Surgical pearl: manual dermabrasion

Comparative Evaluation of Clinical Outcomes of Laser Skin Resurfacing Using an Ultra-Pulse Carbon Dioxide Laser and Manual Dermabrasion Using a Medium-Grit Drywall Sand Screen for Scar Revision in Adults: A Split-Scar Prospective Study

PURPOSE

The purpose was to evaluate the clinical outcomes of laser skin resurfacing using an ultra-pulse carbon dioxide (CO₂) laser and manual dermabrasion with a medium-grit drywall sand screen for scar revision in adults with Fitzpatrick skin type III to V.

MATERIALS AND METHODS

A total of 20 postsurgical and post-traumatic scars in individuals with Fitzpatrick skin type III to V were included in this study. Preoperative evaluation of the scars was performed by 3 blinded observers using the Manchester scar rating scale. Each scar to be treated was divided into 2 equal halves, and each half was randomly allotted to either ultra-pulse CO₂ laser resurfacing (group A) or manual dermabrasion (group B). Postoperative clinical evaluation was performed by the same observers using the Manchester scar rating scale at the end of the first month, third month, and sixth month.

RESULTS

This study showed that both methods were effective in improving the appearance of the postsurgical and post-traumatic scars. No significant difference was found between them (P = .978). Hyperpigmentation occurred in 4 scars in both the half treated with manual dermabrasion and the half treated with laser resurfacing; however, it had resolved by the end of the sixth month in all 4 scars.

CONCLUSIONS

CO₂ laser resurfacing and manual dermabrasion are equally efficacious and safe methods for scar resurfacing in adults with Fitzpatrick skin type III to V.

The management of postacne scarring

BACKGROUND

Therapeutic intervention for postacne scarring has historically been limited by the considerable morbidity of most treatments for only marginal disease improvement. Within the past decade, however, a greater understanding of the pathogenesis of acne scarring has led to the development of techniques that offer more favorable risk-benefit profiles.

OBJECTIVE

The aims of this article are to highlight a number of newer techniques and to assign their appropriateness to particular grades of acne scarring.

MATERIALS AND METHODS

Current modalities are discussed as they relate to disease process and specific acne scar types. Techniques are presented in order of most effectual therapeutic interventions for defined grades of acne scarring. Acne scarring grades have been described previously in terms of disease load, severity, and lesion morphologies.

RESULTS

A comprehensive discussion of updated therapeutic techniques and their biologic rationales in the treatment of acne scarring is presented. These include targeted interventions of inflammatory and postinflammatory processes, angiogenesis, immunologic processes, dermal and subcutaneous fibrosis, hypertrophy, and keloid scarring.

DISCUSSION

A requirement for developing successful treatments for postacne scarring is a greater understanding of its pathogenesis, variability among afflicted individuals, and the inflammatory mediators and immunology of the scarring process. Many innovative techniques introduced in the past decade attempt to counteract these pathologic processes while keeping the procedural and postoperative risks to a minimum.

Simple things that make a difference in nasal reconstruction

The nose is the most common location for nonmelanoma skin cancer. As a result, nasal reconstruction is a frequent challenge for Mohs surgeons. The esthetic outcome of each nasal repair can be improved by replacing nasal skin with the most similar match, restoring the intricate three-dimensional structure of the nose and applying the principle of cosmetic subunits. This article will present techniques and helpful hints, which are useful during nasal reconstruction to improve the selected repair and enhance the final result.

Perioperative care of the surgical patient

Efficient care of the surgical patient necessitates attention to key elements of preoperative patient preparation prior to the day of surgery, a standardized approach to patient monitoring and education on the day of surgery, and careful postoperative monitoring. Patient education is fundamental to all phases of surgical management so that patient expectations and concerns are practically addressed. Quality assurance endeavors must also be integrated into these preioperative phases so that optimal care of the surgical patient is ensured.

Post acne scarring: a review

Historically, post acne scarring has not been well treated. New techniques have been added and older ones modified to manage this hitherto refractory problem. The patient, his or her expectations and overall appearance as well as the morphology of each scar must be assessed and treatment designed accordingly. Upon reaching an understanding of what the pathology of the scar is and where it resides in the skin, the most pertinent treatment for that scar may be devised. Post acne scars are polymorphous and include superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new methods includes the latest resurfacing tools such as CO(2) and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous (including fat and blood transfer) and non-autologous tissue augmentation and the advent of tissue undermining has greatly improved the treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males, these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Effectiveness of dermasanding (manual dermabrasion) on the appearance of surgical scars: a prospective, randomized, blinded study

BACKGROUND

Dermasanding using sterile sandpaper has been described as a simple treatment for scars but has not been evaluated in a prospective randomized fashion. It could provide a safe, simple, and cost-effective option for the treatment of scars.

OBJECTIVE

Our purpose was to assess the effectiveness of dermasanding on the appearance of surgical scars of the face.

METHODS

We evaluated 15 patients using a blinded, split-scar model. Each scar was divided into 2 equal portions, and half of the scar was treated according to randomized assignment. Scars were treated with dermasanding 6 to 8 weeks after operation. The treatment half was compared with the control half by blinded observers at 3 time points.

RESULTS

Improvement in the treated half of scars was seen in 80% of patients at 6 months (95% confidence interval, 60%-100%), and 47% had an excellent response. In 20% of patients the unsanded side was better.

CONCLUSIONS

Dermasanding is an effective procedure in the treatment of surgical scars.

Successful treatment of a hypochromic scar with manual dermabrasion: case report

BACKGROUND

Manual dermabrasion is a simple and safe cosmetic procedure that is used to improve unsightly cutaneous disorders.

OBJECTIVE

To describe an 11-year-old white female patient who was successfully treated with manual dermabrasion for a hypochromic scar on the left forearm.

RESULTS

The hypochromic wound healed without scar and with good cosmetic appearance.

CONCLUSION

Although similar to conventional dermabrasion in terms of cosmetic results, manual dermabrasion presents a less expensive and safe alternative.

Postacne scarring: a review of its pathophysiology and treatment

BACKGROUND

There has been a largely unheralded revolution in the number of techniques that can now be used in the treatment of atrophic postacne scarring. Atrophic scarring is the more common type of scarring encountered after acne.

OBJECTIVE

To illustrate the range of techniques useful in the therapy of postacne scarring, their relative advantages and disadvantages, and their place in treatment.

METHOD

A review of available techniques is used to illustrate the treatment of indented or atrophic acne scars.

RESULTS

The individual architecture of the indented scar must be assessed so that treatment may be designed to maximize its improvement. A variety of new methods now exist, including newer resurfacing tools such as infrared lasers, dermasanding, and others in their infancy such as nonablative resurfacing and radiofrequency methods. A true explosion in autologous and nonautologous tissue augmentation and the advent of tissue undermining and the use of punch replacement techniques has added more precision and efficacy to the treatment of these scars.

CONCLUSION

Atrophic postacne scars may be satisfactorily treated in many patients, but multiple methods are often required to ensure the best results.

Management of post-acne scarring. What are the options for treatment?

Post-acne scarring is a very distressing and difficult problem for physician and patient alike. Recently, newer techniques and modifications to older ones may make this hitherto refractory problem more manageable. Options for dealing with post-acne scarring are explored. The patient, his or her overall appearance and the morphology of each scar must be assessed and treatment designed accordingly. To adequately address the patient with scarring, a thorough knowledge of the pathophysiology and anatomy of the different types of scars should be sought. Once an understanding of what the pathology is and where it is occurring is attained, the most pertinent treatment for that scar may be devised. A variety of post-acne scars is produced including superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new treatment methods for post-acne scarring includes newer resurfacing tools such as CO2 and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous and nonautologous tissue augmentation and the advent of tissue undermining have greatly improved treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser, and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Electrosurgical skin resurfacing: a new bipolar instrument

BACKGROUND

Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages.

OBJECTIVE

The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated.

METHODS

Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes.

RESULTS

Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer.

CONCLUSION

Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.

Treatment of upper lip wrinkles: a comparison of the 950 microsec dwell time carbon dioxide laser to manual tumescent dermabrasion

BACKGROUND

High-energy pulsed or computer-scanned continuous-wave carbon dioxide (CO2) laser resurfacing has gained popularity as a wrinkle treatment because of its minimal thermal injury and precise control of tissue vaporization depth. Manual tumescent dermabrasion has also been effective for treating facial wrinkles. This is, to our knowledge, the first study comparing the use of CO2 laser to manual tumescent dermabrasion for the treatment of wrinkles on the upper lip.

OBJECTIVE

To compare prospectively the clinical efficacy of the 950 microsec dwell time CO2 laser to that of manual tumescent dermabrasion in the treatment of upper lip wrinkles.

METHODS

Twenty female subjects with moderate to severe upper lip wrinkles were randomly treated with the 950 microsec dwell time CO2 laser on one side of the upper lip and manual tumescent dermabrasion on the other.

RESULTS

The average upper lip laser-treated wrinkle score (0 = none to 5 = severe) decreased from 4.3 +/- 0.2 before treatment to 1.8 +/- 0.3 at 6 months after treatment. The average upper lip dermabrasion-treated wrinkle score decreased from 4.4 +/- 0.2 to 1.5 +/- 0.3. The degree to which the wrinkle score improved after laser treatment compared with that after dermabrasion was not statistically significant (P =.216).

CONCLUSION

Manual tumescent dermabrasion and 950 microsec dwell time CO2 laser resurfacing are equally effective for the treatment of upper lip wrinkles.

Scar revision

Scar improvement is an age old endeavor. Multiple modalities exist for improving a scar's appearance. This article will review scar types and offer a brief overview of nonsurgical and surgical options for scar revision.

Laser resurfacing of atrophic scars

Many patients seek treatment for the disfigurement caused by obvious variations in skin texture secondary to atrophic scarring. Many different procedures, including dermabrasion, chemical peels, punch grafting, and augmentation with filling materials, have been implemented for the treatment of atrophic scars. With the advent of high-energy, pulsed and scanned CO2 laser technology, precisely controlled, layer-by-layer tissue vaporization may be achieved with minimal thermal damage to adjacent skin. Atrophic scars resulting from acne, surgery, or trauma respond more favorably to laser resurfacing than to other, more conventional forms of treatment when proper techniques are employed.

Scar revision

BACKGROUND

Scars of cosmetic or functional importance may form following cutaneous surgery, trauma, or inflammation. Many factors interplay in the formation of these scars. Knowledge and proper planning can help eliminate these consequences. Various scar revision techniques, both surgical and nonsurgical, are now available for treating undesirable scarring.

OBJECTIVE

To review the various scar revision options for the various types of scars.

LEARNING OBJECTIVE

After reading this review the participant should have a better approach and understanding of the appropriate scar revision techniques.

Manual resurfacing and trichloroacetic acid for the treatment of patients with widespread actinic damage. Clinical and histologic observations

BACKGROUND

A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce excellent results, but the histologic depth of injury produced by this technique has not been studied.

OBJECTIVE

To describe our experience with this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced.

METHOD

We treated 40 patients using manual resurfacing and trichloroacetic acid, primarily for widespread actinic keratoses. Resurfacing tools included silicone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent sequential biopsies to evaluate the depth of wounding using this technique.

RESULTS

Manual resurfacing combined with trichloroacetic acid consistently produced excellent cosmetic results and nearly complete eradication of actinic keratoses. Histologically, treated areas showed replacement of the dermal elastotic band by newly formed collagen, a significantly deeper level of wounding than the Jessner's/35% trichloroacetic acid peel. There was no evidence for foreign body granulomas clinically or histologically as a result of the abrasive materials.

CONCLUSIONS

The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.

Repair of defects of the nasal ala

BACKGROUND

Alar defects present a reconstructive challenge.

OBJECTIVE

To define closure options for alar defects of variable thickness and location.

METHODS

The repair options for closure of alar defects are reviewed and discussed with regard to depth of defect and complexity of reconstruction.

CONCLUSION

Surgeons repairing defects of the nose should develop a variety of reconstructive approaches for the ala including but not limited to those presented here.

Saturated phenol as a local anesthetic for manual dermabrasion

BACKGROUND

Dermabrasion is a painful procedure that requires the use of anesthetics, which, in their application, adds to the patient's pain.

OBJECTIVE

To describe the use of saturated phenol as a transient local anesthetic for manual dermabrasion.

METHODS

Manual dermabrasion of small areas (4 cm2) was performed in 12 patients using saturated 88% phenol as a local anesthetic.

RESULTS

Cosmetic results were good or excellent in 11 patients. Pain was minimal in eight patients, moderate in three, and absent in one.

CONCLUSION

Saturated phenol is an effective and safe anesthetic alternative for manual dermabrasion of small areas.