Dermabrasion and Microdermabrasion

Dermabrasion & Microdermabrasion - Skin Deep Dive

• Dermabrasion:
  • Mechanical resurfacing; ablates to papillary/reticular dermis.
  • Tool: High-speed rotary abrader (wire brush, diamond fraise).
  • Indications: Deep acne scars, traumatic scars, rhinophyma.
  • Deeper penetration; significant downtime; anaesthesia required.
• Microdermabrasion:
  • Superficial exfoliation; removes stratum corneum.
  • Tool: Fine crystals (e.g., aluminium oxide) or diamond-tipped wand + suction.
  • Indications: Fine lines, dull skin, mild hyperpigmentation.
  • Gentler; minimal downtime; no anaesthesia.

⭐ Dermabrasion carries a higher risk of scarring and pigmentary changes, especially in darker skin types, compared to the more superficial microdermabrasion.

Dermabrasion & Microdermabrasion - When to Resurface

• Dermabrasion (Deeper Resurfacing):
  • Significant acne scars (e.g., ice-pick, boxcar)
  • Deep wrinkles, traumatic/surgical scars
  • Rhinophyma, extensive actinic damage
  • Pre-malignant lesions (actinic keratoses)
• Microdermabrasion (Superficial Exfoliation):
  • Fine lines, early photoaging
  • Mild, superficial acne scarring
  • Dull complexion, uneven skin tone/texture
  • Superficial dyschromia (e.g., melasma, PIH)

⭐ Microdermabrasion is generally safe for all skin types (Fitzpatrick I-VI) with minimal risk of post-inflammatory hyperpigmentation, making it a preferred option for superficial concerns in skin of color.

Dermabrasion & Microdermabrasion - No-Go Zones

• Absolute Contraindications:
  • Active infections (bacterial, viral e.g., herpes simplex)
  • Recent isotretinoin use (within 6-12 months)
  • History of keloids/hypertrophic scarring
  • Immunodeficiency states
  • Bleeding disorders
• Relative Contraindications:
  • Active acne, rosacea
  • Darker skin phototypes (Fitzpatrick IV-VI)
  • Prior radiation therapy
  • Unrealistic expectations

⭐ Recent isotretinoin use (within 6-12 months) is a critical contraindication due to impaired wound healing and increased risk of atypical scarring.

Dermabrasion & Microdermabrasion - How It's Done

Dermabrasion

• Technique: Controlled surgical skin planing; removes epidermis & superficial dermis.
• Instrument: High-speed rotary device + abrasive attachments (diamond fraise, wire brush).
• Anesthesia: Local (infiltration, nerve blocks), tumescent, cryoanesthesia (ethyl chloride/Frigiderm spray), or general.
• Key Steps:
  • Pre-op: Antiviral prophylaxis (HSV). Skin cleansing.
  • Intra-op: Skin held taut. Precise depth control. Debris wiped.
  • Post-op: Occlusive dressing, strict sun avoidance.

Microdermabrasion

• Technique: Superficial epidermal exfoliation. "Lunchtime peel".
• Instruments:
  • Crystal-based: Fine inert crystals (e.g., Al₂O₃) abrade, vacuum removes.
  • Diamond-tip: Diamond-encrusted tip abrades, vacuum removes. (No loose particles)
• Anesthesia: Typically none; topical anesthetic if patient is sensitive.
• Key Steps: Skin cleansed. Multiple passes. Moisturizer & sunscreen post-procedure.

⭐ Dermabrasion requires pre-operative antiviral prophylaxis (e.g., acyclovir) to prevent herpes simplex reactivation, especially for perioral procedures.

Dermabrasion & Microdermabrasion - Healing & Hues

• Dermabrasion Pre-op: Antiviral prophylaxis (e.g., Acyclovir) if history of herpes simplex to prevent reactivation.
• Post-procedure Care (Both):
  • Gentle wound care; keep moist.
  • Strict sun avoidance (SPF 30+).
  • Liberal use of emollients.
  • Expect erythema, edema; resolves gradually.
• Microdermabrasion: Superficial; minimal downtime; repeat sessions often needed.

⭐ Post-inflammatory hyperpigmentation (PIH) is a common concern, especially in darker skin types (Fitzpatrick IV-VI); meticulous sun protection is key to prevention and management after both procedures. Advise broad-spectrum sunscreen.

Dermabrasion & Microdermabrasion - Uh Oh Moments

• Dermabrasion Risks:
  • Pigmentary changes (hyper/hypo)
  • Scarring, keloids
  • Infections (bacterial; viral: HSV reactivation)
  • Milia, acneiform eruptions
  • Prolonged erythema
• Microdermabrasion Risks:
  • Mild: transient erythema, petechiae
  • Very low scarring/pigmentary risk

⭐ HSV reactivation is a key dermabrasion risk, especially perioral; antiviral prophylaxis is often indicated.

High‑Yield Points - ⚡ Biggest Takeaways

• Dermabrasion reaches deeper dermis for significant resurfacing; Microdermabrasion is superficial, targeting stratum corneum.
• Indications: Dermabrasion for deep acne scars, rhinophyma; Microdermabrasion for fine lines, dullness, mild texture issues.
• Dermabrasion has longer recovery and higher risks like pigmentary changes, scarring, and infection.
• Contraindications for Dermabrasion: active infections (e.g., herpes), recent isotretinoin use, keloidal tendency.
• Microdermabrasion is safer for darker skin types (Fitzpatrick IV-VI) due to lower dyspigmentation risk.