20. Dermabrasion



10.1055/b-0038-163144

20. Dermabrasion

George Broughton II, James L. Baker, Jr.

Preoperative Evaluation


1 4




  • 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.





































Table 20-1 Fitzpatrick Skin Type Classification

Skin Type


Characteristics


Sun Exposure History


I


Pale white, freckles, blue eyes, blond or red hair


Always burns, never tans


II


Fair white, blue/green/hazel eyes, blond or red hair


Usually burns, minimally tans


III


Cream white, any hair or eye color


Sometimes burns, tans uniformly


IV


Moderate brown (Mediterranean)


Rarely burns, always tans well


V


Dark brown (Middle Eastern)


Rarely burns, tans easily


VI


Dark brown to black


Never burns, tans easily



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.





























Table 20-2 Glogau Photoaging Scale

Type


Description


Features


I (mild)


Wrinkles not present or minimal


Early photoaging


No keratoses, pigmentary changes


Patient generally wears minimal or no makeup


Typical age range: 20s–30s


II (moderate)


Wrinkles present only when skin is in motion


Early to moderate photoaging


Early actinic keratoses


Sallow color


Smile lines begin


Patient generally wears some makeup


Typical age range: Late 30s–40s


III (advanced)


Wrinkles present when skin is at rest


Advanced photoaging


Dyschromias, telangiectasias


Actinic keratoses


Persistent wrinkling


Patient always wears makeup


Typical age range: 50s or older


IV (severe)


Only wrinkles


Severe photoaging


Yellow-gray skin


Dynamic/gravitational wrinkling throughout


Actinic keratoses ± skin malignancies


No normal skin


Patient wears makeup, but coverage is poor (it cakes or cracks)


Typical age range: 60s or older



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

































Absolute


Relative


Isotretinoin therapy within the last 6-12 months*


History of hypertrophic scars


History of keloids


Congenital ectodermal defects


Burns—deep thermal or chemical


Radiodermatitis (only if severe)


Fitzpatrick skin types IV, V, VI (test patch should be tried first)


Pyoderma

 

Psychosis


History of hepatitis or HIV


Active herpes labialis

 

*Seven patients with atrophic acne scars on the face taking oral isotretinoin to treat facial acne had manual dermabrasion on an area approximately 1 cm. 2 At the 6-month follow-up, all patients had normal cicatrization, and the atrophic acne scar revision was deemed excellent. 5 In another study, 10 patients treated with oral isotretinoin for acne had a medium-depth chemical peel applied to the entire face and manual sandpaper dermabrasion (until the appearance of a blood dew) 1-3 months after the isotretinoin therapy was concluded. At the 6-month follow-up, all patients had normal cicatrization, and no hypertrophic scars or keloids were observed. Depressed acne scar revision was satisfactory. 6


†Personal decision of the surgeon.

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May 18, 2020 | Posted by in Aesthetic plastic surgery | Comments Off on 20. Dermabrasion

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