Microdermabrasion On Africa American Advice.
Microdermabrasion?
I'm certified in Microdermabrasion and just bought this machine Called Dbrasion, that does the same work for you. I have used this machine on several people and on my self, Its been okay so far. but one of my volunteer, who is an African American, got tiny scar on her left cheeks. ITs been more than a month that the scar is not going away.Has any of you ever dealt with this situation before? What can I do to help her?
Please advice
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Replies to This Discussion
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Permalink Reply by coldsalineplexus on
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Can you describe or attach a photo of what you mean when you say "scar"? A scar is technically fibrous tissue that replaces normal tissue at the site of an injury, and it would be extremely unlikely for your client to develop a true scar in this short period of time. For this reason, I am going to assume that when you say "scar," what we're actually discussing on your client's face is post-inflammatory hyperpigmentation, which is a temporary darkening of the skin at the site of an injury and is a way that the skin uses pigment to protect a vulnerable site. If I am correct that this is what your client is seeing, there is good news which is that you'll be able to fade it by working carefully.
First, you should be aware that most microdermabrasion educators teach not to use MDA on anyone above a Fitzpatrick 4. I will occasionally make exceptions but set my crystal machine very low if I think it would be beneficial to prep the skin for closed comedone extraction. That's pretty much the only time I break the rule. I would not see a benefit to breaking the rule with a diamond-tipped machine such as the one you are using, as there is no potential benefit by having crystals pelt the skin to loosen the skin above closed comedones, and only potential for risk of scratching.
As for clearing that pigmentation up, please tell me that she's at least been pretreated and has continued to treat with a retinoid and a tyrosinase inhibitor, along with an effective broad spectrum SPF? This is the minimum precaution you need to take with anyone above a Fitzpatrick 4 if you are going to be doing any sort of treatments on their skin. If she's not already, then this PIH might fade just by getting her onto that appropriate home care. If she is already on a retinoid and a tyrosinase inhibitor, then I would focus on fading the spot by using a very mild (20-35%) lactic acid peel for just 3-4 minutes once every 3 weeks until it is resolved. You'll need to make sure that in addition to maintaining the retinoid+tyrosinase inhibitor routine throughout these mild peels, she is also adequately hydrating her skin with a properly balanced moisturizer that has both humectants and emollients, and preferably is no higher than 5.5pH, and that she is serious about her sun protection.
In the future, you'll need to remember the following: 1) microderm is contraindicated for Fitzpatrick 5&6; 2) those skin tones MUST be pretreated before anything other than extremely mild facials; 3) mild lactic acid peels neutralized after a short time and repeated frequently are your best bet for the darker skin tones (eventually you may work them up to tolerate peels with a mild salicylic component, but not at first, and never use glycolic).
Of course, others may have been trained differently or have differing opinions based on their experience, but that is my working knowledge.
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Permalink Reply by NBSkinCare on
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great reply Christine.
When you say 'mild lactic acid peels', what strength are you referring to, in general (with the knowledge that PH plays a big factor) :)
Also, do you require a client such as this to stop the retinoid before every lactic peel? When peels are being done so close together, that's a lot of off and on again (assuming they go off 5 days before and have to wait a few days after peel to go back on)
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Permalink Reply by MySkin on
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Nicole,
You always want to discontinue using retinoid or retinol because it can cause hyper pigmentation. This agent should be discontinued for 4 days prior and 4 days post peel procedure unless the client is still peeling from the peel.
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Hi Nicole,
No, I do not take my clients off retinoids before treatments, but I do usually instruct them on how many days to let pass before they resume their regular retinol schedule. I also carefully moderate the treatment based on their last scheduled day of retinoid treatment - I'd rather go milder in the treatment room and stay more consistent on the home care than vice versa... I agree that a lot of off and on again is problematic. For example, if a client is scheduled to use it every other night, and I am seeing them the day after they used it, I would go milder than if they were scheduled to use it that same night (which ordinarily they would not do) and had not used it the prior night.
I made this decision several years into practicing, once I was very comfortable with my products and treatments, having observed that I was more likely to have complications on skin that was not adequately pretreated than with skin that might already be a little flaky from a retinoid.
When I say light lactic peel, I am normally referring to Allura Esthetics' L20 Pre-Fin treatment (ethanol suspension), and sometimes a 30% gel lactic that I am no longer able to get my hands on. I agree that the pH's are the most important, but I regret that I don't have them on hand because the latter has been discontinued, and the former site is under construction. If memory serves they would both have been around the 2.5pH mark. For both, I am talking about cold water neutralization, because I don't believe in putting alkaline substances on the skin (which is why I switch to self-neutralizing solutions once I hit a relatively low ceiling with lactic or mandelic acids that can still be neutralized with water, and I don't use glycolic at all except in home-care strengths). When I peel this lightly, I ordinarily instruct the client to resume the retinoid in 48 hours.
I would stress that this particular approach (everything described above) is generally milder than what I would do with someone in the Fitzpatrick 1, 2 or 3 ranges. With those clients, I'd be more willing to peel deeper, and consequently they would likely need to stay off their retinol longer post-treatment. It is all a balance.
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Hello
Christine Giustra,
Thank you so much for your kind reply. Yes, it is post inflammatory hyper pigmentation and she is Fitzpatrick IV that is why I performed this treatment on her. I have been doing TCA peels on her for age prevention, I had given her the post hydrating kit and she hasn't been using as she was directed. She lacked in using Sunscreen and didn't follow direction correctly and therefore the pigment got little darker. I am going to do Lactic peels one her till we see the results. Thank you for your help.
Regards.
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How very disappointing that she botched her results through improper post treatment care. Have you considered writing up an instruction sheet?
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the Post kit has all the instructions and each client leaves the spa by signing that they have read and understand after care.
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Great policy! I love the signature! I guess you can lead a horse to water...
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MySkin,
I am an African American and so are many of my clients.
MDA: I use a DiamondTip MDA machine. Generally I usedo the MDA tx for 15 minutes in 3 steps. Smaller 180 tip for about 4 minutes all over face, and concentrating on any "spots"; followed by a larger tip 150 or 200grit all over for about 8 minutes; then return to the 180 tip for approx. 2 minutes, only focusing on the "spots". Here's what I do for "us".
Peels: I use a 70% Lactic peel; not TCA.
PIH: I have them on a 2% Hydroquinone regimen (fade cream). Use 2x daily, with the 2nd application as early in the evening as possible. Not to be used within 48 hours of TX (before or afterwards).
Successful plan: Take pictures, then MDA. Have client use the Fade Cream as listed above. Schedule next MDA no sooner than 14 days, and take before and after pics. After 2 MDA's and if their skin permits a lactic can be combined with a MDA but I would shorten the MDA experience by at least 5 minutes.
Home care should include a gentle cleanser, fade cream, and a treatment mask or exfolliant if needed. Sunscreen is good BUT, when using a Fade Cream, advise them to use it at least 1 hour before going into the sun if possible. Hence why often tell them to apply the cream as early in the evening as they can.
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Great info! Do you ease into the 70% lactic by way of lower strengths? What pH do you use?
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And am I reading correctly that you recommend them wearing their lightener into the sun?
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If the clients skin appears sensitive, then I'd lower the % of the peel; otherwise after a few MDA's one can tell if they are "reactive or not". Also, note that you can always lessen the time the client is exposed to the peel. I judge on a case by case basis; and gauge their level of itchiness during the procedure.
Regarding the 2nd question: NOOOOOooooo, I do not recommend wearing the Fade Cream into the Sun. I instruct them not to go into the sun within an hour of applying the product. BECAUSE of the longer summer day's I tend to stress the importance of applying the cream in the evening due to the lower intensity of the sun; especially if they don't apply it in the AM. (BTW I avoid the terms Bleaching/Lighteners...unless they are going for a "whole body" change).
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