DermabrasionDermabrasion is a procedure that is used to smooth fine wrinkles and scars left by acne or previous surgery. It involves controlled surgical scraping that 'refinishes' the top layers of the skin to give a smoother appearance. Dermabrasion can be performed over the full surface of the face or on small areas, and may be done in conjunction with other cosmetic procedures such as facelift or face peel. Dermabrasion is not an appropriate treatment for some people. Asian or dark-skinned people may experience permanent discolouration and blotchiness. People with freckled skin should avoid
dermabrasion over small areas, because their freckles will disappear in the treated areas only. People who develop allergic rashes or other skin reactions are also advised against undergoing dermabrasion.
Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully about your expectations and discuss them with your surgeon. Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area. In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.
Before beginning dermabrasion, the surgeon must have a thorough knowledge of skin anatomy and normal wound healing. Skin covers the entire external surface of the human body and is the principle site of interaction with the surrounding environment. It serves as a protective barrier preventing internal tissues from exposure to trauma, ultraviolet radiation, extremes of temperature, toxins, and bacteria. Other important functions include sensory perception, immunologic surveillance, thermoregulation, and control of insensible fluid loss.
Dermabrasion is the process of mechanically removing the damaged outer layers of skin. The epidermis then regenerates from the epidermal appendages located in the remaining dermis. This process begins within 24 hours of wounding and is usually complete after 7-10 days. The new epidermis shows greater organization and vertical polarity with the disappearance of actinic keratoses and lentigines. Dermal regeneration is a slower process but usually is complete within several months. The regenerated dermis demonstrates less elastosis and improved organization, with compact horizontally arranged bundles of collagen interspersed with elastic fibers. Ground substance is decreased, and telangiectasias are absent. The overall result is soft supple skin that appears more youthful and has fewer rhytids and dyschromias.
Adequate evaluation and photographic documentation of patients before dermabrasion are absolutely essential. Evaluation includes consideration of the severity and depth of the condition being treated and the need for additional or alternative procedures. The patient with deep rhytids and excessive facial skin is likely to be better served with traditional rhytidectomy. The patient with severe generalized photodamage and medium-to-fine rhytids may be an optimal candidate for chemical peeling or laser resurfacing. Patients may benefit from rhytidectomy and resurfacing rather than dermabrasion because rhytidectomy addresses skin quantity whereas peeling addresses overall skin quality.
Dermabrasion is indicated for surgical or traumatic scarring, acne pits and scars, rhinophyma, chickenpox scars, premalignant actinic damage, melasma, tattoos (both traumatic and intentional), and perioral rhytids and has been demonstrated to be as efficacious as laser resurfacing in treatment of these conditions. Whereas chemical peeling and laser resurfacing usually are applied globally to the face, dermabrasion more often is used for specific areas of troubling scarring or wrinkling. Dermabrasion is used for specific areas of the face more often than laser resurfacing or chemical peeling because dermabrasion does not injure melanocytes and is less likely to cause pigmentation changes. Laser resurfacing and chemical peeling, when applied to only a portion of the face, often leave lines of demarcation between treated and untreated regions, denoting damage to melanocytes in the treated areas. In addition, dermabrasion is much less costly to the patient than laser resurfacing or chemical peeling.
Dermabrasion requires rather simple tools and, in comparison to laser resurfacing, does not require specialized safety equipment for surgeon or patient, with the exception of protective face shields for the surgeon and staff. The surgeon uses a handheld device to abrade a controlled depth of facial skin. The handpiece has a rapidly spinning tip to which multiple interchangeable abrading devices may be attached. These include sandpaperlike burrs, curettes, diamond fraises, rasps, and wire brushes. The tip generally spins at a speed of 12,000-15,000 rpm. The surgeon can control speed, usually with a foot pedal. Irregular or imperfect facial surfaces are abraded to yield a smooth and even surface. The only danger in performing dermabrasion is abrading too deeply into the facial skin.
Dermabrasion may require admission to hospital or it may be done as an outpatient procedure in a doctor's surgery. The procedure begins with thoroughly cleaning the area to be ‘sanded’ with antiseptic cleansing agent. A numbing spray may be applied to freeze and firm the surface that is being treated. The doctor will then carefully manoeuvre 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.
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.
Postoperative care is aimed at providing an ideal environment for moist wound healing. Initially apply a generous amount of ointment to the entire treated area. This should be a bland ointment such as white petrolatum, A & D Ointment, or vegetable shortening. Instruct patients to reapply the ointment throughout the day any time the face feels tight or dry. The patient is allowed to shower and gently wash the face with nonresidue soap using fingertips only. After showering, the face should be patted dry and a new coating of ointment applied. Instruct patients not to pick at their wounds during the recovery period.
Some practitioners have used topical agents that contain platelet products or growth factors following dermabrasion. While these products have been shown to improve wound healing in other clinical situations, no randomized controlled clinical trial presently supports their use in this setting. Further research continues in this area. The patient should understand the process of reepithelialization and the importance of compliance with the prescribed posttreatment regimen. Antiviral therapy, if instituted, should be continued until reepithelialization is complete. In the early stages of wound healing, the patient should be reexamined early and repeatedly, generally within 48 hours and again every several days. Instruct patients not to reapply transretinoic acid, sunscreen, or makeup until the face is healed to the satisfaction of the treating physician.