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Perform an aesthetic consultation, and review the patient’s medical history (see Aesthetic Procedures Introduction).
Obtain informed consent (see Aesthetic Procedures Introduction).
Take pretreatment photographs (see Aesthetic Procedures Introduction).
Prophylax with an oral antiviral medication such as acyclovir or valacyclovir if there is a history of herpes simplex or zoster in or near the treatment area for 2 days prior to procedure, and continue for 3 days postprocedure.
Prior to MDA, patients should avoid chemical peels, dermal filler injections, waxing, and direct sun exposure for 2 weeks; discontinue use of products containing retinoic acid or alpha-hydroxy acids (e.g., glycolic acid); and avoid botulinum toxin injections for 1 week.
MDA device with abrasive element (e.g., crystals, diamond tips). Aluminum oxide is the most commonly used crystal and is ideal for MDA because it is inert and second only to diamonds in hardness. Other crystals used include sodium chloride, sodium bicarbonate, and magnesium oxide. Crystal-free MDA devices have become popular because of the lack of dust and associated risks of ocular injury. Diamond-tipped devices employ diamond-tipped pads as the abrasive element and can be used with topical solutions for dermal infusion.
Facial wash and astringent to cleanse and degrease the treatment area.
Towel to drape the patient.
Eye protection for the patient with small goggles or moist gauze.
For crystal MDA devices, the operator should use clear goggles for eye protection and a mask to reduce particle inhalation.
Gauze, 4 × 4 inches
Physical sunscreen (with zinc or titanium) and a soothing moisturizer for postprocedure application.
Rough texture, enlarged pores
Superficial acne scarring
Rosacea and telangiectasias
Enhanced penetration of topical products
Active infection in the treatment area (e.g., herpes simplex and verrucae)
Melanoma or lesions suspected of malignancy
Isotretinoin (Accutane) use in the past year
Dermatoses (e.g., eczema and psoriasis)
Rosacea and telangiectasias (not recommended with crystal MDA)
Papulopustular acne (not recommended with crystal MDA)
Very thin skin or excessive laxity and skin folds
PITFALL: Treatment of papulopustular acne and rosacea are contraindicated with crystal MDA devices.
Pearl: Two passes with the SilkPeel using a 60-grit treatment head and vacuum setting of 5 psi (260 mm Hg) penetrates to 30 to 35 μm and will fully remove the stratum corneum.
Pearl: Two passes with most aluminum-oxide crystal MDAs using a vacuum setting of 4 psi (200 mm Hg) will fully remove the stratum corneum.
PITFALL: Greater depths of penetration have greater potential for improvements but are also associated with greater complication risks. Once the dermis is breached, which is typically evident as bleeding, scarring becomes a consideration.
Pearl: With the SilkPeel, most treatments can be performed with the 100-grit head. Hyperkeratotic areas such as elbows and knees respond well to a coarser, 60-grit head. The lips can be treated with the smooth head.
PITFALL: Treatment of the lips is contraindicated with crystal MDA.
Pearl: The SilkPeel vacuum should be set at 3.5 to 4 psi (180 to 200 mm Hg) for treatment on the face and chest, 2.8 to 3 psi (145 to 155 mm Hg) for the neck, and 5 to 6 psi (260 to 310 mm Hg) for the hands and back. For crystal MDA devices, initial treatment vacuum settings range from 50 to 200 mm Hg and are device dependent.
Pearl: Patients with higher Fitzpatrick skin types are more prone to prolonged postinflammatory erythema PIH, and the lower limits of the range for vacuum settings should be used.
PITFALL: Devices utilizing simultaneous dermal infusion are associated with less discomfort. Patients may experience superficial abrasions without reporting pain during treatment, and patient feedback may be a less reliable indicator of treatment intensity. Observation of tissue response is therefore particularly important in determining vacuum settings with dermal infusion devices.
Pearl: Two topical solutions may be used during a treatment, for example, to address dehydration and hyperpigmentation.
Pearl: Typical SilkPeel dermal infusion rates range from 15 to 20 mL/min (see Step 5).
PITFALL: Petechiae or pinpoint hemorrhages indicate that the settings are too intense and must be reduced.
Pearl: Reduce treatment intensity near thinned skinned areas such as the periorbital area. With the SilkPeel, reduce the vacuum pressure to 2.8 to 3 psi (145 to 155 mm Hg).
PITFALL: With crystal MDA, do not leave the hand piece in one spot because this will increase abrasion depth and may cause injury to the skin.
Pearl: Acne scars require more aggressive treatments. With the SilkPeel, a 100-grit head with 6 psi and up to four passes cross-hatched over the area may be performed.
Pearl: If using a crystal MDA, remove all crystal debris from the face with moist gauze prior to product application, paying close attention to the periorbital area.
Activation of herpes simplex
Pain or temporary discomfort
Prolonged irritation and/or erythema
Postinflammatory hyperpigmentation (increased risk with high Fitzpatrick skin types)
Petechiae or purpura
Urticaria (with crystal MDA)
Remote possibility of scarring
Aesthetic Technologies/Parisian Peel (crystal MDA and diamond-tipped MDA), EC-34, Sector I, Salt Lake City, Kolkata 700 064, India. Phone: 408-464-8893. Web site: http://www.mmizone.com/public/web/default.htm.
Cosmetic R & D (dermal infusion and other abrasives), 4125 Pine Crest Court, Rocklin, CA 95677. Phone: 916-632-9134. Web site: http://dermasweep.com/.
Edge Systems (crystal MDA and diamond-tipped MDA), 2277 Redondo Avenue, Signal Hill, CA 90755. Phone: 1-800-603-4996. Web site: http://www.edgesystem.net/microdermabrasion.htm.
emed (dermal infusion and diamond-tipped MDA), 31340 Via Colinas, Suite 101, Westlake Village, CA 91362. Phone: 1-888-848-3633. Web site: www.silkpeel.com.
DermaMed International (crystal MDA), 394 Parkmount Road, P. O. Box 198, Lenni, PA 19052. Phone: 1-888-789-6342. Web site: http://www.megapeel.com/.
Lumenis (crystal MDA), 5302 Betsy Ross Drive, Santa Clara, CA 95054. Phone: 408-764-3000. Web site: http://www.lumenis.com/wt/home/home/?flash=true.
Mattioli Engineering (crystal MDA), 7918 Jones Branch Drive, Suite 600, McLean, VA 22102. Phone: 703-312-6000, 877-MATTENG. Web site: http://www.matteng.com/pepita.html.
Med-Aesthetic Solutions (crystal MDA and ultrasonic MDA), 2033 San Elijo Ave., Suite 200, Cardiff-by-the-Sea, CA 92007. Phone: 760-942-8815. Web site: http://medaestheticsolutions.com/content/view/7/33/.
RAJA Medical (dermal infusion and other abrasive), 801 South Olive Avenue, Suite 124, West Palm Beach, FL 33401. Phone: 877-880-4184. Web site: http://rajamedical.com/.
Refine USA (dermal infusion, diamond-tipped MDA, and ultrasonic MDA), 13500 Sutton Park Drive South, Suite 701, Jacksonville, FL 32224. Phone: 866-491-7546. Web site: http://refineusa.com/micro-gem.html.
Sybaritic (dermal infusion and ultrasonic MDA), 9220 James Avenue South, Bloomington, MN 55431. Phone: 1-800-445-8418. Web site: http://www.sybaritic.com/.
Syneron (crystal MDA and diamond-tipped MDA), 28 Fulton Way, Unit 8, Richmond Hill, ON L4B 1L5, Canada. Phone: 905-886-9235, 866-259-6661. Web site: http://www.syneron.com/