Researched by Ralph Hill

There are a number of modalities available to the therapist to resurface the skin to improve skin quality and improve cell turnover, and Microdermabrasion is one that has found a recent renaissance with the development of new devices. However, there is too often client expectations not met due to lack of understanding of what can be effectively treated with this modality. This primer covers the modality, it's use, limitations, and technologies employed for use by the beauty therapy industry.

The Microdermabrasion technique has been around for about twenty years, and as the name indicates, is a method of micro-abrading the very top layers of the skin, (stratum corneum).

There are two strengths of machine available to practise this modality of ablation. One is the medical version, which has the capability of being able to be fully ablative, and the version that is available to the skin treatment therapist for the superficial, more non-ablative technique of resurfacing and creating an inflammatory response within skin.
It is the lack of understanding of exactly how this inflamatory response works, and it's effects that may lead to both therapists and device marketers to offer unrealistic expectations to clients.

A tool, not an answer
The advantages of Microdermabrasion over dermabrasion, chemical peels, or laser resurfacing are that it does not require anaesthesia, is painless, and can be repeated at short intervals. (Dependant on cell turnover)
Microdermabrasion is also simple and quick to perform (approximately 30-40 minutes for the face) and so does not significantly interrupt the clients lifestyle.
In most cases, there is little visual erythema after three or four hours following the treatment.

The need for multiple treatments and their overall effectiveness are the limitations of the procedure, however this subliminal inflammatory response produced will wake-up the fibroblasts, with collagen synthesis occurring as a result
This collagen synthesis will only occur if the supporting systems (lymphatic and microcirculatory system) are in good health and functioning correctly. In addition it is equally important that the skin be in reasonably good health, with all skin lipids and skin barrier defence systems in place so the skin can repair quickly.

Practical Microdermabrasion in the clinic
Microdermabrasion is fast becoming a choice of modality to prepare the skin for the penetration of actives and used as a precursor to another more intensive treatment program. It is very effective on skin conditions like excess keratinisation, comedones (those without inflammation) keratosis pilaris and for refreshing and resurfacing the epidermis with minimal risk and rapid recovery unlike the older more dated chemical peels.

Microdermabrasion is most effective with these superficial skin conditions because it produces a shallow depth of ablative response, not only assisting with epidermal conditions that evolve around the keratinocyte but also creating some increase in the cellular turnover of the keratinocyte, thus improving epidermal strength and density.
With the added bonus of the indirect controlled inflammatory response to the dermis and the waking up of the fibroblasts to produce glycosaminoglycans, collagen and elastin will rebuild the structural integrity and density of the dermis.

By improving the production of the collagen fibrils, strength and density of the loose connective tissue, papillary layer and superficial fascia septa will have a knock on effect and improve superficial lines, and reduce diffused redness by the added support of the microcirculation and lymphatic capillaries.
It has shown that there can be some minor improvement on superficial scarring and stretch marks providing that they are treated within months of occurring, however, older more established scars may not respond fully. This also applies to deep wrinkles and actinic aging where the reticular layer has been damaged.

Microdermabrasion does not carry the risks of pigmentary changes or scarring produced by the ablative techniques such as the older form dermabrasion, dermal depth chemical peels, or laser resurfacing, making it well suited for skin with Fitzpatrick skin tones 4-6, who may be at more risk of complications with other resurfacing techniques.

Considerations
As with all treatments that abrade the skin surface, care must be taken to not increase the depth of ablative response by the application of excessive pressure. This recommendation particularly applies to treatment of the neck.
With traditional methods of resurfacing, such as chemical peels, dermabrasion, and laser resurfacing, the neck carries an increased risk of scarring. Because the depth of injury is superficial with Microdermabrasion, the neck area may be treated with relative safety as long as correct and careful technique is practiced.

Client expectations must be realistic. The objective is improvement of the overall skin quality by improving cell turnover and resurfacing, so clients must be prepared for the number and frequency of treatments required to obtain satisfactory results. If clients are unwilling to commit to a series of treatments over a 4 6 week period, they will be unlikely to see significant results and will not be satisfied with the outcome.

Microdermabrasion has its limitations and clients must be fully prepared for what it is unable to accomplish. Clients with moderate and deep wrinkles, deep scars, or pigmentary abnormalities are unlikely to achieve significant results; these clients are best treated with other modalities.

Contraindications
The contraindications for Microdermabrasion are similar to those for other resurfacing procedures.
These contraindications include the current or recent use (less than 1 year) of Isotretinoin (Accutane), open acne, active herpes infection, malignant skin tumours, evolving dermatoses, and particular keratoses. If in doubt, consult a dermatologist for an opinion.