Equipment and Technique
Microdermabrasion can be performed by a physician, nurse, or licensed aesthetician. The most commonly treated area is the face, but it can also be used effectively on the neck, hands, and chest. The depth of the treatment depends on the strength of flow of the crystals generated by the crystal pressure and vacuum level, the rate the handpiece is moved against the skin, and the total number of passes over the treatment area. Deeper abrasion can be achieved with slower movement of the handpiece and more passes, which allows for longer contact between the crystals and the skin.
The crystal pressure and vacuum level can be determined by testing an area of nonfacial skin, but it can also be dictated by patient tolerance, which may require an adjustment in the power settings. At the conclusion of the treatment, the entire handpiece must be sterilized to prevent the transmission of infectious particles to the next patient receiving treatment. [17]
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.
Patient Selection
Microdermabrasion is most effective for superficial skin conditions such as early photoaging, fine lines, and very superficial scarring. It creates only a superficial depth of injury and does not carry the risks of pigmentary changes or scarring seen in other techniques such as dermabrasion, chemical peels, or laser resurfacing.
As a result, even patients with Fitzpatrick skin types IV-VI, who may be at risk for pigmentary complications with other resurfacing procedures, can undergo microdermabrasion with relative safety. Care must be taken to avoid deeper injury in these patients by not applying excessive pressure during the procedure.
This technique is also well suited for the neck, which is an area that carries the increased risk of scarring with the other resurfacing methods. Since the depth of injury with microdermabrasion is superficial, the neck area may be treated with relative safety as long as proper and careful technique is practiced. Overall, microdermabrasion involves little risk and rapid recovery.
Patient selection is paramount to ensure optimal results. When evaluating patients for any resurfacing procedure, it is important to address the patient’s concerns and expectations. It is necessary to distinguish skin-color changes due to photoaging versus chronological aging in order to ensure that the proper treatment is offered to the patient. Chronological aging is associated with sagging and loss of skin elasticity and can best be addressed with surgical rejuvenation procedures or other nonsurgical treatment modalities that are able to target collagen production or volumization of the aging face. While some tightening of the skin may occur with resurfacing procedures, facial contour is not significantly affected and issues such as jowling, midface ptosis, or neck laxity are not corrected. Patients must understand and be comfortable with this limitation.
Photoaging severity should be assessed, and skin should be classified according to Fitzpatrick skin type. The patient’s skin must also be evaluated for changes in texture, acne, or other scarring. Deep scars and rhytides must be distinguished from those that are superficial, as a greater depth of injury is required for effective treatment of the deeper lesions.
Patient lifestyle must also be addressed when gathering the history, as the amount of recovery time needed from work or social activities may affect the choice of resurfacing technique. Inquiries into upcoming social events should also be made in order to ensure adequate recovery time. Photoaging preventative measures should also be addressed, especially if the patient does not use sun protection daily.
Past and current use of medications and medical problems should be identified. Current use of isotretinoin, or use within the past 6 months to 1 year, is a contraindication to any resurfacing technique because of the increased risk of scarring. Inquiries should be made into the use of herbal remedies, as they may produce an anticoagulative effect with dermabrasion, chemical peels, or laser resurfacing.
Patients with a history of herpes simplex may require prophylaxis, as the procedure may cause reactivation of latent herpes simplex. [18, 19] Inquiries should also be made into any history of hypertrophic scarring or keloid formation in the patient and family members.
It is important to manage patient expectations and ensure that they are realistic. The goal is the improvement of overall skin quality by addressing changes of mild photoaging, fine lines, age spots, enlarged pores, and superficial scarring.
Results on brown spots and acne are variable.
Patients should be prepared for the number and frequency of treatments. A commitment to the series of treatments is important to ensure adequate results. Patients who do not commit to the full series are unlikely to see significant results and thus unlikely to be satisfied with the outcome. Patients should also be prepared for what microdermabrasion cannot accomplish, such as resolution of deep rhytides, deep scars, and pigmentary abnormalities. These issues are best treated with other modalities such as traditional dermabrasion, chemical peels, and laser resurfacing, which can achieve a greater depth of injury. These modalities increase the effectiveness but may also carry higher risks of complications and increased length of recovery.
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Anatomy of the skin.
Tables
| Type | Skin Color | Characteristics |
| I | Very white | Always burns, never tans |
| II | White | Usually burns, tans with difficulty |
| III | White or light brown | Mildly burns, average ability to tan |
| IV | Brown | Rarely burns, tans easily |
| V | Dark brown | Very rarely burns, tans very easily |
| VI | Black | Never burns, darkly pigmented |
