Medium-depth peels with dermasanding

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

Dermasanding is used with medium-depth chemical peeling to remove thick, keratotic lesions not amenable to peel alone. An example is the patient with diffuse, thick seborrheic keratoses with photoaging skin. Such lesions cannot be removed by peel as the only treatment. A medium depth peel is performed first then, after the skin has frosted appropriately, the keratotic lesions are removed by dermasanding (Fig. 14.12). 

Dermasanding is used as an added procedure with medium-depth, facial chemical peeling in which further resurfacing is needed. It is used for the following indications ... 

Acne scars are best treated with dermabrasion. In many instances, a full-face mechanical dermabrasion is not needed and may be excessive. To simplify the procedure, a medium-depth chemical peel can be performed over the entire face and the scar units can then be resurfaced with dermasanding or dermabrasion. An example is the patient with rolling scars and ice pick scars on the medial cheek. The deepest ice pick scars are treated with punch graft... 

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