Combining microdermabrasion and facial ultrasound makes for more effective skin rejuvenation

Microdermabrasion has reached an all-time high in the total number of procedures performed, and it heads up the list of the latest modalities in skin-rejuvenation treatments. The procedure has become one of the most popular and sought-after treatments in the aesthetic industry.

Microdermabrasion was first performed in Italy, and it has been safely used in Europe for the past 25 years. It was introduced into the United States and cleared by the Food and Drug Administration (FDA) in 1997.

Although microdermabrasion might seem like a standard, well-known treatment option, recent statistics from the American Society for Aesthetic Plastic Surgery (ASAPS) show that 200,000 more treatments were performed in 2004 than in 2003, an increase of 28%. With the recent introduction of consumer-based “home” microdermabrasion kits—both in topical form and using a handheld rotary device—the overall consumer awareness of the benefits of the treatment will only increase the number of office-based microdermabrasion treatments performed in the year to come. Micro­dermabrasion is an integral part of antiaging medicine, a market that only shows signs of growth as the baby boomer population ages.

Microdermabrasion is an exfoliation process that rejuvenates the skin using fine aluminum oxide, sodium bicarbonate, or sodium chloride crystals to remove the superficial layer of skin, most notably the stratum corneum. The microdermabrasion instrument emits ultra-fine crystals, and also contains a vacuum, which evacuates both crystals and the skin’s cellular debris (see diagram above). The idea is to remove or break up the matrix of the stratum corneum, which the body interprets as an injury, and responds by replacing the dead skin cells with new, healthy cells. This creates an inflammatory response, producing edema and erythema which, when resolved, leaves a healthy, natural glow. The process of microdermabrasion leads to the production of collagen and elastin, which results in firmer, more youthful-looking skin.

The skin is made up of two main layers: the dermis and the epidermis. In the epidermis, the stratum corneum acts as a barrier between the outside world and the deeper skin layers. The superficial layer of the epidermis holds the dead skin cells, upon which another layer of cells are in the process of maturing. Minor skin imperfections and fine lines and wrinkles are found in the stratum corneum, which is the same layer in which the action of microdermabrasion takes place. When the stratum corneum is affected by microdermabrasion, the rate of epidermal replacement is accelerated from the normal 12–14 days.

Through a series of six biweekly treatments, specific skin issues can be targeted and greatly improved. The inflammatory re­sponse elicited through a series of micro­dermabrasion treatments resembles a reparative process in both the dermis and epidermis. This is the mechanism of action by which microdermabrasion produces its clinical results.

Because microdermabrasion accelerates cell turnover, it stimulates fibroblastic activity, thereby increasing collagen production. As a result, the overall quality, tone, and texture of the skin improve. The procedure has evolved into a treatment for acne scars, age spots (sun-damaged skin), postsurgical scars, stretch marks, enlarged and oily pores, and fine wrinkles. Microdermabrasion is indicated for all skin types and colors; and, unlike laser or acid treatments, burns and hyper/hypo pigmentation are not of concern. Micro­dermabrasion does not result in downtime, and the patient’s return to regular activities is not affected. This treatment option involves little risk and offers rapid recovery. The only real downtime from microdermabrasion is that of the treatment itself.

Microdermabrasion is the backbone of aesthetic treatments. Although the concept seems basic, the treatment is extremely profitable, and its noticeable results create ongoing demand. Stand-alone microdermabrasion has been proven to be extremely effective in treating the aforementioned conditions. However, greater overall results are being realized when microdermabrasion is used in combination with other noninvasive treatment modalities such as chemical peels, intense pulsed light phototherapy, or other nonablative laser treatments. This is the case because these other treatments often require less energy and a lower concentration of chemicals when the stratum corneum has been pretreated with microdermabrasion.

Optimum skin rejuvenation can be achieved using a resurfacing technique that combines microdermabrasion with facial ultrasound. The combination regimen is performed as a series of treatments with an increasing vacuum setting on the microdermabrasion unit and an increasing frequency setting on the ultrasound unit. I have used this combination therapy in my practice with positive results and no complications.

The theory behind the combined technique is that microdermabrasion removes cells from the stratum corneum, destroying the barrier and providing a medium into deeper tissue layers. Then, using the facial ultrasound with vitamin C serum, retinols penetrate better for deeper remodeling of subepidermal tissues, which accounts for the enhanced ability to induce skin-tightening and assist with new collagen production, thereby minimizing the appearance of fine wrinkles and acne scars. The treatment protocol requires lipid-soluble vitamin C antioxidant serum to be applied to the dermabraded area and “driven” into the deeper tissue layers with the ultrasound.

Why vitamin C? The dermis contains mucopolysaccharides, which include collagen, elastic, and hyularonic acid. The main component of these building blocks is vitamin C. Without vitamin C, collagen production in the dermis slows; so that environmental and self-inflicted damage to the skin quickly exceeds the body’s ability to repair it.

The ultimate goal of this combined procedure is to remove dead cells in the stratum corneum. However, by affecting the stratum corneum, new cells are produced, providing new texture to the skin. More importantly, with the destruction of the barrier and the usage of the ultrasound, more active ingredients found in topicals—such as vitamin C, vitamin E, retinols, and alpha hydroxy acids—will reach the deeper layers of the skin matrix. While there is no official data showing the actual depth of penetration or the increased amount of collagen production that this combination therapy stimulates, my patient-satisfaction rates are high, and visual results are noticeable. However, these promising findings warrant further clinical investigation. This top-down (microdermabrasion) and bottom-up (deep penetration of topicals through ultrasound therapy) approach to skin rejuvenation is a natural step in advancing antiaging therapies. Additionally, this combination therapy can add an additional $50–$75 per treatment.

Patient expectations must be realistic. Patients must be willing to undergo a series of six to eight treatments for results to be effective. Like microdermabrasion alone, the combination treatment option is safe and effective for all skin types and colors, requires no downtime, and can be customized for the needs of each patient. Patients with deep rhytids or pigmentary abnormalities may be better suited with more invasive resurfacing modalities.

Microdermabrasion with facial ultrasound is a noninvasive, nonsurgical, and nonchemical procedure that can be done safely and without interruption to the patient. This mode of therapy has been well-tolerated and has brought increased patient satisfaction. n

Suggested Reading

Bernard RW, Beran SJ, Rusin L: Microdermabrasion in clinical practice. Clin Plast Surg. 2000;27(4):571–577.

Freeman MS. Microdermabrasion. Facial Plast Surg Clin North Am. 2001;9(2):257-266.

Tsai RY, Wang CN, Chan HL. Aluminum oxide crystal microdermabrasion: a new technique for treating facial scarring. Dermatol Surg. 1995;21(6): 539–542.

Warmuth IP, Echt A, Scarborough, DA. Microdermabrasion—a new rejuvenation treatment option. Cosmet Dermatol. 1999;12 (10): 7–10.

John A. Kotis, DO, serves as the chairman of plastic and reconstructive surgery and hand surgery at Lincoln Park Hospital in Chicago. He is also the associate clinical professor of plastic and reconstructive surgery and hand surgery at Illinois Masonic Medical Center in Chicago. He is a member of the American Osteopathic Board of Surgery and the teaching faculty at the University of Illinois Medical Center. He is currently in private practice in Arlington Heights, Ill, specializing in plastic and reconstructive surgery and hand surgery. He can be reached at (847) 577-6700 or [email protected].