Dermabrasion is an excellent technique to improve scars and to refine final results after reconstructive surgery. In Dr. Lindsey’s practice, it is most often used after nasal reconstructive surgery following skin cancer excision. It is also used after facial trauma to make scars less visible. Another common indication is to improve facial scars after pitting acne. Dr. Lindsey also uses it to improve facial wrinkling, particularly in the perioral area.
Dermabrasion is contraindicated for any patient who has been on Isotretinoin (Accutane) within 1 year. For patients who have undergone recent surgery or sustained significant facial trauma, Dr. Lindsey recommends a waiting period of at least 6 months prior to dermabrasion for two reasons. First, scars generally improve dramatically over the first 6 months, and what appears as a bad scar initially can often improve spontaneously with time. Second, collagen responsible for the wound healing is soft for the first 6 months, and dermabrasion can result in unwanted gouging of the healing area during that time.
The procedure involves the use of a rapidly rotating device (dermabrader) which removes the outer layer of the skin (epithelium) and a very thin layer of the underlying papillary dermis. Dr. Lindsey, using magnification with loupes, is able to smooth uneven or irregular scars, which in turn greatly improves cosmetic appearance. For facial scarring due to any of a number of reasons, dermabrasion remains one of the most effective means of treatment. For severe scars, more than one treatment with dermabrasion may be required. Treatments are typically spaced 4 to 6 months apart.
Patients who benefit the most generally have light or white skin pigmentation (Fitzpatrick types 1-2 skin). Darker-skinned patients have a higher risk of depigmentation in the treated area. Patients who have red, raised, hypertrophic scars are also poor candidates for dermabrasion. Hypertrophic scarring is treated differently, which usually entails topical or injected steroids and/or use of silicone sheeting.
Dr. Lindsey generally recommends 7 to 10 days off work. The treated areas are raw and require wound care twice daily (see postoperative dermabrasion instructions on this website). After two weeks, the skin is healed and pink in coloration. At this time Dr. Lindsey recommends sunblock every morning and makeup as usual. Improvement in the smoothness of the skin and the diminution of the scar are evident at this time; however, it will take months for the normal skin coloration to return.
A personal consultation with Dr. Lindsey is required to make sure dermabrasion is right for you. As with other procedures, Dr. Lindsey will review similar patients and before-and-after photographs with you.