Dermabrasion in cosmetology

Background

The first mention of dermabrasion is found in ancient Egyptian papyri. And the first description of the dermabrasion technique belongs to Kromajer (1905), who used a conventional drill for this purpose. At that time, the technique was not widely used, since the low speed of the drill did not make it possible to effectively scrape the skin.

In 1949, Schreuss in Germany first proposed the use of high-speed burs for polishing leather. Together with the Schumann engineer, they created a small-sized Diros device with a high rotation speed - the cutters acquired speeds of up to 30 thousand revolutions per minute.

In the United States, the greatest interest in dermabrasion occurred in the 50s of the last century. Dr. Kurtin used a technique of first freezing the skin with ethyl chloride, and later with a combination of ethyl chloride and Freon-114 to a rigid state, followed by abrasion with brushes. E. Stolar (Argentina) combined dermabrasion with pre-treatment of the skin with liquid nitrogen, and Goodman - with the use of infiltration anesthesia. However, they were forced to abandon these methods, since deep freezing could lead to frostbite, which delays regeneration processes and provokes the formation of keloid scars.

Currently, in the USA they usually use devices with a speed of 20-30 thousand revolutions per minute. Initially, only steel tips and carborundum stones were used for dermabrasion. Subsequently, the range of attachments expanded, diamond burs, rubber brushes, and nylon brushes appeared.

Modification of the working part of the device is extremely important for the doctor, since strict delimitation of the use of burs depends on the pathological process that dermabrasion is aimed at. After the creation of the Schumann-Schreuss rotary apparatus, the technology was constantly improved. Devices weighing 225 grams appeared, as well as varieties of devices with a motor located directly in the handle.

Along with traditional dermabrasion, there are techniques that use abrasive paper on a swab with a cotton pad or on a wooden base. Sanding with sterilized sandpaper was first used in 1947 by Dr. Iverson to treat keratoderma, and in 1952 Rosenberg used manual dermabrasion to eliminate impregnation.

In the last 20 years, the so-called microcrystalline microdermabrasion has become widespread. The method is based on the ability of a fine metal filler supplied under pressure to provide targeted abrasion of micron layers of the epidermis. Microresurfacing is an extremely gentle method that does not require anesthesia and does not cause complications, but requires multiple repetitions of the resurfacing procedure to achieve a minimal cosmetic effect.

In Ukraine, classical dermabrasion began to be carried out in the early 80s of the last century. At that time, the hospital at the Ministry of Coal Industry used a device from the Schumann-Schreuss company, which was used to remove coal impregnation from miners. But, in connection with the move of the Ministry of Coal Industry from Kyiv to Donetsk, the device was donated to the capital's beauty institute. Personally, I mastered the dermabrasion technique and put it into practice since 1986.

Unfortunately, classical dermabrasion has not found wide practical application in our country. This is due to the fact that the operation requires special technical equipment and training of medical personnel. Dermabrasion still remains the prerogative of specialized clinics.

Indications and contraindications for the procedure

Dermabrasion is used:

• in patients with cicatricial changes in the skin of the face and body, different in nature - consequences of acne, patients who have suffered burn injuries;
• for aging facial skin;
• to remove impregnation, embedded foreign particles in the skin (coal, paints, asphalt, fuel oil), including tattoos;
• Dermabrasion gives an excellent and long-lasting effect in the treatment of rosacea (grade 2-3) and especially rhinophyma. The use of methodical diamond cutters allows you to radically eliminate connective tissue hypertrophy and form a thinner nose configuration.
• to eliminate extensive pigmented nevi. Along with acquired cosmetic imperfections, dermabrasion is successfully used to treat genodermatoses: trichoepitalioma, Mibelli porokeratosis, Ringle's adenoma, Balser's adenoma, pigmented xeroderma.

Dermabrasion can be used as the only method of treatment, as well as in combination with medium-length chemical peels, microcrystalline resurfacing, bookitetherapy, and physiotherapeutic methods.

There are few contraindications for dermabrasion:

• the tendency to form keloid scars is absolute;
• relative - a tendency to dyschromia, allergic skin diseases, the presence of pustules and acute inflammatory elements.

Complications after dermabrasion

The most common complication is persistent hyperemia and possible dyschromia.

Early postoperative hyperemia is inevitable, therefore, during the first 20 days after complete healing, the patient is recommended to use cold lotions. I use a 1% solution of boric acid, and if there is a tendency to form pustules, a solution of furatsilin 1: 5000, then we switch to green tea, chamomile, and eucalyptus lotions.

If there is significant hyperemia, corticosteroid creams can be used for 5-7 days. Recently we have been using Sensetive anti-erythema creams and the Relax mask. When going outside, apply cream with SPF.

We perform facial dermabrasion only in the autumn-winter period (until January 14) to avoid dyschromia.

Features of the technique

We performed dermabrasion on an outpatient basis, in a small operating room. Conducted in practically healthy people.

The preoperative preparation program included: clinical analysis of blood and urine, Wasserman reaction, determination of blood clotting and HIV testing. If necessary, a therapist and sometimes a psychiatrist were consulted.

Medication preparation included: vitamin therapy, sedatives, analgesics. Since skin resurfacing is a provoking factor for the development of Herpes Simplex, patients with a complicated medical history received a preventive course of antiherpetic therapy: acyclovir 400 ml/day the day before surgery and in the next 5-7 days. Two weeks and a month after the operation, the drug Proteflazid was prescribed according to the regimen indicated in the annotation.

Own experience

A large number of patients with indications for dermabrasion come to our clinic. Since 2014, we have operated on 194 people.

According to diagnoses, the first place was occupied by cicatricial skin changes, the second by age-related skin changes, the third by tattoos, the fourth by impregnation, and the last by rosacea. Mostly, patients were referred to us by dermatologists, aestheticians and related specialists. If necessary, patients were consulted by dermato-oncologists. A positive effect was achieved in 100% of cases. The postoperative period was uneventful.

conclusions

The method of mechanical dermabrasion can be successfully used in the practice of dermatosurgery. The only drawback to this procedure is the long rehabilitation period and the need to perform it in an operating room.

Photo 1. Man 23 years old before and one year after surgery

Photo 2. A 20-year-old man before and a year after 3 dermabrasion procedures

Photo 3. Woman 64 years old before and one year after surgery and biorevitalization course

First published by “Cosmetologist” No. 5, 2015