Outcome

Critics of microdermabrasion will agree that among the risks associated with this procedure, “disappointment” should be included. Because microdermabrasion was approved by the FDA as a type 1 device, the manufacturer does not have to establish performance standards for the machine, only to manufacture the device using good manufacturing practices (GMP) guidelines. With the 1998 issuance of “exempt” status, there is no need for a clearance letter from the FDA in order to sell the instrument in the United States [82]. The effects are described as superficial in most cases, although the physician can reach the level of the dermis with a machine capable of positive pressure crystal delivery. Evidence that the epidermal-dermal junction has been reached may present clinically as punctate hemorrhage.Re-epithelialization is usually complete within 1 week,but erythema may persist just beyond 2 weeks.More uniform punctate bleeding may indicate reaching the papillary dermis, and treatments extending to the reticular dermis are marked by full-face bleeding [92]. With variation in the depth of penetration, the anticipated results depend greatly on the treated lesions.

Tan et al. treated ten volunteers on the face with Fitzpatrick skin types I–III with Glogau scale II–III photodamage once a week for five to six treatments. Assessments immediately before and after the first, second, and fifth visit, and a final evaluation 1 week following the last session, were performed. The vacuum pressure was maintained at 30 mmHg for four passes full face and 15 mmHg for two passes periorbitally. An increased roughness consistent with mild abrasion and a slight flattening of wrinkles were detected immediately following the treatment but did not last in the majority of patients beyond 1 week. A significant but transient decrease in sebum production was also noted. Increased skin compliance and decreased skin stiffness was noted on the cheeks, a finding that persisted for 1 week following the final treatment. Seven of the ten patients reported clinical improvement in their photodamage as a result of the microdermabrasion treatments. The three patients without any improvement were classified as Glogau group III photodamage. Histologic evaluation was performed on preauricular 2 mm punch biopsies of 2 volunteers at baseline and following the final session.A slight increase in orthokeratosis, and a diminished epidermal rete ridge pattern were noted superficially. Vascular ectasia, a perivascular mononuclear cell infiltrate, and edema were seen in the reticular dermis. Two additional healthy males received 3-mm forearm punch biopsies before and immediately following four passes at 65 mmHg (aggressive setting). Results demonstrated thinning of the stratum corneum and slight dermal edema but no epidermal change. No significant change was seen in the content of collagen or elastin [82].


In another study by Hernandez-Perez et al., seven women (median age 45 years) underwent five microdermabrasion treatments at weekly intervals.A 3-mm punch biopsy was taken from the malar area before the first treatment and following the fifth,which showed the most dramatic change in epidermal increase thickness – a change that was statistically significant.Clinically, there was a moderate to excellent improvement in oily skin and dilated pores in all patients. In 86% of the patients, the improvement in fine wrinkles was good and in 14% only moderate [87]. Histologically, improvement in inflammation, telangiectasias, and edema were noted. Collagen fibers in the dermis were reportedly more fibrillar and less basophilic, and an improvement in the elastotic material was detected. With such dermal effects, some have compared the outcome of microdermabrasion to medium-depth chemical peels [86]. Others have declared that even ten serial microdermabrasion treatments cannot achieve the results possible with one papillary dermis peel [93].

Comparing microdermabrasion with glycolic acid peels in terms of efficacy and patient satisfaction, Alam et al. treated ten female patients (mean age 43) split face with six consecutive weekly 20% glycolic acid peels and mild-setting microdermabrasion.Comparative reviews were composed of patient ratings, investigator ratings, and photographs before any treatments and 1 week following the last treatment. Skin features under review included redness, brown spots, smoothness, softness, and wrinkles. Investigators’ ratings revealed no significant treatment-specific differences when evaluated by photographs or in person. Patient ratings, however, revealed some marked differences between the two procedures. With respect to skin texture, four of the ten patients favored the glycolic acid peels, two favored microdermabrasion treatments, three found that both procedures improved the skin texture equally, and one felt no significant change from either intervention. Fine wrinkles were improved more by glycolic acid peels in four patients, by microdermabrasion in one patient, and equally in five patients. Skin color was improved more by glycolic acid peels in four patients, by microderm abrasion in one patient, equally in three patients, but not at all in two patients. An overall preference for glycolic acid peels was stated by seven of the ten patients while,of the remaining three, one preferred microdermabrasion and two revealed no preference [94].


Chemexfoliation and superficial skin resurfacing continue to be two essential techniques in the arsenal allowing cosmetically oriented physicians to be competitive in the anti-aging war. From the most superficial chemical peel agents to those more deeply penetrating, the dermatologist is able to implement for the patient a treatment regimen targeted to meet specific goals but tailored to individual lifestyles. Chemical peels and microdermabrasion will likely remain among the most popular “cosmetic procedures” of younger generations whose early intervention may afford them the luxury of preventive rather than therapeutic practices.