Filling Up the Valleys

September 2019 | Volume 18 | Issue 9 | Features | 957 | Copyright © September 2019

James M. Swinehart MD

Denver, CO

A Bell hand engine is most effective for dermabrasion utilizing a soft wire brush for the forehead, regular wire brush for acne scars, cheeks, or deeper wrinkles, with diamond fraise for the infraorbital areas, perioral areas around the lips, feathering into the hairline at least 1cm to anticipate future possible hairline recession, for the nose (unless deeper scars are present), and onto the neck with a very fine diamond fraise. The eyelids are generally peeled with Jessner's solution plus 25% trichloroacetic acid solution. It should be emphasized that dermabrasion must be performed by a physician.

Following the dermabrasion, a moist dressing is applied, secured to the face by Kling, Kerlix, or Hypafix. This is changed in 1 day and 3 days. Healing is quite rapid, with a pink appearance visible after 3 days, and reepithelization generally complete in 7 days. Erythema disappears completely, and although patients have a near normal appearance at 28 days, sunscreens must be applied for months. Greasy postoperative creams should be avoided, as these may tend to cause milia. Dermabrasion may be repeated for isolated areas, but on the first procedure, the entire face must be treated with one technique or another in order to avoid lines of demarcation.

Drawbacks to Techniques Currently in Vogue: 
1) Chemical peels work quite well for finer wrinkles, but areless effective for deeper acne scars, deep wrinkles, andnasolabial folds.

2) Micro needling: The fact that no heat is generateddecreases the risk of side effects or harm, but it is onlyminimally effective, since many microscopic skip areas areleft remaining.

3) Fractional lasers: Because of the fact that skip areas arepresent, and heat is generated, the techniques are oftenless effective and desirable, and there is prolongederythema with risk of scarring. Laser heat penetrates atmost 100 microns into the skin, but many scars are 1 to 2mm deep - therefore, lasers do not go as deeply as oftenrequired.

4) Heat generating machines or ultrasound techniques:These may produce waffling, with unpredictable results,prolonged erythema, and a risk of scarring.

5) "Platelet rich plasma" is generated by the dermabrasionitself, since the patient's platelets create clotting. However,the injection of separate blood-derived platelet enrichedplasma has not been proven to erase scars.

Advantage of a Full-Face Wire Brush Dermabrasion Include:
1) Uniformity of results.

2) There is direct operative control, vs laser with computerchip.

3) Immediate results can be seen while performing theprocedure, with instant touchup of scars not completelyerased by the first pass.
4) Healing is far faster than that with a laser, with muchquicker resolution of erythema.

5) Minimal or no postoperative pain.

6) Greatly decreased cost, since the equipment used is ofvery low cost.

7) The equipment will not become obsolete, unlike lasers, which may be supplanted by newer models within severalmonths.
James M. Swinehart MD
Denver, CO

References
1. Yarborough JM Jr. Dermabrasion by wire brush; J Dermatol Surg Oncol.1987;13(6):610.

2. Yarborough JM. Preoperative evaluation of the patient for dermabrasion: J Dermatol Surg Oncol. 1987;13(6):652.

3. Swinehart JM. Test spots in dermabrasion and chemical peeling. J Dermatol Surg Oncol. 1990;16(6):557-563.

4. Swinehart JM. Fine Points of full-face dermabrasion: edge feathering,combined with chemical peeling, for uniform results. Am J Cosmet Surg.1992;9:289-293.