Microdermabrasion: a clinical and histopathologic study

Combining Diamond-Tip Dermabrasion Treatments and Topical Skincare in Participants with Dry, Hyperpigmented, Photodamaged or Acne-Prone/Oily Facial Skin: A Clinical Usage Study

Purpose

An in-office diamond tip microdermabrasion device (DG) was designed to simultaneously exfoliate, extract, and infuse topical cosmetic serums into the skin to improve its appearance. Combining in-office procedures with take-home skincare may enhance treatment outcomes. This study aimed to assess the efficacy of a novel combination of DG treatments with a take-home cosmetic skincare regimen (DGR) to address facial dryness, hyperpigmentation, photodamage, or acne-prone/oily skin.

Patients and Methods

In this 12-week, open-label, single-center study, participants were assigned to 1 of 4 groups according to skin presentation: dry, hyperpigmented, photodamaged, or acne-prone/oily. All participants received 6 bi-weekly DG treatments with tailored DGR topical products. During the DG treatment, the dry, hyperpigmented, photodamaged, and acne-prone/oily groups received hydrating, brightening, antioxidant, and pore-clarifying serums, respectively. Study endpoints included investigator grading, standardized photography, and participant questionnaires.

Results

Sixteen participants aged 22 to 70 years with Fitzpatrick Skin Types I-V completed the study. Immediately after the first DG treatment, significant improvements in dryness, radiance, texture, photodamage, and fine lines were achieved (P<0.01). At 72 hours, significant improvements were maintained in all these parameters except fine lines (P<0.05). The DG and DGR combination provided significant long-term improvements at week 12 compared to baseline for dryness, radiance, texture, hyperpigmentation, photodamage, skin tone unevenness, and periocular/perioral fine lines (P<0.05).

Conclusion

The combination of DG and DGR showed significant immediate and long-term improvements in skin appearance. These results show that the DG and DGR combination is a well-tolerated and effective intervention to enhance different aspects of facial skin quality.

Efficacy and Tolerability of Cosmetic Serums Enriched with Five Forms of Hyaluronic Acid as Part of Biweekly Diamond Tip Microdermabrasion Treatments for Facial Skin Dryness and Age-Associated Features

Purpose

There is growing interest in combining topical treatments with aesthetic procedures to combat signs of aging skin. This study aimed to assess the efficacy and tolerability of a novel cosmetic serum containing 5 different forms of HA (HA⁵ DG) when used via a proprietary diamond-tip microdermabrasion procedure (DG) to treat skin dryness, fine lines/wrinkles, rough texture, and dullness.

Patients and Methods

In this open-label, single-center study, participants received HA⁵ DG as part of a biweekly DG procedure on the face and neck for 12 weeks. Study participants also applied another take-home HA⁵ serum to the face twice daily at home, along with a basic skincare regimen. The efficacy of the combined treatment was measured by clinical quantification of multiple skin appearance features, analysis of bioinstrumental measurements, and digital photography.

Results

This study enrolled 27 participants, with an average age of 42.7 years and Fitzpatrick skin phototypes I-III (59.3%), IV (18.5%), and V-VI (22.2%), and 23 participants completed the study. The combined treatment had effects in fine lines/wrinkles, skin dryness, smoothness, radiance, firmness, and hydration 15 minutes post-DG. Furthermore, the significant improvements observed in dryness, fine lines/wrinkles, skin smoothness, and radiance were still visible 3 days after and maintained at week 12. Additionally, smoothing of coarse lines/wrinkles, improvement of skin tone evenness, hyperpigmentation, photodamage, and transepidermal water loss were observed at week 12. The treatment had a favorable tolerability profile and was perceived as efficacious and highly satisfactory.

Conclusion

This novel combined treatment delivered immediate and prolonged skin hydration and high participant satisfaction, proving it can be an excellent approach for skin rejuvenation.

A Comprehensive Review of Non-Energy-Based Treatments for Atrophic Acne Scarring

Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.

Effects of lactobionic acid peel, aluminum oxide crystal microdermabrasion, and both procedures on skin hydration, elasticity, and transepidermal water loss

BACKGROUND

Topical applications of alpha-hydroxy acids and poly hydroxy acids in the form of peels gained popularity. To enhance the effect of these substances, aluminum oxide crystal microdermabrasion can be used in one procedure.

AIMS

The assessment of skin hydration, elasticity, and TEWL after using lactobionic acid in the form of 20% peel and lactobionic acid in the form of 20% peel combined with aluminum oxide crystal microdermabrasion.

MATERIAL AND METHODS

The study involved 20 Caucasian female subjects. Six treatments were performed at weekly intervals, using the Split face method-20% LA was used on the left side of the face and aluminum oxide crystal microdermabrasion followed by 20% LA application on the right side of the face.

RESULTS

Corneometric measurement showed statistically significant differences between the hydration level for sessions 1 and 3 and 1 and 6. A higher hydration level was found on the side with the combined procedure. Tewametric measurement showed that the TEWL values were different for sessions 1 and 3 and 1 and 6-they decreased. There were no statistically significant differences between the two procedures. The cutometric measurement indicated statistically significant differences between skin elasticity for pairs in session 1 and 3 and 1 and 6.

CONCLUSIONS

The results of the study indicate that the combination of LA peel with microdermabrasion increases its moisturizing effect and improves skin elasticity. The use of both procedures also contributed to the decrease in TEWL; however, greater exfoliation of the epidermis in combined procedures resulted in slightly higher TEWL values.

Surgical scar revision: an overview

Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

Current status of surgery in dermatology

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Dermabrasion

This review presents skin anatomy, dermabraders, indications for dermabrasion and microdermabrasion, and dermabrasion techniques for the face, along with potential complications. Dermabrasion is a minimally invasive technique used for skin resurfacing. Its applications include treatment of rhytids, abnormal scarring, and premalignant lesions. The risks of complications are low and include pigment changes, hypertrophic scarring, and infection. Despite the introduction of newer therapies, such as lasers and chemical peels, dermabrasion remains an effective tool for physicians to combat the effects of aging without the downtime required for surgery.

Recovery of skin barrier after stratum corneum removal by microdermabrasion

Microdermabrasion is widely used as a non-invasive cosmetic technique that has recently been adapted to selectively remove stratum corneum to increase skin permeability for transdermal drug delivery. This study measured the kinetics of skin barrier recovery after stratum corneum removal using microdermabrasion in hairless guinea pigs. The skin was abraded at two sites on each animal, one of which was allowed to recover under occlusion while the other remained non-occluded. Histological measurements showed that skin barrier properties to sulforhodamine B largely recovered within 12 h, and the stratum corneum appeared largely reformed within 24 h for both occluded and non-occluded skin. Skin electrical resistance measurements showed significant recovery of the skin barrier within 24 h. We conclude that transdermal drug delivery may occur for up to 12 h after microdermabrasion in guinea pigs; however, humans will probably have a longer recovery time due to expected slower skin healing rates.

Optimization of microdermabrasion for controlled removal of stratum corneum

Microdermabrasion has been shown to increase skin permeability for transdermal drug delivery by damaging or removing skin's outer layer, stratum corneum. However, relationships between microdermabrasion parameters and effects on the stratum corneum barrier have not been developed. In this study, we determined the effect of microdermabrasion crystal flow rate, time, and suction pressure applied in both static and dynamic modes on the extent of stratum corneum removal from excised porcine skin. In addition to controlling the depth of tissue removal by microdermabrasion parameters, we also controlled the area of tissue removal by applying a metal mask patterned with 125- or 250-μm holes to selectively expose small spots of tissue to microdermabrasion. We found that the extent of stratum corneum removal depended strongly on the crystal flow rate and exposure time and only weakly on pressure or static/dynamic mode operation. Masking the skin was effective to localize stratum corneum removal to exposed sites. Overall, this study demonstrates that optimized microdermabrasion in combination with a mask can be used to selectively remove stratum corneum with three-dimensional control, which is important to translating this technique into a novel method of transdermal drug delivery.

Age-reversing drugs and devices in dermatology

The quest for youth and beauty is an ongoing one. No organ conveys youth and beauty to the extent that skin does. Advances in research over the past several decades have yielded a tremendous amount of information on the molecular pathways involved in both intrinsic aging (natural) and extrinsic aging (photoaging). In this article, we aim to describe the molecular pathways that lead to an aged appearance and to describe the latest and most commonly employed drugs and procedures to reverse skin aging and stimulate the production of new collagen. With enhanced understanding of these molecular pathways, drugs and devices used to treat aging skin can be more precisely tuned.

Acne scars: pathogenesis, classification and treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.

Selective removal of stratum corneum by microdermabrasion to increase skin permeability

This study sought to determine if microdermabrasion can selectively remove stratum corneum to increase skin permeability. Although, microdermabrasion has been used for cosmetic treatment of skin for decades, no study has assessed the detailed effects of microdermabrasion conditions on the degree of skin tissue removal. Therefore, we histologically characterized the skin of rhesus macaques and human volunteers after microdermabrasion at different conditions. Using mobile tip microdermabrasion, an increase in the number of treatment passes led to greater tissue removal ranging from minimal effects to extensive damage to deeper layers of the skin. Of note, these data showed for the first time that at moderate microdermabrasion conditions selective yet full-thickness removal of stratum corneum could be achieved with little damage to deeper skin tissues. In the stationary mode of microdermabrasion, selective stratum corneum removal was not observed, but micro-blisters could be seen. Similar tissue removal trends were observed in human volunteers. As proof of concept for drug delivery applications, a model fluorescent drug (fluorescein) was delivered through microdermabraded skin and antibodies were generated against vaccinia virus after its topical application in monkeys. In conclusion, microdermabrasion can selectively remove full-thickness stratum corneum with little damage to deeper tissues and thereby increase skin permeability.

Microneedling therapy in atrophic facial scars: an objective assessment

BACKGROUND

Atrophic facial scars are always a challenge to treat, especially the ones that are deep-seated and/or involve much of the face. Microneedling or dermaroller therapy is a new addition to the treatment armamentarium for such scars that offers a simple and reportedly effective management of these scars.

AIMS

The aim of the present study was to perform an objective evaluation of the efficacy of dermaroller treatment in atrophic facial scars of varying etiology.

MATERIALS AND METHODS

Thirty-seven patients of atrophic facial scarring were offered multiple sittings of microneedling (dermaroller) treatment and their scars were evaluated and graded clinically and by serial photography at the start as well as at two months after the conclusion of the treatment protocol. Any change in the grading of scars after the end of treatment and follow-up period was noted down. The patients were also asked to evaluate the effectiveness of the treatment received on a 1-10 point scale. The efficacy of dermaroller treatment was thus assessed both subjectively by the patients as well as objectively by a single observer.

RESULTS

Overall 36 out of the total of 37 patients completed the treatment schedule and were evaluated for its efficacy. Out of these 36 patients, 34 achieved a reduction in the severity of their scarring by one or two grades. More than 80% of patients assessed their treatment as 'excellent' on a 10-point scale. No significant adverse effects were noted in any patient.

CONCLUSIONS

Microneedling therapy seems to be a simple and effective treatment option for the management of atrophic facial scars.

Microdermabrasion as a novel tool to enhance drug delivery via the skin: an animal study

BACKGROUND

Microdermabrasion is a widely performed skin rejuvenation procedure. It can partly ablate and homogenize the stratum corneum (SC) layers.

OBJECTIVE

The effect of microdermabrasion treatment on the skin permeation of hydrophilic and lipophilic drugs was examined in this study.

METHODS

5-Fluorouracil (5-FU) and clobetasol 17-propionate were used as the hydrophilic and lipophilic permeants, respectively. In vitro skin delivery using porcine skin and in vivo topical application employing nude mouse as the animal model were both used to examine the effect of microdermabrasion. The vacuum pressures used in this study (15-25 cmHg) were much lower than those used for therapeutic purposes.

RESULTS

The 5-FU permeation across microdermabrasion-treated skin was 8- to 24-fold higher than that across intact skin and depended on differences in treatment pressure and duration. An intensity of 15 cmHg for 10 seconds showed the greatest enhancement of 5-FU delivery via the skin. In contrast to the results for 5-FU, microdermabrasion reduced the skin permeation and deposition of topically applied clobetasol. The partitioning effect of clobetasol from the vehicle to the SC may have predominated this result. Microdermabrasion also enhanced the skin delivery of the hydrophilic 5-aminolevulinic acid (ALA). Confocal laser scanning microscopy (CLSM) of microdermabrasion-treated skin revealed intense red fluorescence of ALA-transformed protoporphyrin (PpIX) within the epidermis and upper dermis.

CONCLUSIONS

Microdermabrasion can improve the skin permeation of hydrophilic molecules.

Microdermabrasion with and without aluminum oxide crystal abrasion: a comparative molecular analysis of dermal remodeling

BACKGROUND

Microdermabrasion is a popular method of superficial skin resurfacing with effects on dermal remodeling.

OBJECTIVE

The purpose of this study was to evaluate the relative importance of the two components of microdermabrasion, negative pressure and abrasion, in stimulating expression of key genes involved in dermal remodeling.

METHODS

Ten subjects were treated with a microdermabrasion machine using focal crystal abrasion and negative pressure or negative pressure alone for 3 seconds. Serial biochemical analyses were performed. Reverse transcriptase real-time polymerase chain reaction assays were used to evaluate changes in transcription factor activator protein-1, primary cytokines (interleukin 1beta, tumor necrosis factor-alpha), and matrix metalloproteinases (MMP-1, MMP-3, MMP-9).

RESULTS

Significant increases in gene expression of the c-Jun component of activator protein-1, interleukin 1beta, tumor necrosis factor-alpha, MMP-1, MMP-3, and MMP-9 were found with crystal abrasion combined with negative pressure. Negative pressure alone resulted in increased gene expression of MMP-1 and MMP-3 but of a quantitatively reduced magnitude when compared with negative pressure with crystal abrasion.

LIMITATIONS

It is unclear that molecular changes seen with these treatments can result in clinical effect.

CONCLUSION

The abrasive component of microdermabrasion is necessary for stimulating expression of key genes involved in dermal remodeling.

Rejuvenation of the aging hand

This article reviews aging of the hand and the treatment options for cosmetic rejuvenation. Options available for cutaneous rejuvenation include microdermabrasion, chemical peeling, intense light sources, and laser therapy, including pigment lasers, ablative resurfacing, and noninvasive rejuvenation. Protuberant veins of the aging hand can be treated effectively with sclerotherapy. The soft tissue atrophy of the aging hand is best treated with fat augmentation. The article concludes with a mention of new fillers that are just beginning to be used for soft tissue atrophy of the hand.

Microdermabrasion followed by a 5% retinoid acid chemical peel vs. a 5% retinoid acid chemical peel for the treatment of photoaging - a pilot study

BACKGROUND

Both retinoid acid (RA) chemical peeling and microdermabrasion are minimally invasive procedures recently developed for the treatment of photoaging. The efficacy of each procedure has been proved, but the results of the combination of these two methods have not been studied until now.

OBJECTIVES

To assess and compare the efficacy of microdermabrasion followed by a 5% RA chemical peel with that of a 5% RA chemical peel alone.

METHODS

Six female patients with moderate degrees of photodamage were evaluated. Three submitted to microdermabrasion followed by the application of a 5% RA chemical peel and three submitted to a 5% RA chemical peel alone. Each patient underwent three treatment sessions, with intervals of 7-10 days. Photographs were taken, and both biopsies and histological assessments were carried out, before treatment and 7 days after the final treatment session.

RESULTS

In the opinion of the patients, in both groups there was improvement in the texture, pigmentation, and appearance of the treated skin, and this was confirmed with the assessment of the pre- and post-treatment photographs. The combination of microdermabrasion followed by a 5% RA peel showed slightly greater improvement in the histological alterations resulting from photoaging. Conclusion Both methods, microdermabrasion followed by a 5% RA chemical peel and a 5% RA chemical peel alone are effective in the treatment of photoaging.

Microdermabrasion: A molecular analysis following a single treatment

BACKGROUND

Microdermabrasion is a popular method of superficial skin resurfacing. It is unclear if dermal remodeling actually occurs.

OBJECTIVE

To rigorously investigate the molecular alterations observed following a single microdermabrasion treatment.

METHODS

Forty-nine subjects received a single microdermabrasion treatment to buttock skin. Serial in vivo biochemical and immunohistological analyses were performed. Reverse transcriptase real-time polymerase chain reaction and immunohistochemistry assays were used to evaluate changes in transcription factors (AP-1, NF-kappaB), primary cytokines (interleukin-1beta, tumor necrosis factor-alpha), matrix metalloproteinases (MMP-1, MMP-3, MMP-9), barrier repair enzymes (acetyl-coenzyme A carboxylase, 3-hydroxy-3-methylglutaryl coenzyme A reductase), and type I procollagen. Results Elevation of transcription factors, primary cytokines, and matrix metalloproteinases occurs rapidly after a single microdermabrasion treatment. Two of 11 subjects also demonstrated increased type I procollagen messenger RNA and protein levels 14 days after treatment. No alteration in stratum corneum thickness was detected.

CONCLUSION

Microdermabrasion activates a dermal remodeling/wound healing cascade with minimal epidermal disruption. Evidence now exists to further study manipulation of variables such as number and timing of microdermabrasion sessions.

Superficial skin resurfacing

Options for both the cosmetic surgeon offering and patients seeking treatment for cutaneous aging have expanded greatly in recent years and continue to grow. Increasingly sophisticated aesthetic patients are seeking procedures to rejuvenate in record numbers,but many are unwilling to tolerate a large amount of downtime. In expert hands, ablative laser resurfacing has a long history of dramatic results for the treatment of cutaneous aging. During the last decade, there have been a growing number of reports of modalities targeting the more superficial skin structure. Such modalities offer more modest results without the downtime associated with more aggressively ablative procedures. These resurfacing techniques include the use of mechanical, chemical, and thermal forces.

Acne vulgaris

Acne vulgaris is a common inflammatory skin condition that presents management difficulties to cosmetic surgeons. Acute management and treatment focuses on early diagnosis as well as treatment with topical agents, oral antibiotics, hormonal therapy,and nonablative chemical peel and laser applications. The treatment of postinflammatory scarring must be individualized to address potential macular dyschromia, cystic lesions,epithelial bridges, or deep pitted scars. A review of interventional options is presented to apply to the spectrum of acne scarring as well as a review of the literature to address objectively published reports on efficacy.

A Prospective Controlled Assessment of Microdermabrasion for Damaged Skin and Fine Rhytides

Aged skin is characterized by rhytides but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, and laxity. Microdermabrasion is an office-based mechanical resurfacing technique alternative to traditional dermabrasion. It has been used in Europe since 1992 with great acceptance. The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin and fine rhytides following a series of microdermabrasion treatments. A single operator treated 20 patients with varying degrees of photodamage and rhytides with a series of eight microdermabrasion treatments at 1-week intervals; 17 subjects completed the entire study protocol. Standardized photographic documentation was performed before and after each treatment, and a survey questionnaire was completed by each subject. Punch biopsy specimens (3 mm) were collected on treated and matched nontreated control sites and evaluated for histological characteristics. Preprocedure and postprocedure photographs were rated on a 5-point scale by independent blinded observers. A total of 30 blinded observers (16 plastic surgeons and 14 laypersons) rated all photographs. The results showed that all observers rated a significant improvement of hyperchromic discoloration (p = 0.004), while only nonmedical observers observed improvement in fine rhytides. All patients were very satisfied with the results. Common side effects were mild to moderate discomfort occurring on bony areas during the treatment and an itching and tingling sensation for 2 days after treatment. No infections or scars were observed postoperatively. The average epidermal thickness in the untreated samples was 103 +/- 23 microM (mean +/- SD) before treatment compared with 148 +/- 41 microM after treatment (p < 0.001). Histologic analysis of the matched punch biopsy specimens showed an increase in organized collagen in treated versus nontreated sites. Treatment of aged skin using a series of microdermabrasion treatments is an effective, noninvasive method of skin rejuvenation with minimal risk and patient downtime. It is safe and improves skin quality by minimizing certain hyperchromic pigmentations.

Cosmetic considerations and nonlaser cosmetic procedures in ethnic skin

The face of the aesthetic patient is changing to be more representative of the ethnic diversity of the United States population. It is imperative that the cosmetic dermatologic surgeon not only understand the concerns of the ethnic aesthetic patient but have an awareness of the unique needs of those with darker skin.

Microabrasion versus microabrasion followed by 15% trichloroacetic acid for treatment of cutaneous hyperpigmentations in adult females

BACKGROUND

Cutaneous hyperpigmentations are common skin disorders that are often refractory to currently available treatments.

OBJECTIVE

To evaluate the efficacy of microabrasion alone or microabrasion with 15% trichloroacetic acid (TCA) for treatment of cutaneous hyperpigmentations.

METHODS

Twenty female patients were treated with microabrasion alone every 2 weeks (group 1), and 20 female patients were treated with microabrasion and application of 15% TCA every 3 weeks (group 2). All patients underwent up to eight treatments. The overall duration of treatment ranged from 2 to 4 months.

RESULTS

In group 1, a complete remission was observed in 8 of 20 cases (40%), partial remission in 10 of 20 cases (50%), and no remission in 2 of 20 cases (10%). In group 2, a complete remission was observed in 10 of 20 cases (50%), a partial remission in 8 of 20 cases (40%), and no remission in 2 of 20 cases (10%). No unexpected or serious side effects were observed in either group.

CONCLUSIONS

Microabrasion alone or microabrasion with 15% TCA is an effective, well-tolerated treatment for cutaneous hyperpigmentations.

Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus noncentrifuged fat

BACKGROUND

Fat augmentation has long been utilized by cosmetic surgeons for volume restoration of the face and hands. However, it is not clear which methods of fat preparation optimize survival and aesthetic results. The need for centrifugation of the fat prior to augmentation has been debated in the literature.

OBJECTIVE

To evaluate the long-term efficacy of fat transplantation to the hands using centrifuged versus noncentrifuged fat.

METHODS

Fourteen patients underwent fat augmentation to the hands utilizing 10 ml of centrifuged fat in one hand and 10 ml of noncentrifuged fat in the contralateral hand in a randomized, double-blind comparison study. Evaluation intervals were at 1, 3, and 5 months at which time aesthetic results, vein prominence, and depth of metacarpal space were evaluated.

RESULTS

At 1 month the subjective and objective preference was the hand with the noncentrifuged fat in 75% of patients, even though vein prominence and depth of metacarpal space were higher in that group. By 3 months the preferred result was centrifuged fat in 62.5% of patients; 25% had equal results and 12.5% preferred the noncentrifuged fat. By 5 months the subjective and objective preference was for the centrifuged fat in 100% of patients. This preference was supported by a lower score in vein prominence and depth of metacarpal space in that group.

CONCLUSION

This preliminary study supports the use of centrifuged fat compared to noncentrifuged fat for longevity and improved aesthetic results at 3 and 5 months for fat augmentation of the aging hands.

Clinical application of lasers in Asians

BACKGROUND

Laser surgery for Asians differs from that for Caucasians in several important respects. In Asians, some conditions such as nevus of Ota are frequently seen and certain adverse reactions, especially postinflammatory hyperpigmentation, tend to be more common.

OBJECTIVE

This article reviews the use of different types of lasers and intense pulsed light (IPL) sources for the treatment of Asian patients.

METHODS

Various cutaneous conditions amenable to laser treatment, including lentigines, nevus of Ota, acquired bilateral nevus of Ota-like macules, port-wine stains, and acne scarring, are discussed. Strategies for the management of postinflammatory hyperpigmentation are offered.

RESULTS

Appropriate selection and careful planning of the treatment can lead to excellent clinical outcome.

CONCLUSION

Lasers and intense pulsed light sources are important tools for the treatment of a wide range of cutaneous conditions in Asians.

An unusual acute urticarial response following microdermabrasion

BACKGROUND

Microdermabrasion is widely performed in a number of clinical settings, including medical offices, salons, and spas. This procedure is generally regarded as safe and easy to perform.

OBJECTIVE

To determine if latex exposure caused an acute urticarial response following microdermabrasion in a latex-allergic patient.

METHODS

The patient was prick tested to saline and histamine controls, latex, and sterile medical grade 100 m aluminum oxide crystals that had been passed through the microdermabrader.

RESULTS

The strongly positive latex prick test confirmed latex allergy in our patient. Negative prick testing to aluminum oxide crystals that had passed through the microdermabrader make it unlikely that the patient was exposed to latex via this system.

CONCLUSION

Physicians need to carefully evaluate patients who are considering microdermabrasion and appreciate that unexpected serious complications can occur.

Skin barrier changes induced by aluminum oxide and sodium chloride microdermabrasion

BACKGROUND

Microdermabrasion has become an extremely popular method for superficial resurfacing. Despite the popularity of this technique, published studies of skin barrier function changes following microdermabrasion are lacking.

OBJECTIVE

To study assessed transepidermal water loss (TEWL), hydration, pH, and sebum production following aluminum oxide (Al2O3) and sodium chloride (NaCl) microdermabrasion.

METHODS

Eight patients were included in this split face study. Transepidermal water loss, stratum corneum hydration, skin pH, and sebum production measurements were taken from the right and left sides of the face at baseline. One side of the face was treated with Al2O3 microdermabrasion and the other side with NaCl microdermabrasion. Measurements were repeated at 24 hours and 7 days.

RESULTS

Both NaCl and Al2O3 microdermabrasion was associated with a statistically significant increase in TEWL at 24 hours. In contrast, at 7 days, levels of TEWL were decreased to less than baseline. In addition, an increase in hydration was observed 24 hours after NaCl and Al2O3 microdermabrasion. Hydration in NaCl-treated areas remained significantly increased at 7 days.

CONCLUSION

The results of this investigation suggest that both NaCl and Al2O3 microdermabrasion alter the epidermal barrier. These changes in epidermal barrier function may be responsible for the clinical improvement following microdermabrasion.