Dermabrasion
|
If you have fine wrinkles, sun damage, old scarring from acne, freckles and other hyperpigmentation spots, or vertical wrinkles around your mouth, you might be helped by facial resurfacing with dermabrasion. |
|
In dermabrasion, a surgeon will manually abrade your skin with a fine grit surgical sandpaper or with a special sanding machine that will look somewhat like an acrylic nail sander or a small handheld drill with a sanding bit. The top layer of your skin will be removed to a controlled depth. This depth depends on what needs to be corrected. If you have acne scars, the skin will basically be sanded even with them. If you are having thin winkles treated, you may need less of the skin removed.
The most reasons to get dermabrasion is to remove being perioral lines, the little vertical lines around the mouth that are also called smoker's lines, and to remove acne scarring. Dermabrasion can be used in combination with other types of skin treatments as well. However, dermabrasion is not for everyone. Many people get great results with simples treatments such as a chemical peel or punch grafting or other acne scar revision techniques. For some people, laser resurfacing is a better choice.
Dermabrasion is not an instant cure-all for facial skin problems. It has a recovery time. The top layer of your skin is removed and you will be left with pink or red skin, or in cases where more of the top layers must be removed, weeping, crusting skin, You may need a week or more to heal enough for you to be presentable in public. You should keep this in mind if you are considering dermabrasion.
Are You a Candidate for Dermabrasion?
Not everyone is a candidate for dermabrasion. Only a qualified medical professional with a lot of experience in this procedure can tell you if you could truly benefit from dermabrasion. If you are prone to keloids or other excessive scarring, or form pale or dark spots after skin injuries, or if you do not react well to burns, minor cuts, and abrasions, then dermabrasion is not a good idea for you. Essentially, dermabrasion is a controlled injury to the skin, with the top layers of skin literally being abraded off to reveal younger looking, fresh skin beneath. Therefore, if you scar badly from abrasions or scrapes, the results of dermabrasion could be disastrous.
People with darker skin or olive skin may not do well with dermabrasion. People of Greek, Italian, Asian, Hispanic, or African-American, for example, can be prone to hyperpigmentation or hypopigmentation after dermabrasion.
Because dermabrasion removes a layer of skin, you might not be a good candidate if you have thin skin.
If you have a history of certain viral diseases, you are possibly not a good candidate for dermabrasion. If you have oral herpes outbreaks (cold sores or fever blisters), you must should be cleared for dermabrasion by your primary physician and get a prescription for oral acyclovir (Zovirax), an antiviral drug. This is very important! If you get an outbreak of fever blisters or cold sores during your healing, the infection can spread to your entire face and result in severe and permanent scarring. Taking an antiviral drug can significantly decrease your chances of this happening.
You should not have a dermabrasion treatment on the affected area if you have the following:
• Undiagnosed skin lesions
• Recent herpes outbreaks
• Warts
• Active, weeping acne
• Active rosacea
• Unstable diabetes
• Autoimmune system disorders
• Pigmentation problems
• Taken Accutane (isotretinoin) in the past 12 to 18 months. (Accutane can thicken the skin and can cause increased scarring.)
You have to understand what results you want from dermabrasion and you have to be able to communicate that goal to your plastic surgeon or dermatologist. He or she will sit down with you and discuss what is realistic and help you meet those goals.
You must be mentally and emotionally stable to undergo any cosmetic procedure, even one as minimally invasive as dermabrasion. You will need patience and stability to deal with the healing period. You can become depressed after the procedure and this should be considered before committing to it.
What to Expect at Your Consultation
If you are thinking about dermabrasion, find out what doctors in your area offer it. Check out their backgrounds and credentials, in advance and make an appointment for a consultation with a few of them. A consultation appointment is your time to meet with the doctor and discuss your goals. The two of you will discuss how deeply your skin can be abraded and how much skin whether dermabrasion is right for you, how much skin can be safely removed, and the amount of improvement you can expect. Your doctor should discuss all the risks associated with dermabrasion with you, as well
At the consultation, you will tell your doctor everything about your health. You will need to give a complete medical history and family medical history. Make sure the doctor knows if you smoke and has a complete list of what medications or vitamins you take, including herbal products. Smoking impairs wound healing and certain medications can interfere with blood clotting or with any anesthetics that are used. We have a list of medications and supplements that can cause problems during or after surgery. However, this list should not take the place of telling your surgeon what medications you take.
You will also discuss what type of anesthesia that will be used for your procedure. Dermabrasion is usually done under light sleep sedation, regional anesthesia, or sometimes local anesthesia with oral sedation. It depends at least in part on how large an area is being treated. Some physicians may use general intravenous sedation. There are risks will all types of anesthesia. For more information, see our Anesthesia Page so that you can make a fully informed choice.
For more information on consultation or a list of questions to ask your surgeon please visit our Consultation Help Page.
Your Preoperative Appointment
At the preoperative appointment, your doctor will take another look at your face and the skin to be treated. This will be another chance for you to ask questions. Don't hesitate to ask any questions. You will also discuss your preoperative instructions and the recovery period and what to expect. You may be given prescriptions for antibiotics, antiviral medications, or pain relievers so that you can fill them in advance of your dermabrasion. You may be instructed to start taking an antiviral drug before your procedure date.
You may be asked to have blood tests done a week or so before your procedure and may even be asked to have a full physical with your regular doctor if you have any underlying condition such as diabetes or asthma.
You will be told not to take certain drugs and over-the-counter medications for 7 to 14 days before your procedure. These will probably include anything containing aspirin or ibuprofen, since they can slow down blood clotting. If you take any prescription medications, you will be told by the doctor whether to take those or not.
Preparing for Your Dermabrasion
You should be given an information packet that explains everything you should do and know before your treatment date. A lot of what you will be asked to do depends on how extensive your dermabrasion will be. If you are just having a few spots treated or are having a very minimal amount of skin removed on a larger area, preparation for the treatment may be minimal. If you are having large areas treated deeply, and more anesthesia, you will need to prepare more.
For example, if you are having a few small areas of acne scarring removed, this might be done with a small amount of local anesthetic and you don't need to do much. For a larger treatment, with intravenous sedatives and anesthetics, you might be asked not to eat after a certain time the evening before.
How Dermabrasion Is Performed
A dermabrasion procedure normally takes anywhere from 15 minutes to 2 hours to perform, again depending upon the size of the area being treated.
If you will be anesthetized for your procedure, you will be attached to monitors to keep track of your blood pressure and heart rate. You may also be given an oral sedative. In some cases, you will have an intravenous (IV) line inserted that will allow saline and medications to be administered.
You may be injected with a solution of lidocaine (a local anesthetic) for pain relief and epinephrine, which helps control bleeding. This is usually necessary for dermabrasion during deeper resurfacing procedures.
At this point, the actual abrading of your skin will begin. Your surgeon will carefully sand or abrade your skin to the depth needed to treat your skin problem. He or she may make several passes with the abrading tool or one deeper pass until the surrounding skin is at the same level as the scar.
If you have severe acne scarring, dermabrasion may be combined with additional procedures, such as punch-grafting or injectable fillers to treat deeper scars.
After the skin resurfacing is completed, your surgeon will cover your face with either a thin film of antibiotic ointment like Bacitracin or a burn cream like Silvadine. Some surgeons use a thin layer of synthetic breathable skin to protect the newly surfaced tissue as it heals. There are several experimental coverings that are undergoing testing. Your face will be bandaged before you leave the surgical suite.
You are then brought into the recovery room where you will be monitored until you are ready to be released. This varies, but may take 2 hours or so. Your face may feel tight and sore as the anesthesia wears off. For all but the most minimal of dermabrasion procedures, someone will have to drive you home.
The Road to Recovery
You may be groggy from the anesthetic and or oral medications, if you got them. You probably won't remember much of the first day or two if you were sedated. You will have to take it easy for at least a week. For the first week or two after your dermabrasion, you may be asked to sleep with your head and shoulders elevated. Use two pillows or by a foam wedge pillow. Your surgeon may also tell you to sleep on your back to avoid rubbing your face as much as possible.
Your face will be swollen and may become more swollen over the first three days after dermabrasion and you may also have some bruising. As the days go on, swelling will dissipate. The treated skin will be very red and may actually become wet with clear fluid. This is normal.
Your doctor will tell you how to take proper care of your treatment area. Wash your hands carefully before you touch the treatment areas or change dressings or bandages. Do not put anything on the treated area without checking with your doctor first, and that includes cosmetics. Take your pain medication as prescribed and take all antibiotic and antiviral drugs on time. Take your temperature regularly and regularly. An elevated temperature could mean an infection.
Your surgeon may also tell you to use cold packs, ice packs, gel packs, or vinegar soaks on your face for the first 48 hours after your treatment.
Your healing time totally depends entirely upon the depth of your dermabrasion. You can expect to be out of the public eye for at least 1 to 2 weeks, unless your treatment is very superficial. Your skin will feel like you have a wind or sun burn. It may weep clear fluid and need dressing changes regularly. You may need to wear these bandages for a week.
After your bandages are removed your doctor will go over with you the proper care for your treatment area such as cleaning and applying antibiotic or other ointment. If crusts or scabs form, do not pick at them or pick them off! That will cause you to scar. Crusting and scabbing will usually heal by day 10.
You may be given special solutions to wash your face with. Some of these have ingredients that promote skin healing.
After your dermabrasion, you will essentially have brand new skin and you must protect it carefully. Use sun screen with a high SPF factor faithfully! Your skin is very susceptible to sun damage. Avoid sun exposure and tanning salons. You should not use skin products containing alpha hydroxy acids, vitamin A (Retin A), or exfoliants until your surgeon tells you that you can. Your skin is very fragile while it is healing, a stage that can last for months.
As the weeks pass, your skin will heal and become very smooth and young looking. The pinkness will subside as will the tenderness. You may be pink for up to 5 months or more, depending on your skin's ability to bounce back and on the depth of the abrasion.
Ask your doctor when you can start applying cosmetics again. Usually, this will be about 2 weeks after your dermabrasion or after any crusts have healed. There are special cosmetics one can buy to offset the redness or you can experiment on your own with what you have.
Risks and Complications of Dermabrasion
Your doctor must discuss all of the risks and complications of dermabrasion with you at your consultation. Risks range from allergic reactions to the anesthetics or other medications used to serious infections. Make sure that you disclose your entire medical history.
If you are susceptible to keloid formation or excessive scarring, have active skin infections, or are subject to herpes outbreaks (including cold sores, fever blisters, and shingles), you are at greater risk of complications and a poor outcome with dermabrasion. The risk of a poor outcome if you have a history of cold sores, herpes or other viral infections is due to the nature of these infections. After your initial outbreak, the virus stays in your body and becomes dormant. After any skin resurfacing procedure, including dermabrasion treatments, chemical peels and laser resurfacing, the virus may come back out and spread, leading to serious scarring in the treatment area. To help prevent this, you will be placed on antiviral medications beforehand and will continue taking them during the healing phase.
In addition to viral infections, bacterial infections are a risk after dermabrasion. You essentially have a large open wound on your face and this can become infected if you are not careful. Before you touch any of the treated area or change dressings or apply ointment, wash your hands with an antibacterial soap.
If your skin is olive, black, brown, or yellow toned, take care in your choice of resurfacing techniques. Dermabrasion, laser resurfacing and chemical peels can cause noticeable damage to darker shades of skins. You should ask a spot test, where a small spot of skin in an unobtrusive area is treated, if you or your doctor are uncertain. You can never be too careful.
There is also the risk of bullae (blisters), small pimples, infection, scar tissue forming in the treatment area, and pigmentation problems.
The Cost of Dermabrasion
The average fees for dermabrasion run anywhere from $100 for a spot treatment to $4,000 for treating larger areas. Again, the fee charged varies with the amount of skin being treated. These prices usually include anesthesia and the surgeon's fee. Prices will also vary significantly in different areas of the United States.