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Complications of Dermabrasion and Microdermabrasion

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 16
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Please introduce headings and subheadings such as Introduction
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Chapter

Adverse Effects of Dermabrasion and

Microdermabrasion
Anil Ganjoo, Shikhar Ganjoo

Aged skin is characterized by epidermal and different methods of dermabrasion have

and dermal atrophy, presence of wrinkles, been developed. Applying the technique with
irregular pigmentation, telangiectasia, and sterile sandpaper (sometimes referred to as
flaccidity. With increasing technological dermasanding) was shown to be equivalent
advances, there are many options for cosmetic to dermabrasion with the motor-powered
procedures that minimize skin changes diamond fraise. The term “electrobrasion”
associated with aging. Among them are is used to represent a distinct means of
dermabrasion and microdermabrasion. The surgical planing using the common office
history of dermabrasion dates back to 16th electrosurgical unit. Electrosurgical resurfacing
century Egypt, but its introduction in the has been described at least as far back as 1999.
plastic surgery literature occurred in 1947, Earlier observations that precise ablation
when Iverson described a technique of planing could be achieved by adjusting power settings
skin to the dermis with sandpaper in order and tissue contact time prompted the question
to correct traumatic tattoos.1 The technique of how the technique of electrobrasion worked
was further refined by Kurtin in 1953, who compared with traditional dermabrasion.
pioneered the use of the mechanized wire The observed benefits of electrosurgical
brush, specifically for acne scars. For the past resurfacing techniques include ease of use and
50 years, dermabrasion has also been used decreased cost of equipment, relative to laser
to improve surgical and traumatic scars. In ablation.4
1988, Yarborough found in an observational Mi c ro d e r ma b ra s i o n c o n s i s t s o f
study that dermabrasion with a wire brush negative-pressure systems, which pass
performed 4–8 weeks after the initial injury aluminum oxide crystals onto the skin, while
achieved excellent correction, changing the simultaneously vacuuming the used crystals.
widely held impression that scars had to be Microdermabrasion treatment promoted
treated at a greater interval after injury.2,3 skin rejuvenation through an increase in skin
As a means of planing surgical surfaces and thickness due to an increase in epidermal
improving photodamaged skin, dermabrasion thickness and collagen organization. This
has been compared with laser resurfacing treatment causes little or no bleeding, and
 Adverse Effects of Dermabrasion and Microdermabrasion 173

fewer complications. There is no need for local a recent course of isotretinoin therapy. As
anesthesia or high surgical skills compared a result, it is currently recommended that
with traditional dermabrasion.5,6 patients wait at least 6 months after completion
However, in the authors’ experience, if of isotretinoin therapy before undergoing
the operator is not careful and uniform in a dermabrasion procedure. Despite this
movement, there may be superficial abrasions recommendation, there are reports of patients
that may end up with pigmentory disturbances undergoing dermabrasion with current
or superficial scarring. So it is imperative to be isotretinoin therapy, without hypertrophic
gentle and uniform while doing the procedure scar formation.8,9
and also to apply gentle vacuum to start with The authors recommend that the patients
and then build up the pressure gradually. should be primed with a triple combination or
Farris and Rietschel 7 did a study hydroquinone or retinoids at least 2 weeks prior
to determine if latex exposure caused to the dermabrasion sessions. Also strict sun
an acute urticarial response following protection should be prescribed between the
microdermabrasion in a latex-allergic patient. sessions and thereafter. This can go a long way
The patient was prick tested to saline and to prevent complications like postprocedure
histamine controls, latex, and sterile medical hyperpigmentation and hypopigmentation.
grade 100 m aluminum oxide crystals that had Gogia and Grekin10 reported eruptive self-
been passed through the microdermabrader. resolving keratoacanthomas that developed
The strongly positive latex prick test confirmed after treatment with photodynamic therapy
latex allergy in the patient. Negative prick and microdermabrasion. Microdermabrasion
testing to aluminum oxide crystals that had is well tolerated by most patients and minimal
passed through the microdermabrader make side effects have been reported, among which
it unlikely that the patient was exposed to latex are a mild to moderate erythema, which
via this system. Physicians need to carefully lasts on average 1 or 2 days after treatment,
evaluate patients who are considering mild discomfort during the procedure, and
microdermabrasion and appreciate that a tingling sensation. Literature describes
unexpected serious complications can occur. only uncomfortable feeling of a low intensity
Dermabrasion has many potential that occurred during the procedure and the
complications, most of which are often operator appearance of mild to moderate erythema
and technique dependent. Photosensitivity after the procedure lasting up to 2 days. The
occurs universally postprocedure, and negative pressure applied to the skin is also
patients must use strict sun protection while responsible for the appearance of erythema,
the skin re-epithelializes. Additionally, partly by increasing local blood circulation,
erythema after dermabrasion can last several and may contribute to faster healing and
weeks to months, and can be treated in part repair.11
with topical corticosteroids. Postinflammatory In the authors practice, mild erythema
pigmentation alterations, especially persisting for a few weeks after the procedure
hypopigmentation, are frequent complications has been experienced. This is usually self-
that can be permanent. Postprocedural limiting and resolves on its own. Resolution
hypertrophic scarring is a potential risk. This may be hastened with use of emollients
phenomenon was first reported in patients containing hyaluronic acid that maintains
undergoing dermabrasion after receiving moisture and suppleness of the skin. Of course
174 Complications of Cosmetology Crafting Cures

sun protection has to be strictly followed and factors like skin hydration, turgor, and
to avoid development of postinflammatory texture should be taken into account. If the
hyperpigmentation. skin is dry or irritated, the procedure can be
Svider and Jiron12 did a study to enumerate postponed until the skin becomes better. This
the factors raised in litigation following these will prevent the development of side effects.
procedures that included poor cosmetic Also maintenance of hydration of the skin
outcome (80%), alleged intratreatment postdermabrasion is extremely important
negligence (68%), permanent injury (64%), since the deficient epidermis during the
informed-consent deficits (60%), emotional/ postprocedure period is prone to TEWL
psychological injury (44%), post-treatment and dehydration. So hyaluronic acid based
negligence (32%), and the need for additional moisturizers are of great help.
treatment/surgery (32%). Fakhouri and Harmon 14 reported a
Kim and Lim13 did a study with an objective very serious side effect in which the patient
to see changes in transepidermal water loss developed subarachnoid hemorrhage during
(TEWL), hydration, and erythema of the face dermabrasion for scar revision and was on of
following diamond microdermabrasion. direct thrombin inhibitors.
Twenty-eight patients were included in this Local side effects are uncommon and
spilt face study. Transepidermal water loss, transient but include pain, burning, sensitive
stratum corneum hydration, and the degree skin, photosensitivity, tiger stripes, or diffuse
of erythema were measured from the right hyperpigmentation. Workers who routinely
and left sides of the face (forehead and cheek) inhale silica dust (silicosis), asbestos fibers
at baseline. One side of the face was treated (asbestosis), or hard metal dust are at risk
with diamond microdermabrasion and the of pulmonary fibrosis. Hence, the operator
other side was left untreated. Measurements must protect himself/herself with a mask.
were taken right after the procedure and The crystals may also get into the eyes of the
repeated at set time intervals. Diamond operator or more commonly the patient.
microdermabrasion was associated with Hence, the patient must wear protective
a statistically significant increase in TEWL eyewear during the procedure.15
immediately after the procedure and at 24
hours. However, on day 2, levels of TEWL were REFERENCES
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 Adverse Effects of Dermabrasion and Microdermabrasion 175

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