Dermabrasion

For ablative facial resurfacing, dermabrasion is a well-known and effective procedure. There are a variety of laser resurfacing systems are available, and they can be quite expensive instruments with related expensive disposable items for every use. When used for the intended purpose, dermabrasion is a very cost-effective and reliable procedure.

Dermabrasion aims to eliminate a thin layer of damaged skin to promote natural tissue repair and skin renewal while preventing scars and pigmentary alterations. Because of the availability of a rich blood supply and supporting network, as well as the supply of key nutrients, this regulated injury cures quickly, promoting tissue reformation of the proteins and architecture of the skin, resulting in renewed skin that is finer and firmer than before.

Dermabrasion vs microdermabrasion

What is a Dermabrasion?

Dermabrasion is a surgical technique that is used to remove rhytids, wrinkles, and scars from the skin. Dermabrasion uses abrasives to cause epidermal and dermal damage, resulting in improved skin look after the healing process. 

Various studies have shown that dermabrasion is a safe and effective procedure for rejuvenating damaged skin and the aging and injured face, and it should be included as a part of a plastic and dermatologic surgeon's toolkit. It has advantages over chemical creams and lasers, including the potential to treat focused areas of the face, a lesser risk of damage to pigmented melanocytes resulting in pigmentary alterations, and a reduced price when compared to laser therapy. Scar tissue and skin shedding from tension injuries are extremely rare.

Microdermabrasion

Microdermabrasion is a minimally invasive epidermal rejuvenation treatment for abnormal skin color and texture, photodamage, stretch marks, melasma, and scarring, especially acne scars. It's commonly available, and it's among the most popular non-invasive cosmetic procedures. it is first invented in 1985 as a less invasive alternative to chemical treatments and dermabrasion. Without an anesthetic, a qualified physician, aesthetician, physician assistant, or nurse can conduct the microdermabrasion procedure in an outpatient clinic (medical office).

Under the operation of a portable vacuum machine, scratchy crystals are driven against the skin during the therapy. The crystals create moderate physical abrasion of the skin, eventually removing the stratum corneum layer (the outermost area of the epidermis). A newer epidermis with improved cosmesis develops as part of the healing process. The procedure is proven to be safe for all skin types, with few adverse effects. Microdermabrasion has been proven to improve transdermal delivery and the distribution of transdermal drugs dosed on a region of the skin treated with microdermabrasion.

Anatomy

The epidermis and dermis are the two layers that make up the skin. The following are the layers that make up the epidermis (from outside to inside):

• stratum corneum (outermost layer)
• stratum lucidum (only in acral regions)
• stratum granulosum, 
• stratum spinosum 
• stratum basale (the innermost layer)

The dermis is separated into two layers: the more superficial papillary dermis and the deeper reticular dermis. The surgeon must be knowledgeable about the look of all of these layers to appropriately practice dermabrasion. The papillary dermis has a dense blood supply, and erosion of this layer causes tiny hemorrhages. Large collagen bundles, which look like yellowish parallel fibers superficially and ragged white fibers in the deeper reticular dermis, make up the reticular dermis.

Indications of Dermabrasion

A variety of skin conditions can be treated with dermabrasion and involve the following:

• Lentigines, actinic keratoses, and acne scars 
• Rhinophyma, and rhytids
• Scars, including acne scars
• Acne and uneven skin tone/texture
• Stretch marks and melasma
• Photodamaging
• Seborrheic skin, fine wrinkles, and enlarged pores

Because dermabrasion removes the skin to the half of the dermis, problems involving components in the skin at or above this depth are usually treatable with dermabrasion. Manual dermabrasion is excellent for treating smaller regions and more sensitive skin, as well as integrating rejuvenated skin into undamaged skin next to it.

Contraindications of Dermabrasion

Active Herpes Simplex Infection

Dermabrasion should not be used on patients who have an active herpes simplex virus infection. before the procedure, the virus should be latent for at least 6-8 weeks. Individuals with a history of Herpes simplex infection should be managed prophylactically with antiviral medicine, such as acyclovir or valacyclovir, starting 2 days before the surgery and continuing for 2 weeks afterward. before the dermabrasion, it has been proposed that all patients take antiviral prophylaxis.

Patient on Isotretinoin

Patients who are taking isotretinoin or who have taken it in the preceding six months have traditionally been labeled as poor candidates for dermabrasion. Isotretinoin-induced pilosebaceous unit shrinkage may lengthen the wound healing process. In addition, isotretinoin raises the risk of hypertrophic or keloid scarring. Before dermabrasion, patients should be off isotretinoin for at least one year. In the context of recent or current isotretinoin usage, more recent data suggests that manual or microdermabrasion may be safer; an informed discussion should be undertaken with every individual.

In general, patients with Fitzpatrick skin types I and II are the best candidates for dermabrasion. Postoperative color changes are more common in Fitzpatrick skin types III and higher. The probability of dyspigmentation must be balanced against the potential benefit. Following the operation, a 2-to-4-week treatment of topical 4% hydroquinone may reduce the likelihood of color disturbances.

What are Fitzpatrick Skin Types?

Fitzpatrick is a skin typing system depending on the color (before and after skin exposure), natural hair color, and eye color.

• Type I: pale, extremely sensitive white skin
• Type II: very sensitive white skin
• Type III: sensitive light brown skin
• Type IV: mildly sensitive moderate brown skin
• Type V: resistant dark brown skin
• Type VI: very resistant deeply pigmented to black skin

Equipment of Dermabrasion

Dermabrasion is usually performed with:

• Hand-held dermabraders. They involve a diamond fraise, wire brush, or serrated wheel. 
• The handpieces. They are usually operated by a foot pedal and are driven by pneumatic or electric motors. These devices are connected to a unit that regulates the endpiece's spinning speed. They can rotate at speeds ranging from 10,000 to 85,000 revolutions per minute, however, dermabrasion is normally done at 12,000 to 15,000 RPM. 
• Diamond fraises. They are diamond-studded industrial tips that come in a range of shapes, including cones, cylinders, wheels, bullets, and pears. Finer fraises are better for dermabrasion of small regions, sensitive skin, or superficial scars, whereas coarser fraises are best for deep scars and full-face dermabrasion.  Frictional damage causes the skin to be abraded by diamond fraises. As long as the tool is handled appropriately, the diamond extensions are very small, reducing the possibility of entering too deeply into the skin. 
• Rotary wire brushes. The tips of the wires are made out of 2-3 mm wires that protrude from a core cylinder. They come in a different sizes, shapes, and coarseness. As opposed to diamond fraises, these cause harm to the skin by causing micro-lacerations. Because even light pressure can penetrate the epidermis, rates more than 25,000 RPM are not recommended.

Preparation of the Patient

The success of dermabrasion depends on the proper patient selection and acceptable patient expectations. Patients with a history of isotretinoin usage, hypertrophic or keloid scar development, blood thinners use or coagulation diseases, herpes simplex infection, chronic steroid treatment, or HIV or hepatitis C should be evaluated. Prior to the treatment, all patients with a history of herpes simplex virus should be given antiviral prophylaxis; some doctors argue for giving antiviral prophylaxis to every patient. To reduce the risk of color changes, careful photoprotection should be recommended for 2 months prior to the treatment. This risk is also reduced by starting topical hydroquinone a few weeks before the surgery. To expedite wound healing and new collagen creation, a topical retinoid regimen is frequently started at least one month before dermabrasion.

How Dermabrasion is performed?

Anesthesia and Precautions

To ensure the best possible patient satisfaction during dermabrasion, local or general anesthetic may be used. Regional anesthetic injections or nerve blocks can help with localized dermabrasion. Tumescent anesthesia, intravenous sedative, or general anesthetic are all options for full facial dermabrasion. An ophthalmologically safe cleaner, such as povidone-iodine, should be used to prepare the procedure region. To protect themselves from bleeding and other inhalational particles, the surgeon and colleagues should use sterile masks, shields, and gloves.

Area Marking out and Abrasion Technique

The treated skin area is then marked out, and the handpiece is fitted with the dermabrasion tip of choice. At a time, one anatomic unit is addressed. The dermabrader must be moved across the skin with regular, mild pressure while being held taut by one hand or an assistant. Wire brushes are moved unidirectionally while diamond fraise tips are brushed back and forth.

Postoperative Care

After dermabrasion, the treated area can be covered with saline gauze. To avoid infection and provide a moist environment for the healing process, an occlusive cream is applied to the skin. The dressing should be changed every day, and the region should be gently cleansed and the cream reapplied. Daily weak acetic acid soaks are recommended by some doctors. Expect redness, puffiness, and cracking.

In some cases, topical steroids are recommended to reduce inflammation. In most cases, skin renewal takes one to two weeks. Granulation tissue that persists after surgical day Ten is an indication of impaired wound healing and could be caused by infection, dermatitis, or other systemic causes; further assessment is required. It can take up to 2 months for the redness to go away. To reduce the risk of color changes, strict photoprotection is required; hydroquinone can be administered to prevent or treat discoloration.

Advice for Better Outcomes

1. Dermabrasion to the correct layer of the skin is critical for achieving a cosmetically pleasing result with the least amount of danger of side effects. The presence of tiny bleeding indicates entry into the papillary dermis.
2. Treatment should ideally reach the superficial or mid-reticular dermis, where there is greater confluent hemorrhage. Parallel yellow chamois-colored collagen strands characterize the superficial reticular dermis, while ragged white strands are visible in the deep reticular dermis. Because of the increased risk of scarring, dermabrasion into the deep reticular dermis should be avoided.
3. The dermabrader must be handled, manipulated, and controlled correctly to avoid negative results. There are a variety of procedures available, and each doctor must choose the one that best fits their needs.
4. The item can be used as a spatula or a pencil. The pencil grip could make the device more prone to beveling. 
5. The area is cleaned with chlorhexidine or another antiseptic solution and then injected with a local anesthetic in smaller areas to be treated with manual dermabrasion. The surgeon's finger, syringe, or another round object can be wrapped with sterile sandpaper.

Complications of Dermabrasion

There are a few complications of dermabrasion and include:

• Infection. Most commonly caused by staphylococcus aureus (with honey-colored crust, edema, and erythema are observed in the first 2-3 days), herpes simplex virus (within 2-3 days with severe pain), or candida (within 5-7 days with delayed healing, itches, and exudate).
• Scarring. Although patients with a hereditary tendency to scarring are at a greater risk at any depth, scarring is most typically noticed when dermabrasion is done deeper than the mid-reticular dermis.
• Milia. They are small white bumps that develop at the site of operation and their incidence is constant.
• Color changes. They include hypo and hyperpigmentation that cause patient’s dissatisfaction.
• Persistent erythema.

Dermabrasion Acne Scars

Dermabrasion is a procedure that involves abrading the skin to the papillary dermis with a serrated wheel, diamond-encrusted fraises, sterilized sandpaper, or a wire brush coupled to a rapidly spinning handpiece. Microdermabrasion, on the other hand, uses aluminum oxide crystals fed by a nozzle to abrade the stratum corneum superficially through a succession of microulcerations. Dermabrasion may be particularly beneficial in reducing rougher scar edges in acne scarring. However, the procedure is extremely operator-dependent, with any mistakes leading to substantial scarring.

Additional negatives include postoperative pain and up to one-month recovery duration, as well as the potential for milia formation. Dermabrasion has generally been substituted with rejuvenation lasers as a result of these drawbacks. 

Microdermabrasion vs HydraFacial

HydraFacial is considered as a new version of microdermabrasion, and sometimes it can be called wet microdermabrasion. It is a revolutionary process that mixes crystal-free microdermabrasion with the appliance of an antioxidant-based serum via a pneumatic application. It's a medical-grade face rejuvenation procedure with really no inconvenience and quick effectiveness. The HydraFacial is a multi-step procedure that may be tailored to your specific needs.

Dermabrasion at Home

There are various types of home dermabrasion kits that are widely available commercially. It is easy to use devices that give you different choices depending on the area of your face you want to brad.

These devices are designed to be used by non-medical individuals with guides that demonstrate the way of using them.

Conclusion

Dermabrasion has long been used to treat a variety of dermatological disorders, including scar repair and facial skin rejuvenation. With the introduction of newer therapies including chemical exfoliation, laser rejuvenation, non-ablative laser resurfacing, and microdermabrasion, the popularity of this therapy has declined. Dermabrasion has a place in the treatment of acne and traumatic face scars, as well as cosmetic facial rejuvenation. The most popular equipment available today are small, compact hand-held dermabraders that can generate rotation speeds of 18-35 thousand rotations per minute.

The dermabrasion treatment, like all cosmetic surgical procedures, requires careful patient selection and facility preparation (including the use of proper light and monitoring tools). Patients must be aware of all of the procedure's possible risks, advantages, and limitations. Patients must also be aware of the potential alternative therapies.

Dermabrasion is technique-dependent, so the surgeon should be well-versed in the procedure before providing it. The regions to be treated are marked with a gentian purple solution. Prior to the operation, the skin is frozen with a refrigerant topical anesthetic. The dermabrasion process is performed in a normal manner, holding the skin taut and treating one anatomic unit at a time.

Antiviral medications, antibacterial, and steroids are all suggested as part of postoperative medical care. The skin renewal process takes 5-7 days on average, and erythema might last up to 4 weeks. Following dermabrasion, adequate sun protection is required. To improve the effects of dermabrasion, it has been combined with various dermatologic operations such as chemical exfoliation, soft tissue augmentation, and laser therapies. Dermabrasion is still a useful choice for facial skin rejuvenation and scar remodeling, especially when done by a trained and skillful surgeon.