Overview of Skin Resurfacing Dermabrasion
Dermabrasion is a skin process that uses rough materials to cause small injuries to the top and beneath the layers of your skin. This improves the look of your skin after it heals from these small injuries.
Anatomy and Physiology of Skin Resurfacing Dermabrasion
The skin is made up of two main layers: the top layer called the epidermis and the underneath layer called the dermis. The epidermis has five layers, from top to bottom, they’re called the stratum corneum, stratum lucidum (found in parts like palms and soles of your feet), stratum granulosum, stratum spinosum, and stratum basale. Now, the dermis also has two sub-layers, on the top is the so-called papillary dermis and below is the reticular dermis. For safe skin-resurfacing treatments, such as dermabrasion, your doctor needs to know how these layers look and behave.
The papillary dermis has many tiny blood vessels; when it is touched during dermabrasion, these vessels can bleed a little. The reticular dermis is made up of big collagen bundles that look like yellow parallel fibers on the top, and like white fibers that are coming apart deeper in the skin.
Now, during dermabrasion, your doctor can safely remove skin down to the level of the upper or middle reticular dermis. But if they go any deeper, there’s a greater chance of unpleasant side effects, such as scarring and skin color changes. Hair follicles (which are the roots of your hair) and sebaceous glands (which produce an oily substance) living in the dermis are very important for the rebuilding of the removed skin. When skin gets removed down to the dermis, it disrupts the structure made of collagen, a protein that gives our skin strength. This then boosts activity in cells called fibroblasts, which helps to make new collagen, lead to changes in the dermal layer, and ultimately improves how the skin looks.
Why do People Need Skin Resurfacing Dermabrasion
Dermabrasion is a skin-resurfacing procedure that can help treat certain skin issues. These might include age spots (lentigines), sun-damaged patches (actinic keratoses), acne scars, an enlarged nose due to rosacea (rhinophyma), and wrinkles (rhytides). It’s also used to improve the appearance of scars after they’ve been surgically removed or treated with a procedure known as Mohs surgery. Typically, dermabrasion is carried out around six to ten weeks after these procedures.
Dermabrasion works by removing layers of skin down to the middle layer, known as the mid-dermis. This means it can be effective for conditions that involve structures in the skin that are at or just above this level. Dermabrasion done by hand is usually the best option for treating smaller areas or more sensitive skin. It’s also useful when you need to smoothly blend the treated skin into the nearby untreated skin.
When a Person Should Avoid Skin Resurfacing Dermabrasion
If you have an active outbreak of herpes simplex virus (HSV), which is an illness that causes cold sores and genital herpes, you should not get a skin-resurfacing treatment called dermabrasion. Before this procedure, the HSV infection needs to be inactive or “dormant” for at least six to eight weeks. If you have a history of HSV, you should take an antiviral medicine, like acyclovir or valacyclovir, starting two days before and lasting two weeks after the procedure. Some doctors even suggest taking this medicine as a precaution before a dermabrasion treatment.
People who have taken isotretinoin, a medication used to treat severe acne, in the last six months may not be good candidates for dermabrasion. This medication could make the healing process after dermabrasion longer because it can cause the skin structures associated with hair and oil glands to shrink or “atrophy”. It also increases the risk of thick or raised scars, known as hypertrophic or keloid scars. Ideally, patients should stop taking isotretinoin one year before dermabrasion. However, recent research suggests that less invasive dermabrasion techniques could be safer for people who have recently taken or are currently taking isotretinoin. Each patient’s situation should be considered on an individual basis. It is also important to note that if you have active acne, you may be more susceptible to an infection after dermabrasion.
Dermabrasion is generally safer for patients with lighter skin types (known as Fitzpatrick skin types I and II). People with moderate to dark skin tones (Fitzpatrick skin types III or higher) could risk abnormal changes in skin color after dermabrasion. If you are considering dermabrasion and have a dark skin tone, you should discuss the risk of changes in your skin color with your healthcare professional. Using a 4% hydroquinone topical treatment, which lightens the skin, for 2 to 4 weeks before the procedure could potentially reduce this risk.
Equipment used for Skin Resurfacing Dermabrasion
Dermabrasion is a cosmetic procedure often done using a small, handheld tool. This tool is fitted with different attachments like a diamond fraise, wire brush, or a wheel with rough edges. The tool is usually powered by air or an electric motor which a doctor can control using a foot pedal. The device has a speed control unit that can regulate how quickly the attachment spins. This speed can vary between 10,000 to 85,000 spins in a minute, but typically, doctors use the tool at speeds between 12,000 to 15,000 spins per minute. The speed of spinning and the amount of pressure that the doctor applies determines how deeply the tool can affect your skin. The faster the tool spins, the stronger the effect on the skin, and in turn, less pressure is required to reach a certain depth in the skin.
The diamond fraise is just one of the tool’s attachments. It’s a piece that has tiny diamond chips embedded in it and comes in different shapes like a cone, cylinder, wheel, bullet, or pear. The diamond chips’ size, known as grit, can also vary. Attachments with small diamond chips are used for delicate skin jobs, for smaller work areas, or for shallow scars, while attachments with larger diamond chips are used for deeper scars and full-face dermabrasion jobs. The diamond fraise works based on friction; it rubs against the skin to achieve its purpose. By maintaining proper control, doctors can make sure they don’t penetrate the skin too deeply. These diamond fraises are easier to control than the wire brushes, hence they’re a better choice for less experienced doctors.
Wire brush tips is another attachment for the tool where there are small wires protruding from a central cylinder. It’s available in different sizes, shapes, and coarseness. Unlike diamond fraises that work on friction, these wire brushes cause tiny cuts in the skin to achieve their purpose. They tend to penetrate the skin even with light pressure, so doctors are advised not to use them at high speeds exceeding 25,000 spins per minute.
For smaller localized areas, the doctor might use manual dermabrasion, which works with sterile sandpaper or drywall sanding screens, such as when you need to correct a scar.
Who is needed to perform Skin Resurfacing Dermabrasion?
Dermabrasion, a procedure that helps improve the look of your skin, is usually done with the help of a surgical assistant. This trained professional’s job is to make your skin tight and control any bleeding during the procedure. This teamwork ensures the procedure goes smoothly and safely.
Preparing for Skin Resurfacing Dermabrasion
It’s vital to choose the right patients for a skin-resurfacing treatment known as dermabrasion, as well as manage their expectations properly for the best results. Surgeons will check for a several factors before deciding to perform the procedure. These include usage of isotretinoin, a type of acne medication; any history of excessive or abnormal scar formation; regular use of blood-thinning drugs or bleeding disorders; history of herpes simplex virus (HSV or simply herpes) infection; chronic use of steroids; or history of HIV or Hepatitis C.
Particularly for patients with a history of herpes, doctors will give them antiviral drugs beforehand to prevent a possible outbreak. In fact, some doctors recommend all patients to take these preventive drugs before the procedure.
In preparation for the dermabrasion, it’s very important that patients avoid sun exposure for two months prior to the procedure; this is to reduce the risk of skin discoloration after the dermabrasion. The use of a skin-lightening agent called hydroquinone a few weeks before the procedure can also help minimize this risk. Additionally, the use of a topical retinoid (a variant of Vitamin A) could be started a month before the procedure to increase the speed of wound healing and new collagen formation, which is essential for a smoother, younger-looking skin after the dermabrasion.
How is Skin Resurfacing Dermabrasion performed
Dermabrasion is a cosmetic procedure that involves removing the top layers of your skin with a special device. This procedure can be performed under local or general anesthesia, whichever makes you most comfortable. If only a specific part of your face is being treated, you might receive local anesthesia injection or nerve blocks. Full facial procedures can be done with a special technique called tumescent anesthesia, or through intravenous sedation or general anesthesia. Before the procedure begins, the area of treatment is cleaned with a safe eye cleanser called povidone-iodine.
During the procedure, the doctor and their assistants must wear protective masks, shields, and gloves to protect themselves from any possible spray or splatter of blood or other fluids. The area on your skin that needs treatment is first marked, after which a specific tip on the dermabrasion device is chosen to start the treatment. The treatment is done on one specific area of your body at a time, applying the dermabrasion device gently and evenly across your skin.
Depending on what type of dermabrasion tip is used, the device may be moved in different directions. Diamond fraise tips are moved back-and-forth, while wire brushes are moved in one direction. It’s important to control the device well during the operation to prevent any unintended side effects. The treatment patterns may include back-and-forth, left to right, opposing right angles, and superior to inferior (from top to bottom). The device is usually moved across the skin in a direction opposite to its rotation for maximum control.
Special attention must be paid in areas where the skin is loose, such as the eyelids, lips, and the wing of the nose. It’s vital to treat the right layer of the skin during dermabrasion to get a good cosmetic result and minimize the risk of side effects. The tool will penetrate until the layer where small, pinpoint spots of bleeding appear. Going deeper is not recommended since it increases the risk of scarring.
In smaller areas where manual dermabrasion is to be done, your skin is cleaned with an antiseptic solution and then injected with a local anesthetic. Sterile sandpaper (or a similar abrasive material) is then gently rubbed in a circular and/or back-and-forth motion until pinpoint bleeding is observed. The factors like the grit of the sandpaper, the force applied, and the duration of rubbing all affect the depth of penetration.
After dermabrasion, a saline-soaked gauze may be applied to your skin. An ointment is also applied to your skin to prevent infection and keep the skin moist, promoting wound healing. The dressings should be changed daily, which involves a gentle cleanup of the area and re-application of the ointment. Redness, swelling, and crusting are normal after the treatment. In some cases, you might be prescribed topical steroids to decrease inflammation.
Complete healing typically takes one to two weeks. Any granulation tissue (clumps of a type of tissue that forms on the raw surface of a wound) present after 10 days might signal a delay in healing, which can be due to infection, contact dermatitis, or other factors, and would need to be evaluated. Redness may take up to two months to go away completely. It’s very important to protect the healing area from sunlight to decrease the risk of changes in skin pigmentation. For prevention or treatment of hyperpigmentation, a medicated skin-lightening cream may be used.
Possible Complications of Skin Resurfacing Dermabrasion
Dermabrasion, a skin treatment that aims to improve the look of the skin, can sometimes lead to complications. Some people might experience infections, scarring, discoloration of the skin, small white bumps (milia), or lasting redness.
The most common cause of infection after dermabrasion is bacteria like Staphylococcus aureus, viruses like the Herpes Simplex Virus (HSV), or yeast like Candida. Infections due to Staphylococcus usually show up within 2 to 3 days with symptoms like a honey-colored crust on the skin, swelling, and redness. Depending on how bad the infection is, a doctor might prescribe a cream or a pill that kills the bacteria. HSV infections also usually show up within 2 to 3 days and cause more pain than normally expected after this procedure. Antiviral drugs like acyclovir or valacyclovir are usually prescribed to treat this. Candida infections usually show up within 5 to 7 days with symptoms like slow healing, pus, swelling, and/or itching. For Candida infections, doctors will prescribe medicines that kill the yeast.
Scarring can happen when dermabrasion is done too deeply, although some people might be more likely to scar due to their genes. People with darker skin (known as Fitzpatrick skin types III or higher) have a higher risk of skin discoloration after the procedure. The risk of skin discoloration can be reduced with careful patient selection, avoiding sun exposure, and use of a medication called hydroquinone. Milia, or small white bumps, are also a common side effect. Most milia might go away on their own or can be treated with removal, retinoid creams, or a procedure called electrodesiccation that uses electricity to dry out the bumps.
What Else Should I Know About Skin Resurfacing Dermabrasion?
Dermabrasion is a cosmetic procedure that greatly enhances the look of wrinkles, age spots, sun-damaged skin (actinic keratoses), and scars. This procedure works by gently removing the surface layers of your skin which triggers the natural healing process, leading to the production of new collagen – a type of protein that gives the skin its strength and flexibility. This results in visible improvements and healthier skin.
