Flashcards in Microdermabrasion and Dermabrasion not in 3rd Ed Deck (81):
The most common indication for dermabrasion is facial acne scars
Regarding dermabrasion, wounds need to be limited to a deep-reticular dermal depth, as wounding deeper than this results in surface changes that are perceived as a scar.
F mid-reticular depth
Traditional dermbrasion utilises a wire brush or diamond fraise on a rotary hand engine to mechanically remove tissue.
Scarring, dyspigmentation and infection are potential complications of any deep abrasion procedure.
Acne scars that disappear by stretching the skin are an indication for recontouring with dermabrasion.
F Scars that don’t disappear with stretching.
Dermabrasion should not be combined with CO2 laser.
F Can be combined to ‘tighten’.
Surgical procedures for scars should be performed 6-8 weeks or more before dermabrasive or laser resurfacing.
CO2 laser and Nd:YAG laser will tighten and smooth superficial acne scars and rhytides.
F - Er:YAG (not Nd:YAG).
Dermabrasion is a helpful resurfacing adjunct for sculpting the elevated ridges of wrinkles that persist despite 2-3 passes with an ablative laser.
Dermabrasion removes the thermal coagulum left after heat-induced injury of CO2 lasers, thereby promoting healing and reducing postoperative erythema.
Rhinophyma tends not to respond to dermabrasion.
F Responds well.
There is a significant risk of scarring associated with dermabrasion of rhinophyma.
F Minimal risk due to sebaceous nature of rhinophymatous tissue.
Epidermal naevi, seborrhoeic keratoses, syringomas, angiofibromas and trichoepitheliomas can be dermabraded with good results.
Decorative tattoos can be abraded followed by the application of 1% gentian violet directly to the abraded surface and dressed with Adaptic gauze.
T Gentian violet promotes removal of tattoo pigment by stimulating phagocytes to carry away abraded pigment.
Traumatic and surgical scars cannot be treated with dermabrasion.
F Can perform as early as 6-8 weeks following injury of surgery.
Cosmetic patients undergoing dermabrasive surgery should expect 50-70% improvement in the appearance of deep acne scars and adynamic rhytides.
Distensible acne scars and dynamic rhytides that disappear by stretching are best treated with tissue tightening procedures such as ablative and non-ablative laser resurfacing treatments.
Sharp shoulders of scars of chicken pox or acne and deep non-distensible rhytides should be treated with surgery only.
F Can treat with mechanical dermabrasion or laser sculpting.
For full-thickness defects, surgical excision punch grafting and/or dermal grafts should be performed at least 6-8 weeks before resurfacing.
Patients with a history of impetigo should have a nasal swab to assess for S.aureus colonisation prior to dermabrasion.
T These patients will need prophylactic Abs.
Only patients with a history of HSV require prophylactic antiviral medication for dermabrasion.
F All patient should take until fully re-epithelialised. 14 days is recommendation.
Most herpetic infections occur 1-2 days after resurfacing surgery.
F 7-9 days after.
Delayed re-epithelialisation and hypertrophic scarring have been reported in patients undergoing dermbrasion during or shortly after isotretinoin therapy.
Dermabrasion should be postponed 1-2 months after a course of isotretinoin.
F 6-12 months.
Topical tretinoin cream applied daily for 2-3 weeks before dermabrasion has been shown to reduce the time required for re-epithelialisation.
A test spot dermbrasion is recommended in patients with a history of keloids or koebnerising conditions.
There is no need to observe universal precautions in performing dermabrasiion.
F Aerosolised viral particles can be produced.
The areas to be abraded should be outlined preoperatively with gentian violet while the patient is lying supine.
F Patient sitting.
Dermabrasion should be performed along the angle of the mandible and along the inferior jawline.
F Should perform to 1-2 fingerbreadths below to hide transition zone.
Partial abrasions (eg. around mouth, nose) should follow lines of facial cosmetic subunits.
Tumescent anaesthesia should be used to anaesthetize the entire face for dermabrasion.
Some microdermabrasion devices employ aluminium oxide crystals, which are sharp-edged and hard, as an abrasive.
Microdermabrasion is essentially painless, quick, easy to perform and has few associated risks.
The clinical benefits of microdermabrasion can be profound.
F Clinical benefits are modest.
Following treatment with microdermabrasion, mild erythema is present, but resolves quickly.
Eye protection is not needed for microdermabrasion.
F Corneal abrasions can occur from crystals.
The fraises used for dermabrasion are available in a variety of sizes, shapes and grades of coarseness.
Cone-shaped fraises should be used on broader surfaces on the forehead and cheeks.
F Confined areas around nose, mouth, eyelids.
Wheel-shaped fraises or the wire brush should be used on confined areas around the nose, mouth and eyelids.
F On broader surfaces.
The extra coarse fraise is more forgiving than the wire brush.
The bristles of the wire brush are angled such that clockwise rotation cuts more deeply in the skin, whereas counterclockwise rotation brushes the bristles over the surface more gently.
For dermabrasion, the abrading endpiece is passed over the skin in arciform strokes parallel to the direction of endpiece rotation.
To abrade, the hand engine in pushed over the skin surface.
For dermabrasion, the direction of rotation is only important when a wire brush is used.
For deep surfacing of acne scarring on the mid cheek, traumatic or surgical scars, or debulking large nodules of rhinophyma, clockwise rotation is more efficient.
For full-face procedures, it is best to start abrading along the jawline or preauricular area and progress toward the centre of the face and nose.
T This allows for bleeding from the abraded areas to flow away from the skin being abraded.
Two-point retraction of skin should be used to stabilise the area being abraded.
F Three-point retraction.
When using spray refrigerant during dermabrasion, the scar or rhytide should be frozen in its stretched position.
F Unstretched position.
The depth of abrasion can be monitored by closely observing the abraded surface.
T Papillary dermis appears as glistening white surface. Points of bleeding with depth.
Yellow globules of sebaceous glands are seen with deep dermabrasion of acne scars in the mid-cheek or rhinophyma of the nose.
The dermal fibrosis of acne scars tends to be resistant to abrasion.
F It will crumble and become friable.
The peripheral margin of the abraded regions should be feathered to create a natural-looking transition zone.
Acriform strokes should be perpendicular to the border of the abraded areas
Upon completion of a full-face dermabrasion procedure, most of the abraded areas will still be bleeding.
F Most will have stopped.
Post-operative oedema can be reduced with im kenacort A40 given immediately post-dermabrasion.
The abraded surface should be dressed with a semipermeable dressing held in place with paper tape and backs with non-adherent pads and gauze.
The patient should return to clinic for the full-face dressing to be changed every 7 days.
F Every 3-5 days.
The development of pain with or without erosions generally indicates a postoperative herpetic infection.
Superinfection by bacteria or fungi is not uncommon following dermabrasion.
F Much less common than HSV.
The presence of bright erythema after the first 2-3 post-operative weeks is the first sign of early scar formation and should be treated with topical high-potency steroid ointment od-bd.
Pulse dye laser should not be used following dermabrasion.
F Can decrease erythema and scar induration.
Intralesional steroid injections can be given if any induration, elevation or hypertrophy develops after dermabrasion.
After successful aggressive scar management following dermabrasion, the skin should be clear.
F Usually have small focal areas of hypopigmentation.
Following 3-5 days of wearing a full-face mask after dermabrasion, an open wound care technique can be employed with topical petrolatum ointment.
Petrolatum ointment should be applied sparingly after dermabrasion.
F Apply 3-4 times daily.
The open wound produced by dermabrasion heals by the mechanism of second intention wound healing.
Regions rich in sebaceous glands (eg. nose and mid-cheek) re-epithelialise more slowly than skin over the bony prominences of the forehead, malar cheek and mandible after dermabrasion.
F More quickly.
In dermabrasive wound healing, the collagen fibres align perpendicular to lines of tension before intermolecular cross-linkages are complete.
Following dermabrasion, increased tenascin expression may promote cellular migration, while integrin mitigates the epithelial mesenchymal interaction of wound healing.
F Increased integrin expression may promote cellular migration, tenascin mitigates epithelial mesenchymal interaction of wound healing.
As wound healing progresses following dermabrasion, intradermal oedema continues to dissipate for up to 3 months.
Continuing improvement of the skin surface irregularities and depressions occur for up to 24 months following dermabrasion.
F 6-12 months.
Re-epithelialisation is usually complete within 7-10 days following dermabrasion.
The skin heals faster with open techniques of wound care compared to using a semi-permeable dressing.
F Faster with semi-permeable dressing.
Normal skin tone tends to return within 2-3 months following dermabrasion.
T Need to avoid sun exposure during this time.
Most patients will develop some degree of transient post-inflammatory hyperpigmentation over the malar prominences and jawline following dermabrasion.
Bleaching regimens can be used from the 3rd-4th week after dermabrasion and continued for 4-8 weeks or until hyperpigmentation resolves.
Permanent pigment alteration occurs in less than 5% of patient following dermabrasion.
Skin types V-VI are more likely to develop post-inflammatory hyperpigmentation following dermabrasion.
F Skin types III and IV.
Pseudohypopigmentation refers to the phenomenon of when normally repigmented abraded skin appears to have a different tone and appearance than adjacent non-abraded skin.
T Can correct non-abraded areas with chemical peels, IPL or non-abalative laser.
Increased milia formation is an expected postoperative sequelae of dermabrasion.
T Treat with gentle extraction after 1 week.