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Manual Dermabrasion Step-by-Step
Manual Dermabrasion Step-by-Step
- Ensure that all preoperative preparation is complete (e.g., photograph, consent).
- Administer preoperative anxiolytics as needed. For limited treatment sites in
areas typically unaffected by herpetic or impetigo outbreaks, prophylaxis is generally not necessary.
3. Clean treatment area with antiseptic of choice (e.g., alcohol, chlorhexidine,
betadine).
4. Provide necessary anesthesia with local anesthetic.
5. Abrade the skin with sterile (or autoclaved) 200-grit waterproof sandpaper
(e.g., Canada Sandpapers Ltd.), drywall/plaster sanding screening (3M Corp, St. Paul, MN), or electrocautery scratch pad (Valleylab, Boulder, CO). The sandpaper can be wrapped around the barrel of a syringe or folded in three around the surgeonโs index finger. A gentle back-and-forth or circular motion should be used.
6. Continue until punctate bleeding is visualized. This is the level of the papillaryโ
reticular dermal junction. More superficial resurfacing results in a more limited degree of improvement, while deeper dermabrasion risks increased scarring due to adnexal structures being removed.
7. An assistant should help keep the skin taut and blot as needed.
8. 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.
9. After the treatment area is fully abraded, feather the periphery to create a more
natural appearing transition zone. Smooth the entire area with 400-grit sandpaper.
10. Compress with a 1% lidocaine with epinephrine soaked gauze for 5 to 10
minutes to obtain hemostasis and reduce stinging from the procedure.
11. Apply Vaseline 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.
12. Patients should be instructed to take acetaminophen and ibuprofen as needed for
pain.
- Reepithelialization should take 7 to 10 days, after which make-up can be
applied. Patients should be instructed on strict sun avoidance and can be started on retinoic acid and hydroquinone 3 weeks following the procedure.