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Dermatologists, aestheticians, and technicians have used microdermabrasion for over 20 years to combat the signs of photo-aging on the skin, provide treatment for acne and discoloration, and minimize the appearance of superficial wrinkles, scars, and stretch marks on the face and body. Experts in the industry continue to make advancements in technology, technique, and sanitation to provide optimal results and protect their clients and staff. As treatments become all too standard, we must ask how much care are we putting into skin care regimens and treatments. It is important to understand the needs, skin types, backgrounds, and daily regimens of clients, otherwise microdermabrasion can be damaging to their skin and diseases may be spread.

Microdermabrasion is a technique that was developed in Europe during the mid 1980s. It involves scraping and sanding of skin on the microscopic level. Essentially the machine blasts crystals onto the skin surface creating microscopic incisions. These incisions cause cellular trauma and force the cells into a regenerative process, resulting in collagen stimulation. However, if pre- and post-procedure regimens and precautions are not assigned, the skin can suffer from over-exfoliation, thus resulting in thinning of the skin, couperose capillaries, or discoloration. Because it works at a superficial level, it can be a precursor to laser treatments.
One of the foremost guides before undergoing microdermabrasion treatments is the clients concern and expectations for their skin care needs. Understanding clients' needs will determine whether this will be the appropriate treatment for them. Microdermabrasion has proven to be effective for skin damage due to photo-aging, superficial scarring, and stretch marks. Photo-aging includes sun damage, fine lines, and discoloration. For clients who are concerned about chronological aging, including loss of elasticity, skin shape, heavy wrinkles, and scarring, or deep puncture scars resulting from acne, it is a possible treatment modality, but other treatments are available that may be more effective for this skin group.
Pre-procedure regimens should be assigned to each client at least two weeks prior to treatment. For example, those suffering from discoloration or melasma should use a bleaching regimen before a procedure. This will assist in suppression of the melanocyte cells and bring the discoloration or the staining of the skin to the surface for a more rapid removal. Remember when dealing with melasma, the area will become darker during treatment because the discolored skin is being drawn to the surface, making it more obvious. Clients must be informed about the procedure and aware of the preventative measures that need to be taken before and after the procedure. Preventative measures include maintaining a daily skin regimen that includes the use of a sun block and keeping up-to-date on follow-up treatments. Obtaining a client history is also necessary before providing any treatment. Key information regarding prescription medication and other conditions can determine which treatment and the frequency of these treatments need to be taken. An example of key information would include hormone therapy, pregnancy, decongestants, allergic reactions or sensitivity to specific ingredients, at home exfoliation such as Retin A™, Renova™, or other AHA use, as well as a family history on keloid or hypertrophic scarring. Normally, it takes four to six bi-weekly treatments to obtain desired results for the client, with monthly maintenance to follow.
Clients and aestheticians should also engage in discussion post-procedure. This is a good way to find out how your client feels about treatment. They must be advised if there needs to be a change in their regimen to allow their skin time to heal. Topical vitamin C (Ester or L-ascorbic acid) and retinol will help stimulate growth and strengthen the skin between treatments. In addition, an AHA such as glycolic acid or corundum-based lotion is beneficial for maintenance in between treatments. However, there must be a balance between home care and treatment so that the skin does not become damaged. The key is moderation both on the part of the aesthetician and the client.
Before administering a microdermabrasion treatment, the clients' skin should be cleansed and contact lenses removed (if applicable). There are several microdermabrasion techniques that have been created and used over its development. Essentially, the machine consists of a closed loop vacuum unit, separate canisters for fresh crystals and waste, and a hand piece. In general, the microdermabrasion machine uses a vacuum and pressure to force the crystals over the surface of the skin. Control of the unit determines the depth of treatment. The rate of movement and the number of passes over the surface area of skin determines the amount and depth of abrasion that occurs. This allows for special care to be taken over problem areas of the skin. Treatments can be enhanced through the use of alpha hydroxy acids, topical vitamin A, or other treatments. Using additional topical treatments allows for greater absorption into the underlying layers of skin and enhanced exfoliation, exposing fresh skin cells and giving a healthy glow to the skin. After the procedure, the resurfaced skin will feel tight and dry. Applying a moisturizer or healing balm can soothe skin.
Traditional microdermabrasion machines use some form of crystal to abrade dead skin cells. The most common type of crystal used is the corundum crystal; also known as aluminum oxide, the second hardest mineral known to man. Corundum is widely used because of its rough, irregular surface, bactericidal property. Additionally, it is hypoallergenic and is not easily absorbed into the skin. These crystal machines will benefit clients that suffer from oily/acneic skin and acne scarring. The inert crystals help in drying excess oils, while the microscopic incisions exfoliate helping to open comedones and remove other impurities of the skin.
Due to the shape and size of crystals, care must be taken to prevent them from entering the eyes and nose, as it could irritate the sensitive tissues inside, or cause microscopic lacerations on the eye. Personal protective equipment such as a mask and protective eyewear is necessary for aestheticians when providing crystal microdermabrasion treatments.
There is an evolving trend from the corundum crystal to the crystal-free microdermabrasion, which uses a diamond (or other materials) tipped hand piece to abrade the skin as opposed to crystals. Control over the intensity of the crystal-free microdermabrasion can be determined by the density of the crystal on the tip of the hand piece and by the rate of movement and number of passes that are taken over the surface area of the skin. This technique is less drying than the traditional crystal technique and therefore is more beneficial when dealing with dry and mature skin types. Crystal-free methods can also assist in the re-introduction of nourishment into the underlying layers of skin.
Innovations in the machine have also led to increased protective measures for the client and the aesthetician. Modern microdermabrasion machines are equipped with either a disposable, one-time use hand piece tip that can easily be disposed of, or an autoclave safe tip for sterilization preventing contaminates. Aestheticians must maintain a clean procedure room and microdermabrasion unit to prevent cross-contamination. Proper sanitation measures are vital before conducting any type of skin care treatment. Failure to practice sanitation measures and recognize skin diseases will result in infection of the aesthetician and/or the client. Occupational Health and Safety Administration (OSHA) Bloodborne Pathogen Standard is something to be recognized by all individuals, especially those who may be exposed to them at work. Bloodborne pathogens are any form of microorganism, such as a bacteria or virus that are carried in the blood and can cause a disease. Human Immunodeficiency Virus (HIV) and Hepatitis B (HBV) are two that are addressed by OSHA. These diseases can be transmitted through mucous membranes of the mouth, nose and eyes, open sores, cuts, abrasions, acne, and simple sunburns and blisters. In addition to bloodborne pathogens, care must be taken to the visible surface of the skin. Normal skin contains a bacteria population and skin diseases include folliculitis, eczema, psoriasis, impetigo, acne, shingles, and warts (to name a few). Aestheticians must be educated in these conditions and recognize a skin problem to provide the proper treatment and take precaution in dealing with these conditions.
Any treatment that is performed needs to be safe for the client, and the aesthetician. Protection and safety is priority for everyone and no one benefits from problems associated with carelessness. Client protection and knowledge is vital in order to provide the best service possible for each individual. Product knowledge and product ingredients are also important information to understand and follow. A combination of product use and treatment can yield the best results or a damaging disaster. There are many factors to be considered during any procedure, and continuous training and development are crucial in maintaining a service standard.

Tina Zillmann is a paramedical aesthetician, having a focus in acne care and light-peeling treatments. She is also the owner of the Skin Rejuvenation Clinique, Inc., a facility that services to pre- and post-operative patients. Zillmann also acts as a national educator for Advanced Rejuvenating Concepts™. Recently, she was the recipient of the Entrepreneur Spirit Award from the National Association of Women Business Owners.

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