominant hand to guide the handpiece is the method used to achieve this effect. When treating the neck, the neck is placed in extension to assist in skin tension.

The handpiece is moved over the treatment area in a single, smooth stroke, which can then be repeated. The pressure of the crystal stream is controlled with a foot pedal. Thicker skin, such as that on the forehead, chin, and nose, can be treated more aggressively (ie, adjust the speed of handpiece movement or number of passes). Decrease the pressure when treating the thinner skin of the lower eyelids and upper cheek. Vertically orient all strokes when treating the neck. This approach differs from the approach used in treating the face, upon which a second treatment perpendicular to the first treatment is generally performed.

Between treatments, the face is cleaned of any residual crystals. Usually, 2 treatments per session are sufficient for the face. The desired endpoint of treatment is erythema. Specific areas, such as acne scars or age spots, can be focally treated more aggressively with additional passes. Treatment sessions generally last approximately 30-40 minutes for the face and 20 minutes for the neck.

The treated area is cleaned with a wet cloth to remove any residual crystals. After drying, a moisturizer or ointment is applied. Continue the application of moisturizer or ointment postoperatively because exfoliation may occur. Erythema generally resolves within hours after treatment, but the patient may experience a mild sunburnlike sensation for a couple of days. Sunscreen should be used liberally because photosensitivity may be increased.

Effective microdermabrasion usually requires a series of 5-12 treatments. The series can be significantly longer, particularly with acne scarring. Initially, treatments are weekly or biweekly for several treatments, followed by monthly to biannually for maintenance treatments, depending on the patient.

The great advantage of microdermabrasion is its lack of complications. In early years of use, reports cited redness of the eyes, photophobia, and epiphora after examination by an ophthalmologist. The examination revealed conjunctival congestion, crystals adherent to the cornea, and superficial punctate keratopathy. Using eye protection virtually eliminates ocular complications, but corneal abrasion from stray crystals remains a theoretic risk.

The erythema generally resolves within hours after treatment, allowing patients a rapid return to their usual activities. Scarring has not been documented from microdermabrasion, although scarring is theoretically possible when producing any injury to the skin. However, microdermabrasion barely extends through the epidermis, so the depth of injury is very superficial. This fact is both its advantage and its limitation. Superficial injury means rapid healing and recovery with little risk; however, only superficial skin conditions, such as fine lines, quality of the skin, and shallow scars, can be addressed.

In appropriately selected patients, microdermabrasion can be a very effective technique. Patients with photodamage, fine rhytides, age spots, acne, and enlarged pores can experience significant improvement in the quality and uniformity of the appearance of their skin. This improvement is accomplished with little risk and essentially no downtime, excluding the treatments themselves. Therefore, microdermabrasion is well suited to the patient with a busy lifestyle and superficial skin conditions. The number and frequency of treatments can be tailored to the individual patient, depending on the condition and desired result.

Microdermabrasion is not effective for deep wrinkles and scars or ice-pick acne scars because these lesions extend into the deeper layers of the dermis. Similarly, microdermabrasion is not effective for pigmentary problems, such as melasma or postinflammatory hyperpigmentation, because this treatment does not effectively address the dermis where these problems arise. Patients with these problems are best treated with more traditional resurfacing modalities, such as chemical peeling, dermabrasion, and laser resurfacing.

The advantages of rapid recovery and low risk have led to the widespread popularity and use of the microdermabrasion technique. In patients with fine lines and early photoaging, microdermabrasion serves as an effective technique with little or no impact on their lifestyle. The effectiveness of microdermabrasion is limited for deeper skin conditions, such as deep wrinkles and scars, which are currently best treated with other resurfacing modalities. Deeper injury increases complications and recovery time along with effectiveness. Techniques that allow dermal injury and rejuvenation without a degree of epidermal injury currently do not exist, but such techniques may be the future of resurfacing technology.