29 Dermabrasion and Microdermabrasion: Rationale, Application, Safety Concerns, and Complications

Abstract

The history of dermabrasion dates back to 1550 BC when Egyptian physicians used alabaster and pumice to smooth scars and skin blemishes. 1 They recognized that producing partial-thickness abrasion improved the appearance of skin. Modern era dermabrasion was pioneered in 1905 by Kromayer. 2 In 1953, Kurtin refined the dermabrasion technique with modified, powered dental equipment using topical refrigerants and a wire brush. 3 There are three main modalities for skin resurfacing: chemical peel, laser resurfacing, and mechanical dermabrasion. The contemporary trend favors the use of the laser-resurfacing technique. Many clinicians feel that laser resurfacing allows for more controlled thermal injury and more consistent outcomes with less operator-dependent variability. Whereas the newest laser technology has significantly reduced risk associated with thermal injury to surrounding tissues, in experienced hands, dermabrasion provides great manual control to the depth of destruction without spreading the thermal injury to deeper layers of the skin. MechanismThere are five layers of epidermis: stratum corneum at the surface followed by lucidum, granulosum, spinosum, and basalis. The thickness of epidermis varies depending on age of the patient and location of the skin. Average thickness of facial skin epidermis is approximately 100 µm thick, although at the eyelids it may be only 50 µm thick. 4 Four major cell types are found in the epidermis, including keratinocytes (80%), melanocytes, Langerhans cells, and Merkel cells. In the basalis layer, melanocytes generate skin pigmentation through the actions of the tyrosinase enzyme. 5 The rete ridges are projections of the epidermis into the dermis that help increase the surface area of contact between the two interfaces. In both processes of aging and scar formation, histological changes observed include loss of elastic fiber, atrophy of collagen bundles, and flattening of rete ridges. 6,7 The dermis consists of papillary and reticular layers. The papillary layer is located below the basement membrane and contains mostly loose collagen and fibrocytes. The reticular layer contains thicker, compact collagen, and the adnexal structures of the skin such as sweat glands, hair follicles, and sebaceous glands. On the hairless part of the face, such as the nose, the sebaceous unit is the predominant adnexal structure. Within the adnexal structures are the epithelial stem cells capable of differentiation and re-epithelialization. 8 The goal of dermabrasion is to mechanically remove the epidermis while preserving the adnexal structures (▶ Fig. 29.1). This is accomplished with the use of a motorized handpiece and a rotating tip composed of either a wire brush or diamond particle-coated fraise (▶ Fig. 29.2). The depth of injury is controlled by the surgeon carefully abrading the skin to the desired layer (▶ Fig. 29.2). Controlled injury to the epidermis and papillary dermis heals without scarring; however, if the injury penetrates deep into the reticular dermis where the adnexal struct...