By now, everyone knows that Microdermabrasion Light Therapy Combo was developed in Europe in the mid-1980s, but only recently, in late 1996, brought to the United States. For more than a year, there were only a handful of manufacturers supplying machines, but after the FDA de-regulated Microdermabrasion Light Therapy Combo in 1998 as a Class I exempt status (giving it the same status as an electric toothbrush!), the number of different machines available expanded almost exponentially. Today, there are more than 40 different manufacturers producing more than 60 models of Microdermabrasion Light Therapy Combo machines. I frequently receive calls from estheticians, or am confronted at conferences by those who exclaim, "I'm even more confused now than when I started!" This article is meant to assist you in choosing a machine by giving some direction to your questions.

Introducing Microdermabrasion Light Therapy Combo
Deciding to introduce Microdermabrasion Light Therapy Combo into your treatment menu whether you are a salon, spa or a physician’s office, can be a daunting task, but only if you let it. Virtually every salesperson will tell you that his or her machine is the best-they're salespeople, and they want your money. Remember, though, it is your money, and you have to make the informed,
educated decision-one that you will no doubt live with for a number of years, given the cost of these machines.
Once you've decided to include Microdermabrasion Light Therapy Combo, you will want to begin evaluating the different types of machines in order to find those that might fit within your budget, space and treatment philosophy. Your decision should be based upon sound judgement and valid information, not, as sometimes occurs, because the machine is the least expensive, the "cutest" or the salesperson was the most persistent.

Avoiding pitfalls in choosing machines
Someone else cannot tell you which machine is the best for you or your facility, since only you can decide that. Listed below, is a compilation of suggested questions to ask both yourself and the sales representative who demonstrates the unit:

Does the machine have disposable crystal and waste container jars?
This type of feature is available on many machines today, and is an important aspect to consider for reducing the amount of ambient dust you are exposed to on a day-to-day basis. The "pouring and dumping" or crystal into fixed containers is the prime exposure point for the professional, and you can generally obtain this information by simply asking the sales representative. (We'll touch more on crystal issue later.)

Does the machine have viral filters? If so, what size?
.1 micron filters will keep outside viruses from invading clean crystal or the internal machinery from the air filtered through the machine. HIV and hepatitis C exposure is not as rare as it once was, and many clients may not even be aware of their infection. Using “universal precautions," even in a spa or salon setting, is mandatory for the protection of you and your staff. The hepatitis C virus can exist outside the body for up to seven days-longer even than the HIV virus. The medical and legal communities have an acronym for this "C.Y.A," it only makes sense!

Does the machine have separate vacuum and crystal controls?
This is a feature that some of the newer manufacturers have implemented and many people like the option, because you can reduce the amount of vacuum while maintaining a slightly higher level of crystal flow. This can be advantageous when treating the more delicate tissues of the neck and eye area, or for treatments on clients with mild telangiectasias. At least one of the machines available has been engineered so as to maintain sufficient crystal flow when the vacuum has been reduced, although this is certainly not the case with all of them. This is something to test when you have the demo in office.

In training
How much training is provided upon purchase?
Will you really want to settle for three to four hours of training from a sales rep who isn't necessarily a licensed esthetician, or will you demand a more thorough instruction of your staff-requiring that they perform a certain number of treatments or series on each other before performing treatments on paying clients? Proper certification and training of personnel is key to the success of your Microdermabrasion Light Therapy Combo program and your client's results, and is now required in at least one state (Ohio) .The training should include how to conduct a thorough consultation and how to educate the client on the realistic expectations for Microdermabrasion Light Therapy Combo treatments. Recognizing if a client is an appropriate candidate for the procedure (this includes contraindications) is extremely important, and hands-on training for the proper and safe technique for the treatment itself should be mandatory. Record keeping, staying within the scope of a treatment's parameters and using the appropriate topical ingredients to maximize results will prevent adverse reactions and ensure return business. This is imperative for the success of your program. Adequate training is of utmost importance and unfortunately the downfall for many of the manufacturers

I think I can
One question that constantly comes up is ”Who should be performing Microdermabrasion Light Therapy Combo exfoliations?" Commitment to thorough hands-on training for any procedure, including Microdermabrasion Light Therapy Combo, follows my belief that only licensed estheticians or cosmetologists, with advanced skin care training, who are adequately trained and certified should perform these types of enhancing treatments. This ensures that your facility, whether it is a salon, spa or physician's office, is providing the best possible service to your clients and that they are obtaining the optimal results achievable.

Length of warranty
Is there an extended warranty available?
As with most electronic gadgets. There is an "infant mortality” rate wherein most problems usually present themselves early-on as opposed to later. These machines are really glorified vacuum cleaners-yes, really! Most likely, the mechanical problems you will encounter will have to do with the amount of humidity in the air and crystal clogging, which a service technician can usually address over the phone.

Are loaners available if repair is necessary? There is usually a 24 to 48 hour turnaround time for this type of service. Unless there is a sales representative in your area who can bring a loaner to your facility immediately, you will undoubtedly end up either cancelling Microdermabrasion Light Therapy Combo appointments, or attempting to placate the clients with a different type of exfoliation treatment.

Pieces and parts
What types of handpieces or tips are provided?
Disposable tips?
Sanitizable handpieces or tip?
Handpiece comfort is important-you will be handling these on a day-to-day basis, and they must not create undue hand fatigue or possibly scratch the client's skin! Some metal tips are softer than the crystal itself, and may leave slightly blue-gray streaks on the client's skin, which calls for the creation of a feasible explanation when the client asks why they have an interesting gun-metal gray cast to their skin. Most plastic tips are meant to be disposable, although many salons (and physician's offices), to be economical, simply sanitize and reuse them. Caution here is necessary, as many of these plastic tips can sharpen much like the older glass handpieces, and can become uncomfortable or possibly dangerous to use. It is mandatory that you check each tip before use on a client. Handpieces that are entirely sanitizable are also available and you just need to make sure that they are completely dry inside after sanitizing. To do this, you can spray a shot of "canned air" through the orifice. Disposable tips should be included in the disposable cost per treatment

Disposable income
Are disposable filters necessary?
Some machines still require disposable filters that must be cleared ("knocked out") after every two or so treatments and disposed of after 10 to 12 treatments. This increases the potential for exposure to airborne viruses and these filters should be handled with adequate protection such as gloves, masks and eye protection. Filters must also be included, when you consider the cost of disposables.

What is the cost for disposables per treatment (crystal, tips. filters, tubing)? This is the figure that many people do not think about in the excitement of looking at machines. Filters, handpieces and tips have been mentioned before, but a reminder that regular servicing of the tubing carrying the crystal is also important and should be inquired about.

Crystal will no doubt be your largest disposable expense, and can be purchased from the manufacturer, which also provides an added income for them. In fact, most manufacturers insist that the warranty is null and void if you use any crystal but theirs during the life of the warranty. Some machines require large filters (they look like nicely painted auto oil filters) to hold the waste crystals. These filters must be replaced at the same time you replenish the new crystal. This type of system can possibly incur more cost, so be sure to inquire.

Trying to economize on crystal is frequently akin to cutting off your nose to spite your face. There are a number of corundum suppliers advertising extremely low prices for crystal. However, some machines do not work well with crystal that was not specifically milled for that machine. Yes, there are differences in the grit and micron sizes and there are three grades of crystal: industrial, professional and pharmaceutical grades. The grades are a function of purity, with the type used for Microdermabrasion Light Therapy Combo being approximately 98.9 percent pure and pharmaceutical grade being 99.9 percent pure. Keep in mind that there is no "medical" grade of crystal, per se; this is a marketing ploy, pure and simple.

The pharmaceutical grade is used in toothpaste, antiperspirants and products that are ingestible in nature and is extremely expensive. However, purity of the crystal is of great importance, as the impurities in the industrial grade variety will be uncomfortable upon impact on the skin and we really do not want to expose those substances to the clients skin. "Sterile" crystal is also available. However, my question to the spa and salon industry is why would you need that? It's an unnecessarily added expense because legally, you should not be performing any treatments necessitating the use of sterile crystal, besides, once you open that jar to put the crystal in the machine, it is no longer sterile! (Even more on crystal later.)

Lights and gauges What do you need in terms of vacuum gauge or LEDs or light functions?
The vacuum gauges on the machines vary in their readings and settings. It can sometimes be difficult to record exactly what parameters were used in a particular treatment on a client, until you become extremely familiar with your machine. Accuracy In recording the vacuum/crystal levels is necessary and extremely important to determine tile progressiveness for future treatments. Numerous manufacturers now have LEDs or light gauges to indicate crystal or vacuum flow, and these can make recording progress in the client's chart much easier. They can also facilitate precision in changing the vacuum/crystal flow for the different areas of the face while doing the actual treatment.

Weight
The portability of the machine can be a major issue, especially if you have smaller treatment rooms or multiple users. Larger, more cumbersome machines obviously must be assigned to a particular room which could be inconvenient for staffing and scheduling, or placed on a dedicated rolling trolley. Keep in mind that bigger and more powerful is not necessarily better when it comes to Microdermabrasion Light Therapy Combo equipment.

Humidity and clogs
Can the machine be used in the same treatment room as a steamer? This is a real issue in a spa setting. There is frequently much humidity in a spa because of therapy tubs, vichy showers and steam rooms, not to mention the in-room steamers. All of the crystals used by Microdermabrasion Light Therapy Combo machines are hydrophilic, which means they love water, hence the clogging problem battled by most of us in the treatment room. Some machines combat this by including a heater within the system that must be left on at all times. Others have changed the way the crystal is fed to the tubing, ensuring that it is free from clogs before it gets to the handpiece. In Arizona, we don't have too much of a clogging problem. since it is a dry heat, but for others of you in the South, or the Pacific Northwest, this is a real concern that must be addressed when considering a Microdermabrasion Light Therapy Combo machine.

The aluminum oxide controversy
One of the issues that you will most certainly encounter when you investigate the different machines will be the aluminium oxide controversy and debates on its use verses the use of sodium chloride, sodium bicarbonate (salt/baking soda) or no crystal. Each person must make his or her own decision regarding the machine that he or she chooses to purchase. However, it is wise to make sure your homework is done before the sales representatives come calling.

Aluminium oxide is an inert substance, it is insoluble in water and organic substances, and its melting point is 2000 degrees centigrade. MSDS indicate that it is non-carcinogenic and non-toxic for ingestion. It is an irregularly shaped crystal, and the next hardest substance to diamonds, which makes it an excellent substance for exfoliation.
Both sodium chloride and sodium bicarbonate are soft, regularly-shaped, water-soluble crystals. While this makes it relatively easy to clean up after treatments, this means that the “abrasive" power is approximately 25 percent that of aluminum oxide The velocity of these crystals hitting the skin must be increased in order to obtain as even an exfoliation as one might get with aluminum oxide. Most recipients find that these alternative crystals are significantly more uncomfortable during treatment because of this increased impact.

The machines that utilize diamond chips in and around the orifice of the handpieces obviously use no loose crystals and this is certainly to their benefit, with some claiming that these machines are gentler than the crystal machines. Obviously, sales representatives techniques and training are key with any machine, but some industry experts have concerns regarding these handpieces. These units appear to have the potential to abrade in a manner similar to the traditional dermabrasion systems and when demonstrated, the vacuum can be quite uncomfortable, leaving red scratches on the skin for up to 48 hours.

Some machines can use either aluminum oxide crystals or salt or baking soda. This is a choice that you must make for yourself; however, as a reminder;

1. Aluminum oxide has been used in the dental industry for more than 60 years as an alternative to drilling teeth because it does not create heat. This is crystal that has been applied directly into the mouth.
2. The studies presented to support the possible toxicity of aluminum oxide dwell, for the most part, on aluminum (bauxite). (Mine workers. who developed health problems were exposed to a significant amount of bauxite dust over a period of about 20 to 30 years-which was inhaled without the use of OSHA mandated respirators. Toxicity of sodium chloride and sodium bicarbonate would be of concern to clients or patients who are hypertensive, as these substances, while admittedly easy to clean up, dissolve upon contact with liquid, and could then be absorbed through the epidermis and create unwanted reactions systemically
3. All particulate dust-including acrylic nail dust, salt, baking soda and even flour dust-inhaled over time without the benefit of masks or other protection, can and will create respiratory problems. Common sense must prevail and the use of gloves, particulate masks and eye protection is a must if you pour any crystal into containers and during clean up.

It is strongly recommended that-once you've decided on your top three or so picks-you request that the sales representative leave the machine in your office for a day so that you can check out clogging issues without someone hovering over your shoulder. Alternatively, you can ask for side-by-side demos of your choice picks. You can then experience for yourself how noisy each machine may be in your treatment rooms, have your staff test the comfort of the handpiece in their hands, along with the ease of crystal replacement and disposal, and how much of a mess each machine makes. Perform treatments on your staff, and each other so that you can see how several skin types respond and judge comfort levels, as well. These are only a few of the many questions you should ask.

The bottom line: In every instance, for you as a spa owner, manager, physician or esthetician, it is the client's safety and well-being that is of utmost concern. The professional must be appropriately trained to understand skin conditions, how to treat ethnic skin and on which clients to avoid treatments. In addition, the professional must also understand how to handle adverse reactions. And must be taught to protect themselves from undue exposure to ambient dust and pathogens. Making sure that your professionals are trained and perform within the scope of their licensing is your very important job. .

Laura Root, a licensed esthetician in both Arizona and Oregon, is a CIDESCO diplomate, and has published a manual for the esthetics industry about Microdermabrasion Light Therapy Combo. She established two-day, non-manufacturer sponsored Microdermabrasion Light Therapy Combo classes through Esthetics Education Resource. For further information, Root may be contacted via e.mail at lIroot@home.com or through www.medical-esthetics.com

Learning to recognize who is and who is not a good candidate for micro-
dermabrasion is an important part of training.

Any particulate dust-including acrylic nail dust, salt. baking soda and even flour dust-inhaled over time without the benefit of masks or other protection, can and will create respiratory problems.