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History of DermabrasionAblative resurfacing of the facial skin is an age-old practice that has been well described, studied, and applied since ancient times. Whether it is used to reverse the signs of aging or to treat cutaneous lesions, or as treatment for acne scarring, ablative skin resurfacing has been an integral part of the practice of cosmetic surgery and dermatology.
Ablative skin surgery is the process of wounding of the skin to the level of the dermis to promote new skin growth and replenishment.
The dermis consists of two layers - papillary dermis, the thinner more superficial layer comprising of loose collagen and abundant fibrocytes, and reticular dermis that is thicker with many blood vessels, structural proteins and fewer fibroblast cells. Fibroblasts (sometimes also called fibrocytes) are involved in production of the structural proteins (collagen, reticulin, and elastic fibers).
With aging, the skin starts becoming loose and pendulous and it tends to have a poor elasticity. This happens because of a decrease in the number and function of fibrocytes and also because of that the arrangement of the structural proteins becoming irregular.
When a wound is created in the dermis, it prompts wound healing to originate from the support cells in the dermis. Many inflammatory cells are brought to the site of injury and the process of remodeling of the structural proteins takes place. The healing process as an aftermath of wounding produces smoother, firmer, and rejuvenated skin.
Dermabrasion is one of the oldest known methods of ablative resurfacing, popularized by physicians in ancient Egypt who used sandpaper for the treatments of acne scarring.
Modern history of DermabrasionThe modern history of Demabraion can be traced back to Kromeyer who is credited with the using rasps or burrs with rotation in the early 1900s for the first time. He used carbon dioxide snow or ether spray as a refrigerant to freeze the skin prior to the procedures.
It was his important contribution that showed that the unique dermabrasion process was able to promote wound healing without causing scarring if the penetration of the abrasion was not allowed to proceed into the reticular dermis.
Iverson in 1947, reported the successful removal of tattoos with sandpaper.
In 1953, Kurten, treated a variety of conditions with a wire-brush dermabrasion machine.
The technique and the machine were refined by many researchers through to the late 1990s to bring it to its present form.
A variety of dermabraders have been made available over the years. While larger machines, with greater rotational rpms, were used in the past; smaller machines are predominantly used today.
The most popular units available today include the Bell hand engine and the Osada hand-held device. Both devices have a rotation of speeds between 18 000–35 000 revolutions per minute (rpm). The hand-held device is attached to a control box (which has speed controls and on/off buttons), which attaches to a foot pedal. The foot pedal allows for easy operator control during the dermabrasion procedure.
Modern dermabrasion technique has also replaced the manual wire brush technique used in the past, with a powered diamond fraise.
Dermabrasion is used to physically remove the epidermis and dermis in a controlled fashion making every effort not to make the wound too deep.
Dermabrasion the treatment for acne scarringAs a procedure, dermbarasion was widely used in the past to treat (and remove) tattoos, but today dermabrasion has found its niche primarily for the treatment of acne scars.
The technique is also widely used for facial rhytids and various other conditions and is considered superior than other techniques for the treatment of facial acne scarring.
Dermabrasion today is mainly performed on actinically damaged skin and other skin conditions particularly for early scar revision.It is in fact the best acne treatment procedure for the fast removal of acne scarring.
Dermabrasion has also been used in combination with other dermatologic procedures, including chemical peeling, soft tissue augmentation and laser resurfacing techniques to enhance the results of dermabrasion.
Dermabrasion remains a useful facial skin resurfacing and scar revision technique, particularly when performed by a trained and skilled surgeon. Most dermatologic surgeons argue that pure dermabrasion is a useful modality in skilled surgical hands and should be considered when appropriate.
Michael H. Gold, Dermabrasion in Dermatology, Am J Clin Dermatol 2003; 4 (7): 467-471
Deborshi Roy, MD, Ablative Facial Resurfacing, Ophthalmol Clin N Am 18 (2005) 259 – 270