Microdermabrasion

Microdermabrasion is a superficial, office-based, minimally invasive technique of mechanical abrasion of the skin using a pressurized stream of abrasive particles such as aluminum oxide crystals. It may also be performed with a disposable or reusable diamond tip. There is superficial wounding of the skin, followed by epithelialization, stimulation of epidermal cell turnover and it may also cause stimulation and remodeling of dermal collagen. It is mainly indicated for the treatment of superficial acne scars and is ineffective for deeper scars. It is contraindicated in the presence of active infection and concurrent dermatoses on the face. The patient must be adequately counseled regarding the limitations of the procedure, the need for multiple sittings and expected outcome and complications. Contact lenses should be removed and eye protection is important to prevent stray particles from entering the eyes. After degreasing and cleansing the skin, the machine parameters are set with pressure levels from 10-30 mm of Hg depending on the thickness of the epidermis, the depth required and number of passes planned. The key to effective microdermabrasion is stretching the skin under tension for effective abrasion and achieving a vacuum to aspirate the epidermal debris and used crystals. The hand piece is then moved over the treatment area in a sweeping, outward motion covering each cosmetic unit. Thicker skin over the forehead, nose and chin can be treated more aggressively, while delicate areas such as eyelids should be avoided. A second pass of treatment can be done in a direction perpendicular to the first pass, except on the neck where treatment should be in a vertical direction. The desired endpoint is erythema while focal acne scars are treated more aggressively. The area is wiped with wet gauze to remove residual crystals and a moisturizer or topical antibiotic is applied. Treatment is repeated weekly until the desired result is obtained. Erythema, edema, infection, purpura, pigmentary changes and scarring can occur. If eye protection is not adequate, eye complications such as conjunctival congestion, crystals adherence to the cornea, and superficial punctate keratopathy can occur. Thus, microdermabrasion is a safe procedure particularly in darker skin and requires no downtime. It has the limitations of requiring multiple sittings with maintenance therapy and the inability to improve deeper scars.