| DiamondSkin |
| Volume 36, Issue 10, Pages 529-533 Published Online: 28 Sep 2009 Skin barrier function recovery after diamond microdermabrasion Hei Sung KIM 1 , Sook Hee LIM 1 , Ji Youn SONG 1 , Mi-Yeon KIM 1 , Ji Ho LEE 2 , Jong Gap PARK 2 , Hyung Ok KIM 1 , Young Min PARK 1 1 Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 2 Gowoonsesang Clinic, Skin, Cosmetic Surgery and Aesthetic, Seoul, Korea Correspondence to Young Min Park, M.D., Department of Dermatology, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Copyright © 2009 Japanese Dermatological Association KEYWORDS diamond microdermabrasion • skin barrier • skin resurfacing ABSTRACT Microdermabrasion is a popular method for facial rejuvenation and is performed worldwide. Despite its extensive usage, there are few publications on skin barrier change after microdermabrasion and none concerning diamond microdermabrasion. Our object was to see changes in transepidermal water loss (TEWL), hydration and erythema of the face following diamond microdermabrasion. Twenty-eight patients were included in this spilt face study. TEWL, stratum corneum hydration and the degree of erythema were measured from the right and left sides of the face (forehead and cheek) at baseline. One side of the face was treated with diamond microdermabrasion and the other side was left untreated. Measurements were taken right after the procedure and repeated at set time intervals. Diamond microdermabrasion was associated with a statistically significant increase in TEWL immediately after the procedure and at 24 h. However, on day 2, levels of TEWL were back to baseline. An increase in hydration and erythema was observed right after microdermabrasion, but both returned to baseline on day 1. The results show that skin barrier function of the forehead and cheek recovers within 2 days of diamond microdermabrasion. Diamond microdermabrasion performed on a weekly basis, as presently done, is expected to allow sufficient time for the damaged skin to recover its barrier function in most parts of the face. Received 1 August 2007; accepted 13 July 2009. DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1346-8138.2009.00695.x About DOI ___________________________________________________________________________________________ INTRODUCTION Microdermabrasion is a form of superficial skin resurfacing, which removes the topmost layer of skin to make it more supple and vibrant.1,2 Among various types of equipment currently commercially available, diamond microdermabrasion has become the most popular. It allows skin rejuvenation without producing loose particles and causes minimal irritation. Diamond microdermabrasion enables the patient to return to normal daily life immediately after the procedure which is a feature highly appreciated by many. Because microdermabrasion causes partial skin ablation, repeat procedures are necessary to achieve significant cosmetic improvement.1,3 If the procedures are repeated before the skin recovers its normal function, a deeper dermis would be affected, causing difficulties in controlling the abrasion depth and predicting the final outcome. Diamond microdermabrasion is currently repeated at 7–10-day intervals as recommended by the manufacturer. However, we feel that more objective criteria are needed to determine the optimal time interval between the procedures. Skin at different body sites show distinct patterns of barrier recovery which is likely related to their structural and physiological differences.4–7 Locational differences in biophysical functions have been found to exist even within the facial skin.8 In this study, we measured the degree of acute skin damage and the time required for the facial skin barrier function (forehead and cheek) to recover after diamond microdermabrasion, using a number of non-invasive bioengineering methods, including an evaporimeter, corneometer and colorimeter. ___________________________________________________________________________________________ METHODS Subjects and materials Twenty-eight healthy volunteers (13 women and 15 men; median age 27.5 years), with no evidence of skin lesion in the test areas, were enrolled in the study. No application of emollients was permitted during the study period. Written informed consent was obtained from each patient. Exfoliation occurs as the wand is drawn across the skin by polishing the superficial layers (i.e stratum corneum). The grit size and the vacuum pressure determine the degree of abrasion. Microdermabrasion procedure Prior to performing microdermabrasion, the patients' faces were cleansed with a skin cleanser and water. The right side of the face was microdermabraded and the left side was left untreated. The wand with a grit size of 100 μm and vacuum pressure of 12 in.Hg was used for women and a wand with a grit size of 125 μm and vacuum pressure of 15 in.Hg for men. Two passes (each in a horizontal and perpendicular direction) were performed in all treated areas. Measurements Transepidermal water loss (TEWL), stratum corneum hydration and skin erythema were measured at baseline, immediately after the procedure, and at 24-h intervals for 3 days (days 1–3). Measurements were taken from the forehead and cheeks in a respective manner. The amount of TEWL was measured using an evaporimeter Tewameter 210 (Courage and Khazaka, Köln, Germany) in a sealed room devoid of air flow and direct sunlight. Stratum corneum hydration measurements were taken with a Corneometer CM 820 (Courage and Khazaka), which measure electrical capacitance of the skin as an indicator of stratum corneum hydration. Capacitance was expressed digitally in arbitrary units. A colorimeter Chromameter CR-300 (Minolta Camera, Osaka, Japan) was used to measure the amount of erythema indicated as a*. A standard white plate (Minolta Camera) was used to correct the a* values. All measurements were performed in a room where the temperature was kept at 22°C (range 21–23) and relative humidity at 50% (range 40–60). Volunteers adapted to the test room ambient conditions for at least 30 min prior to each measurement. Barrier function measurements and microdermabrasion were performed by blinded and separate investigators. Statistical analysis Mean values were calculated based on measurements of TEWL, hydration (expressed as capacitance) and erythema. A paired Student's t-test was employed to compare mean values. P < 0.05 was considered significant. StatMost (Dataxiom Software, Los Angeles, CA, USA) was used for statistical analysis. ___________________________________________________________________________________________ RESULTS Change in TEWL (Transepidermal water loss) Compared to baseline, a statistically significant increase in TEWL was observed from the treated side of the forehead and cheek immediately after diamond microdermabrasion and at day 1 (P < 0.05). But from day 2, the mean level of TEWL was back to baseline. On the untreated side, there was no significant change during the entire study period. The TEWL of the face was slightly higher in men before dermabrasion, but there was no sex difference in the recovery time of TEWL. A slightly higher TEWL was obtained from the cheek compared to the forehead at baseline and at certain time periods, but failed to reach statistical significance. Figure 1. Transepidermal water loss (TEWL) measured by the tewameter. Compared to baseline, TEWL significantly increased on the treated side immediately after diamond microdermabrasion and at day 1 (P < 0.05). ___________________________________________________________________________________________ Change in Hydration Compared with the values measured before peeling, the moisture content (hydration) surged immediately after the microdermabrasion process (P < 0.05) at treated sites. However, there was a quick return of stratum corneum hydration to baseline on day 1. The degree of hydration on the forehead was statistically higher than that of the cheek (P < 0.05). Figure 2. Water content measured by the corneometer. Compared to the baseline level, the stratum corneum hydration was significantly increased on the treated side immediately after diamond microdermabrasion (P < 0.05). ___________________________________________________________________________________________ Change in Erythema The a* values, which indicate the degree of erythema, increased significantly after microdermabrasion. The values, regardless of site (forehead and cheek), returned to baseline at day 1 and remained fairly constant till day 3 Figure 3. Erythema measured by the colorimeter. Compared to baseline, the degree of erythema significantly increased on the treated side immediately after diamond microdermabrasion (P < 0.05). ___________________________________________________________________________________________ DISCUSSION Microdermabrasion is a resurfacing technique that involves "sandblasting" or "polishing" the skin. Depending on the number of passes made and pressure used, the epidermis and superficial dermis can be exfoliated. Microdermabrasion has been successfully used on the face, neck, chest and hands to treat actinic damage, acne and its complications, and to improve the skin quality overall. Despite its popularity and wide use, there are few published studies on the physiological changes induced by microdermabrasion.7,9 In this particular study, we aimed to assess skin barrier damage and its recovery following diamond microdermabrasion. In order to measure the physiological changes, we employed methodology currently accepted as the gold standard for measuring epidermal barrier parameters. At baseline, there was no statistically significant difference between the right and left side of the patients' faces. The forehead and cheek showed similarity in erythema, but the capacitance was significantly higher in the forehead compared to the cheek. The TEWL values were slightly higher on the cheek than the forehead, but lacked statistical significance. In a previous study where the biophysical properties of the face were evaluated, the TEWL and capacitance of the cheek measured to be significantly lower than that of the forehead and the reverse was true for facial blood flow where the blood flow was highest on the cheek.8 However, in another study measuring the TEWL of the face, the authors claimed the cheek to show higher TEWL than that of the forehead.10 Only few studies on the biophysical properties of the skin have been conducted over different areas of the face and we believe there is still much controversy over TEWL at the moment.8,10 One explanation for this difference among studies may be the failure to measure TEWL from the same points within the forehead or the cheek. Right after the diamond microdermabrasion process, we observed a statistically significant increase in TEWL, evidently caused by the disruption of the lipid barrier in the epidermis. The TEWL was still significantly higher than baseline on day 1 (i.e. 24 h after the process) but returned to baseline on day 2. The face has been reported to show fast barrier recovery after acute barrier disruption and we believe that our TEWL results are consistent with previous observations.4,7 Compared to baseline, the diamond microdermabrasion group demonstrated a statistically significant increase in the stratum corneum hydration (expressed as capacitance) immediately after the procedure. The capacitance returned to baseline on day 1 and showed minimal change till day 3. In a study comparing stratum corneum hydration at different anatomical locations (forehead, back, lower leg, ventral forearm and abdomen) after acute barrier disruption (either through applicating acetone or tape stripping), only tape stripping of the forehead showed a surge of capacitance values immediately after the procedure.4 The capacitance was checked till day 4 where the values remained fairly constant except for the group with tape stripping of the forehead. In this particular group, there was a tendency of increase in capacitance since day 3. The capacitance after aluminum oxide and sodium chloride microdermabrasion on the face was measured on day 7 in a single study where an increase was noted compared to baseline.7 The authors explained the findings attributed to increased hydration in the regenerated stratum corneum. We believe that the same might have been seen in our patients had the capacitance been measured on day 7. Erythema significantly increased after the diamond microdermabrasion process (measured immediately afterwards) owing to the expansion of the vascular circulation. However, from day 1, the degree of erythema was back to baseline. Our results are consistent with another study which measured the degree of erythema after aluminum oxide crystal microdermabrasion on the volar forearm.9 The significant increase in TEWL, hydration and erythema immediately after the diamond microdermabrasion provides convincing evidence that the epidermal barrier is disrupted by the procedure. The TEWL normalized at day 2 whereas stratum corneum hydration and erythema returned to baseline on day 1. From the findings, we believe that diamond microdermabrasion performed on a weekly basis, as presently done, allows sufficient time for the damaged skin to recover its barrier function in most parts of the face. From the results of previous studies and ours, we conclude that there are indeed some baseline differences in the biophysical properties in different body sites, even within the face and that the degree of barrier damage largely influences the change in the biophysical properties. In a study measuring the impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption, not acetone but only tape stripping, resulted in change of capacitance in the forehead but not the back, lower leg, ventral forearm or the abdomen.8 This implies that only greater barrier damage and specific locations produce changes in the biophysical parameters of the skin. Crystal microdermabrasion was performed in two previous studies: one on the forearm and the other on the face.7,9 The TEWL and capacitance values (both baseline and after acute barrier damage) of the face and forearm differed, which we believe is most likely due to the difference in the thickness of the stratum corneum as well as other innate properties specific to the location. Overall, the face is more prone to show changes in TEWL and capacitance than the trunk or extremities after acute barrier damage such as crystal microdermabrasion and diamond micropeel, which we believe are of similar intensity. In this study, we observed prompt recovery (within 2 days) of barrier function after diamond microdermabrasion on the forehead and cheek. The degree and speed of barrier recovery in more specified and sensitive areas of the face (i.e., nasolabial fold, chin) should be measured in future to confirm the optimal interval time for repetition of diamond microdermabrasion. ___________________________________________________________________________________________ REFERENCES 1 Koch RJ, Hanasono MM. Microdermabrasion. Facial Plast Surg Clin North Am 2001; 9: 377–382. 2 Freeman MS. Microdermabrasion. Facial Plast Surg Clin North Am 2001; 9: 257–266. 3 Shim EK, Barnette D, Hughes K, Greenway HT. Microdermabrasion: a clinical and histopathologic study. Dermatol Surg 2001; 27: 524–530. 4 Fluhr JW, Dickel H, Kuss O et al. Impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption. Br J Dermatol 2002; 146: 770–776. 5 Yosipovitch G, Maayan-Metzger A, Merlob A, Sirota L. Skin barrier properties in different body areas in neonates. Pediatrics 2000; 106: 105–108. 6 Schwindt DA, Wilhelm KP, Maibach HI. Water diffusion characteristics of human stratum corneum at different anatomical sites in vivo. J Invest Dermatol 1998; 111: 385–389. 7 Rajan P, Grimes PE. Skin barrier changes induced by aluminum oxide and sodium chloride microdermabrasion. Dermatol Surg 2002; 28: 390–393. 8 Kobayashi H, Tagami H. Distinct locational differences observable in biophysical functions of the facial skin: with special emphasis on the poor functional properties on the stratum corneum of the perioral region. Int J Cosmet Sci 2004; 26: 91–101. 9 Song JY, Kang HA, Kim MY, Park YM, Kim HO. Damage and recovery of skin barrier function after glycolic acid chemical peeling and crystal microdermabraion. Dermatol Surg 2004; 30: 390–394. 10 Szepietowski JC, Noxicka D, Reich A, Pasicka B, Kozera M, Strzelecka E. Transepidermal water loss (TEWL) measurements on the face. Contact Dermatitis 2000; 43: 123–124. |
| Site Map | Privacy Policies | Terms of Use | Copyright 2010. DiamondSkin |
| Information from journal articles are intended for educational purposes. DiamondSkin microdermabrasion machine. |
| As a member in the "Partners in Quality Program", we offer a 15% discount to ABPS, or ASAPS. |
