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Introduction
CHAPTER 56 Dermabrasion
Baran Ho Daniel B. Eisen
SUMMARY
Dermabrasion resurfaces skin, improving texture and contour irregularity.
Manual dermabrasion is performed using sandpaper, drywall sanding screen, or
a cautery scratch pad, and is a useful technique for treating smaller areas.
Electrobrasion may provide similar outcomes to manual dermabrasion for
discrete areas, possibly with less risk of milia formation.
Beginner Tips
Manual dermabrasion requires only minimal instrumentation, while electrobrasion
utilizes electrosurgical devices generally found in any dermatologic surgeonโs office.
Regardless of technique, dermabrasion should be continued to the depth of the
papillary-reticular dermis interface.
Expert Tips
Traditional mechanical dermabrasion is useful for treating larger areas.
Manual dermabrasion or electrobrasion should be performed 6 to 8 weeks
postoperatively for scar revision.
Donโt Forget!
Personal protective devices are of vital importance, particularly when performing
traditional dermabrasion, as a significant amount of blood and body fluids may become aerosolized.
Continuing dermabrasion to a level deeper than the papillary-reticular dermis interface
increases the risk of scarring.
Pitfalls and Cautions
Dermabrasion is relatively contraindicated for patients currently using isotretinoin or
those that have used isotretinoin within 6 to 12 months.
Infection postprocedure may lead to significant scarring; preoperative history taking
and diligent postoperative monitoring or education are very important.
Patient Education Points
Patients should be highly motivated to care for their wounds in the postoperative
period.
It is important to educate patients regarding the immediate postoperative appearance of
a dermabraded area and regarding the importance of diligent wound care and sun protection.
Billing Pearls
Dermabrasion should be coded with the 15780 series codes, and dermabrasion for
purely cosmetic reasons is generally not covered by insurance.
Since postoperative dermabrasion is usually performed 6 to 8 weeks postsurgery, it
cannot be billed for in the case of flaps and grafts as they have 90-day global periods.
CHAPTER 56 Dermabrasion
INTRODUCTION
Dermabrasion is a technique designed to resurface skin by improving texture and contour irregularity. Traditional dermabrasion involves the use of a handheld motordriven rotary device, mounted with a diamond fraise, wire brush, or serrated wheel.1 A topical refrigerant may be used for anesthesia and to make the skin surface rigid for mechanical abrasion.2 Typically, the level of abrasion is to the level of the papillary or superficial reticular dermis.3 Dermabrasion has been used to treat a wide variety of skin conditions, ranging from spot treatment of postoperative scars to full facial rejuvenation.4 Manual dermabrasion is performed using sandpaper, drywall sanding screen, or a cautery scratch pad, and is a useful technique for treating smaller areas.5
Different grades of sandpaper can be used to achieve multiple depths of ablation.6 Electrobrasion utilizes an electrosurgical device to ablate the skin with the added advantage of hemostasis intraoperatively, and is most suited for treatment of a focused skin area.7 In electrobrasion, machine power settings and distance between electrode tip and treated tissue can be adjusted to provide varying depths of tissue destruction.8