clinical roundtable next generation vibraderm surpasses … · 2015. 1. 16. · become aerosolized...

40 Aesthetic Buyers Guide July/August 2004 www.miinews.com

Next GenerationVibraderm SurpassesMicrodermabrasionCapabilities

Clinical Roundtable

Effective, painless dermabrasion with minimalrecovery time can now be performed with theVibraderm system from Vibraderm, Inc. (Irving, Texas).This patented cosmetic device gently exfoliates the epi-dermis while stimulating collagen growth, but unlikeconventional dermabrasion treatments, Vibradermdoes not use particulates. Instead, a fixed abrasive,vibrating stainless steel paddle is used to treat the face,neck and upper chest in just ten minutes.“This is a painless procedure with absolutely nopatient downtime,” said developer Brian Zelickson,M.D., an associate professor of dermatology at theUniversity of Minnesota in Minneapolis. “Currentmicrodermabrasion machines have several drawbacks,including a small spot size, which can lead to unevenand slow treatments. The aluminum oxide crystals alsobecome aerosolized and form a residue that remains onthe skin after treatment.”

Dr. Zelickson was principalinvestigator of an 11 patientstudy to evaluate the efficacy ofvibradermabrasion in the treat-ment of photodamaged skin. “Ourthree major goals were to deter-mine the percent clearance ofphotodamage, patient satisfactionwith treatment and examiningthe histological skin changesfound in skin biopsies.”The 11 patients (ranging in age from 24 to 43 yearsold) were selected for five treatment sessions of vibra-dermabrasion, spaced at weekly intervals. “Each sub-ject randomly had one side of his face treated with theVibraderm and the other side treated with a standard

particulate microdermabrasion device,” Dr. Zelicksonexplained. Photographs were taken prior to each ses-sion and one week after the last treatment.

Two patients also had skin biopsies prior to treat-ment and one week after the final session on the sideof the face treated with the Vibraderm. In addition, twoother subjects (ages 69 and 70) had the dorsal surface

of their arm treated with the Vibraderm three times aweek for three weeks. Biopsies were then taken for his-tologic examination.“The most dramatic results in the study were histo-logic in nature,” Dr. Zelickson said. “Clinically, short-term results were mild, but after three weeks, the epi-dermis and papillary dermis were undergoing dynam-ic remodeling, much like that seen after past tape-stripping studies. These findings suggest that the long-term cosmetic and healthy skin results of this mildwounding procedure may be cumulative.”

Histologic examination revealed an even and ade-quate removal of 75% of the stratum corneum, with theremainder being compacted. Epidermal thickening wasalso observed compared to pre-treatment samplesand the Grenz zone was thickened. “There is a reactiveepidermal hyperplasia noted after treatment.Immunohistochemistry also shows increase staining

Brian Zelickson, M.D.

“Clinically, short-term results were mild,but after three weeks, the epidermis andpapillary dermis were undergoing dynamicremodeling, much like that seen after pasttape-stripping studies.”

41Aesthetic Buyers Guide July/August 2004 www.miinews.com

How is the Vibraderm system used inyour practice?

Eric Bernstein, M.D. – We now exclusively use thedevice on all our microdermabrasion patients. It isused between non-ablative laser treatments toenhance the penetration of topicals.

Robert Weiss, M.D. – We use the Vibraderm as a sub-stitute for microdermabrasion. It is easier to use on largebody areas, and there is virtually zero risk of purpura.

Brian Beisman, M.D. – The machine is used by ouraesthetician when performing facials, prior to peels,and in conjunction with cosmeceuticals for skin rejuve-nation.

Michael Gold, M.D. – This system has potentialadvantages over traditional methods in enhancing thepenetration of topical medicines and formulas into the

skin, as well as a potential benefit in our Levulan pho-todynamic therapy (PDT) patients by enhancingLevulan’s penetration.

Suzanne Kilmer, M.D. – I’m alsousing the Vibraderm as a micro-dermabrader to smooth skin andenhance penetration of topicalproducts.

Suzanne Yee, M.D. – The systemsmoothes the skin and helps withexfoliation. Six weeks after laserresurfacing, I will begin Vibraderm treatments to helpremove any dullness to the skin. Occasionally, the skinfeels like it has a grainy texture in some areas. Thesepatients should benefit from vibradermabrasion. Ihave also used the technique for fine textural lesionson the skin, as well as for milia and syringomas, if apatient has a lot of these lesions. In addition, thetreatment seems to help decrease the incubation timeof Levulan. It can also be used in conjunction with ahome skincare program to enhance the effects and tohelp skin achieve a healthy glow.

Jeffrey Dover, M.D., FRCPC – We use theVibraderm as an alternative to traditional microder-mabrasion. Patients are given a choice. Our staff andpatients have been very pleased with the procedure.

Mitchel Goldman, M.D. – Levulan also penetratesbetter by performing vibradermabrasion beforehand.

Editor’s Note:

The following Clinical Round-

table was moderated by Mitch

Goldman, M.D., who is one of the

first physicians to investigate the

broad uses of Vibraderm in an aesthetic practice.

for type I collagen in the superficial papillary dermisfollowing treatment,” Dr. Zelickson said.Patient satisfaction was also high: 75% felt they hadimprovement in the tone and texture of their skin onthe Vibraderm treated side compared to only 55% ofpatients who observed improvement on the microder-mabrasion side. Further, 85% of patients preferred theVibraderm system over the microdermabrasion sys-tem. “There was noticeably less post-treatment erythe-ma after vibradermabrasion as opposed to microder-mabrasion,” Dr. Zelickson said.

The Vibraderm is powered by a standard electricaloutlet. Each 30 mm x 30 mm paddle is reusable andspecific to the client. A smaller paddle (10 mm x 30mm) for fine features is also included. It is recom-mended that a non-alcoholic based moisturizer beapplied to the skin during treatment.

“Objective clinical assessment of 35 mm slidesshowed vibradermabrasion improved fine lines twice asmuch compared to conventional particulate devices,”Dr. Zelickson reported.

As for safety, “There were no complications associat-ed with any of the treatments,” Dr. Zelickson said. “Therewas also less patient discomfort with vibradermabrasioncompared to standard microdermabrasion.” n

Suzanne Kilmer, M.D.

“75% felt they had improvement in thetone and texture of their skin on theVibraderm treated side compared to only55% of patients who observed improve-ment on the microdermabrasion side.”

Clinical Roundtable


Victor Ross, M.D. – We have found somewhat fasterprotoporphyrin IX fluorescence after using the device.

James Spencer, M.D. – The Vibraderm is currentlyused in our practice in place of conventional microder-mabrasion. Microdermabrasion has become a largepart of our cosmetic skincare for polishing photoagedskin, for melasma and dyschromia, and for keratosispilaris of the arms.

How does vibradermabrasion differfrom standard particulate microder-mabrasion?

Dr. Bernstein – The skin seems smoother and morevibrant than standard microdermabrasion. The rapidmotion really massages the skin. There is no mess aswith sand microdermabrasion and no gritty feel.

Dr. Weiss – There are no particlesin the air, a more soothing vibra-tion for patients, and a faster pro-cedure time.

Dr. Beisman – The Vibradermdoes not create the biohazardwaste associated with particulatemicrodermabrasion and it is alsoneater and cleaner to operate.Because there is no particulate debris to contend with,we are able to use the Vibraderm on the eyelids, anarea that must be treated with great caution when per-forming particulate microdermabrasion.

Dr. Gold – Although most of us feel that crystal micro-dermabrasion is safe, there is always the thought ofpotential long-term effects from the aluminum oxidecrystals. The Vibraderm eliminates that risk. The noiselevel has also been reduced.

Dr. Kilmer – I also really like the fact that there areno messy particles.

Dr. Ross – Another advantage is the relatively largearea that is abraded per unit time because of the sizeof the paddle.

Dr. Spencer – Vibradermabrasion is a more pleasantexperience for patients. Many find the treatment soothing.

What are the unique advantages of theVibraderm system?

Dr. Bernstein – In my opinion, you achieve betterresults than with standard micro-dermabrasion. The system is alsomore compatible with post-treat-ment topicals, due to the lack ofany mess.

Dr. Beisman – Particles can alsobecome wet or clogged in the vac-uum line. There are no filters tochange with the Vibraderm. Thelarge size of the paddles alsoallows treatments to be performed more efficientlythan is otherwise possible with particulate microder-mabrasion devices.

Dr. Yee – I’m seeing great results. We can treat veryclose to the eyelid margin. The machine is much fasterthan microdermabrasion, easy to use, and can be usedon the body.

Dr. Dover – Microdermabrasionperformed even by the mostskilled operator leaves a residueof crystals on the skin and espe-cially in the ears and along theneck. The various paddle sizes ofthe Vibraderm permits largerareas of the body — back, hands,arms – to be treated more quicklythan with microdermabrasion.

Dr. Spencer – The Vibraderm also has some convinc-ing science behind it.

Eric Bernstein, M.D.

Robert Weiss, M.D.

Jeffrey Dover, M.D.,FRCPC

Before Tx After Vibraderm Tx

Clinical Roundtable


What specific clinical indications doyou use the Vibraderm for?

Dr. Weiss – It can be used prior to treatment with lightemitting diode (LED) photomodulation, and also as anadjunct for intense pulsed light or pulsed dye lasertreatments. It is gentler, with less risks of melasma.

Dr. Beisman – We use the Vibraderm for similar indi-cations as microdermabrasion:exfoliation, treatment of epider-mal pigment, enhanced penetra-tion of cosmeceuticals, prior toglycolic acid peels, etc.

Dr. Yee – We use it in combina-tion with chemical peels for skinwith acne and also for pigmentedareas of the skin. Other indica-tions are hyperpigmentation,exfoliation, syringomas, milia, superficial skin lesionsand keratosis pilaris of the arms.

Dr. Dover – Photoaging is our major indication, butthe machine is also effective for mild inflammatoryacne and very mild acne scarring.

Dr. Goldman – We use the Vibraderm before applica-tion of Levulan for treating both acne and actinic ker-atoses. The device can also be used for photorejuvena-tion with Levulan / intense pulsed light.

Dr. Ross – We use this system mainly for speeding theaction of topical anesthetics and Levulan.

Dr. Spencer – In our practice, we recommend micro-dermabrasion, and now vibradermabrasion, for a pol-ishing of the skin. I find that a series of treatments pro-

duce a noticeable tactile sensation of smoother skin, aswell as changing the optical prop-erties of the skin. Specifically, theskin is a better reflector of light,such that the face appearsbrighter. However, we have hadgreat success combining thesetreatments with bleaching creamsfor the treatment of melasma andother dyschromias. These treat-ments are also quite effective forkeratosis pilaris.

Describe the treatment protocols thatyou typically use involvingVibradermabrasion.

Dr. Bernstein – I prep the skin with a pre-treatmentcleanser, evenly covering the skin. The Vibraderm canalso be used when applying post-treatment antioxi-dants.

Dr. Weiss – The Vibraderm is used for ten minutes onthe face. We have also performed epidermal smoothingon arms and legs for better absorption of topicals.

Dr. Beisman – We often combine Vibraderm treat-ments with cleansing facials, in conjunction withretinoids, TNS (tissue nutrient solution) RecoveryComplex, antioxidants and other topical treatments for

skin rejuvenation. The device is also used prior to someenergy based (laser, pulsed light) non-ablative rejuve-nation and photomodulation.

Dr. Gold – The Vibraderm is useful for mild exfoliationof the skin when our aestheticians are performingfacials, which combines procedures and gets patientsused to the idea of cosmetic treatments.

Dr. Kilmer – We first cleanse before using theVibraderm evenly over the skin. We often apply glycol-ic / salicylic acids or vitamin C afterwards.

James Spencer, M.D.

Brian Beisman, M.D.

Immunocytochemistry staining for Type 1 Collagen 1) Prior to treatment. Notepaucity of staining. 2) One week after treatment three times per week for threeweeks. Note increased staining in the superficial dermis (400x).

“We have had great success combiningthese treatments with bleaching creamsfor the treatment of melasma and otherdyschromias.”

Clinical Roundtable

1 2


Dr. Yee – We first wash the face and tone, before usingthe Vibraderm for 8 to 15 minutes, depending on thepatient’s response. We then apply a soothing photocor-rective gel and sunblock. If I am using the device with apeel, like lactic acid, I will first perform vibradermabra-sion before applying lactic acid. That is then followed upwith the photocorrective gel and sunblock. I also use theVibraderm on the face and then wipe with acetone.

Dr. Dover – Vibradermabrasion is performed by ourmedical aestheticians. The visit lasts about one fullhour. It starts with a medical cleansing, followed by theten minute procedure, cooling packs, and finally theapplication of a gentle moisturizer.

Dr. Goldman – For facials, we combine the Vibradermwith a cell rejuvenation serum(CRS) with growth factor toincrease penetration of the CRS,as well as an addition to our cel-lulite treatments.

Dr. Ross – We normally do a full-face Vibraderm treatment justbefore application of the topicalanesthetic or Levulan.

What future applications do you envi-sion for the Vibraderm?

Dr. Bernstein – To enhance penetration of numeroustopicals.

Dr. Weiss – There could also be liposomal packets onthe Vibraderm paddle for topical anesthesia.

Dr. Gold – The Vibraderm maybe helpful in improving early cel-lulite changes. This is a promisingarea we are beginning to explore.

Dr. Goldman – Although somecellulite creams have been foundto be effective alone and underbioceramic short occlusion, pre-liminary results demonstrate afurther enhancement of results when used after vibra-dermabrasion. We now incorporate this technique priorto cellulite treatments with the TriActive (Cynosure),followed by daily use of an anti-cellulite cream.

Dr. Yee – I envision full-body treatments in conjunc-tion with laser or other light-based devices.

Dr. Dover – As paddle sizes are further optimized andmodified, large areas will be easily treated in a shortertime.

Dr. Ross – The Vibraderm could be used to enhancethe effects of topical bleaching agents and other topicalagents in the treatment of melasma.

Dr. Spencer – Topicals can be directly applied withthe paddles, thus treatment may significantly enhancetopical penetration. n

Light microscopy 1) Prior to treatment. Note thinned irregular epidermis (3 - 4 cell lay-ers in thickness) and elastotic dermis. 2) One week after treatment three times perweek for three weeks. Note removal of stratum corneum, epidermal hyperplasia (4 - 6cell layers in thickness) and lightly increased grenz zone (400x).

Michael Gold, M.D.

Victor Ross, M.D.

“Topicals can be directly applied with thepaddles, thus treatment may significantlyenhance topical penetration.”

1

2

Clinical Roundtable


Brian Beisman, M.D.Nashville Center for Laser and Facial SurgeryNashville, Tenn.voice (615) 329-1110fax (615) 320-0192email: [email protected]

Eric Bernstein, M.D.Clinical Associate Professor of DermatologyUniversity of PennsylvaniaBryn Mawr, Penn.voice (856) 797-9099fax (856) 797-0277email: [email protected]

Jeffrey Dover, M.D., FRCPCClinical Associate Professor of DermatologyYale University School of MedicineBoston, Mass. voice (617) 731-1600

Michael Gold, M.D.Gold Skin Care CenterNashville, Tenn.voice (615) 383-2400fax (615) 383-1948email: [email protected]

Mitchel Goldman, M.D.Medical DirectorDermatology/Cosmetic Laser Associates of La Jolla, Inc. and La Jolla SpaMDLa Jolla, Calif.voice (858) 459-7011fax (858) 459-7017email: [email protected]

Suzanne Kilmer, M.D.The Skin Surgery Center of Northern CaliforniaSacramento, Calif.voice (916) 456-0400fax (916) 456-0499email: [email protected]

Victor Ross, M.D.Scripps ClinicLa Jolla, Calif.voice (619) 532-9700fax (619) 532-9458email: [email protected]

James Spencer, M.D.Vice Chairman and Director of Surgical ProgramsMount Sinai Medical CenterNew York City, N.Y.voice (212) 241- 6189fax (212) 426-3160

Robert A. Weiss, M.D. Assistant Professor of DermatologyJohns Hopkins University School of MedicineBaltimore, Md.voice (410) 666-3960fax (410) 666-3981email: [email protected]

Suzanne Yee, M.D.Cosmetic and Laser Surgery Center-MedSpaLittle Rock, Ark.voice (501) 224-1044fax (501) 224-0447email: [email protected]

Brian Zelickson, M.D.University of Minnesota, Minneapolis, Minn.voice (612) 338-0711email: [email protected]

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clinical roundtable next generation vibraderm surpasses … · 2015. 1. 16. · become aerosolized...

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