20. Dermabrasion
Preoperative Evaluation
Consultation with the patient to establish realistic goals and expectations (see Chapter 4)
Comprehensive medical and surgical history and physical examination. Some medical conditions are contraindications to dermabrasion (see Box 20-2).
Bleeding complications/risks from prescription and herbal medicine
Is the patient taking isotretinoin, birth control pills, or immunosuppressants?
Is the patient pregnant?
History of cold sores requires herpes simplex prophylaxis
History of hypertrophic or keloid scars?
History or risk of hepatitis or HIV?
Tip:
Dermabrasion results in aerosolization of tissue and blood. Physicians and their assistants (including the anesthesiologist) must take appropriate measures to protect themselves. This involves wearing a gown, face shield, face mask, and gloves.
History of connective tissue disorders, cold intolerance, or Raynaud phenomenon? (These patients may not be candidates if a refrigerant is used.)
Current and past skin regimens and their results?
Prior history of skin rejuvenation? When and what kind? Results/problems from those treatments?
Tanning history: Does the patient have hyperpigmentation or hypopigmentation?
Documentation of patient’s skin type (Fitzpatrick skin type classification) (Table 20-1) and photoaging grouping (Table 20-2), degree of actinic damage, sebaceous gland density, dyschromias, suspicious lesions, and scarring.
Skin excess and gravitational changes that will not be corrected by dermabrasion are pointed out.
Senior Author Tip:
Skin types I through III will have a uniform blended skin color postoperatively. Types IV proceed with caution and best to not dermabrade types V and VI due to hyperpigmentation postoperatively.
Standard preoperative photographs for surgical planning
Patients evaluated for facial rejuvenation or scar improvement are asked to provide photographs of themselves (in repose) when they were younger.
Preoperative and postoperative photographs are helpful for those who had prior surgery on their face.
Preoperative arrangement and discussion of financial responsibilities for revisions
Analysis and operative planning based on patient desires, clinical examination, and photographs
Patients are given an antibacterial cleanser to wash and shampoo with the night before and the morning of surgery and prescriptions for cephalexin 500 mg twice per day for 5-7 days, acyclovir 1 g once per day (twice per day for patients with history of oral herpes, start the day before the procedure) for 5-7 days, diazepam (or similar relaxant), and narcotic pain medication.
Test spot close to the area to be treated should be considered. This allows the patient to experience the procedure in a limited fashion and provides some information about expected results. Usually a 1 cm area is abraded with the patient under local anesthesia.
Tip:
The test spot should be placed close to the area to be treated but in an obscured area that can be easily camouflaged or hidden if further treatment is not performed. For example, for patients who will have facial or neck dermabrasion, the spot can be made behind the ear. Stressing that the test spot is not predictive of the overall outcome is critical.
Indications and Contraindications
(Boxes 20-1 and 20-2)
Box 20-1% Conditions Treatable With Dermabrasion
Acne rosacea | Lichenified dermatoses |
Actinically damaged skin | Linear epidermeral nevus |
Active acne | Discoid lupus erythematosus |
Adenoma sebaceum | Mibelli porokeratosis |
Angiofibromas of tuberous sclerosis | Multiple pigmented nevi |
Basal cell carcinoma (superficial type) | Multiple seborrheic keratoses |
Blast tattoos (gunpowder) | Multiple trichoepitheliomas |
Chloasma | Neurotic excoriations |
Chronic radiation dermatitis (mild) | Postacne scars |
Congenital pigmented nevi | Pseudofolliculitis barbae |
Darier’s disease | Rhinophyma |
Dermatisis papillaris capillitii | Scleromyxedema |
Early operative scars | Smallpox or chickenpox scars |
Facial rhytids | Striae distensae |
Favre-Racouchot syndrome | Syringomas |
Fox-Fordyce disease | Syringocystadenoma papilliferum |
Freckles | Tattoos (decorative and traumatic) |
Hair transplantation (elevated recipient sites) | Telangiectasias Traumatic scars |
Hemangiomas | Verrucous nevus |
Hypertrophic scars | Vitiligo |
Keratoacanthomas | Xanthelasma |
Lentigines | Xeroderma pigmentosum |
Lichen amyloidosis |
Box 20-2% Contraindications to Dermabrasion