Since the FDA approval of injectable bovine collagen in the early 1980s, the possibility of improving one’s appearance during a quick office visit captivated the public. Soon after, topical tretinoin was hailed as the first agent that could improve the signs of photoaging [1]. Next, the concept of “lunchtime” peels revolutionized skin resurfacing.
No longer did patients have to endure the extensive wound-healing time required for wire-brush or diamond-fraize dermabrasion, or trichloroacetic acid or phenol peels. Now the patient could do a glycolic peel one to two times per month, and see a gradual improvement of their skin without downtime. The continued growth of nonsurgical rejuvenation can be reasonably expected, given the availability of new and more long-lasting dermal fillers, combined with the success of injectable neurotoxin and the ongoing improvements in laser and light devices, and cosmeceuticals.
The procedure dubbed microdermabrasion was first presented to the aesthetic medical community by the Italians in the 1980s [2,3]. It was released in the United States in 1994.
It still enjoys enormous popularity. Over 993,000 microdermabrasion procedures were performed in the United States in 2006 [4]. The procedure known as microdermabrasion is performed by different types of equipment. The most well-known is a closed loop system under negative pressure, dispensing aluminum oxide crystals out of a hand piece with a vacuum that sucks up the used particles along with skin surface impurities and piloseba – ceous surface plugs. Other systems use different particles such as baking soda or sodium chloride, or positive rather than negative pressure.
Suggestions by some of a danger of particulates to the eyes or respiratory system have prompted newer systems that abrade the skin without any particles. One such device employs a gritty paddle without any suction or pressure, but instead utilizes vibration to complement the abrasive action. In one limited study, less treatment-associated erythema was reported and improved tone and texture was demonstrated [5]. Another unique technology nicknamed “wet dermabrasion” uses medical-grade diamonds embedded in the hand piece along with the benefits of the vacuum. The skin is elevated by the vacuum to come into contact with the gritty head, while selected cosmeceutical fluids irrigate the skin. These various fluids are chosen based on patient’s cosmetic needs. The solution and exfoliated tissue are then evacuated into a container [6]. The concept of exfoliation to improve penetration during the process of irrigation with a cosmeceutical simultaneously is intriguing.
Whatever the machine type, there is considerable chance of operator variation. Factors such as the amount of pressure, flow and size of particles (or pressure on abrasive paddle, or coarseness of grit on hand piece), number of passes, and dwell-time on skin, all can result in differential clinical and microscopic results. The fundamental action is clear: removal of layers of stratum corneum, and deeper layers of the epidermis that then results in clinical and biological changes.