Microdermabrasion and Dermabrasion not in 3rd Ed Flashcards
The most common indication for dermabrasion is facial acne scars
T
Regarding dermabrasion, wounds need to be limited to a deep-reticular dermal depth, as wounding deeper than this results in surface changes that are perceived as a scar.
F mid-reticular depth
Traditional dermbrasion utilises a wire brush or diamond fraise on a rotary hand engine to mechanically remove tissue.
T
Scarring, dyspigmentation and infection are potential complications of any deep abrasion procedure.
T
Acne scars that disappear by stretching the skin are an indication for recontouring with dermabrasion.
F Scars that don’t disappear with stretching.
Dermabrasion should not be combined with CO2 laser.
F Can be combined to ‘tighten’.
Surgical procedures for scars should be performed 6-8 weeks or more before dermabrasive or laser resurfacing.
T
CO2 laser and Nd:YAG laser will tighten and smooth superficial acne scars and rhytides.
F - Er:YAG (not Nd:YAG).
Dermabrasion is a helpful resurfacing adjunct for sculpting the elevated ridges of wrinkles that persist despite 2-3 passes with an ablative laser.
T
Dermabrasion removes the thermal coagulum left after heat-induced injury of CO2 lasers, thereby promoting healing and reducing postoperative erythema.
T
Rhinophyma tends not to respond to dermabrasion.
F Responds well.
There is a significant risk of scarring associated with dermabrasion of rhinophyma.
F Minimal risk due to sebaceous nature of rhinophymatous tissue.
Epidermal naevi, seborrhoeic keratoses, syringomas, angiofibromas and trichoepitheliomas can be dermabraded with good results.
T
Decorative tattoos can be abraded followed by the application of 1% gentian violet directly to the abraded surface and dressed with Adaptic gauze.
T Gentian violet promotes removal of tattoo pigment by stimulating phagocytes to carry away abraded pigment.
Traumatic and surgical scars cannot be treated with dermabrasion.
F Can perform as early as 6-8 weeks following injury of surgery.
Cosmetic patients undergoing dermabrasive surgery should expect 50-70% improvement in the appearance of deep acne scars and adynamic rhytides.
F 30-50%.
Distensible acne scars and dynamic rhytides that disappear by stretching are best treated with tissue tightening procedures such as ablative and non-ablative laser resurfacing treatments.
T
Sharp shoulders of scars of chicken pox or acne and deep non-distensible rhytides should be treated with surgery only.
F Can treat with mechanical dermabrasion or laser sculpting.
For full-thickness defects, surgical excision punch grafting and/or dermal grafts should be performed at least 6-8 weeks before resurfacing.
T
Patients with a history of impetigo should have a nasal swab to assess for S.aureus colonisation prior to dermabrasion.
T These patients will need prophylactic Abs.
Only patients with a history of HSV require prophylactic antiviral medication for dermabrasion.
F All patient should take until fully re-epithelialised. 14 days is recommendation.
Most herpetic infections occur 1-2 days after resurfacing surgery.
F 7-9 days after.
Delayed re-epithelialisation and hypertrophic scarring have been reported in patients undergoing dermbrasion during or shortly after isotretinoin therapy.
T
Dermabrasion should be postponed 1-2 months after a course of isotretinoin.
F 6-12 months.
Topical tretinoin cream applied daily for 2-3 weeks before dermabrasion has been shown to reduce the time required for re-epithelialisation.
T
A test spot dermbrasion is recommended in patients with a history of keloids or koebnerising conditions.
T
There is no need to observe universal precautions in performing dermabrasiion.
F Aerosolised viral particles can be produced.
The areas to be abraded should be outlined preoperatively with gentian violet while the patient is lying supine.
F Patient sitting.
Dermabrasion should be performed along the angle of the mandible and along the inferior jawline.
F Should perform to 1-2 fingerbreadths below to hide transition zone.
Partial abrasions (eg. around mouth, nose) should follow lines of facial cosmetic subunits.
T
Tumescent anaesthesia should be used to anaesthetize the entire face for dermabrasion.
T
Some microdermabrasion devices employ aluminium oxide crystals, which are sharp-edged and hard, as an abrasive.
T
Microdermabrasion is essentially painless, quick, easy to perform and has few associated risks.
T
The clinical benefits of microdermabrasion can be profound.
F Clinical benefits are modest.
Following treatment with microdermabrasion, mild erythema is present, but resolves quickly.
T
Eye protection is not needed for microdermabrasion.
F Corneal abrasions can occur from crystals.
The fraises used for dermabrasion are available in a variety of sizes, shapes and grades of coarseness.
T
Cone-shaped fraises should be used on broader surfaces on the forehead and cheeks.
F Confined areas around nose, mouth, eyelids.
Wheel-shaped fraises or the wire brush should be used on confined areas around the nose, mouth and eyelids.
F On broader surfaces.
The extra coarse fraise is more forgiving than the wire brush.
T
The bristles of the wire brush are angled such that clockwise rotation cuts more deeply in the skin, whereas counterclockwise rotation brushes the bristles over the surface more gently.
T
For dermabrasion, the abrading endpiece is passed over the skin in arciform strokes parallel to the direction of endpiece rotation.
F Perpendicular.
To abrade, the hand engine in pushed over the skin surface.
F Pulled.
For dermabrasion, the direction of rotation is only important when a wire brush is used.
T
For deep surfacing of acne scarring on the mid cheek, traumatic or surgical scars, or debulking large nodules of rhinophyma, clockwise rotation is more efficient.
T
For full-face procedures, it is best to start abrading along the jawline or preauricular area and progress toward the centre of the face and nose.
T This allows for bleeding from the abraded areas to flow away from the skin being abraded.
Two-point retraction of skin should be used to stabilise the area being abraded.
F Three-point retraction.
When using spray refrigerant during dermabrasion, the scar or rhytide should be frozen in its stretched position.
F Unstretched position.
The depth of abrasion can be monitored by closely observing the abraded surface.
T Papillary dermis appears as glistening white surface. Points of bleeding with depth.
Yellow globules of sebaceous glands are seen with deep dermabrasion of acne scars in the mid-cheek or rhinophyma of the nose.
T
The dermal fibrosis of acne scars tends to be resistant to abrasion.
F It will crumble and become friable.
The peripheral margin of the abraded regions should be feathered to create a natural-looking transition zone.
T
Acriform strokes should be perpendicular to the border of the abraded areas
F Parallel.
Upon completion of a full-face dermabrasion procedure, most of the abraded areas will still be bleeding.
F Most will have stopped.
Post-operative oedema can be reduced with im kenacort A40 given immediately post-dermabrasion.
T
The abraded surface should be dressed with a semipermeable dressing held in place with paper tape and backs with non-adherent pads and gauze.
T
The patient should return to clinic for the full-face dressing to be changed every 7 days.
F Every 3-5 days.
The development of pain with or without erosions generally indicates a postoperative herpetic infection.
T
Superinfection by bacteria or fungi is not uncommon following dermabrasion.
F Much less common than HSV.
The presence of bright erythema after the first 2-3 post-operative weeks is the first sign of early scar formation and should be treated with topical high-potency steroid ointment od-bd.
T
Pulse dye laser should not be used following dermabrasion.
F Can decrease erythema and scar induration.
Intralesional steroid injections can be given if any induration, elevation or hypertrophy develops after dermabrasion.
T
After successful aggressive scar management following dermabrasion, the skin should be clear.
F Usually have small focal areas of hypopigmentation.
Following 3-5 days of wearing a full-face mask after dermabrasion, an open wound care technique can be employed with topical petrolatum ointment.
T
Petrolatum ointment should be applied sparingly after dermabrasion.
F Apply 3-4 times daily.
The open wound produced by dermabrasion heals by the mechanism of second intention wound healing.
T
Regions rich in sebaceous glands (eg. nose and mid-cheek) re-epithelialise more slowly than skin over the bony prominences of the forehead, malar cheek and mandible after dermabrasion.
F More quickly.
In dermabrasive wound healing, the collagen fibres align perpendicular to lines of tension before intermolecular cross-linkages are complete.
F Parallel.
Following dermabrasion, increased tenascin expression may promote cellular migration, while integrin mitigates the epithelial mesenchymal interaction of wound healing.
F Increased integrin expression may promote cellular migration, tenascin mitigates epithelial mesenchymal interaction of wound healing.
As wound healing progresses following dermabrasion, intradermal oedema continues to dissipate for up to 3 months.
T
Continuing improvement of the skin surface irregularities and depressions occur for up to 24 months following dermabrasion.
F 6-12 months.
Re-epithelialisation is usually complete within 7-10 days following dermabrasion.
T
The skin heals faster with open techniques of wound care compared to using a semi-permeable dressing.
F Faster with semi-permeable dressing.
Normal skin tone tends to return within 2-3 months following dermabrasion.
T Need to avoid sun exposure during this time.
Most patients will develop some degree of transient post-inflammatory hyperpigmentation over the malar prominences and jawline following dermabrasion.
T
Bleaching regimens can be used from the 3rd-4th week after dermabrasion and continued for 4-8 weeks or until hyperpigmentation resolves.
T
Permanent pigment alteration occurs in less than 5% of patient following dermabrasion.
F 20-30%.
Skin types V-VI are more likely to develop post-inflammatory hyperpigmentation following dermabrasion.
F Skin types III and IV.
Pseudohypopigmentation refers to the phenomenon of when normally repigmented abraded skin appears to have a different tone and appearance than adjacent non-abraded skin.
T Can correct non-abraded areas with chemical peels, IPL or non-abalative laser.
Increased milia formation is an expected postoperative sequelae of dermabrasion.
T Treat with gentle extraction after 1 week.
Acne flares following dermabrasion are due to the occlusive nature of postoperative wound care.
T Treat with routine acne regimens.
