Dermabrasion

Surgery Overview

Dermabrasion is a technique that uses a wire brush or a diamond wheel with rough edges (called a burr or fraise) to remove the upper layers of the skin. The brush or burr rotates rapidly, taking off and levelling (abrading or planing) the top layers of the skin. This process injures or wounds the skin and causes it to bleed. As the wound heals, new skin grows to replace the damaged skin that was removed during dermabrasion.

Factors that affect the depth of the resurfacing include how coarse the burr or brush is, how quickly it rotates, how much pressure is applied and for how long, and the condition and features of your skin.

The face is the most common site for treatment, but other areas of the skin can be treated as well. Dermabrasion is used most often to improve the appearance of acne scars and fine lines around the mouth. It also may be used to treat an enlarged nose (rhinophyma) caused by rosacea, an inflammatory skin condition.

How it is done

The areas to be treated are cleaned and marked. A local anesthetic (such as lidocaine or epinephrine) is usually used to numb the skin before treatment, and ice packs are applied to the skin for up to 30 minutes. A freezing (cryogenic) spray may sometimes be used to harden the skin for deeper abrasions if the anesthetic and ice packs do not make the skin firm enough. For deep abrasions, or if the entire face is going to be treated, you may need stronger anesthesia, pain killers, sedation, or general anesthesia.

One small area at a time is treated. The freezing spray (if needed) is applied for a few seconds and then the rotating burr or brush is used to take off the top layers of skin. Gauze is used to stop any bleeding, and the area is covered with a clean dressing or ointment.

Dermabrasion is almost always done in your doctor's office or on an outpatient basis.

What To Expect After Surgery

Your recovery and healing time after dermabrasion depends on the size and depth of the area that was treated. Someone who has a full-face dermabrasion, for example, will require a longer recovery time than someone who has just a small area of skin treated. Deeper abrasions take longer to heal.

In general, regrowth of skin occurs within 5 to 8 days. This new skin is a pink or red colour, which usually fades within 6 to 12 weeks. Until then, normal skin tones can be achieved using makeup.

Many people have little or no pain and can get back to their regular activities soon after the procedure. Some people require pain relievers. If swelling occurs, a corticosteroid such as prednisone may be used to reduce the swelling.

Proper care of the treated area while the skin is healing is extremely important. This involves:

• Cleansing the skin several times a day to avoid infection and to get rid of the crusting that sometimes develops.
• Changing the ointment or dressing on the wound to keep the area moist and to promote healing.
• Avoiding sun exposure and, after peeling has stopped, using sunscreen every day. New skin is more susceptible to sun damage.

You may be given an antiviral drug called acyclovir to prevent infection if you have a history of infection with the herpes simplex virus.

Several follow-up visits to your doctor may be needed to monitor the skin's healing and regrowth and to identify and treat early signs of infection or other complications.

Why It Is Done

Dermabrasion is used to treat damage and defects in the upper layers of the skin, such as:¹

• Acne scars. Removing and improving the appearance of acne scars are the most common uses for dermabrasion.
• Scars caused by surgery or trauma, if they are not deep.
• Superficial skin growths, such as rhinophyma. On rare occasions, dermabrasion may be used to treat small cysts, epidermal nevi, some basal cell skin cancer, or Bowen's disease.
• Tattoos (rarely). There are better ways to remove tattoos (such as with laser resurfacing).
• Colour changes in the skin (solar lentigines or melasma). Chemical peels or laser resurfacing are used more commonly than dermabrasion for these problems.
• Fine lines and wrinkles around the mouth.

You may not be a good candidate for dermabrasion if you:

• Have used isotretinoin (such as Accutane, a drug used to treat acne) within the last 6 to 12 months.
• Have recently had a face-lift or brow-lift, although skin areas that were not affected by the lift can be treated.
• Have a history of abnormal scarring (keloid or hypertrophic scars).
• Have an active herpes infection or other skin infection.
• Are overly sensitive to cold (if freezing spray needs to be used).
• Have a skin, blood flow, or immune disorder that could make healing more difficult.

How Well It Works

Your skin type, the condition of the skin, your doctor's level of experience, the type of brush or burr used, and your lifestyle following the procedure can all affect the short-term and long-term results. Some types of skin problems or defects respond better to dermabrasion than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those with darker skin and those who continue to spend lots of time in the sun.

In general, dermabrasion results in a smooth, even skin texture and gives scarred skin a more uniform appearance.

• Dermabrasion is effective in improving superficial or nearly flat acne scars. Deeper, pitted acne scars may require another form of treatment (such as punch grafting, elevation, or excision) in addition to or instead of dermabrasion.
• Scars from surgery or injury may be improved when dermabrasion is done 8 to 12 weeks after the surgery or injury (although most new scars will heal and fade somewhat on their own for the first 6 months or so).
• Some superficial growths on the skin can be completely removed, but they are rarely treated using dermabrasion.
• Colour changes in the skin can be improved, especially when dermabrasion is used with a bleaching agent and tretinoin (Retin-A), which can enhance the bleaching agent's effects.
• Dermabrasion does not have a dramatic effect on deeper wrinkles, but it may improve fine wrinkles around the mouth and eyes.

The removal of scars, growths on the skin, and tattoos using dermabrasion is permanent. However, changes in the colour and texture of the skin caused by aging and sun exposure may continue to develop. Dermabrasion is not a lasting fix for these problems.

Risks

Common temporary side effects of dermabrasion include:

• Scarring.
• Redness. This usually fades within 6 to 12 weeks.
• Swelling.
• Flare-ups of acne or tiny cysts (milia). These can often be treated successfully with tretinoin. Antibiotics are sometimes needed.
• Increased colour in the skin. The skin in the area that was treated may turn darker (hyperpigmentation) than the surrounding skin several weeks after dermabrasion.
• Increased sensitivity to sunlight.

Less common complications may include:

• Scarring. The risk of scarring is higher with deeper abrasions and is more likely to occur in bony areas. People who have taken isotretinoin to treat acne are also more likely to have scarring after dermabrasion.
• Lasting redness.
• Prolonged loss of colour in the skin. This is more of a problem in darker-skinned people.
• Tissue damage caused by excessive freezing (when a freezing spray is used).
• Infection. This is rare. An antiviral drug may be given before the procedure if the area around the mouth or the entire face is going to be treated.

What To Think About

Expectations

Dermabrasion wounds and destroys the skin. You need to prepare yourself for how your skin will look immediately after treatment and throughout the healing process. It is also extremely important for you to follow your doctor's instructions on caring for your skin after the treatment so you can avoid infection and help your skin heal properly.

Be sure that your doctor understands what you hope to achieve and that you understand what results you can realistically expect. Do not expect a 100% improvement. In general, a 50% improvement in the skin condition is considered a good result. Even with realistic expectations, you may not see results for several weeks or months after dermabrasion.

Sun protection

After dermabrasion, you will need to wear sunscreen every day and avoid sun exposure as much as possible. New skin is more susceptible to damage and discoloration from sunlight.

Options for resurfacing

Dermabrasion, chemical peel, and laser resurfacing are the most commonly used techniques for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin—they destroy and remove the upper layers of skin to allow for skin regrowth.

No one technique is necessarily better than the others. When performed by an experienced surgeon, laser resurfacing may be slightly more precise than dermabrasion or chemical peels. Laser treatment also tends to be more expensive than dermabrasion or chemical peeling. In general, the choice of technique is based on the site you want to treat, your skin type and condition, the doctor's experience, your preferences, and other factors. Some people may get the best results by using a combination of techniques.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: October 31, 2006
Medical Review:	Patrice Burgess, MD - Family Medicine Martin Gabica, MD - Family Medicine James D. McMahan, MD, FACS - Plastic and Reconstructive Surgery Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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