BY

DR.SHAKIL ASHRAF
POSTGRADUATE TRAINEE
CONTENTS
 TYPES OF SKIN RESURFACING PROCEDURES
 DERMABRASION
 RELEVANT SKIN ANATOMY
 PRINCIPLES OF PROCEDURE
 MICRODERMABRASION
 INDICATIONS
 CONTRAINDICATIONS
 PREPARATION OF PT
 PROCEDURES
 POST-PROCEDURE COMPLICATIONS
Some people, no matter how old they get, never lose their
beauty - they merely move it from their faces into their
hearts.
~Martin Buxbaum
WHAT HAS HAPPENED?
WHAT HAS HAPPENED ?
 Dermabrasion
1905

Microdermabr
asion
Treatment Laser
Resurfacing
1985 Options 1990

Chemical Peels
1960
SAND PAPER ? ? ?
Dermabrasion
 Accelerated exfoliation or skin damage induced by
mechanical dermabrador
 Controlled fashion
 Results in:
1. Thickening of the epidermis
2. Deposition of collagen
3. Reorganization of structural elements
4. Increase in dermal volume
5. Decrease solar elastosis
Core Principle of Dermabrasion
Use of various abrasive instruments to
remove superficial layers of skin using
appropriate anesthesia, most often
with high-speed rotary instruments
with abrasive end pieces
SUPERIOR FEATURES
Use in the focal segments of
face

Lower incidence of injury to

melanocytes

Much lower cost

Lower scarring risk

 Facial acne scars
Seborrheic
keratosis Deep rhytides

 Epidermal nevi Rhinophyma


INDICATIONS

Trichoepithelomas Syringomas

Decorative tattoos
Angiofibromas
removal

Traumatic and Superficial BCC

surgical scars and SCC in situ
 Active
infection
DM
Open wounds
HIV +

Bleeding
disorders drugs

CONTRAINDICATI
ONS

Pre –exist
Radiation inflam:
therapy
dermatoses

Abn scar, Uncooperativ

keloid pt
Unrealistic
exp
Skin Structure
Epidermis

Dermis
papillary dermis

reticular dermis
Papillary and Reticular Dermis
• Blood vessels dilate
• WBC & clotting agents released
• Granulation tissue forms
• Capillary beds invade clot
• Clean up begins
• Scar area has contracted
• Epithelium regeneration begins
RE-EPITHELIZATION
Fitzpatrick Classification
Type Color Tanning response

I White Always burns, never tans

White Usually burns, sometime

II tans

Sometimes burns, usually

III White tans

IV Brown Never burns, always tans

Moderate constitutive
V Dark Brown pigmentations

Marked constitutive
VI Black pigmentation
 The Glogau Classification of Photoaging
Groups
Mild Moderate Advanced Severe
(aged 28-35 y) (aged 35-50 y) (aged 50-65 y) (aged 60-75 y)

Little wrinkling Early wrinkling, Persistent wrinkling Wrinkling -

or mild scarring Photoaging,
scarring gravitational,
dynamic

No keratosis Sallow color with Discoloration with Actinic keratoses

early actinic telangiectasias and with or without skin
keratosis actinic keratosis cancer

Requires little or no Requires little Wears makeup Wears makeup with

makeup makeup always poor coverage
 THICKNESS OF SKIN LAYERS(micrometers)
AREA EPIDERMIS DERMIS SUBCUTANEOUS TOTAL
TISSUE
Neck 115 138(thinnest) 554 1,697

Eyelids 130 215 248 (thinnest) 593 (thinnest)

Cheek 141 909 459 1,509

Nose 111(thinnest) 918 735 1,764
Forehead 202 (thickest) 969 1,210 (thickest) 2,381
Lower lip 113 973 829 1,915
Upper lip 156 1,061 931 2,143
Chin 149 1,375(thickest) 1,020 2,544(thickest)
COSMETIC UNIT:
Areas of skin that share similar characteristics (e.g. the nose, cheek and
periorbital skin).
The junction lines separating these areas are also important because scars
placed in junction lines are usually unobtrusive whereas scars that
cross a junction line (bridge two cosmetic units) are very obvious
 PATIENT SELECTION
1. History
 General health status, medical conditions affecting
cardiac,renal,liver diseases
 Abnormal scarring tendency
 Drug allergies
 Clotting or pigmentary disorders
 Koebnerizing skin conditions. … test spot dermab:
 Drug history (eg, oral isotretinoin , Exogenous estrogens, oral
contraceptives, and other medications maybe
photosensitizing , warfarin)
PT SELECTION CONTD…
 History of recent radiation
 Smoking, (dynamic action of puffing and ezymatic
reaction weakens skin)
 Previous cosmetic procedures (eg, surgical lifts, fluid
silicone injections),
 H/O Infections ( HSV, Impetigo,HIV, hepatitis status )
 Keloid formation
 Identify pt specific motivation and expectations
PT SELECTION CONTD…
 EXAMINATION :
1. Fitzpatrick skin type
2. Sebaceous quality of skin
3. Presence of hypertrophic scarring
4. Presence of keloids
5. Vascular malformations
6. Pigmentory alterations
7. Severity and depth of condition to be treated
8. Identify need for additional or alternative procedures
PRE-OP PREPARATIONS:
 Photographs (standardized camera angles)
 Nasal swab
 Prophylactic anti-viral medication
 Base line labs
1. CBC
2. Chemistry profile
3. Hepatitis panel
4. Screening for HIV
PRE-OPERATIVE MEASURES
 Anesthesia
1. Local
2. General
 Drugs
1. Diazepam
2. Meperidine
3. Hydroxyzine
4. Flurazepam
5. Trans-retinoic acid
6. Topical hydroquinone
7. Anti viral prophylaxis
END PIECES
 STEPS OF PROCEDURE
PRE-OP MEDICATIONS

ANESTHESIA
REFRIGERENT AGENTS,G/A,N.BL

MARK TREATMENT AREAS

HOLD THE SKIN TAUT

HOLD THE ABRADING INSTRUMENT

IN CORRECT POSITION
STEPS OF PROCEDURE CONTD…
START FROM DEPENDENT AREAS ALONG
THE SIDES OF FACE …WORKING TO THE
CENTRE

KEEP THE ROTAT HEAD PARALLEL TO SKIN

SURFACE

MOVE DELIBERATELY WITH FIRM EVEN

PRESSURE

SURG LAND MARKS…..NO BLEEDING…EPID

UNIFORM PUNCTATE BLEEDING…SMOOTH
SURF..PAP DERM

BLEEDING POINT INCR….ROUGH SURF..DEEP

PAP DERM
 POST-OP DETAILS
TOPICAL PETROLIUM

CLOSE WOUND CARE

REGIMEN..semipermeable dressing…5 days

OPEN WOUND CARE REGIMEN..saline

compresses

MEDICATIONS…pain,antibiotics,short course
of oral steroids,continue anti-viral
FOLLOW UP
Removal of fibrinous exudate

Phase of transient
hyperpigmentation..hydroquinone

Change of dressing

Post-operative oedema

Sun block application…6-12 month

COMPLICATIONS:
Secondary infections

Pain with or without erosion…post herpetic infection

Bright erythema…scarring

Pigmentory alterations

Pseudo hypopigmentation

Milia formation

Acne flares
MICRODERMABRASION? ? ?

 Mechanical or physical
exfoliation using crystals
to remove the outer layer
of dead or damaged skin
cells revealing a more
youthful skin.
Features of MDA
 No down time
 Non-invasive
 Suitable for most skin
types/skin colors
 Minimal risk/side effects
 Early photo
damage


Fine lines

Indications Fine wrinkles

MDA

Superficial
scarring

Stretch marks
Principles of MDA
 Depth of one pass..15µm
 Number of passes .. 2 passes
 Vacuum pressure
 Size and coarseness of diamond tipped treatment head
 Speed of hand piece
 Crystal sizes
 Crystal flow rate
 Number of sessions
 Factors Affecting MDA
Treatments
1. Amount of vacuum suction How taut the skin is pulled
into the opening of the handpiece. .. suction pressure
directly affects the depth of the abrasion and the
intensity of the surface exfoliation.
2. The volume of the crystals. projected onto the skin
determines the amount of exfoliation as well as the
velocity of the crystals
3. Speed of movement. directly connected to depth of the
abrasion, faster strokes are less stimulating.
4. Number of passes done over a given area.
We can change the above variables
 Features of Suction
 Controls the depth of treatment, as well as velocity of
material (high suction, high velocity) and stimulates
blood flow for the oxygenation and nourishment
benefits
 Activates the lymph system for natural cleansing and
draining.
A standard aluminum oxide microdermabrasion
system.
MDA END PIECES
Dermabrasion tip and particles. A microdermabrasion tip with aluminum oxide
microparticles flowing inside the tip (a). Scanning electron microscopy image of
aluminum oxide microparticles with a small population of very small particles
(pointed to by arrows) (b).
Histological Evidence of
Microdermabrasion
Effect of the number of passes on removal of skin layers in monkeys after microdermabrasion.
Brightfield images of H&E stained skin sections from biopsies obtained from an untreated control
site (a), and sites exposed to mobile-mode microdermabrasion with 50 kPa vacuum pressure for 10
passes (b), 30 passes (c), 50 passes (d), 80 passes (e) and 100 passes (f). Dotted rectangles indicate
areas of selective yet full-thickness stratum corneum removal, and arrows point to residual
aluminum oxide particles.
Effect of exposure time and vacuum pressure on removal of skin layers in monkeys after
microdermabrasion. Brightfield images of H&E stained skin sections from biopsies obtained from an
untreated control site (a), and sites exposed to microdermabrasion with 30 kPa vacuum pressure
and exposure time of 3 s (b) or 6s (c), and 50 kPa vacuum pressure and exposure time of 3 s (d) or
6s (e). Double-lined arrows point to blisters and single-lined arrows point to residual aluminum
oxide particles.
TREATMENT PASS APPROACHS
MDA WORKS ?
gently sandblasting the skin with a high pressure
flow of ultra fine inert aluminium oxide crystals

remove the outer most layers

of the epidermis(stratum corneum)

vacuum suction action removes

the crystals and skin debris

stimulating the lower layers of the skin

Two passes on each cosmetic unit

PERI-ORBITAL AND CHEEK
RHYTIDES IN MDA
RESEARCH ARTICLES
 Amany M et al. Treatment of striae distensae with
microdermabrasion: a clinical and molecular study J
Egypt worn Dermatol Soc. 2008
 Parastoo Davari et al.The Effects of Different Intervals of
Microdermabrasion Sessions on Skin Biophysical
Parameters: A Randomized, Assessor-Blind, Within-
Patient Trial. Iranian Journal of Dermatology. 2008
 Darius J et al.Molecular Analysis of Aggressive
Microdermabrasion in Photoaged Skin. Arch Dermatol.
2009
VIDEOS