Microdermabrasion: a clinical and histopathologic study

BACKGROUND

Microdermabrasion is a widely performed skin rejuvenation procedure. Few studies have examined its efficacy.

OBJECTIVE

To evaluate the clinical and histopathologic effects of microdermabrasion.

METHODS

Fourteen patients underwent microdermabrasion treatments over 12-14 weeks. Self-rated questionnaires were given before and after the treatment series and were evaluated by a paired t-test. Three of the 14 patients were treated for moderate to severe acne scarring. Acute histologic effects were assessed ex vivo on human abdominal skin. Chronic histopathologic effects were examined in three volunteers who underwent skin biopsies before and after a treatment series on the dorsal forearms.

RESULTS

By patient assessment, there was statistically significant improvement in roughness, mottled pigmentation, and overall improvement of skin appearance, but not in rhytides. Acne scarring sometimes improved, but required deeper ablation. Acutely the stratum corneum was homogenized and focally compacted. Chronically there was epidermal hyperplasia, decreased melanization, and some increase in elastin.

CONCLUSION

Microdermabrasion improves some aspects of photoaging and select cases of acne scarring.

Nonablative skin remodeling: selective dermal heating with a mid-infrared laser and contact cooling combination

BACKGROUND AND OBJECTIVE

Many of the microscopic changes associated with photodamage reside in the dermis. It follows that subsurface heating of the skin might allow for cosmetic enhancement without loss of the epidermis. Accordingly, we investigated the clinical and microscopic changes produced by a mid-infrared laser coupled with a contact cooling device.

STUDY DESIGN/MATERIALS AND METHODS

Nine patients were treated with an erbium glass laser and sapphire cooling handpiece in contact with the skin. Postauricular sites were irradiated with pulse energies varying from 400-1,200 mJ and numbers of pulses from 4 to 40. Outcome measures included pain, edema, and erythema at predetermined postoperative intervals. Biopsies were performed just after treatment and 2 months postoperatively for selected pulse energy-pulse number combinations.

RESULTS

Erythema, edema, and pain increased with pulse energy and number of pulses. Likewise, immediate epidermal necrosis and subsequent scarring were observed for larger pulse energy-pulse number combinations. At sites with epidermal preservation, on biopsy, immediate dermal thermal damage was observed in a band-like pattern. The deep boundaries of this band were dependent on pulse energy and pulse number. After 8 weeks, biopsies showed dermal fibroplasia roughly correlating to the band of immediate dermal thermal damage.

CONCLUSION

Selective dermal heating can be achieved with a mid-infrared laser coupled to a contact surface cooling device. In this study, the range of fibroplasia and lack of clinically substantial cosmetic enhancement suggest that the dermal thermal damage achieved may be too deep and that the injury should be confined to more superficial levels to alter the most severely photodamaged dermis. Lasers Surg. Med. 26:186-195, 2000. Published 2000 Wiley-Liss, Inc.

The effect of wiping on skin resurfacing in a pig model using a high energy pulsed CO2 laser system

BACKGROUND

The impact of wiping in laser skin resurfacing has not been systematically studied.

METHODS

We examined the effects of wiping during single- and multiple-pass high energy pulsed CO2 laser skin resurfacing in a farm pig. Consequences of wiping were evaluated with regard to depth of residual thermal damage, tissue necrosis, and fibroplasia. Also, the impact of wiping on gross wound healing was observed. Wounds were followed for 21 days and biopsies were obtained on postoperative days 0, 1, and 21.

RESULTS

Immediate postoperative biopsies of single-pass wounds showed equivalent residual thermal damage regardless of wiping; in contrast, biopsies from multiple-pass sites without wiping showed more extensive and variable residual thermal damage than wiped sites. On postoperative day one, single pass sites without wiping were grossly less erythematous than wiped sites, and biopsies showed less extensive necrosis and inflammation. In contrast, multiple pass sites without wiping were grossly more erythematous than corresponding wiped sites, and biopsies revealed significantly increased and variable necrosis. After 21 days, multiple pass sites without wiping were grossly more erythematous and showed a thicker band of fibroplasia microscopy.

CONCLUSIONS

For single pass wounds, not wiping decreased the level of wounding. In contrast, not wiping in multiple pass wounds significantly increased the depth and variability of residual thermal damage and necrosis, resulting in prolonged healing.

Gift of life: enhancing the availability of obstetrical care in Alabama

In mid-May, 1988, Montgomery and surrounding counties were dealing with a health care crisis approaching the break-down point. Indigent women were giving birth to about a third of the babies born in the area. Most without the benefit of any prenatal care.