Dermabrasion

What is dermabrasion?

Dermabrasion is a skin resurfacing technique that is 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 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 equipment

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.

Preparation for dermabrasion

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 (III-IV) that tans easily is more likely to show transient hyperpigmentation (dark marks) 4-8 weeks after the surgery and hypopigmentation (pale marks) 12-18 months post surgery. However, discolouration 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.

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.

Medical treatment for dermabrasion

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.

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

Dermabrasion procedure

Dermabrasion may require admission to a 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 an 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.

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

Care after dermabrasion

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 daily for at least 3 months after dermabrasion. Even the sun through window-glass can promote unwanted pigmentation.

Microdermabrasion

Microdermabrasion was developed in Italy in 1985 and has since become a popular skin resurfacing technique. It has the advantages of low risk and rapid recovery compared with other techniques such as standard dermabrasion, chemical peeling and laser resurfacing.

Microdermabrasion is similar to dermabrasion but as its name suggests, it uses tiny crystals to remove the surface skin layers. It is promoted for correcting fine lines and more superficial scars.

Advantages include:

• Anaesthesia is not required
• It is almost painless
• Facial redness is minimised
• Simple and quick to perform
• Can be repeated at short intervals
• Does not disrupt the patient's life greatly

The disadvantages of microdermabrasion are that multiple treatments are needed and there may be minimal improvement in appearance.

Microdermabrasion is now possible using home kits that use a vibrating foam applicator to massage a moisturising cream containing aluminium oxide crystals on the surface of the skin.