Disclaimer: In some states, only medical professionals are allowed to perform procedures. Each state has specific governing rules and it is your responsibility to contact the proper governing body for approval before using any of the featured equipment.

 

Histologic Effects of Aluminum Oxide Microabrasion on Facial Skin

JOURNAL OF AESTHETIC DERMATOLOGY and COSMETIC SURGERY
Volume 1. Number 4, 2000 ,
Mary Ann Liebert,. Inc.


Histologic Effects of Aluminum Oxide Microabrasion
on Facial Skin

MARK G. RUBIN, M.D.1, and STEVEN S. GREENBAUM, M.D.2

ABSTRACT

Aluminum oxide crystal microabrasion is rapidly becoming one of the most popular superficial peeling therapies. There is a great deal of anecdotal information regarding what this therapy is capable of doing. However, there is no previously published data showing the microscopic changes that occur with microabrasion. We have examined the depth of injury to facial skin that occurs with microabrasion. In addition, we biopsied the skin of 3 patients before and then after six treatments with microabrasion. The microscopic changes seen with this therapy include a thickening of the epidermis and an increase in superficial papillary dermal collagen.


INTRODUCTION

MICROABRASION (power peeling, derma- peeling, or skin polishing) is a new treatment modality in the United States. It has been used in other countries for about 10 years to treat various skin conditions, including acne, dyschromia, fine wrinkles, acne scars, and stretch marks. Since its introduction to the United States, there have been several authors documenting varying degrees of efficacy. (l,2) However, there have been no published microscopic examinations of treated skin to try to correlate with the clinical changes seen.

Microabrasion is a procedure that consists of stripping off layers of the epidermis using a machine employing airflow and sterilized corundum (aluminum oxide) crystals. The machine is a closed system of airflow generated by the use of compressors and/ or aspirators. Small (100-micron) particles of aluminum oxide are mixed into the airflow, and they are then delivered through a sterilized "U"-shaped handpiece to the surface of the skin. The hand- piece has a small aperture which is rubbed over the surface of the skin. After the particles stream across the skin surface, they are sucked back up into the machine along with the cellular debris. This material is then deposited in a closed receptacle attached to the machine. This material is periodically removed and disposed of as biohazardous waste.

The depth of the abrasion created is dependent on several factors:

  1. The velocity of the air flowing through the handpiece and across the skin.
  2. The amount of abrasive (number of parti- cles/second). This is related to point 1 also.
  3. The number of passes of the handpiece across the surface of the skin.
  4. The thickness of the patient's skin.
  5. The size of the abrasive particle.

The commonly used procedure of microabrasion is performed as a series of treatments performed every 1-3 weeks with the end point of treatment being erythema of the skin. This correlates histologically with the removal of the stratum corneum (and a small part of the superficial epidermis in some patients). Based on this level of injury, this technique should be referred to as microabrasion or microepiderm-abrasion, not microdermabrasion, because the dermis is not being abraded. Although there is some variation in treatment protocols among different practitioners, the average number of treatments per patient is a series of 5-8.

Over the last 18 months, we have used microabrasion to treat dyschromia, acne, actinic keratoses, acne scars, and fine wrinkles. It is easy to understand why this therapy has been successful in the treatment of epidermal lesions, because this technique, like superficial chemical peeling, removes part of the epidermis. However, the improvement seen in some wrinkles and scars is markedly better than would be expected from a purely epidermal treatment. These clinical signs imply that there are some dermal changes occurring as well.

In an effort to evaluate the histologic changes seen with repetitive microabrasion, we performed biopsies on 3 patients before treatment and after six microabrasions. The patients were 2 females (ages 29 and 64) and 1 male (age 31).
All 3 patients had a 2-mm punch excision taken from the right preauricular area prior to any treatment;. They had not used any topical skin care products for at least 6:weeks prior to their biopsy. They were instructed to use a bland cleanser and moisturizer after each microabrasion treatment and for the continuation of the study. After their biopsy, each patient received 6 weekly microabrasion treatments to the full face. One week after the final treatment, another 2-mm punch biopsy was taken 0.5 cm from the original biopsy in the right preauricular area.

Each treatment consisted of three passes of the microabrader on the first treatment and, then an increasing number of passes with each subsequent treatment. Treatment was limited by the appearance of significant erythema or patient discomfort. The average treatment consisted of five passes. All patients had some degree of erythema for 12-24 hours after each treatment. In addition, 1 patient had a biopsy performed immediately after treatment with five passes of the handpiece. This biopsy identifies the microscopic depth of the treatment.

RESULTS

Biopsies from all of the patients showed the following changes: 1. a normalization of the stratum corneum; 2. epidermal thickening; and 3. increased collagen deposition in the papillary dermis.

DISCUSSION

Previous authors have shown that repetitive abrasion of the skin with a cleanser containing aluminum oxide granules created similar changes in the epidermis to those we have seen with aluminum oxide microabrasion. (3) In addition, Collins showed that repetitive intraepidermal peels with low-concentration TCA created new collagen deposition in the papillary dermis. (4) Finally, Tsai et al. showed "slight fibrotic changes in the upper dermis" in a patient following a series of microabrasions. (5)
Our findings certainly agree with those previously reported. Repetitive intraepidermal injury has the ability to improve a photo damaged epidermis gradually. Additionally, through an unidentified pathway, these intraepidermal injuries stimulate changes in the dermis leading to increased fibroblast activity and new collagen deposition.
This study, although small, documents some of the histologic changes seen with a series of microabrasion therapies. On the basis of the histologic changes seen with this therapy, the clinical improvement we and others have seen would be expected. What is interesting to keep in mind is the idea that a dermal wound is not necessarily needed to create dermal changes.

REFERENCES

1. Hopping, S.B.: The power peel: Its emergence and future in cosmetic surgery .Int J Cosmetic Surg 1998-1999; 6: 98-100.
2. Newman, J. et al.: Power peeling (micro skin abrasion). Int J Cosmetic Surg 1998-1999; 6: 101-105.
3. Marks, R, Hills, S., Barton, S.: The effects of an abrasive agent on normal skin and on photodamaged skin in comparison to topical tretinoin. Br J Dermatol 1990; 123: 457.
4. Collins, P .: The chemical peel. Clin Dermatol 1987; 5: 57-74.
5. Tsai, R Y., Wang, C.N., and Clan, H.O.: Aluminum oxide crystal microdermabrasion. Dermatol Surg 1995; 31: 539-542.

Address correspondence to:
Mark G. Rubin, M.D.
201 S. Lasky Drive
Beverly Hills, CA 90212