Dermabrasion is a method of treating skin diseases using mechanical abrasion. Dermabrasion began primarily as a treatment for acne scars. It is an effective surgical method for cosmetic surgery and the treatment of certain diseases. It can be expanded to treat many skin diseases that affect beauty, such as fine wrinkles on the face, chloasma, freckles, rhinophyma of rosacea, vascular nevus, It has a wide range of treatments for syringoma, cutaneous adenoma, keloid, discoid lupus erythematosus, epidermal hemorrhoids, perioral pseudoclefts, xanthelasma, basal cell carcinoma, keratosis pilaris, nevus and tattoo removal.
There are four main types of dermabrasion: sandpaper friction method: wire brush friction method, silicon carbide grinding head method, and stainless steel olive-shaped grinding head method.
Sandpaper rubbing method: roll sterilized sandpaper around an empty syringe or wrap it around a gauze circle to rub the damage with your bare hands. This method is simple and easy to perform, but has the following shortcomings: it is easy to leave sand particles on the skin wound, and foreign body granuloma may occur after a few years. It is inconvenient to rub the parts around the eyes, nose, and mouth, and it is difficult to be effective. It is time-consuming and labor-intensive, and the surgery requires It's time-consuming and labor-intensive.
Line brush friction method: This method uses an electric motor as power to drive it to rotate. Its disadvantages are: because epithelial and other tissues adhere to it, it is inconvenient to clean and disinfect, and it is difficult to use.
Silicon carbide grinding head method: Grinding with this grinding head is better than the previous two. But its disadvantage is that it consumes a lot of money. For example, the whole operation of grinding smallpox scar requires multiple grinding heads. The grinding heads are exchanged back and forth from the handle, which can easily contaminate the sterile area and leave silicon particles on the wound surface.
Stainless steel olive-shaped grinding head method: This grinding head overcomes the above shortcomings. It is easy to grind, flexible and light, and safe to use. No matter what angle is used, a spherical surface contacts the skin, which is easy to use. It is easy to control, brush and disinfect, durable and easy to master.
Indications
Dermabrasion is not suitable for everyone. Its indications can be divided into four categories: scars, pigmented lesions, benign tumors, Related to skin diseases. Among these four categories, they can be divided into preferred indications and relative indications.
Preferred indications include acne, smallpox, chickenpox, shingles, eczema, superficial scars left after trauma or surgery, and insect-eaten skin atrophy;
Relative indications Symptoms include freckles, café-au-lait spots, incontinence pigmentosa, nevus of Ota, facial telangiectasia, rosacea, cutaneous amyloidosis, and facial wrinkles or radial lines at the corners of the mouth.
Contraindications to dermabrasion:
* People with hemophilia or bleeding abnormalities;
* People with hepatitis B surface antigen positive, Those with a history of severe or recurrent herpes simplex;
* Those with active pyoderma;
* Those with keloid or hypertrophic scars;
* Those with radiation dermatitis or localized or burn scars that have received radiotherapy within six months, those with psychiatric symptoms, emotional instability or excessive demands.
Common complications of dermabrasion
Like other surgeries, complications sometimes occur during dermabrasion. Although these complications are not serious, we should have a Comprehensive understanding, preventive and remedial work, and strive for better curative effects. Common complications of dermabrasion include hyperpigmentation, hypopigmentation, milia, hypertrophic scars, infection, erythema, compensatory seborrhea, and herpes simplex.
Pigmentation This is a common problem. The occurrence of pigmentation varies from race to race. White people are lower and yellow people are taller. Among yellow people, those with white skin have light pigmentation, while those with darker skin or those with chloasma have heavy pigmentation. Pigmentation usually appears about 1 month after surgery, with a peak at 2 months. Some people can see the pigmentation as soon as the gauze comes off after grinding. People with this situation will develop more pigmentation than the average person. The pigmentation is heavy and takes a long time to show. The mechanism of pigmentation and fading is complex and affected by many factors. Patients after grinding surgery should try to eat less food containing elements such as copper, iron, silver, bismuth, mercury, gold and arsenic, and eat more food containing zinc.
Hypopigmentation is mainly caused by the loss of pigment cells due to excessive grinding.
Milia occur at the site of dermabrasion in about 1 month, and occur in about 30% of people.
It is mainly caused by the discharge of the contents of the skin appendages when they regenerate and reach the surface; secondly, it is related to damage to the pilosebaceous glands and sweat gland ducts, which often subsides on its own and generally does not require treatment, or it can be punctured with a needle tip and the contents scraped off with a curette. Get better.
Hypertrophic scars are mostly concentrated around the mouth, especially in women. Because the skin around the mouth is thin and tender, this is related to improper control of the grinding depth. You can use triamcinolone acetonide plus an equal amount of procaine, dilute it and inject it into the lesion once a week or every two weeks for 6 consecutive times. The total amount of each injection should not exceed 20 mg to avoid corticosteroid side effects.
The incidence of infection is extremely low. Candida infections have been reported abroad, which is explained by the removal of the stratum corneum, destroying the host's resistance to Candida. In order to reduce edema, some people often take large doses of oral hormones, which affects their resistance.
Erythema may appear to varying degrees after surgery and last for weeks or months before disappearing.
Herpes simplex is seen in patients with large-area grinding and is related to a decrease in the body's resistance.
The principle of dermabrasion is to use electric grinding heads, radio frequency scalpels, microcrystals (tiny aluminum trioxide polygonal crystals) and other equipment to grind or impact the uneven skin scar surface to achieve the desired effect. Smoothing effect on the skin.
1. Indications:
Rough skin, dull complexion, acne, oily particles, enlarged pores, fine wrinkles, stains, and improvement of acne scars.
2. Treatment principle:
Use electric grinding heads, radio frequency knives, microcrystals and other equipment to grind or impact the uneven skin scar surface to remove necrotic keratinocytes and lesions. The epithelium and raised scars can improve the appearance and achieve cosmetic or therapeutic effects.
3. Precautions after surgery:
Apply a thin layer of antibiotic ointment and bandage with gauze after surgery. Usually, a thin layer of scab will form on the ground area after 2 days, which will generally fall off on its own after 6 to 14 days, without much impact on work and life. After microdermabrasion treatment, the skin is relatively delicate and requires daily hydration care, and sun protection must be done, such as wearing a sun hat, sunglasses, and applying sunscreen. Avoid wound contamination to avoid infection. Within 1 month after the wound heals, hot water bathing and scrubbing are strictly prohibited to prevent the occurrence of eczema.
Second, dermabrasion is a surgery that grinds the epidermis and superficial dermis. After grinding, the remaining skin appendages (hair follicles, sebaceous glands, sweat glands) will quickly form new epidermis, and the wound will heal with little or no scarring.
Surgical method: Generally, local infiltration anesthesia is used, and a special grinder is used, or a dental drill is used instead of a grinder for grinding. When grinding after local anesthesia, adjust the speed to 5000~10000r, use the index finger and thumb of the left hand to fix and tighten the skin for grinding. When grinding freckles or old flat warts and pigmentation after skin grafting, grind until the lesions are removed. Generally, These lesions are all in the epidermis, and there is no obvious bleeding after grinding. When grinding depressed scars, the main purpose is to grind the depressed edges until point-like uniform bleeding occurs. If it is too shallow, the effect is not good, and if it is too deep, it will leave scars in the deep dermis. During the operation, the high-speed rotating grinding head may injure the eyes, corners of the mouth, etc., and should be strictly protected. For comprehensive grinding, you should generally grind the forehead first, then grind both cheeks, then grind the nose and around the mouth, and finally carefully grind around the eyes. After all grinding is completed, wipe it clean with saline gauze. If you find that some parts have not been grinded, you can re-grind. At the end of grinding, clean the wound surface with normal saline and dry it gently with gauze. After checking that there is no obvious bleeding, cover the grinding wound surface with a layer of oil gauze, and drop gentamicin on the oil gauze to prevent Infect. Place 8 to 12 layers of sterile gauze on the oil gauze. Because bleeding will be obvious within 48 hours after grinding, the dressing should be slightly thicker. The bleeding will decrease and gradually stop after 3 days, and the external dressing can be removed after 5 to 6 days. It usually takes about 10 days for the oil gauze layer to be soaked with physiological saline and then carefully peeled off. Note that the oil gauze layer must not be forcibly removed, because the new epithelium is still very fragile at this time and is not closely integrated with the deep dermis. Forcibly removing the oil gauze can easily tear off the epithelium, causing wound bleeding and leaving scars. In addition, when bandaging the dressing after complete grinding, openings should be made in the dressing around the eyes, nostrils, and mouth of the patient, and appropriate fixation should be made; when eating and drinking, special attention should be paid to keeping the dressing around the mouth clean and dry. To prevent infection. After removing the dressing for the first time, in order to protect the new skin, you can apply some antibiotic ointment appropriately, and some people recommend applying antibiotic ointment containing hormones. Makeup can be applied after two weeks.
To prevent pigmentation in the surgical area, direct sunlight should be avoided. Generally, you can wear a mask or a wide-brimmed hat, and you can also use sunscreen.
Notes
(1) Master the grinding depth. Some people are afraid of grinding too deeply and leaving scars. In fact, as long as the grinding depth is mastered, no scars will be left. Generally, it is enough to grind to the papillary layer of dermis, that is, even spot-like bleeding will appear. In addition, the cheeks can be worn deeper because of the rich subcutaneous tissue. The skin of the eyelids and around the mouth is thin. There are many subcutaneous tissues under the skin, including the orbicularis oculi and orbicularis oris muscles, that should be worn thinner. Lesbian facial skin is relatively thin and should be lightened.
(2) Master the grinding area. Generally speaking, where there are scars such as acne, the skin should be rubbed. There is no need to rub the area without lesions. For shallow but large lesions such as freckles and old flat warts, in order to make the color consistent after grinding, the entire face should be grinded as much as possible. Since the grinding depth is not deep, the patient has less postoperative exudation and faster recovery, and avoids color inconsistency between the grinding area and the non-grinding area on the entire face. When grinding, you should pay attention to grinding the periphery of the depressed scar, not its central depression.
(3) Grinding scars must be loosened first. When grinding depressed scars, use a small pointed blade to make several horizontal and vertical cuts on the depressed scar, deep into the dermis, to loosen the scar and bounce it upwards, and then grind it again.
(4) Grinding combined with other surgeries. For smallpox scars in the elderly, because the facial skin has become loose, if wrinkle removal is performed first and then grinding is performed, the smallpox scars will become shallower due to the tight skin, and the grinding effect will be better. In addition, for large depressed scars such as smallpox, acne, and chickenpox, a small sharp blade can be used to cut and suture these large depressed scars in a fusiform shape in the direction of the natural wrinkles and then grind them. The comprehensive surgical effect will be better.
Complications: 1. Pigmentation
The incidence of pigmentation in China is 90%, and people with white skin have lighter pigmentation than people with yellow or darker skin. Pigmentation usually appears about one month after surgery, peaks at two months, and disappears after half a year to one year. In some cases, it takes more than a year to subside. (1) Reason. The reason for the occurrence of pigmentation may be that the sulfhydryl groups in normal skin inhibit the oxidation of tyrosinase to melanin. During grinding, a large number of sulfhydryl groups in the skin are removed, causing tyrosinase to rise and locally forming melanin; the strong stimulation of grinding further activates tyrosinase, thereby increasing pigment production; in addition, ultraviolet rays can enhance The activity of tyrosinase; another reason is that iron, mercury, arsenic, silver, etc. have a greater affinity for sulfhydryl groups than copper ions, and combine with sulfhydryl groups to release copper ions, which increases the activity of tyrosinase and aggravates pigmentation.
Pigmentation during dermabrasion is a very common phenomenon. Patients should be informed in advance before surgery that there is currently no good prevention method. After surgery, you should avoid direct sunlight and eat less iron-containing spinach and other foods, which may reduce pigmentation. After pigmentation occurs, you can take multivitamins orally, 3 times a day, for 4 weeks. You can also apply 3%-5% hydroquinone cream externally and use a whitening mask, 1 to 2 times a week. The vast majority of patients with pigmentation after dermabrasion can resolve within a year.
2. Milia (1) Causes. After grinding, about 30% of patients develop milia at the grinding site. This kind of milia is scattered and usually not many in number. The appearance of milia is related to damage to the sweat gland ducts.
(2) Prevention and treatment. When you remove the oil gauze and find milia, you can disinfect it with 75% alcohol and then prick it with a needle tip, and then use tweezers to remove its contents and it will heal. You can also leave it to subside on its own without any treatment.
3． Scar hyperplasia
Scar hyperplasia can appear in any part of the grinding area, but it is most common around the mouth and is more common in women. (1) Reason. The main cause of scar hyperplasia is grinding too deeply.
(2) Prevention and treatment. The preventive method is to strictly control the grinding depth. Acne, smallpox scars, etc. cannot be required to be grinded at one time, and the second grinding operation must be performed 3 months after the first grinding. Pay more attention when grinding around the eyes and mouth, and don't go too deep. If scar hyperplasia has occurred, you can apply scar softening patch or external scar removal ointment. You can also let it fade slowly. Generally speaking, mildly hypertrophic scars are expected to fade and become flat on their own in about a year. If necessary, grinding can be performed again after one year to smooth out the hypertrophic scars that are higher than the skin surface. After grinding, the scars can be covered with oil gauze dressing according to the normal grinding technique.
In severe cases, triamcinolone suspension plus 3 times the amount of novocaine can be diluted and injected into the scar, 1 to 2 times a week, 4 to 6 times in a row.
4. Infection
Because the face has rich blood circulation, the incidence of infection is extremely low. Generally, it can be seen occasionally during large-area grinding in summer.
(1) Reason. When performing large-area grinding in the hot summer, the wound is easily contaminated by bacteria and can become infected.
(2) Prevention and treatment. The preventive method is to strictly control the indications. Patients with facial folliculitis or acne in the papulopustular stage should not undergo dermabrasion. Comprehensive dermabrasion should not be performed in summer. It is best to use antibiotics routinely for 3 to 5 days after dermabrasion. , to prevent infection. When local infection occurs, the dressing should be removed immediately, the infected wound should be exposed, and the dressing should be changed. TDP lamps can also be used for irradiation. If necessary, the dose of effective antibiotics should be increased.
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