In grade I acne and for light acne scars, excellent results can be achieved using the combination of the Friendly Peel with microdermabrasion at the same session. Finally, we also combine the Friendly Peel with 10–30% salicylic acid peel, which is especially useful for darker skinned patients with very thick and oily skin. The importance of these treatments is that they offer excellent results with minimal skin irritation and with quick recovery.

Light friendly peel is very good for young as well for elderly patients. It can be especially useful if used in combination with chemical cauterization of certain neoplastic growth such as actinic and seborrheic keratosis (Fig. 10.5).

10.3.1.5 Microdermabrasion

This technique uses aluminum oxide crystals to cause delicate abrasion to the skin surface [14–16]. I first began using this technique in 1993. Similarly to the Friendly Peel, it may be performed as the first procedure before starting the skin program for the surgery and it may be continued after surgery. Microdermabrasion may also be used as a sole dermatologic treatment in weekly or biweekly sessions over the course of 6–12 weeks. Microdermabrasion may also be performed in combination with the Friendly Peel. I prefer this combination, as it enhances the results of skin rejuvenation.

a

Microdermabrasion uses a device to project aluminum crystals onto the skin surface and negative pressure to re-aspirate them. This removes or peels off the outer surface of the skin. This mechanism allows new skin to form in a safe and pain-free manner and without the need for local anesthesia. Microdermabrasion can be used for a variety of indications, such as in patients with thick skin, melasma, acne scars, superficial wrinkles, and actinic melanosis. As well as the face, it can be used to treat the neck, the décolleté arms and hands, and stretch marks.

After the patient’s skin has been washed, it is degreased with gauze and 70% alcohol. This is performed gently in sensitive skin, though with slightly more force in skin which is thicker or oilier. This technique is really safe and presents no real risk to patients. Along many years of practice we have heard only very rare reports of complications like post-inflammatory hyperpigmentation and sensitiveness of the eyes due to the presence of crystals adherent to the cornea. In both cases the complications were related to physician malpractice. When performing microdermabrasion it is necessary to understand that the action must be smooth. Eye protection is recommended to avoid crystals entering the eye (Fig. 10.6).

The technique should be performed step by step to cover all the anatomic units of the face. The skin of the area being treated must be stretched either by the physician’s nondominant hand or by the assistant’s hands.

b

Fig. 10.6 Microdermabrasion session. Patients should wear glasses for protection

There are a variety of pressures that can be administered by the machine, but it is advisable to avoid high pressures and to avoid pushing down excessively hard with the hand piece as these will result in bruising. Movements should be done in at least two directions in each anatomic area. Around the eyes, only one movement is required. Uneven distribution of pressure resulting in uneven abrasion may eventually lead to an irregular pattern to the skin. Once the session is completed, the skin must only be cleansed with water to remove the crystals. This must include the eyes, as crystals may cause eye irritation. Once the skin is clean and dry, the Friendly Peel may be applied. The peel is

removed after 6–12 h, generally the following morning. Microdermabrasion is safe, may be employed on any skin surface, and when performed correctly can lead to excellent results in 6 weeks time (Fig. 10.7).

10.3.1.6 Carboxytherapy

Dermatologic injection of carbon dioxide was originally employed at the Thermes de Royat and Marienbad (France), during the 1930s. Its initial purpose was the treatment of peripheral arterial occlusive disease. Laser Doppler flow measurements have shown that topical application of carbon dioxide increases skin blood flow. As well as its initial use, carboxytherapy has been shown to be an excellent noninvasive technique for skin preparation prior to surgery, as well as for skin rejuvenation, scars, and striae. The dermatologic injection of CO2 results in pseudohypoxemia, leading to mechanisms which increase local tissue. Increased blood flow improves skin elasticity and irregularities, as well as allowing neocollagenesis [17–20].

The area to be treated is cleaned with a local antiseptic. Some patient may experience slight discomfort, but most patients will tolerate this procedure without complaint and without the need of local anesthesia. A small needle (30 gauge) is used to insufflate the carbon dioxide through the