As dermatologists honeymoon with laser resurfacing tools, other less invasive skin rejuvenation techniques are becoming more attractive.

One method, developed in Europe, is gaining popularity in the United States. Microdermabrasion uses a controlled delivery stream of minute, disposable aluminum oxide crystals to remove the stratum corneum layer without collateral damage. Unlike laser skin resurfacing's prolonged healing time and potential for long-term side effects such as scarring and hypo- or hyperpigmentation, microdermabrasion carries with it minimal recovery time and no known serious side effects.

"This type of skin rejuvenation differs from older methods of dermabrasion," said Toivo Rist, M.D., Derma-tology Associates of Knoxville. "It is safe, non-scarring, causes little discomfort, and patients are very satisfied with the results."

Laser resurfacing, he continued, has "such a long healing time - two to three months. Added to that are the risks for scarring and other complications. The beauty with this system is that it can be done in 30 minutes and patients can walk out and return to their everyday routine."

Dr. Rist has 20 patients who have had treatments with the GentlePeel system (Candela, Wayland, Mass.). After performing the initial consult, an R.N. or certified aesthetician does the procedures.

The treatment is indicated for general dermabrasion, blending of scars, mild acne scar revision, and skin exfoliation. The treatments are performed in 20 minutes, and patients leave the office looking slightly pink; there is minimal discomfort and healing time and no need for dressings or camouflage makeup, he said. "After three to four treatments, patients' skin looks pink and healthy."

The treatment affects the epidermis, causing sloughing and stimulating cell production at the basal cell layer, causing a faster cell turnover time. The treatment also stimulates the dermis to vaso-dilate, and that causes a mild pink color. At the end of the treatments, patients' skin appears to have increased tone and elasticity, he said.

Good candidates are those with lentigos, broad-based superficial acne scars, and fine wrinkles. Usually six treatments spaced out over a week to 10 days are required to achieve the desired effect, with a maintenance treatment every two or three months, he said.

Gentle as it is, microdermabrasion is not for every patient. Dr. Rist avoids keloid-formers and individuals with facial or labial herpes simplex. Also those with active acne should not have the procedure; neither should patients who have had facial plastic surgery within the past 12 months.

As for patients who need more aggressive treatment, Dr. Rist's first choice is not always the laser; often he uses an Obagi peel.

Dr. Rist has patients discontinue using glycolic acids, retinoids, and other exfoliants a few weeks before the procedure. Immediately after treatments, the area is cleansed to remove debris and a moisturizer is applied. Patients are warned to avoid sun exposure and to use sunscreen about one week after their last treatment.

The procedure originated in Europe and has been performed there for five years, with no reported side effects during that time, he said. Efficacy is good in selected patients with fine lines and wrinkling and mild actinic damage. Maintenance treatments, once every three months, are recommended.

Although Dermatology Times requested clinical or experimental data on the GentlePeel system, none was provided by press time.

Dr. Rist has no financial interest in the products mentioned.