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Dermabrasion Step-by-Step
Dermabrasion Step-by-Step
- Ensure that all preoperative preparation is complete (e.g., photograph, consent).
Administer antibiotic and/or antiviral prophylaxis as indicated prior to procedure.
2. Administer preoperative anxiolytics as needed.
3. Clean the treatment area with an antiseptic of choice (e.g., alcohol, chlorhexidine,
betadine).
4. Provide necessary anesthesia with local anesthetic, tumescent anesthesia, or nerve
blocks, as needed.
5. Paint the surface of treatment area with gentian violet, if desired.
6. Apply cryogenic spray/Frigiderm refrigerant to freeze the skin for approximately
10 seconds to provide a firm surface for dermabrasion. Only freeze the area that will be immediately dermabraded. Avoid refreezing and reabrading an area as much as possible.
7. Abrade the skin by pulling (instead of pushing) the body of the hand engine
perpendicular to the direction of the end piece in arciform strokes.
8. Continue until punctate bleeding is visualized. This is the level of the papillaryโ
reticular dermal junction. A fine, shredded appearance in the texture of the wound indicates the superficial portion of the reticular dermis. More superficial resurfacing results in a more limited degree of improvement, while deeper dermabrasion risks increased scarring due to adnexal structures being removed.
9. An assistant should help keep the skin taut and blot as needed with cotton towels.
Gauze should be avoided as it can be entangled in the dermabrasion end piece.
10. Proceed from inferior to superior, as blood from a previously abraded area will
flow in a gravitational direction away from the next area to be abraded. It can
also be helpful to follow cosmetic subunits. Apply Vaseline ointment along the hairline to prevent entanglement of hair into the dermabrasion device.
11. After the treatment area is fully abraded, feather the periphery to create a more
natural appearing transition zone.
12. Compress with a lidocaine with epinephrine soaked gauze for 5 to 10 minutes to
obtain hemostasis and reduce stinging from the procedure.
13. Apply petrolatum ointment and hydrogel semiocclusive dressing to abraded sites
to prevent crust formation until the epidermis is fully reepithelialized. This dressing should be changed every 3 to 5 days.
14. For larger procedures, consider systemic steroids (intramuscular triamcinolone or
a short course of oral steroids) to reduce postoperative swelling.
15. Patients should be instructed to take acetaminophen and ibuprofen as needed for
pain.
16. Reepithelialization should take 7 to 10 days, after which make-up can be applied.
Patients should be instructed on strict sun avoidance, and may be started on retinoic acid and hydroquinone 3 weeks following the procedure.
Katz and Oca further refined Yarboroughโs findings in 1990.22 A split scar model was used to evaluate linear surgical scars following full-thickness excisions on the face, trunk, and extremities. The top half of each scar was treated with dermabrasion at 4, 6, or 8 weeks and the bottom half was left as a control. Katz found that although scars were improved when treated 4 or 6 weeks after injury, a greater number responded to abrasion at 8 weeks. This established the standard for time to dermabrasion at 6 to 8 weeks.
In 1995, Harmon et al. sought to delineate the cellular and structural mechanisms by which dermabrasion worked.3 They observed that dermabrasion of facial scars 4 to 8 weeks after injury increased collagen bundle formation and upregulated tenascin and a6b4 integrin expression, components vital in epithelial cellโcell interaction, and thus important for reorganization of connective tissue.
In addition to studying the direct efficacy of dermabrasion, several groups have investigated technical factors that may affect the quality of dermabrasion. Hanke et al. performed a laboratory evaluation of skin refrigerants and found a mixture of 35% Freon 114 and 25% ethyl chloride to be ideal, whereas pure Freon 12 preparations were too cold to be safely placed on the skin.2 Rubenstein et al. described the development of atypical keloids following dermabrasion of patients taking isotretinoin. In their case series, one patient had been off isotretinoin for 6 months prior to dermabrasion yet still developed keloids on the cheek that did not completely resolve.23 Though anecdotal, the recommendation to wait at least 6 to 12 months following
isotretinoin for any dermabrasion procedure was therefore proposed.