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Microdermabrasion is a widely performed skin rejuvenation procedure. Few studies have examined its efficacy.To evaluate the clinical and histopathologic effects of microdermabrasion.Fourteen patients underwent microdermabrasion treatments over 12–14 weeks. Self-rated questionnaires were given before and after the treatment series and were evaluated by a paired t-test. Three of the 14 patients were treated for moderate to severe acne scarring. Acute histologic effects were assessed ex vivo on human abdominal skin. Chronic histopathologic effects were examined in three volunteers who underwent skin biopsies before and after a treatment series on the dorsal forearms.By patient assessment, there was statistically significant improvement in roughness, mottled pigmentation, and overall improvement of skin appearance, but not in rhytides. Acne scarring sometimes improved, but required deeper ablation. Acutely the stratum corneum was homogenized and focally compacted. Chronically there was epidermal hyperplasia, decreased melanization, and some increase in elastin.Microdermabrasion improves some aspects of photoaging and select cases of acne scarring.