Dermabrasion




This review presents skin anatomy, dermabraders, indications for dermabrasion and microdermabrasion, and dermabrasion techniques for the face, along with potential complications. Dermabrasion is a minimally invasive technique used for skin resurfacing. Its applications include treatment of rhytids, abnormal scarring, and premalignant lesions. The risks of complications are low and include pigment changes, hypertrophic scarring, and infection. Despite the introduction of newer therapies, such as lasers and chemical peels, dermabrasion remains an effective tool for physicians to combat the effects of aging without the downtime required for surgery.







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    There has been a 70% increase in minimally invasive cosmetic procedures and a 50% increase in dermabrasions over the past decade.



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    Dermabrasion is a minimally-invasive, low-risk technique for skin resurfacing.



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    Dermabrasion is indicated for the treatment of superficial and moderate depth wrinkles in the perioral area.



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    Dermabrasion may be more effective than chemical peels and laser therapy for certain skin conditions.



Key Points


The past decade has seen a dramatic rise in the number of minimally invasive cosmetic procedures performed. In 2009, 12.5 million cosmetic procedures were performed by American Board of Medical Specialties board-certified physicians, an increase of almost 70% from 2000. These minimally invasive procedures have provided the public an alternative to surgery that can improve aesthetic appearances and combat the effects of aging. The popularity of these procedures can be attributed to lower costs as well as less time for recovery and healing.


Dermabrasion is a skin-resurfacing technique that has been around since the 1930s. Kromeyer first treated skin complaints with a rotating burr or rasp after freezing the skin with carbon dioxide snow or ether spray. Its use was expanded to traumatic tattoo removal when Iverson successfully used sandpaper to remove debris from the face in 1947. Over the past 50 years, dermabrasion has also been used for many other problems, including wrinkling, scar revision, and the treatment of precancerous lesions.


A 50% increase in the number of dermabrasion procedures was seen in the past 10 years. However, the popularity of this technique has recently declined with the advent of other resurfacing treatments. Chemical peels and laser therapies have become increasingly popular to address similar problems that are treated by dermabrasion. However, dermabrasion can still be a more effective tool to treat severe or deeper problems of the skin.


Anatomy of the skin


Comprising 16% of the total body weight, the skin is the largest organ system and plays a key role as an immunologic barrier and in the maintenance of homeostasis. Considering how insults to the integumentary system serve as a nidus for many serious systemic infections, a thorough understanding of skin anatomy is necessary in order for the physician to safely treat disorders of the skin.


The skin is functionally divided into 2 layers: the epidermis and the dermis. The epidermis is composed of epithelium and can be further subdivided into 5 layers: the stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, and the stratum basale (germinativum). As the most superficial layer, the stratum corneum is composed of multiple layers of keratinocytes that are continually lost and regenerated. This layer is targeted during mechanical or chemical exfoliation. The stratum lucidum, found mainly in the palms of the hand and soles of the feet, contains a dense layer of keratin filaments that provides additional structural support. The stratum granulosum contains membrane-coating granules whose lipid-rich contents create a waterproof barrier for the skin. The stratum spinosum is the thickest layer of the epidermis and is characterized by the presence of multiple spiny cells rich in cytokeratin. The stratum basale contains the mitotically active cuboidal cells that generate the cells composing all other layers of the epidermis.


The connective tissue dermis forms 2 layers: the papillary layer and the reticular layer. The loose papillary layer is located directly beneath the stratum basale of the epidermis and houses the capillary network supplying the integument as well as the nerve endings critical to touch sensation. The markedly thicker reticular layer contains densely packed collagen that accounts for the skin’s great tensile strength. It also serves as the foundation for hair follicles as well as sweat and sebaceous glands.




Dermabraders


Many dermabraders are available for skin resurfacing ( Fig. 1 ). Most are handheld devices that are attached to a control unit that regulates the speed of the endpiece ( Fig. 2 ). These handpieces may be driven by pneumatic or electric motors. The operator is able to control the dermabrader with a foot pedal. Typically, the speed ranges from 10,000 to 85,000 revolutions per minute (RPM); however, most operators control the dermabrader at 12,000 to 15,000 RPM.




Fig. 1


Dermabraders.

Courtesy of Stryker, Inc., Kalamazoo, MI; with permission.



Fig. 2


Micro drill.

Courtesy of Stryker, Inc., Kalamazoo, MI; with permission.


The burrs come in many different sizes, shapes, and levels of coarseness. The most common endpieces used include diamond fraises, serrated wheels, or wire brushes. The operator chooses the tip based on the area needing dermabrasion and the desired depth of penetration. During the procedure, the dermabrader must be kept in constant motion across the skin with a gentle application of pressure. The amount of pressure applied and the selected speed are the 2 most important factors in determining the end results.




Dermabraders


Many dermabraders are available for skin resurfacing ( Fig. 1 ). Most are handheld devices that are attached to a control unit that regulates the speed of the endpiece ( Fig. 2 ). These handpieces may be driven by pneumatic or electric motors. The operator is able to control the dermabrader with a foot pedal. Typically, the speed ranges from 10,000 to 85,000 revolutions per minute (RPM); however, most operators control the dermabrader at 12,000 to 15,000 RPM.


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Nov 21, 2017 | Posted by in General Surgery | Comments Off on Dermabrasion

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