Scratching the Surface

By Heather Grimshaw

Originally published in Massage & Bodywork magazine, December/January 2004.

In response to the quest for perfect skin, microdermabrasion is gaining popularity in day spas, medical offices and medispas across the country. Coined the “luncheon peel” because it requires virtually no recovery time and as little as 30 minutes to perform, microdermabrasion is described as skin sandblasting, a procedure that exfoliates dead skin cells.

The process involves a hand-held wand which propels crystals, pure or artificial, in a jet stream across the skin and then vacuums the crystals, stimulating the production of collagen and lymph drainage, and reducing the signs of broken capillaries and acne breakouts. Some argue that the vacuum component is the most beneficial aspect of the service.

Great Service or Potential Liability?

Many beauty professionals herald microdermabrasion as a new way to smooth and revitalize skin for clients of all ages, but the jury is out as to whether spa or medical professionals should offer it. Microdermabrasion machines cost between $6,000 and $14,000, plus the price of crystals. Salons charge $100 to $160 per service, making it a lucrative option for spa owners. Yet the risk that the service will affect live tissue, which is prohibited by cosmetology guidelines, has prompted many state boards to prohibit the procedure altogether.

Across the map, state board rules vary on microdermabrasion. According to a recent survey by the National Coalition of Esthetician and Related Associations (NCEA), Florida allows spa professionals to offer it on the head, neck and scalp. South Carolina allows spa professionals to offer it with a doctor’s supervision, and California allows licensees to use microdermabrasion for beautification purposes that do not delve beneath the epidermis. Employing the service for any type of scarring, for example, would not be allowed.

Professionals attribute the inconsistency among state board rulings on microdermabrasion to the lack of streamlined training. “There are different levels of microdermabrasion, and who’s to say who is calibrating the machines — how strong they are,” says Gail Giuliano, board administrator for the Rhode Island Board of Cosmetology. “It’s something that you can’t keep track of,” which is why Rhode Island does not allow cosmetologists or estheticians to offer it.

Colorado is one of several states that allows estheticians and cosmetologists to perform the service and the first state to pass a “Cosmetic Resurfacing Exfoliating” Rule that requires spa professionals to take 14 hours of training for microdermabrasion at a vocational school. By Dec. 31, 2003, professionals must show proof of training to perform the procedure. The rule, which mirrors the NCEA’s educational recommendation, was passed in August and makes no allowances for work experience.

“I think most spa professionals see this as a great new service (but) they should be looking at it as a potential liability,” says Kevin Heupel, program director for the Colorado Office of Barbering and Cosmetology. “I saw what this thing (microdermabrasion machine) was and realized that there was no way we should leave training up to the individual practitioner.”

Letting Skin Breathe

An Italian manufacturer introduced microdermabrasion to the spa industry in 1996. The service is marketed as a skin therapy that can even skin tone and pallor, as well as diminish acne and other scars, stretch marks and fine lines. It varies in length from a half hour to an hour and a half and, depending on the client’s goal, several follow-up visits are required to maintain results.

“With microdermabrasion you see an instant difference in the skin,” says Nina Lobach, an esthetician with Sanctuary Day Spa in Denver, Colo. “It’s an amazing service. You feel like your skin can breathe.” However, since the skin repairs itself, microdermabrasion results are not permanent unless clients have a targeted scar or injury.

The treatment, which lasts an hour at Sanctuary and costs $140, includes a skin cleansing. Lobach starts the treatment at the forehead and works her way down the face to the base of the neck. She includes the eyelids and has seen impressive results on scars from plastic surgery. The salon uses corundum powder, a mineral found at the bottom of the sea, for crystals. Most clients say it feels “scratchy,” but report little to no pain associated with the treatment. Afterward the skin is red but clients do not have the type of peeling associated with chemical peels, which can produce flaking skin for seven to 10 days after the treatment.

Some spas have begun to combine chemical peels and microdermabrasion. “You’re red, but not as red as you’d be with just a chemical peel,” Lobach says. “And there’s slight flaking of the skin, but no hiding out is required.”

Most clients book between six to 10 microdermabrasion treatments, scheduled two weeks apart, Lobach says, to let the skin repair itself. Clients can return to their normal skin care routine after the service but are advised to avoid peeling agents for four to five days and to use lots of sunscreen.

The age of a client and individual concerns should be factored into each microdermabrasion routine, says Petronely Grindea, executive director for the Long Island Plastic Surgery at Maximus, a medispa. Older clients should receive treatments two to three weeks apart, whereas younger clients are advised to receive a few sessions in a row for optimal results. Grindea says clients normally require six sessions to see results, though she says every individual is unique.

Clients receive a consultation and skin analysis to gauge whether they are good candidates for microdermabrasion, a treatment that has contraindications for sensitive skin and those with skin conditions like rosacea or dermatitis. “We try to look at the person as a whole,” Grindea says. Maximus includes a massage and skin treatment as part of each microdermabrasion session, which costs $160. “You receive a complete spa service,” she says, including oxygen masks, which frequently follow microdermabrasion services. “You need to soothe the skin after a treatment.”

A common side effect of microdermabrasion is the appearance of cold sores, which are caused by the machine’s propulsion. However, the sores are not inevitable. “If the service is done properly it shouldn’t happen,” Grindea says.

Microdermabrasion is classified as a Category I prescription cosmetic device by the Food & Drug Administration as long as it only removes the stratum corneum (top layer of skin) and does not affect the skin’s structure or function. But because microdermabrasion is a technique-driven process, the possibility that a professional could inadvertently delve beneath the stratum corneum is a real concern. “With one pass (of the machine) you remove the stratum corneum, with two or three passes you raise pinpricks of blood and know you’re affecting live tissue,” says Susanne S. Warfield, executive director of the NCEA.

And once the door of a treatment room is closed, it is difficult to monitor which estheticians are obeying the rules and which estheticians have been properly trained, some professionals say. “It’s kind of like driving,” Warfield says. “Do you ever speed? Who monitors if drivers speed?”

Estheticians argue, however, that machines are easy to use and with proper training professionals will not delve into live tissue. “The machines are real safe,” Lobach says. “If you’ve had good training it’s easy to use the piece of equipment so that you don’t break the surface of the skin.”

In some states training is left up to the practitioner. Most manufacturers provide training, which varies in length and scope. Peels Salon Services, a wholesale distributor based in Omaha, Neb., provides a half day of training for salons that buy Harmonix or Esthetics Medical microdermabrasion machines. There is a difference in strength between the professional models and the medical models of machines, says Leslie Ashing, salon and spa furnishings manager for Peels. “The professional machines are not usually strong enough to damage the skin unless the esthetician goes over the same area too many times or goes too deep around the eyes or other sensitive areas of the skin,” she says.

When it comes to purchasing machines, salon owners and estheticians should investigate a machine’s tendency to clog and whether the functions for spraying crystals and vacuuming are separated. There are hundreds of machines available and some come equipped with light therapy features that help mitigate redness from microdermabrasion services. “This is one of those areas where you really seem to get what you pay for,” Ashing says.

Unanswered Questions

In Kansas, where the Board of Cosmetologists is currently revising its regulations to allow estheticians and cosmetologists to perform microdermabrasion, training and education have been key concerns. “Dermatologists and other doctors have debated whether it affects living layers of the skin,” says Cherie Daniels, administrative officer for the Kansas board. “Some say that it does, others say that it doesn’t.”

Demand from spa professionals who want to offer the service has prompted the board to revise its regulation prohibiting skin removal that affects living layers of the skin, though Daniels says some salons have been offering the service despite the rule. “People who sell the machines make it seem like it’s OK; they call it a beautifying process,” she says. Whether Kansas will — like Colorado — require estheticians and cosmetologists to get training from a certified school remains to be seen. Heupel specified that Colorado professionals study at a school to “ensure consistent training.”

In addition to concerns about the depth of penetration, some spa professionals worry about the lack of scientific evidence for microdermabrasion benefits. “We don’t know the long-term benefits or contraindications of the service,” says Mary Anne Rubin of Stellar Spa in Corte Madera, Calif. “And we have seen an evolution of more skin sensitivity issues, from overall redness to rosacea and capillary distention from overly assertive treatments. It’s not regulated and there are too many holes,” she says, “too many unanswered questions.”

As a natural alternative, Stellar Spa offers an organic peel that removes excess stratum corneum and is offered as an add-on to facials. “Many times clients jump to the extreme [such as microdermabrasion] when they haven’t even considered a consistent, manual exfoliation on a regular basis,” Rubin says. “We want to help people make better, more educated choices.”

Across the country, microdermabrasion is a popular skin service for spa clients whose goals span the gamut from a more even skin tone to scar removal and reduction in fine lines. However, as popular as the service has become, spa professionals are still in the driver’s seat when it comes to suggesting the service to clients.

“Only about three percent of the people know what it is and why they want it,” Lobach says. “I do a lot of educating.”