Microdermabrasion Overview

Lecture Overview

  • Mechanism of microdermabrasion (MDA) treatments

  • Differences between traditional dermabrasion and MDA

  • Differences between beauty and clinical MDA treatments

  • Indications for clinical MDA treatment

  • Absolute and relative contraindications for MDA treatment

  • Side effects and potential complications with clinical MDA

  • Physiological effects of MDA treatments on the skin

  • Effects of different types of crystal and other mediums used

  • Combination therapies with microdermabrasion treatments

  • Treatment techniques

  • Skin preparation and aftercare for clinical MDA

Background

Catatory of treatments that can be classified as Epidermial Resurfacing that uses the abrasive action of microcrystals delivred at pressure to the skins surface va a handpeice. the impact causes abraision and then the exfloated skin tissue and crystals are spreated in to the waste container. while the handpiece is in contact wtht he skin, i creates a vaccum using negatie pressure which draws around 5-8 mm of skin into th e end of the handpiece. In addition, proper skin preparation is essential, including cleansing the area and assessing skin type to determine the appropriate settings for the treatment. Microderabrasion was intially eveloped as a less invasive alternative to dermabrasion and laser resurfacig. The first microdermabrasion were available in Europe in the mid 80’s and has been popular in Australia fr the last 20 years. The technique has evolved significantly since its introduction, with advancements in technology leading to more effective and customisable treatments tailored to individual skin concerns.

  • Non-surgical

  • No Downtime: Patients can resume normal activities afterward.

  • Predictable Results: Expected outcomes from treatment.

  • Pain-Free: Minimal discomfort during the procedure.

  • No Anesthetic Required: Suitable for patients without anesthesia.

  • Suitable for Most Skin Types: Versatility in application across diverse skin types.

Dermabrasion vs. Microdermabrasion

Dermabrasion

Performed by cosmetic doctors of cosmetic surgeons under anaesthetic, with dermabrasion the skin is abraded by a wire brush/sandpaper. Layers of skin are removed and the healing, infections control, and surgeon skill all contribute t a successful outcome. The high concentration of pilosebaceous glands and rich vascular network of the face will aid in the healing which makes the face the most common and ideal sight for dermabrasion.

  • Significant downtime- 7-10 days

  • Higher risk; surgical procedure

  • Required anesthetic

  • Not suitable for everyone

  • Not commonly performed

Contraindications:

  • bleeding disorders

  • immunosuppression

  • diabetes

all will delay healing and increase the risk of post-prcedure infection.

Microdermabrasion (MDA)

A minimally invasive cosmetic procedure that exfoliates the outer layer of skin, promoting cell turnover and improving the skin's texture.

  • Three Levels of Application:

    Level 1: Performed by beauty therapists

    • Mild/superficial treatment

    • Exfoliation of the epidermis only

    • Visual endpoint: mild erythema.

    • Suitable for congestion, non-inflammatory acne, hyperpigmentation.

    • All skin types.

      Level 2: Performed by dermal therapists, nurses, and doctors

    • Moderate treatment, exfoliating to the papillary dermis and will result in some degree of grazing and occasionally, pinpoint bleeding

    • Visual endpoint: erythema and mild grazing.

    • Suitable for superficial irregularities: fine lines, post-acne scarring, enlarged pores.

    • Skin types I, II, & III.

      Level 3: Intense treatment for specific concerns

    • Exfoliating beyond the papillary dermis

    • Visual endpoint: moderate grazing, pinpoint bleeding.

    • Used for fine lines, post-acne scarring, enlarged pores.

    • Skin types I, II, & III.

Indications for MDA

  • Non-inflammatory acne and congestion

  • Superficial acne scarring

  • Photo-damage and intrinsic aging

  • Hyperpigmentation

  • Striae/stretch marks

  • Keratosis pilaris

  • Fine lines and wrinkles

Fitzpatrick Skin Type and MDA

MDA is a versitle cosmetic procedure tailored to different skin types and concerns. The technique is considered safe for all fitzpatrick skin tyoes, with minimal comlications, MDA is genrally safest in patints with Fitzpatrick skin types 1-4, whereas, Fitzpatrick skin types 4 and higher are at an increased risk of post-inflammatory hyperpigmentation and should be approached with caution. Adjustments in treatment settings and techniques may be necessary to optimise results while minimising potential side effects. In conclusion, it is essential to thoroughly assess each patient's skin type and condition before proceeding with microdermabrasion to ensure safety and efficacy, and post: procedure follow-up care should be emphasised to monitor for any adverse reactions and to enhance the overall outcomes of the treatment.

  • MDA is versatile for different skin types and concerns.

  • Generally safe for Fitzpatrick skin types I to IV; IV+ at increased risk of post-inflammatory hyper-pigmentation.

Contraindications for MDA

Absolute Contraindications

Absolute contraindications means that the treatment could cause adverse side effects and hence the treatment MUST NOT be performed

  • Roaccutane within 6 months: The skin may still be fragile and compromised.

  • Pustular/cystic acne due to the risk of spreading the infection and causing discomfort to the patient

  • Active rosacea may also be fragile and compromised as MDA could result in worsening the condition

  • Skin type IV and above should only use level 1 to reduce the risk of PIH

  • Active infections (e.g., herpes simplex)

  • Recent UVR exposure (sunburn)

  • Recent resurfacing treatments: a minimum of 2 weeks should be observed before performing microdermabrasion to ensure the skin has adequately epithelialised and to prevent any adverse reactions

  • Skin conditions (eczema, psoriasis)

  • Sunburn

Relative Contraindications

Relative contraindications means that you may or may not decide to go ahead with treatment based on consideration of other variables

  • Inactive rosacea and mild telangiectasia may be ok to treat with MDA although other treatment modalities are better options

  • Photosensitising medication pose risk of inflammatory and PIH as they can make the skin more sensitive to th sun, although not all individuals have the same reaction (has this medication made your skin more sensitive to the sun, heat or any stimuli?)

  • Very thin skin or excessive laxity

  • Anticoagulant therapy

  • Cold sores can spread infection to other areas, but treatment can still be considered as the practitioner can avoid the peri-oral and/or using anti-viral medication to the area during the procedure, thus minimising the risk of exacerbating the condition while achieving the desired outcomes.

  • Open lesions pose a risk of infection but the area can be avoided

  • Diabetes affects the patients healing and so treatment levels should be adjusted to levels ½ to minimise risk

Physiological Effects of MDA on the Skin

Epidermal thickness increases overtime after MDA with multiple accompanying changes in the epidermis, which include:

  • More regular distribution of melanosomes

  • Less melanisation of the epidermis

  • Increased thickness of the papillary dermis

  • Changes in elastin and collagen fibres

    Exfoliation treatments are based on the principles of wound healing, by wounding and removing the uppermost layers of ht skin in a controlled manner, cell renewal is stimulated with regeneration of a healthier epidermis and dermis. histological evaluation of facial skin after repeated MDA treatments demonstrate a reparative wound healing process with regeneration of a compacted stratum corneum and a smoother epidermis. Additionally, an. improved epidermal barrier function will prevent TWEL and fibroblast stimulation, increases dermal thickness through production of new collagen and Eastin, improving skin hydration

Factors Affecting Depth of Exfoliation

The physiological effects are dependant on the depth or level of treatment this takes into account:

  • Strength of crystal flow

  • Negative pressure used

  • Movement rate of handpiece over skin

  • Number of passes

  • Pressure applied on the hand piece to the skin

Types of MDA Systems

  • Open Systems: Old technology

    Crystal are drawn from the storage unit, applied to the ski and then discarded directly into the waste bin. This meant that many of the crystals became airborne, the dust collected on many surfaces and concerns were raised for the therapists who inhaled the airborne components.

  • Closed Systems: New technology

    Crystals are sucked back off the skin and are containde inthe used crystal connister. Good quality devices include ergonomically deigned hand pieces, disposable tips, filters and sealed crystal containers. These advancements not only improve safety for therapists by minimising dust exposure but also enhance hygiene during treatments, making it easier to maintain a clean and controlled environment.

  • Outcomes depend on:

    • Type of crystals used

    • Functions of the machine (speed, handpiece, tips, serums)

    • Skill of therapist

Beauty vs. Medical MDA Machines

Medical

Have a greater force and vacuum capacity and may take a more abrasive crystals and therefore, more likely to achieve a level 3

  • Greater force and vacuum capacity

  • More abrasive resources

  • Achieves higher treatment levels

Beauty

Limited in their force and, vacuum and abrasiveness and are sometimes referred to as buff and polish machines

  • Polishing/buffing the skin

  • Lesser force and vacuum capacity

  • Less abrasive resources

Machine Availability

Crystals or other must be recommended by the device manufacture for the specific machine to ensure optimal performance and avoid potential damage to the device.

  • Crystal MDA

  • Crystal-Free MDA

  • Diamond Tip MDA

  • Combination MDA

  • Hydra or Solution MDA

Aluminium Oxide (Corundum) Crystals

  • Original crystals for MDA

  • Various grit and grades

  • Stable and inert, no allergies or reactions

Organic Crystals

  • Husk, salt, grain

  • Non-toxic, water-soluble, similar abrasion degree

  • Issues with irregular nature of particle shapes and sizes

Crystal Hygiene

regardless of the crystal medium used, the disposal of used crystals in imperative as the byproduct is contaminated with the patients skin cells and possibly blood.

  • Used crystals are clinical/bio waste

  • Advanced filters/suction minimise airborne particles

  • Sealed crystal receptacle prevents contamination

  • Used crystals must not be reused and disposed of in biowaste containers

Mechanism of Hand piece

the hand piece is where the crystals are delivered wit force tot the skin, the hand piece will have two seperate lines, one that delivers the crystals and one that removes the crystals ad the skin cells, the hand piece should be designed so that t deliver the crystals evenly to the skin and is efficient at sucking up all the waste material. a comfortable hand piece that is ergonomically designed will decrease he total treatment time ad allow the therapist to perform the treatment with ease

  • Comfortable, ergonomically designed

  • Has two lines: one for crystal delivery, another for crystal removal

  • Delivers crystals evenly to the skin

Diamond Tip MDA

Some MDA machines use a diamond encrusted tip instead of a loose flow of crystals. Diamond tips come in different sizes and textures from very fine to very coarse. the advance is that no crystals have to be purchased ad discarded. the ti however must be sterilised in autoclave between patients. The technique used with a diamond tip is different to crystal flow MDA treatments but the same principles apply. efficacy is considered eh equivalent and selection between both comes down to personal preference

  • Diamond-encrusted tips

  • Sizes and textures vary, remove the nuisance of crystals

  • Require sterilization (autoclaved) between patients

Filters

used to filter the air to remove contaminants and moisture each device will have different filter technology and the therapist needs to be familiar with the type of filters used and when/how to change them

  • HEPA filters for moisture and contaminants

  • Regular maintenance for optimal efficacy

Infusion MDA

also called hydradermabrasion is a newer technology and has been been popularise byt he brand name hydra-facial. These infuse topical serums into the skin during or after the MDA treatment process and take advantage of the transient disruption to the epidermal barrier that occurs with the removal of the stratum corneum. to better deliver nutrients to the deeper dermal layers. Dermal infusion can enhance results for conditions such as dehydration, hyperpigmentation, acne and rosacea, all of which is based on the products/serums infused. Infusion microdermabrasion does not have the same degree of abrasiveness levels used with traditional MDA

  • Hydra MDA using distilled water

  • Includes serums such as Hyaluronic Acid, Glycolic Acid, Lactic Acid, Tyrosionase inhibitors and vitamins

  • Applicable for acne and hyperpigmentation, minimal ablation

Practical Training Equipment

  • Various microdermabrasion machines, including Clairderm and Hydrafacial

Machine Settings

Allow you to alter the vacuum and crystal flow, these will have an affect on the abrasion depth and therefore treatment level. if the setting are too low, the treatment is not effective is hey are too high you are in danger of over-treating and/or striping. each machine has different controls, some have dual control for vacuum d crystal settings and other have a control for each variable. MDA treatment will measure suction using one of the following measurements:

  • Suction measurements: kilopascals (kPa), hectopascals (hPa), inches of mercury (Hg), pounds per square inch (PSI)

  • Ability to convert between MDA units is necessary if you are using mutiple machine or chaging to a new machine

Vacuum and Crystal Flow Settings

Adjusting these settings allows for precise control over the microdermabrasion procedure, ensuring optimal outcomes for different skin types and conditions.

It's important to monitor the effects of adjustments, as patient comfort and treatment efficacy can vary significantly.

  • Negative pressure influences ablation level.

    • Increased negative pressure = more ablation

    • Decreased negative pressure = less ablation

  • Crystal flow settings also influence ablation.

    • Increased flow = more ablation

    • Decreased flow = less ablation

  • Hand piece pressure also plays a crucial role in achieving desired results, as higher pressure can enhance the effectiveness of treatment while lower pressure may require additional passes to achieve similar outcomes.

Cross Contamination Prevention

MDA treatment produce contaminated waste, when the kin is exfoliate the used crystals are contaminated with skin cells, blood, lymph and other body fluids. the possibility of this is increased when treting acne. phyuiiscl contact witht eh used crytal puts you at risk, therefore gloves are used during the treament, when applying incare porducts post procedure, or when cleaning/discarding used crystals. Patients are under no legal obligation to tell you if they have ay form of Hepatitis. additionally some patients may not know that they have a blood borne disease. therapist must protect themselves by using a universal precautions.

  • Handle micro-crystal waste carefully, as it may be contaminated with skin cells or blood.

  • Personal Protective Equipment (PPE) is essential (e.g., gloves).

  • Maintain hand hygiene before and after glove use.

PPE

Gloves should be worn when preparing the skin, during the treatment, post-treament when applying products and when cleaning the equipment to prevent cross-contamination and ensure safety for both the technician and the client. Hands should be washed prior to putting on gloves and after removing them