1. Dermal infusion
can be tailored to
the individual
patient and can
be used when
conventional
microdermabrasion
is contraindicated
Skin Management:
A Practical Approach
by Lawrence S. Moy, MD, with Catherine Maley, MBA
A
lthough traditional particulate majority of them noninvasive.3 It also esti- Each solution to be infused is selected
microdermabrasion is widely used, mates that the Baby Boomer population specifically for the patient’s underlying
health risks, including pulmonary and America’s “makeover” culture may condition. The vacuum and flow rate are
inhalation and eye irritation, are areas of have increased that number to $20 billion carefully regulated (Figure 1). The slow,
concern. The skin is abraded with a by the end of 2006. Every year, the even strokes used in the treatment allow
stream of crystals, such as aluminum American Society of Plastic Surgeons’ for the ancillary benefits of lymphatic,
oxide sapphire, that are delivered under statistics show that microdermabrasion is muscle, and motor-nerve point stimula-
pressure across the face to remove the one of the top five noninvasive procedures tion.
upper dermal layer. Studies have shown performed. Dermal infusion allows maximal
that microdermabrasion is a superficial Suffice to say, there is a huge demand delivery of the agents for treating acne,
peel that can be repeated at 2-week inter- for noninvasive “lunchtime” methods for pigmentation, aging, and rosacea.2 For
vals because the skin recovers histologi- skin rejuvenation with little to no down- optimum results, and depending on the
cally within 1 to 4 days.1 time, especially if those procedures are patient’s skin condition, four to six treat-
Microdermabrasion works for many customized to patients’ individual skin ments can be performed every 2 weeks,
skin ailments, but it has its limitations. It concerns. Dermal infusion offers that cus- followed by monthly maintenance treat-
is contraindicated in patients with active tomized rejuvenation.
skin infections, such as flat warts, impeti-
go, and herpes simplex. Patients with How It Wo rks Before & After
malignant skin tumors involving ker- The patented handpiece
atoses or other specific keratoses, or consists of an interchangeable
those who have used isotretinoin within treatment head containing
the past year, also should not be treated medical-grade diamonds in
with microdermabrasion.2 one of several grit sizes
Enter dermal infusion, or “wet micro- embedded in a translucent
dermabrasion,” an innovative procedure plastic tip. When the hand-
that provides noninvasive exfoliation and piece is brought into contact
delivers skin-specific topical solutions with the skin, a vacuum is
under pressure to treat such concerns as formed that functions to pull
rosacea, dehydration, acne, and post- the tissue through the plastic
inflammatory hyperpigmentation. tip and into contact with the
treatment head. As the hand-
The Market Demand piece is drawn over the skin,
This 20-year-old patient with serious type 2 acne received six
Business 2.0 magazine reports that the treatment head simultane- dermal-infusion treatments, each 2 weeks apart. He is shown
Americans spent more than $12.5 billion ously exfoliates and infuses before the first treatment and immediately after the final treat-
in 2005 on aesthetic procedures, the the condition-specific serums. ment. Courtesy of Gideon Kwok, MD.
PlasticSurgeryProductsOnline.com January 2007

2. Skin Management: A Practical Approach
ments. The treatment is safe and painless, even abrasion with similar depths of lary dermis also demonstrates edema
and results are visible immediately as well effect. Histologic studies revealed a uni- around the collagen fibers and around the
as over time. form, even abrasion to the depth of 30 to vascular structures.
Microdermabrasion is often too 35 micrometers (Figures 2 through 6). The “Traditional microdermabrasion is
aggressive for acne-prone or sensitive abrasion was maintained in the granular limited to mildly exfoliating the epider-
skin, whereas dermal infusion is so unob- layer of the epidermis. The majority of the mis. Microdermabrasion is analogous to a
trusive that even dry skin, a contraindica- epidermal integrity, including the base- superficial peel in both depth and compli-
tion for particulate microdermabrasion, is ment membrane and superbasal layer, re- cations. Microdermabrasion can be
effectively treated. mained intact. Treated areas demonstrated repeated at 2-week intervals because the
regrowth of the superficial epidermal lay- superficial epidermis recovers within 1 to
A Dermal-Infusion Study ers within 2 days. 4 days.1 Studies with dry, crystal micro-
To better understand the differences “Patients in the study also received dermabrasion done weekly demonstrate
between traditional microdermabrasion immediate exposure of the abraded skin histologic and microscopic improvement
and dermal infusion, I conducted a histo- to the fluid, demonstrating an interesting in photoaging and intrinsic aging.4,5 The
logical observational study. effect. The keratinocytes show marked aforementioned studies illustrate that skin
The dermal-infusion technique was swelling from hydration. The upper papil- texture, pigmentation, skin atrophy, oili-
studied on volunteers ness, dilated pores, laxity,
who were preparing for and telangectasias can be
elective facelift proce- improved with weekly
dures. Each patient was microdermabrasions.
pretreated 1 to 3 days “The dermal infusion
before the procedure. system provides the effi-
The preauricular area cacy of the traditional
was treated with the der- microdermabrasion. It
mal-infusion system. provides the soothing
The skin was carefully effects of a delivery sys-
marked and treated as tem that reduces irritation
outlined below. Figure 1. Handpiece in contact with the Figure 2. Dermal infusion provides uniform and erythema while deliv-
During the facelift skin with the effect of even abrasion, fluid abrasion to the depth of 30 to 35 µm within ering solutions that treat
flow, and vacuum. The skin is brought past the epidermis on preauricular skin. The stra-
procedure, the dermal the diamond fraise in the presence of the tum corneum is removed, and portions of the and may prevent progres-
infusion–treated skin fluid. Courtesy of Emed Inc. granular layer are also removed in sections. sion of the underlying
was dissected away. The condition. The effects are
sampled area was placed both efficacious and aes-
into bottles with 10% thetically elegant.
formalin. The tissue “The innovative der-
samples were sent for mal infusion system with
preparation processing the patented, multi-
by embedding onto dimensional handpiece
paraffin sections and minimizes or eliminates
sectioning with a micro- all of the potential com-
tome. The sections were plications such as irrita-
then stained for hema- tion, erythema and xero-
toxylin and eosin. The Figure 3. Vacuolization of the keratinocytes Figure 4. In specific sections, there is sis that often arise from
specimens were evaluat- and margination of the nuclei. This effect is regrowth of the granular layer and the stra- traditional microderma-
consistent with rapid hydration of the ker- tum corneum. Edema of the papillary der-
ed by a dermapatho- atinocytes. mis is resolving. brasion, chemical peels
logist. A calibrated and other exfoliative pro-
micrometer was used to cedures.”
measure depths of effect
from treated tissue. What the Study
Shows
Study Results The study proves that
I reported the fol- dermal infusion is a safe
lowing in this unpub- procedure for lightly
lished study: “The abrading the skin and
results showed patients allows for even treatment
achieved immediate, across the facial skin.
optimum results. The Figure 5. The edge of treatment for dermal Figure 6. Wide spaces between the collagen Dermal infusion can
results demonstrated infusion (right) and untreated epidermis (left). bundles and swollen vascular structures be used with various solu-
that the dermal infusion The hydration effect is dramatically shown demonstrate papillary dermal edema. tions for ideal treatments.
by the enlarged keratinocytes with the dis- Dermal edema was present after 1 day, sug-
system evenly abrades placed nuclei on the treated areas compared gesting solution delivery to the papillary It allows maximal deliv-
the superficial epider- to the untreated areas. Also, the rapid hydra- dermis. Histology images courtesy of Law- ery of the agents for acne,
mis. All of the reviewed tion effect has increased the dermal-infu- rence S. Moy, MD.
sion-treated epidermal thickness by 70%.
pigmentation, and aging.
specimens demonstrated These solutions greatly
PlasticSurgeryProductsOnline.com January 2007

3. Skin Management: A Practical Approach
increase the efficacy of the procedure. introduced for wound healing, photo- Catherine Maley, M BA, is president
The histology demonstrates an ideal, damage, and acne treatment. A trend and senior marketing strategist of
immediate delivery of active solutions toward using these light-based systems Cosmetic Image Marketing in San
in combina- Francisco. Her firm specializes in
tion with helping aesthetic practices grow using
Before & After
microderma- public relations, advertising, and
brasion is also strategic marketing strategies. She can
emerging. be reached at (866) 563-3332 or via
Dermal her Web site, www.cosmeticimage mar-
infusion is the keting.com.
latest innova-
tion in the References
area of micro- 1. Hernandez-Perez E, Ibiett EV. Gross and
microscopic findings in patients undergoing
dermabrasion microdermabrasion for facial rejuvenation.
This 38-year-old patient with postinflammatory hyperpigmentation received and has posi-
eight dermal-infusion treatments, each 2 weeks apart. She is shown before the Dermatol Surg. 2001;27:637–640.
first treatment and immediately after the final treatment. Courtesy of Gregory tioned itself 2. Desai T, Moy L, Kirby W, et al. Evaluation of
Keller, MD. as an effective the SilkPeel™ system in treating erythema-
and proven totelangiectatic and papulopustular rosacea.
Cosmetic Dermatol. 2006;19: 51–56.
for treatments. Removing the stratum clinical procedure in the aesthetic
3. Esfahani E. The new skin trade. Business 2.0.
corneum and the upper layer of the gran- world. Research is under way to find February 5, 2006. Available at:
ular layer removes the Odland bodies.6 many exciting new developments and http://money.cnn.com/magazines/business2/
Odland bodies are impacted membrane applications for the dermal-infusion business2_archive/2006/01/01/8368124/
bodies that are compressed membrane system. PSP index.htm. Accessed December 4, 2006.
materials residual from cell organelles. 4. Coimbra M, Rohrich RJ, Chao J, Brown SA.
A prospective controlled assessment of
Odland bodies are an important barrier Lawrence S. Moy, MD, is a cosmetic
microdermabrasion for damaged skin and
that functions to limit transepidermal dermatologist who practices in Man- fine rhytides. Plast Reconstr Surg.
water loss.4,7 By temporarily lifting off hattan Beach, Calif. He is currently on 2004;113:1438–1443; discussion 1444.
the Odland bodies, the cells undergo staff at UCLA Medical Center in Los 5. Karasiuk KB, inventor; Emed Inc, assignee.
hydration. Angeles and at Harbor-UCLA Medical Microdermabrasion system and method of
Additional studies are currently Center in Torrance, Calif, and teaches use. US Patent 6 695 853. February 24, 2004.
6. Svane-Knudsen V, Halkier-Sorensen L,
under way to determine the efficacy of residents from the Western University Rasmussen G, Ottosen PD. Altered perme-
exfoliation and infusion of skin-specific College of Osteopathic Medicine in ability barrier structure in cholesteatoma
topicals for other skin concerns such as Pomona, Calif. His dermatological prac- matrix. Eur Arch Otorhinolaryngol. 2002;
psoriasis and eczema. In other advances, tice emphasizes cosmetic surgeries and 259:527–530.
new light-based diode systems with hand- procedures as well as general dermatol- 7. Shpall R, Beddingfield FC, Watson D, et al.
Microdermabrasion: A review. Facial Plast
pieces that emit red (600-nm to 700-nm) ogy. He can be reached at (310) 546-
Surg. 2004;20:47–50.
as well as blue (430-nm) light have been 7780.
(#13777) Reprinted with permission. “Skin management: A Practical Approach,” Plastic Surgery Products,
January 2007, Pages 24-28.