MDA is a superficial exfoliating resurfacing procedure consisting of mechanical abrasion of the skin either with constant flow of pressurized stream of crystals (aluminium oxide) or by diamond tip swept across the skin, so as to cause superficial exfoliation of the skin and achieve optimum results.

MECHANISM OF ACTION

Part of the superficial epidermis including stratum corneum, surface debris, oil and dirt are removed immediately on direct impact of Al2O3 crystals on the skin surface or due to superficial abrasion with diamond tips. Resultant superficial epidermis and dermis is then allowed to heal by secondary intention with neocollagenesis along with remodelling of dermal collagen. Visible improvement can only be appreciated at the end of the series of repeated sessions carried out at a stretch of 2 weeks interval.

Following mechanisms are responsible for the final outcome:

1. Mechanical disruption of the corneum

2. Stimulation of epidermal cell turnover (production of new cells)

3. Release of cytokines, growth factors etc. during wound healing

4. Vasodilatation of dermal blood vessels and dermal edema

5. Stimulation and neocollagenesis along with remodelling of dermal collagen

Indications:

1. Mild photoaging, actinic damage, fine lines

2. Comedonal acne (non-inflammatory)

3. Superficial scars (acne, chicken pox, traumatic)

4. Pigmentary condition (Freckles, lentigines, melasma, post-inflammatory hyperpigmentation)

5 Enlarged pores

6 Striae

7 Mild rosacea

Contraindications:

  1. Inflammatory acne (pustular, nodulocystic)
  2. Active bacterial or viral infection
  3. Keloidal tendency
  4. Bleeding disorder or patient on anticoagulants
  5. Excessive laxity and increased skin folds
  6. Patients with unrealistic expectations

Preoperative work:

1. Counselling

Outcome, side effects, and complications (if any) of the procedure are explained to the patient in advance. Commitment from the patient for series of repeat treatment sessions is mandatory for achieving optimum results.

2. Male patients should be informed to shave the area beforehand.

Procedure:

1. Cleansing and degreasing the skin (after patient washes the face)

2. Anesthesia (Not required)

3. Technique:

a. The handpiece is moved with gentle even pressure smoothly and slowly across the skin. Series of multiple such liner sweeping movement are carried out covering the entire face.

b. Wipe the dust and thoroughly clean the skin with water to remove any traces of crystals.

c. Local application of moisturizing cream.

Postoperative Care:

1. Topical application of moisturizer/antibiotic ointment.

2. Oral antibiotic, if required.

3. Sun restriction, photoprotection and sunscreen.

Schedule:

Repeat sitting at 2-3 weeks for 6-10 sittings. Total number of sittings will depend on the type of lesions, its location and response.

Side Effects:

Erythema, edema, petechiae & dryness.

Results:

1. Immediate "feel good" effect on account of disappearance of superficial pigmentation/rough texture of the skin and creation of dermal edema (plumping effect), which is appreciated by the patient as an improvement due to its visual impact.

2. Good improvement in mild cutaneous textural irregularities.3. Moderate to minimal improvement in superficial rhytides.

4. No clinical improvement in deep acne scars.

Advantages:

1. No anaesthesia required.

2. Safe during pregnancy and lactation.

3. NO risk of adverse chemical irritation.

4. Minimal patient recovery and downtime.

5. Mechanical, hence depth of exfoliation can easily be controlled.

6. Overall better patient comfort and compliance.

7. It can be combined with chemical peeling, anti wrinkle injections, fillers, lasers, etc.