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Cosmetic & Reconstructive Surgeries


Dermabrasion

Dermabrasion is a procedure to improve the look of the skin involving the mechanical removal of the damaged top layer using a high speed rotary wheel.

Purpose

Originally developed as a means of treating acne scars, dermabrasion can be used to treat many kinds of skin problems including scars from other types of wounds, wrinkles, skin coloration abnormalities, and other more serious conditions such as rhinophyma, a disfiguring form of rosacea that affects the nose. Although the treatment is not a cure, in that the scar or other abnormality cannot be entirely removed, dermabrasion does soften the edges of the scar or other abnormality and can radically improve its appearance.

Dermabrasion is often used in combination with other plastic surgery techniques, such as chemical peels, excisions, punch grafting, and CO 2 laser resurfacing to achieve an overall smoothing of various skin abnormalities, particularly of the face.

Description

Dermabrasion is commonly performed using a handheld engine that can reach rotational speeds of 18,000–35,000 rpm. Rapid planing of the skin is achieved through the combination of this rotational speed, the abrading attachment, and pressure applied by the operator. Because of the importance of the skill of the operator, patients should select doctors with significant experience with the procedure.

There are three types of abrading attachments in common use: diamond fraises, wire brushes, and serrated wheels. Diamond fraises are stainless steel wheels that have diamond chips of various coarseness bonded to its surface. Cylinder and pear-shaped diamond fraises are also used for work in various locations. The wire brush is a wheel with wires attached at various angles. In experienced hands, it is the most effective attachment for deep scars. The serrated wheel or diamond fraise is often used to soften the edges of skin removed with a wire brush.

Before the procedure begins, medication is often given to relax the patient and reduce pain. For small areas, local anaesthetic nerve blocks are often used to numb the area being treated. Alternatively, topical cryoanaesthesia (numbing the skin using cold) can be used. This is done by spraying a cold-inducing agent on the skin. Sometimes the skin is pre-chilled with ice to increase the anaesthetic effect.

During the procedure the patient lies on his back on the surgical table, eyes covered with disposable eye patches. The area being treated is parted with Gentaian violet, a stain that will help gauge how deep the treatment is going. A gloved and gowned assistant holds the skin taut while each section of the face is abraded using the hand-held engine. The surgeon works in sections to avoid obvious lines of demarcation in the final results. If the entire face is to be dermabraded, laser is commonly used for the lower eyelids and lip as less than satisfactory results often occur in these areas.


Because there are several different skin surfacing techniques now available, the initial meetings with the dermatological or plastic surgeon must ensure that dermabrasion is the technique of choice for the particular skin abnormality and location that is being treated. Although controversial, some studies have reported abnormal scarring in patients previously treated with 13 cisretinoic acid (Accutane), so many surgeons will require a six month break from the medication before performing dermabrasion. A second contraindication for dermabrasion is HIV or hepatitis infection, as small droplets of blood becomes aerosolized (distributed within the air) during the treatment, creating a risk for the doctor and other staff.

Finally, even if there is no patient history of cold sores, it is important that anti-viral medicine is administered to anyone undergoing the procedure, as an outbreak after dermabrasion can be very severe and spread beyond the mouth to other areas of the face.

Aftercare

After the procedure, any treated areas are dressed for healing. For example, a dressing that is primarily water held on a mesh support, called Vigilon, can be used to cover the wound. It is changed daily for about five days, then the wound is left open to the air. This kind of treatment speeds the restoration of the epithelium, the cellular covering of the body. Using this technique, healing occurs in about five to seven days.

Generally, the patient is given pain medication, antibiotics , and anti-swelling medication during recovery. Antiviral drugs are also continued. Patients should avoid the sun during the healing process.

The most common complication of the procedure is the formation of keloid, a type of abnormal scar that results from excessive collagen production. Because this type of scarring tends to be associated with darker skin types, patients with this kind of skin should approach dermabrasion with caution. Other potential complications include abnormal pigmentation of the treated skin, persistent redness of the skin, and a localized dilation of small groups of blood vessels called telangiectasia. Finally, the formation of milia, bumps that form due to obstruction of the sweat glands, although this can be treated after healing with retinoic acid.



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