Research Publications Review articles Tarek Mohamed, Praveen P N Rao Alzheimer’s disease: Emerging trends in small molecule therapies. Curr. Med. Chem. 18, 4299-4320, (2011). Tarek Mohamed, Praveen P N Rao Current and emerging at-site pain medications: A review. Journal of Pain Research (2011) In Press Praveen P N Rao, Saad, N. Kabir, Tarek Mohamed. Nonste
O R I G I N A L C O N T R I B U T I O N
Hydradermabrasion: an innovative modality for nonablative facial
Bruce M Freedman, MD, FACS
Plastic Surgery Associates of Northern Virginia, McLean, VA Background Hydradermabrasion is a relatively new procedure that combines crystal-freemicrodermabrasion with the pneumatic application of an antioxidant-based serum.
Objective This study aims to validate the safety and efficacy of hydradermabrasion fornonablative facial rejuvenation and to determine whether antioxidant levels could beincreased in the skin with this technique.
Methods Twenty female volunteers, aged 34 –56 years, were randomized into twogroups. Group A underwent a series of six facial hydradermabrasion treatments using apolyphenolic antioxidant serum spaced 7–10 days apart. In Group B, the same polyphenolicantioxidant serum was applied manually to the skin for a total of six treatments at 7- to10-day intervals. Digital photographs, skin biopsies, and skin polyphenolic antioxidantlevels were obtained prior to and after the treatment regimen. Patient surveys were takenfollowing the study.
Results In Group A, treated skin demonstrated increased epidermal thickness, papillarydermal thickness, and polyphenolic antioxidant levels (P < 0.01). There was replacementof elastotic dermal tissue, collagen hyalinization, and increased fibroblast density. Finelines, pore size, and hyperpigmentation were decreased following treatment. There wereno reported complications. In Group B, there was no change in skin structure, antioxidantlevels, or clinical skin attributes.
Conclusion Hydradermabrasion effectively improved skin quality both clinically andhistologically. There were no changes to suggest that pneumatic serum applicationadversely affected dermal components. After hydradermabrasion, skin polyphenolicantioxidant levels were increased. In contrast, the intermittent manual application of thepolyphenolic antioxidant serum without the microdermabrasion element did not resultin detectable skin changes.
Keywords: facial rejuvenation, hydradermabrasion, topical antioxidants associated with crystal-based microdermabrasion have Introduction
been reported. These have included reduction in fine Over the past decade, microdermabrasion has been lines and hyperpigmentation, decreased pore size, and accepted as a safe, reliable method for nonablative facial improved skin texture. Likewise, thickening and rejuvenation.1–3 The clinical and histological changes reorganization of the papillary dermal matrix has beendemonstrated.4,5 In an effort to augment the changes observed following Correspondence: Bruce M Freedman, MD, 8180 Greensboro Drive #1015, microdermabrasion, clinicians began using other modalities, McLean, VA 22102. E-mail: email@example.com such as intense pulsed light and topical chemical solutions Accepted for publication May 18, 2008 concomitantly with microdermabrasion. Responses such 2008 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 7, 275– 280
Hydradermabrasion: an innovative modality • B M Freedman as more vigorous epidermal peeling and greater reduction has been established between antioxidant concentration in dyschromia were qualitatively and anecdotally and Raman intensity, indicating that absolute Raman reported with the combinations. In addition, technical intensity counts are a biomarker for skin antioxidant modifications were made to simplify yet enhance clinical levels. In order to validate the technique for this study, outcomes. Crystal-free microdermabrasion was developed baseline values were obtained from the subjects’ ventral to eliminate the need for costly, cumbersome crystals and forearm skin. A polyphenolic-based serum (AntiOx™ 6, to reduce the potential for eye injury.6,7 The most recent Edge Systems Corporation, Signal Hill, CA) containing refinement has been the introduction of pneumatically polyphenolic flavonoids and polyphenolic diterpenes applied topical serums to more efficiently deliver various (e.g., epigallocatechin, ursolic acid) was manually applied to the forearm skin and allowed to dry. Raman spectroscopic Hydradermabrasion, the term coined to describe the analysis was repeated. Postserum application values procedure that combines crystal-free microdermabrasion increased significantly from 16 000 ± 4000 to 35 000 ± using an abrading tip with the pneumatic application of 6000 (P < 0.01). These polyphenolic compounds were an antioxidant-rich serum, represents another step in the most likely the biomarkers responsible for the increase.
evolution of microdermabrasion technology. Recently, This is due to the fact that these polyphenolic compounds there has been substantial interest in the effects of and the carotenoids, which were the biomarkers used by antioxidants on skin health. It has been theorized that Hata et al., have a comparable spectral Raman peak at antioxidants protect skin from ultraviolet radiation damage, reverse photodamage, and improve collagen In Group A (n = 10), a series of hydradermabrasion synthesis.8–10 However, the majority of basic science treatments was performed. A single operator using a research in this area to date has been in vitro or in animal crystal-free microdermabrasion device (HydraFacial™ models, while clinical research has mostly been limited to Tower System, Edge Systems Corporation) treated all participants. Each treatment protocol consisted of facial This study was designed to identify the histological and skin cleansing followed by two passes over the face with clinical changes observed following hydradermabrasion the abrading spiral tip handpiece of the crystal-free and to determine whether skin antioxidant levels could microdermabrasion unit set at 180 mmHg. Then the be increased in vivo when an antioxidant serum was used.
polyphenolic-based antioxidant serum was pneumaticallyapplied to the face at 20 mmHg. The average treatmentlasted approximately 20 min and was repeated at 7- to Materials and methods
10-day intervals for a total of six treatments. In Group B(n = 10), the polyphenolic-based antioxidant serum was manually applied to the face and allowed to dry. This Twenty female volunteers, aged 34–56 years with treatment was performed at 7- to 10-day intervals for a Fitzpatrick skin types I–IV, were randomly assigned into two groups. They consented to participate in a study to Two weeks following the sixth treatment, digital evaluate the effects of hydradermabrasion. The study photographs, skin biopsies, and skin polyphenolic anti- conformed to the guidelines of the 1975 Declaration of oxidant levels were repeated in both groups. Patient Helsinki. Each patient was healthy and advised not to evaluations were obtained to identify clinical skin changes use concomitant skin therapy, such as tretinoin or following facial hydradermabrasion. Using a scale of 1–4 glycolic acid 6 weeks before or during the study period.
Digital photographs were taken, and 2-mm full-thickness patients were asked to assess changes in the following skin biopsy specimens were obtained from the left skin attributes: pore size, fine lines, hyperpigmentation, preauricular area. Skin polyphenolic antioxidant levels were obtained from the left cheek using a non-invasive Each skin biopsy was fixed in a 10% buffered formaldehyde optical device: the Biophotonic Scanner (Pharmanex, solution, embedded in paraffin, and cut in 4-µm sections.
Provo, UT). This technology employed laser energy at Sections were stained with standard hematoxylin and 473 nm and 10 mW power to stimulate molecules eosin for light microscopy. The slides were reviewed in a containing carbon–carbon double bonds, generating an blinded fashion, to evaluate epidermal and papillary dermal optical fingerprint that was captured by a highly sensitive thickness as well as cellular and extracellular elements.
detector. The data were then processed and calculated An Olympus microscope was used and precision meas- using Raman scattering spectroscopic analysis that has urements were performed using a calibrated micrometer been validated in humans in vivo.14 A linear relationship at ×40 magnification. Fibroblast density in the papillary 2008 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 7, 275– 280
Hydradermabrasion: an innovative modality • B M Freedman Figure 1 Histological features observed prior to and following a series of hydradermabrasion with an antioxidant serum
(hematoxylin and eosin; original magnification ×20).
dermis was determined by randomly viewing five fields under ×100 magnification with oil immersion andaveraging the number of fibroblasts per high-powered In Group A, the epidermal thickness increased from 50 ± 7 µm to 79 ± 10 µm (P < 0.01) following a series ofsix hydradermabrasion treatments. Papillary dermalthickness also increased from 290 ± 16 µm to 410 ± 25 µm (P < 0.01). When compared to pretreatment tissue, The Pearson’s χ2 test was used to compare treatment treated tissue contained noticeable replacement of Groups A and B with respect to age, gender, and skin elastotic extracellular matrix with thicker, horizontally types. These parameters were found to be similar oriented collagen fibers. This hyalinization was associated indicating that the patients had been effectively with greater fibroblast density (Fig. 1). Raman intensity randomized such that the subject variables did not units used as a biomarker for skin polyphenolic influence outcome variables. Therefore, a two-sided antioxidant levels increased in all study participants. The paired t-test was justified to identify statistical differences pretreatment value obtained in the study group was in epidermal and papillary dermal thickness fibroblast 14 700 ± 3000; this increased to 22 300 ± 5000 after density and skin polyphenolic antioxidant levels treatment. Using the patients as their own controls, within each group and between groups. A P-value of less this represented a 32% increase (P < 0.01) following than or equal to 0.01 was used to declare statistical hydradermabrasion treatment (Table 1). A majority of patients reported significant or noticeable improvements 2008 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 7, 275– 280
Hydradermabrasion: an innovative modality • B M Freedman Table 1 Results from Group A denoting changes following hydradermabrasion with a polyphenolic antioxidant serum.
Fibroblast density (per high-powered field) Skin polyphenolic antioxidant level (Raman intensity units) Figure 2 Patient self-assessment
illustrating changes in skin attributes
following hydradermabrasion with an
Table 2 Results from Group B denoting changes following manual application with a polyphenolic antioxidant serum.
Fibroblast density (per high-powered field) Skin polyphenolic antioxidant level (Raman intensity units) in all of the surveyed skin conditions. Qualitatively, patients reported no change in any of the surveyed skin decreased pore size, decreased fine lines, and decreased conditions following manual application of the serum.
hyperpigmentation were most commonly observed (Fig. 2).
Furthermore, comparisons between Group A posttreat- No complications were reported by or noted in any of the ment parameters and Group B posttreatment parameters patients. Figure 3 illustrates the clinical improvement (Tables 1 and 2) demonstrated statistically significant following a series of hydradermabrasion treatments.
increases in epidermal and papillary dermal thickness, In Group B, there was no statistical increase in epidermal fibroblast density, and Raman intensity counts in Group or papillary dermal thickness. There was no observable change in the dermal structure or in fibroblast density.
Likewise, the calculated Raman intensity counts prior to Discussion
(15 500 ± 4000) and following (16 000 ± 4500) themanual application of the polyphenolic-based antioxidant The public’s interest in and desire for healthier and more serum were statistically unchanged (Table 2). Group B youthful skin has stimulated the development of more 2008 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 7, 275– 280
Hydradermabrasion: an innovative modality • B M Freedman Figure 3 A 42-year-old woman shown before and after a series of hydradermabrasion treatments with an antioxidant serum.
sophisticated methods for skin rejuvenation. For example, microdermabrasion process as long as another abrading microdermabrasion, a popular nonablative technique, component is present. In hydradermabrasion, that has undergone several modifications and has even been component is the abrading spiral tip handpiece. Second, combined with other modalities. This study was designed this study demonstrates that there were no deleterious to evaluate some of the changes in microdermabrasion effects following the pneumatic application of an antioxidant delivery and to determine their safety and efficacy.
serum to the skin. There were no histological signs of Hydradermabrasion has been recently introduced as a microgranulomas or focal dermal separation. Clinically, crystal-free, vacuum-assisted microdermabrasion pro- there were no reports of focal scarring, pigment problems, cedure with the pneumatic application of an antioxidant- or texture abnormalities following treatment. These data rich serum. This study demonstrated that a series of six support the safety of the hydradermabrasion process.
hydradermabrasion treatments resulted in epidermal This study also demonstrated that polyphenolic and papillary dermal thickening with replacement of compounds in an antioxidant-rich mixture are detectable elastotic tissue and deposition of new collagen fibers.
in the skin following topical application. These polyphenols The increase in fibroblast density further confirmed the have been associated with skin photoprotection and activation of a reparative process. Clinical improvement antiaging properties.18 However, in order to be detected, was documented photographically, and patients noted these compounds had to be applied immediately following qualitative improvement in several skin attributes. These a microdermabrasion procedure; the manual application findings highlight the benefits and efficacy of the hydra- of the serum alone did not result in increased levels of polyphenolic antioxidants. The hydradermabrasion The study results are also notable for the following.
process (the combination of microdermabrasion and the First, the data dispel the concept that salt crystals are pneumatic application of the antioxidant serum) also necessary to produce change. Karimipour et al. reported resulted in changes in skin architecture; this was not seen that aluminum oxide crystal abrasion was necessary with the manual application of the polyphenolic antioxi- for initiation of the dermal remodeling cascade.17 Our dant serum. It has been shown that the flux and skin findings conclude that salt crystals are not required in the deposition of vitamin C across microdermabrasion-treated 2008 Wiley Periodicals, Inc. • Journal of Cosmetic Dermatology, 7, 275– 280
Hydradermabrasion: an innovative modality • B M Freedman skin was approximately 20-fold higher than that across 7 Katz BE, Truong S, Maiwald DC, Frew KE, George D. intact skin.19 The changes in skin permeability immediately Efficacy of microdermabrasion preceding ALA application following microdermabrasion are most likely responsible in reducing the incubation time of ALA in laser PDT. J Drugs for the increased uptake of the antioxidants into the skin.
Dermatol 2007; 6: 140–2.
8 Vayail PK, Elmets CA, Katyar SK. Treatment of green tea It has been estimated that the back-scattered Raman polyphenols in hydrophilic cream prevents UVB-induced light originates from a maximum sampling depth of oxidation of lipids and proteins, depletion of antioxidant 250 µm.15 This would place the polyphenolic antioxidants enzymes and phosphorylation of MAPK proteins in SKH-1 applied in this study within the papillary dermis. It has hairless mouse skin. Carcinogenesis 2003; 24: 927–36.
been postulated that increased resident levels of polyphenolic 9 Fujimura T, Tsukahara K, Moriwaki S, Hotta M, Kitahara T, antioxidants in the skin can reduce photodamage and Takema Y. A horse chestnut extract, which induces improve skin quality.20 It appears that hydradermabrasion contraction forces in fibroblasts, is a potent anti-aging creates this scenario and may enhance the beneficial skin ingredient. J Cosmet Sci 2006; 57: 369–76.
10 Burke KE. Photodamage of the skin: protection and reversal Hydradermabrasion may represent an excellent model with topical antioxidants. J Cosmet Dermatol 2004; 3: 149–
with which to investigate the effects of pneumatically 11 Anstey AV. Systemic photoprotection with α-tocopherol applied compounds, such as antioxidants, in the dermal (vitamin E) and β-carotene. Clin Exp Dermatol 2002; 27:
remodeling process. Further research in this area may shed light on skin rejuvenation at a molecular level.
12 Lin JY, Selim MA, Shea CR et al. UV photoprotection by combination topical antioxidants vitamin C and vitamin E. Acknowledgments
J Am Acad Dermatol 2003; 48: 866–74.
13 Dreher F, Maibach H. Protective effects of topical The author would like to acknowledge Dr. James Henry, antioxidants in humans. Curr Probl Dermatol 2001; 29:
Department of Pathology, Reston Hospital Center, for his assistance with the histological analysis, and Dr. Ian H.
14 Zidichovski JA, Poole SJ, Gellerman W et al. Clinical Dinwoodie, Department of Mathematics, Duke University, validation of a novel Raman spectroscopic technology for his guidance and statistical analysis of the data.
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AZOTEMIA AZOTEMIA CLEARANCE AZOTURIA BARBITURICI (Test qualitativo) BENZODIAZEPINE (Test qualitativo) BETA 2 MICROGLOBULINA BETA 2 MICROGLOBULINA URINARIA BETA HCG BETA HCG URINARIO CALCOLO RENALE CANNABINOIDI (Test qualitativo) CARBAMAZEPINA (Tegretol) CARDIOLIPINA (Anticorpi IgG) CARDIOLIPINA (Anticorpi IgM) CATECOLAMINE TOTALI URINARIE CEA CELLULE PARIETALI (Anticorpi APCA) CI