Dermabrasion
part-1
Indications:
1- Scars of cystic acne, deep rhytides, severe photodamage, and traumatic or surgical scars.
2- Benign tumors, such as syringomas, seborrheic keratoses, angiofibromas, epidermal nevi, trichoepitheliomas, lentigines, cysts, milia, and molluscum, can be removed with dermabrasion.
3- Follicular inflammatory dermatoses, such as pseudofolliculitis barbae, cystic acne, and rhinophyma of acne rosacea.
4- Actinic keratoses, solar elastosis, and discoloration of photoaging.
5- The pigmented changes of melasma, tattoos, and postinflammatory hyperpigmentation can be lightened with dermabrasion followed by topical hydroquinone and tretinoin creams.
6- Superficial malignancies, such as squamous cell carcinoma in situ and superficial basal cell carcinoma.
7- Specifically, the defects of deep acne scarring, bulbous rhinophyma, and heavy perioral rhytides are improved more by wire brush dermabrasion than many other resurfacing techniques because the microlacerations of the wire brush can resurface deeply with less risk for scarring. The abrading end piece can be used to soften the sharp shoulders of acne scars, rhytides, and nodules of rhinophyma. In contrast, diffuse rhytides or undulated acne scars and loose redundant skin are often improved better by using ablative laser resurfacing or deep phenol peels in which the more extensive thermal or chemical injury produces greater collagen shrinkage and skin tightening. Therefore, combining close examination of the skin defects to be treated with a comprehensive knowledge of resurfacing options is important to maximize the surgical outcomes in all patients.
Contraindications
1- do not perform dermabrasion for 6-12 months following isotretinoin therapy. Delayed reepithelialization and hypertrophic scarring have been reported in patients who underwent dermabrasion during or shortly after isotretinoin therapy. This complication is believed to be related to the effect of the isotretinoin molecule on epithelial cells and fibroblasts. Postpone dermabrasive surgery in patients with active herpetic lesions.
2- Bleeding disorders and immunosuppression may cause delayed healing and an increased risk for postoperative infection.
3- Yarborough demonstrated that surgical and traumatic scars respond best to dermabrasion performed 6-8 weeks during the interval following incision or injury. In contrast, it is advisable not to perform dermabrasion on overlying skin for at least 6 months following certain surgical procedures that involve extensive undermining, such as face lifts or brow lifts, to allow reestablishment of the underlying vascular bed.
Lab studies:
· Hepatitis panel
· HIV antibody screening with an informed consent
· A nasal swab for patients with a history of impetigo.
· Some patients may warrant a CBC count and chemistry profile.
Preoperative medications:
1- All patients should receive antiviral prophylaxis.
a. Patients with a history of herpes simplex virus (HSV) infections may require a greater prophylactic dosage (ie, valacyclovir 500-1000 mg qd for 10-14 d. Because the herpes virus requires viable epidermal cells to establish an infection, antiviral prophylaxis is continued for 10-14 days, which is longer than the time required for reepithelialization to occur.
b. Patients with a history of very recent or frequent herpetic infections and those patients with postoperative breakthrough HSV infections require a higher dose of antiviral medication, such as valacyclovir 500 mg 5 times per day for 14 days or famciclovir 500 mg 3 times per day for 14 days.
2- Patients who are immunosuppressed, patients with a history of impetigo, or carriers of Staphylococcus species may benefit from prophylactic antibiotics (ciprofloxacin 500-1000 mg qd for 10-14 d). If prophylactic antibiotics are administered, fluconazole 200 mg every day for 10 days prevents secondary yeast infections.
3- Tretinoin cream applied for 2-3 weeks prior to dermabrasion has been shown to decrease the time for reepithelialization.
4- Topical hydroquinone for several weeks prior to surgery decreases the incidence of postoperative hyperpigmentation.
5- Sleep deprivation can be prevented with sedating medications (Dalmane 15-30 mg administered the night before surgery and each night following surgery while patients are sleeping in a full face mask).
6- Photographs by special Cameras from different views.
7- Written surgical consent is taken before any sedation.
8- Sedative: e.g. sominal tab 60 mg is given the night before the operation.
9- Hair removal: any hair on the face is removed either by an Electric razor or by manual methods.
10- Thirty to 60 minutes prior to surgery, the following is administered: 5-10 mg of diazepam (Valium) sublingually; 50-75 mg of meperidine intramuscularly; 25 mg of hydroxyzine intramuscularly.
11- Regional nerve blocks of the mental, infraorbital, supraorbital, and supratrochlear nerves are achieved with 1% lidoocaine and epinephrine (1:100,000 concentration of epinephrine).
12- Surgical therapy: A close examination of acne scars with careful attention to ice pick scarring and sharp-shouldered defects may identify the need for surgical excision, punch floats, subcision, or geometric closures prior to abrading. These surgical procedures set the timetable to schedule the dermabrasion in the following 6-8 weeks.
د. وائل نبيل
الخميس يوليو 25, 2019 9:03 am من طرف موسسه خبراتنا
موضوع: Dermabrasion- For Dermatologists-1 (عمليات صنفرة البشرة)