What is dermabrasion

Dermabrasion is a skin resurfacing procedure that uses a wire brush or a diamond wheel with rough edges to mechanically remove and level the upper layer of skin. Dermabrasion essentially sanding or scraping them off uppermost dermal layers of skin in order to produce a healing response that generates cosmetically better skin in its place when healed. Dermabrasion is often used to treat facial scarring. When it was first developed in the early 1950’s it was used predominantly to improve acne scars, chicken pox marks and scars resulting from accidents, surgery or disease. Nowadays, dermabrasion is also used to treat deep facial lines and wrinkles, severe sun damage, pigmentation disorders and certain types of skin lesions.

Dermabrasion is a surgical procedure that uses a power-driven hand-held tool that looks a bit like a dentist’s drill. The tool has an abrasive end piece such as a serrated metal wheel, diamond fraise, or a wire brush. Fraises come in a variety of shapes, sizes and grades of coarseness. The doctor moves the rapidly spinning wheel gently over the surface of the scar causing the topmost layers of the skin to be worn away.

Dermabrasion may be performed using general anesthetic but local anesthetic may be preferred for small areas. Sedating medications may be used to induce a calming effect prior to and after surgery.

Patients should understand that dermabrasion injures the skin and must be prepared with how they will look immediately after treatment and during the healing process. Post-procedure instructions must be carefully followed to avoid infection and ensure proper healing. It’s also important to have realistic treatment expectations. Typically a 50 percent improvement in the skin condition is considered a good result. It may take several weeks or months for full results to become apparent.

When is dermabrasion appropriate?

Dermabrasion can be used to treat:

• Superficial acne scars
• Age/Brown spots
• Crow’s feet
• Scars
• Skin growths
• Skin lesions
• Sun-damaged skin
• Wrinkles

Is dermabrasion painful?

Dermabrasion can be uncomfortable, so local anesthetics are used to numb the skin before treatment. A freezing spray may also be used to numb and prepare the treated area. For larger treatments, such as full facials, a general anesthesia may be used. Ice packs may also be used during the procedure. After treatment most patients report little or no pain, though some require pain relievers as well as a corticosteroid for swelling.

Dermabrasion preparation

Before you can receive dermabrasion, your doctor will take a complete medical history and will carefully examine the skin lesion or defect. The doctor will need to know the following factors:

• Skin type – a mid-range skin type (Fitzpatrick skin types 3-4) that tans easily is more likely to show transient to permanent hyperpigmentation (dark marks) 4-8 weeks after the dermabrasion and hypopigmentation (pale marks) or skin discoloration 12-18 months post dermabrasion procedure. Patients of African, Asian and Hispanic descent should specifically be cautioned about skin discoloration or blotchiness. However, discoloration can be a problem with all skin types.
• A tendency to form keloids (deposits of fibrous tissue) or hypertrophic scarring – patients with a history of keloid formation may need to have a test spot performed first before any full-face resurfacing.
• Herpes simplex lesions (cold sores) – active herpes infection usually necessitates postponement of the procedure until the lesions have cleared.
• Other active facial skin diseases such as acne, rosacea and dermatitis – these may flare after dermabrasion.
• Recent isotretinoin therapy – this can delay healing and cause scarring so dermabrasion should be postponed for 6-12 months.

A week or so before treatment, demabrasion patients should:

• Stop taking certain medications, such as aspirin. Check with the doctor for a full list.
• Stop smoking.
• Avoid certain skin care products.
• Avoid sun exposure.

The doctor will tell you about the procedure, possible risks and complications and what results might realistically be expected. Photographs are usually taken before and after surgery to help evaluate the degree of improvement.

For two to three weeks prior to dermabrasion, tretinoin cream may be prescribed to apply each night to the area to be treated. Tretinoin appears to decrease the time for reepithelialization (new skin growth).

Dermabrasion procedure

Dermabrasion may require admission to a hospital or it may be done as an outpatient procedure in a doctor’s surgery.

• Dermabrasion is performed in an out-patient (often office) setting under local anesthesia.
• Full-face dermabrasion is performed under conscious sedation or general anesthesia, often with the assistance of an anesthetist.

The procedure begins with thoroughly cleaning the area to be ‘sanded’ with an antiseptic cleansing agent. A numbing spray may be applied to freeze and firm the surface that is being treated. A small motorized hand piece rotates a wire brush or diamond fraise at speeds of 15,000 to 30,000 rpm. The doctor will then carefully manoeuver the dermabrasion tool over the area to carefully remove layers of skin until he/she reaches the desired level that will make the scar or wrinkle less visible, aiming to avoid more scarring.

This results in a raw, open, partial thickness (through skin) wound that heals by epithelialization of the surface of the skin in a relatively short period of time. Initially the small pinpoint bleeding of the raw wound may be alarming but will subside rapidly with appropriate wound care.

For small areas, the procedure should only take a few minutes. For larger areas, the procedure can take 1-2 hours to perform.

Dermabrasion healing time

Dermabrasion recovery and healing time after dermabrasion depends on the size and depth of the area treated. The recovery following dermabrasion skin resurfacing is approximately 2-3 weeks. Early post-operative pain is controlled with prescription medications for the first few days. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. The skin may weep for the first 10-12 days but eventually stops as the surface layers of the skin are restored. Redness of the treated area is a normal part of recovery and disappears within 3-4 weeks of the procedure. Complete sun avoidance on the treated area must be observed until the redness in the skin has disappeared. Remember good sun protection should still be observed well after the healing period, as it was likely the sun damage to your skin that has driven you to seek this form of treatment in the first place.

Make-up can be used to cover the early skin discoloration once the skin has healed. Please ask your physician or surgeon for directions on when make-up can be used safely.

Following the procedure, the treated skin will be red, swollen and tender. A compress or special dressing is usually applied to reduce any tingling, burning or stinging sensation and to speed up healing. Instructions will be given on caring for the wound until new skin starts to grow; this usually takes 7-10 days. The face may itch as the new skin grows and may be slightly swollen, sensitive, and bright pink for several weeks after dermabrasion.

The following measures should be taken to ensure rapid healing and prevent any complications:

• Inform your doctor of any yellow crusting or scabs – this may be the start of an infection.
• Swelling and redness should subside after a few days to a month. Persistent redness of an area could be the sign of a scar forming so contact your doctor immediately.
• Continue antiviral medication for several days beyond the new skin forming.
• To avoid pigmentation, once the new skin is healed, keep out of the sun and apply a broad spectrum sunscreen SPF 50+ daily for at least 3 months after dermabrasion. Even the sun through window-glass can promote unwanted pigmentation.
• Cleansing the skin several times a day to avoid infection and remove crusting.
• Changing the ointment or dressing on the wound to keep the area moist and promote healing.
• Possibly taking an antiviral drug to prevent infection.
• Several follow-up visits to monitor your skin’s healing and to identify and treat early signs of infection or other complications.

Dermabrasion side effects

Dermabrasion side effects include:

• Uneven changes in skin color.
• Loss of skin color.
• Darkening of the skin, usually caused by sun exposure in the days and months following surgery.
• Redness.
• Swelling.
• Scarring.
• Infection.

Some possible complications associated with a dermabrasion are listed into both early and late complications:

Early complications:

• Excessive surface bleeding
• Redness (fades with time)
• Infection (viral)
• Skin sensitivity

Late complications:

• Hyperpigmentation
• Hypopigmentation
• Milia
• Asymmetry (between sides)
• Residual wrinkles
• Scarring

Dermabrasion can precipitate herpes simplex infection causing unpleasant blistering and possibly permanent scarring so aciclovir, famciclovir or valacyclovir tablets are used to prevent it. Those with a history of cold sores may require larger doses than normal.

Most patients are only prescribed antibiotics if infection occurs after the procedure. The exceptions are immunosuppressed patients or patients with a recent history of impetigo, or who are carriers of Staphylococcus aureus, who may be started on antibiotics beforehand.