Skin Resurfacing, Chemical Peeling And Dermabrasion 

Skin Resurfacing

Improved skin texture, color, tone, and look are achieved by removing the outermost layers of skin, which promotes skin remodelling and regeneration.

Reasons To Consider Skin Resurfacing

• Photoaging and photodamage
• Skin component atrophy
• Pigmented skin can also benefit from skin resurfacing.
• It can be applied on wrinkles, rosacea, acne, and actinic damage.
• There are three key techniques for skin resurfacing:
  • Peeling chemicals
  • Resurfacing with a laser; Dermabrasion

Chemical Peeling

Chemical exfoliation is carried out under control. Skin penetration depths are classified as follows:

• Superficial: Only penetrates the epidermis. Both hyperpigmentation and acne improve.
• Medium depth: For small wrinkles and acne scars that are not too deep. The papillary dermis is reached at this depth.
• Deep: For deep wrinkles and severe/deep acne scars. The mid-reticular dermis is reached.

Also Read: Liposuction  Uses , Contraindications And Complications

Contraindications And Priming

Skin type 3-6 Fitzpatrik; active infection. Allergy to peels; cuts and open wounds; peels based on phenol in renal or hepatic illness.

Pre-treatment

Retinoids: tretinoin (0.025–0.5%) and trans-retinoic acid. The stratum corneum is thin.  It happens 2-4 weeks beforehand.  2.4% for hydroquinone.  Melanocyte tyrosinase is inhibited by it.

Peeling Agents

Keratinolytic peeling agents will cause keratinocyte connections to break. Alpha hydroxy acids, such as sugarcane-derived glycolic acid or lactic acid neutralized with sodium bicarbonate, can be utilized.

Salicylic acid is one of the beta hydroxy acids; because to its higher lipophilicity, it penetrates the skin more effectively. Jesner's solution, which contains 100 ml of 95% ethanol, 4 g of resorcinol, and 14 g of lactic acid, is another peeling agent.

Protein denaturants are another type of peeling agent. Tricloacetic acid is not absorbed throughout the body. Applicable to 20–35% and 40–50% deep peels. Operates through the keratocoagulation process.

For deeper peels, phenol can be used with croton oil to boost its effectiveness. The Baker Gordon solution is applied, which consists of 2 milliliters of distilled water, 3 milliliters of liquid phenol, 8 drops of soap, and 3 drops of croton oil.

Also Read: Laser Resurfacing And Lipotransfer

Peeling Agents As Per Type

1. Light or Superficial: salicylic acid, glycolic acid, and Jessner's solution (30–50%)
2. Medium: 70 percent glycolic acid and 20–35% TCAA
3. Deep: Jessners + TCA, a. 40–50% TCA, b. Phenol (gold standard)/phenol + croton oil
i. Liver and kidney systemic absorption.
ii. Heart monitoring is necessary.

Technical details

Phenol peeling is applied gradually to a tiny portion of the face rather than the whole thing. Small sections gradually peeled.  In 48 hours, occlusive dressing is completed.  There is re-epithelization.  It is less predictable in men.  Patients should limit their exposure to sunlight after the operation.

Related: Reconstructive Techniques – Skin Anatomy And Skin Grafts

 Complications

• Erythema
• Hyper or hypopigmentation
• Scarring 
• Wound infection 

Dermabrasion

It is the mechanical excision of the epidermis. It is most frequently applied to scars from acne and perioral rhytidids. The device employed is a high-speed rotatory motor with an abrasion end piece. At 12000–15000 rpm, it revolves. The presence of fine punctate bleeding signifies the penetration of the papillary dermis. Antiviral medication is used.

Complications

• Erythema
• Bleeding
• Milia 
• Scarring
• Hypopigmentation

Hope you found this blog helpful for your NEET SS Surgery Skin and Subcutaneous preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.