Dermabrasion

Dermabrasion is exactly what you might think it sounds like-abrading of the second layer of your skin. It involves mechanically planing down the skin to give it a smoother yet natural look. This is
accomplished by using a high-speed rotating wheel that abrades (rubs away or wears down) the skin surface down to the depth necessary to get rid of the problem being treated. A number of
different wheels are available to the cosmetic surgeon, depending on the skin problem to be treated. Wheels with wire brushes, diamond fraises, or serrated metal edges are available. Each physician
develops a feel for which wheel to use and when. Not only do the wheels differ in the surface they abrade with, they differ in size. Larger ones are used for broader areas and smaller ones are used for
spots that require a finer touch. They are hand-held units that are powered by electricity or by compressed nitrogen gas. Depending upon the unit used, the wheel can spin anywhere from four hundred RPM to sixty thousand RPM.

Before abrading the skin, the physician must first anesthetize it. Most of the time, this is accomplished by spraying a topical anesthetic on the area to be treated. This freezes the skin for about thirty seconds. While the skin is frozen, the dermabrasion is carried out. An alternative to freezing is to inject anesthetic into key points on the face where the facial nerves run. Regardless of the mode
used for local anesthetizing, some people who get a dermabrasion receive an intramuscular injection of a strong pain reliever prior, the procedure. This can be augmented by oral and/or intravenous medications as well, depending upon the person’s pain tolerance.

Dermabrasion is used most commonly in the treatment acne scarring. Chemical peels have already been discussed for treating acne scarring, but they are effective mainly for superficial scars.

Patients with moderate to severe photodamage can be treated with a mid-to-deep dermal surgical planing of the face to remove wrinkles. Dermabrasion consists of application of diamond fraises or motor-driven steel wire brushes to the aged skin with a deliberate attempt to wound the epidermis and the papillary dermis. In addition to the beneficial therapeutic value for aged and photodamaged skin, dermabrasion has recently been demonstrated to be a valid means of prophylaxis against neoplastic changes.

In patients with significant photoaging treated with full-face dermabrasion, histological examination demonstrates that this procedure can eliminate for many years the observed abnormal epidermal and dermal changes of photo damaged skin and provide quite good anti aging protection for several years to come. After treatment, a revitalized papillary dermal Grenz zone of new collagen and new elastic tissue is observed and may account for the clinical improvement.

Immunohistological examination demonstrates a dramatic increase of papillary dermal fibroblast staining for pro collagen I a few weeks post dermabrasion. Western blotting demonstrated an increase in pro collagen I that has been corroborated by in situ hybridization. These observations suggest that the ability of dermabrasion clinically to improve wrinkled skin may in large part be due to increased collagen I synthesis.

Manual resurfacing combined with 25% trichloroacetic acid is also used to treat patients with extensively wrinkled skin and widespread actinic keratoses. Manual resurfacing is performed by moving sandpaper or cautery tip cleaner, which has been moistened with sterile saline and wrapped around a gauze, against the skin. This technique produces excellent cosmetic results.
Histologically, treated skin shows replacement of the dermal elastotic band by newly formed collagen.

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