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Dermabrasion
What
Is Dermabrasion?
Dermabrasion is the procedure which
utilizes manual abrasion of the skin to remove acne scarring,
hyperpigmentations, wrinkles such as peri-oral (around the mouth)
wrinkles, scar revision and even tattoo removal. The most common
being the peri-oral lines (also called smoker's lines) and acne
scarring. Although this procedure is usually performed by itself
for the above indications, dermabrasion can be used in combination with
other types of treatments as well. However, not all patients will
need dermabrasion and may
receive great results with more simple treatments such as a chemical
peel, punch graft or other acne scar revision techniques -- some may
even chose laser resurfacing if they are a candidate. This is
really a very common and beneficial procedure.
Are You a Candidate for
Dermabrasion?
Not everyone is a
candidate for dermabrasion. If you are prone to keloids, hyper or hypo
pigmentation or do not react well to burns (like me!) or excessive scarring due to minor
cuts and abrasions, dermabrasion is not such a good idea. The abrasive
medium literally rubs off the top layers of skin to reveal the younger-looking, fresh skin beneath. If you scar badly from abrasions, or
scrapes, the results of dermabrasion could be disastrous. Also, if
you have ethnicity (i.e. Greek, Italian, Asian or African-American, etc.) in
your biological family, you may be prone to hyperpigmentation (too much pigment)
or hypopigmentation (too little, or no, pigment) resulting
from any level of dermabrasion.
If you have oral
herpes. You MUST gain the approval of your primary physician and seek a
prescription for oral acyclovir -- one brand name is Zovirax®. This
is very important! Zovirax® (or equal) can significantly decrease your
chances of a break out. If you have a break out during your healing
period, it can spread to your entire face (or treatment area) and result in severe and permanent
scarring.
Also, you should NOT
have a dermabrasion treatment on the affected area if you have the following:
- Undiagnosed lesions
- Recent herpes outbreaks
- Warts
- Active, weeping acne (stages
3-4)
- Active Rosacea
- Unstable diabetes
- Auto-immune system disorders
- pigmentation problems
*source for the
immediate above, Medscape Medical Journal (1999)
Communication is
crucial in reaching one's goals. You must be able to voice your desires to
your surgeon if he/she is to understand what your desired results
are. Discuss you goals with your surgeon so that you may reach an
understanding with what can realistically be achieved. This means if you
have a huge, deep scar(s) don't expect dermabrasion to make your previously
scarred area "flawless". It will not happen.
You must be mentally and
emotionally stable to undergo an cosmetic procedure. This is an operation
which requires patience and stability in dealing with the healing
period. You are going to look red and raw for weeks so get used to
it. You won't be able to sunbathe (indoors or out) and you may feel as if
you look like raw meat after the bandages are first removed. There is sometimes a lull or depression after surgery and if
there is already a pre-existing emotional problem, this low period can develop
into a more serious issue. Please consider this before committing to a
procedure. See our Post-operative
Depression Section.
What to Expect
at Your
Consultation
After checking a
few surgeons' (or dermatologists') backgrounds and credentials, you will make an appointment for a
consultation. You will meet with these surgeons and discuss your goals and you
will disclose all information regarding your health; if you smoke, what
medications or vitamins you presently take, etc., everything -- this is very important.
You
really should consider smoking cessation as this can significantly decrease
healing. Visit the Medication
& Supplements List for more information.
You will discuss your complaints
and concerns and discuss the various levels which can be safely
removed, thus the amount which can be improved, etc. Your surgeon will explain
the technique or methods that may be most appropriate for you. He
or she should discuss the risks associated with dermabrasion with you, as
well.
You will also
discuss the available anesthesia that will be used for your procedure.
Most dermabrasion procedures are performed under Light Sleep Sedation, Twilight
or regional -- sometimes even local with oral sedation. However, some
physicians may use General IV Sedation. Either way, discuss this
beforehand as many people are not aware of the risks of Anesthesia. If you
do go under Deep General, ascertain that the anesthesiologist is
certified. Please read the All About Anesthesia
Page - the risks regarding anesthesia should be considered for a fully
informed choice.
If you would like
more information on consultations or a list of questions to ask your surgeon,
please visit the Consultation Help Page.
If you should choose to book or reserve a surgery date you will usually give a
deposit to hold this surgery date. Most times if you cancel a few days
beforehand, this amount is non-refundable. After paying your deposit and
scheduling a surgery date, you will also schedule a pre-operative appointment...
Your Preoperative
Appointment
This appointment
addresses more questions you may not have thought to ask at the initial
consultation, such as more treatment details, concerns and even ascertaining
that your surgeon is aware of what you desire from your procedure. Just as
your surgeon will make certain that you know what it realistically possible from
this procedure.
You will also
discuss your pre-operative instructions and speak about the recovery period
instructions and what to expect in the months ahead. You will be given
prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines,
prescription anti-inflammatory drugs and perhaps a box or directions for gaining
a box of Arnica montana. Would like to know
more on the benefits of Arnica montana?
Perhaps you will be instructed to obtain Bromelain
or other types of remedies, although many surgeons would rather have you not
take ANYTHING other than your prescription medications, please do not go against
your surgeon's wishes. Remember, always ask your doctor before taking any of
these products.
Please do not
hesitate to address any concerns that you may have during this time and even
after your pre-operative appointment. If you remember something when you get
home or the next day or even the day of treatment - don't be afraid to
ask.
Preparing
for Your Treatment
You should be given an
information packet that explains everything you should do and know before your
treatment date. For more invasive procedures which require anesthesia or
possible blood loss, the packet should
include a list of all the medications you should not take starting
usually at 2 weeks before your treatment. These medications will include, but
are not limited to, aspirin-containing products, stimulants, seratonin
supplements, etc. Would you like to view a typical Medication
& Supplements List? We have a printer-friendly
version as well for your convenience. Also, if your surgeon advised that you may take
Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you should
either have this in your packet or begin shopping for your necessities.
It is quite possible
that you will have preliminary blood work performed. This is normally an
extra out-of-pocket expense that the patient must participate in to check your
white and red blood cell count (CBC, complete blood count) which ultimately
alerts the surgeon to disease or disorders beforehand.
If
you are a female they may take an extra vial for a pregnancy test. Some surgeons
ask that you have physical. This can be yet another out of pocket expense so ask
at your consultation what will be needed when you are quoted a price.
For less invasive or minimal
correction procedures, the routine is much simpler -- please discuss this aspect
with your physician to be sure. It is better to be safe than sorry and preparedness
is a relief once you get closer to your treatment date. Remember, an ounce
of prevention is worth a pound of cure. Okay, I am
finished with my clichés for the day.
So many things to do... so little
time. Your treatment day will be here before you know it so visit the Preparing
For Surgery page and relax. This section contains, printer-friendly pre-op
lists, tips and advice as well as things you must do to prepare for your big
day.
How
Dermabrasion
Is Performed
A dermabrasion
procedure normally takes anywhere from 15 minutes to 2 hours to perform,
depending upon the size of the area to be corrected. For patients
undergoing anesthesia for their procedure, first, you will have
monitoring pads (electrodes) attached to you so that the surgical
team can properly monitor your vital statistics before, during and after your
operation. When you are brought to the operating room, your electrodes
will be connected to the monitoring equipment.
Once you are on the operating room table, you
will then be given your choice or your surgeon's preference in anesthesia as
discussed prior to your surgery date. If you had been given an oral
sedative or valium prior you will have less anxiety. They will more than
likely insert an IV for a saline drip to keep you hydrated and have a vascular doorway for anesthesia, antibiotics, and other medications. If
you haven't been given a sedative, it is more stressful for some patients.
If you feel that you may experience anxiety inquire beforehand regarding an oral
sedative. Having an IV inserted feels sort of like blood being drawn, but
for a shorter period of time. It's the initial placement of the IV that
may sting a bit. Some people get heir IV placed in the crook of the elbow,
some the hand -- I personally like them in the crook of my arm rather than my
poor hand. Hand IV's leave such an utterly horrid bruise, it is so sore
afterwards, and everyone and their grandmaw can see you've recently had an
IV. It all depends upon your veins though. So if your
veins are not very prominent this can be a problem.
You
are then brought to the O.R. if you aren't on the table yet. After
the needle is injected into the vein it is pulled out and a little plastic tube
is left in your vein. This is called a catheter.
The catheter is taped to your skin so it is not accidentally knocked or
pulled out and is ready to be used as a sort of entryway for anything the
surgical team deems necessary for your body. This is usually done before
you get into the actual O.R., by a nurse, and you have a saline bag hooked up
to you. The medications will usually be given with a drip system with this
saline. As said before, the saline will keep you hydrated both during and
post-operatively.
If you have chosen
an IV Liquid Sedative, they will insert a hypodermic into your tube that you are
attached to or they attach the bag of it with a drip system to add a few drops
every few seconds and when they spring open the stopper and it starts heading
towards your body. The effects of the anesthesia are felt soon after
injection or opening the stopper -- a few seconds in fact. It may feel
similar to a sensation of heat entering your arm or hand at the
catheter site. It then feels as though it is creeping up your arm -- then
it jumps from your shoulder to a metallic-like taste under your
tongue and then you are blissfully anesthetized. The anesthesiologist or
surgeon will then determine if you are sedated properly, your stats are stable
and if you are ready for the surgery to begin.
Your treatment area will be injected with a
solution of Lidocaine for pain relief and epinephrine for
vasoconstriction. Vasoconstrictors impede your skin's ability to bleed
excessively by narrowing the bore of the blood vessels. This is usually
necessary for dermabrasion during deeper resurfacing procedures. However,
not all procedures will need injections of epinephrine. However it does
keep down the amount of airborne blood into the air, and most importantly the
absorption of Lidocaine into the bloodstream.
Your surgeon will
then begin to either manually abrade your skin with a fine grit type of surgical
sandpaper or with a sanding machine somewhat similar to
a Dremel® or acrylic nail sander. Your surgeon may make several passes or
one simple, yet deeper, pass until the scar or other irregularity is at the same
lvel
or same color/texture as the
surrounding skin. Some scars are removed completely whereas some ice
pick" type scars may need additional procedures such as punch-grafting or injectable
fillers.
After the skin
resurfacing is complete, your surgeon will cover your face with either a thin
film of Bacitracin or antibiotic burn cream like Silvadine. Some surgeons use a
second synthetic breathable skin to protect the newly surfaced tissue during its
healing process. There are several experimental coverings that are undergoing
testing. Some will even provide you with or suggest that you get a
hydrogel-type masks such as HydroGOLD™ by BioDermis.com
EXTRA!
A relatively new and
exciting burn bandage is made from cotton and purified chitin, called chitosan,
(a polysaccharide), which is extracted from the exoskeletons of crustaceans and
insects (crab, shrimp and lobster shells). Incidentally, Chitosan is also an ingredient
in controversial "fat magnet" pills and supplements. Below is
from Youngdeok Chitosan:
"Chitosan is a natural product derived
from Chitin, a polysaccharide found in exoskeleton of crustaceans like crabs
and shrimps, in the crusts of the insects like beetles, gold bugs, and
grasshoppers, and in the cell wall of bacteria and fungi like molds and
mushrooms.
Crab's shell consists
of Chitin substance, Protein, Calcium carbonate which are all boned together
very strongly to become a hard and stable crust.
Therefore, pure
Chitin (acetylamino-polysaccharide) is extracted by removing protein and
calcium carbonate from crab's shell. Through the process of deacetylization
called purification, Chitosan (amino-polysaccharide) is obtained from Chitin
by getting rid of acetyl radicals.
Chitosan-Oligosaccharide
is obtained by an enzymatic hydrolysis of chitosan using chitosanase. Compared
with Chitin and Chitosan that has poor solubility and absorbability into our
body, Chitosan Oligosaccharide is absorbed perfectly. "
Some bandages
consists of several layers, the main layers consisting of the purified crab shells
(chitosan) as well as a synthetic barrier that whisks
away moisture and fluids from a weeping, healing wound. An outer layer of cotton
gauze absorbs the fluids. The gauze pads can be changed but the synthetic skin
and chitosan covering stays to protect the wound. The chitosan are actually
absorbed harmlessly into the body and excreted. Miraculously, the crab shells
have a superior antibacterial property unheard of in any relative substance.
Reportedly, no known fungus or germ can adhere to it's surface. When the bandage
is removed -- in many cases perfect, freshly smooth skin appears.
You are then gently
awakened and brought into the recovery room where the recovery nurse will
monitor your vital stats until you are ready to be released. This is dependent
upon the individual but may take up to two hours. Your face may feel tight and
quite tender as the anesthesia wears off. You may even feel emotional or upset
--
this will depend upon your body's reaction to anesthesia. You may also
experience rigors or shivering. This may feel uncontrollable and is
usually from the medications - more than likely if epinephrine is used (a vasoconstrictor).
The recovery nurse usually has wrapped you in a warm blanket
but if not, request one. It certainly makes things more tolerable. You may
even be lucky enough to have heating lamps! Some surgical theaters are more like Holiday Inn than Bellagio
-- so ask first.
The Road to
Recovery
You may be groggy from
the anesthetic and or oral medications and probably won't remember much of the
first day or two if you were sedated. You will have to take it easy and sleep on
two pillows to keep your head elevated for 7-14 days - or however long your
surgeon suggests. Try not to sleep ON your face, 1.) You WILL stick to
it 2.) You may get an infection 3.) It CAN affect your outcome.
When you wake up you will notice that your face may look even
more swollen in the first 3 days. But, as the days go on the swelling will
dissipate. There may be some bruising, but this will go away, as well. So make a
mental note of this or you may be shocked into a depression. Bruising and
swelling are a normal occurrence in most invasive procedures. In
dermabrasion, there is marked redness and weeping (wound seepage).
There will be
redness and slight discomfort post-operatively. Your surgeon will have
instructed you on the proper care of your treatment area as well as prescribed
you the necessary antibiotics and pain medications to help alleviate your
discomfort and hinder infection. Take your temperature on time and regularly.
An elevated temperature
could mean an infection. Take those antibiotics ON TIME. And don't forget if you
are taking birth control that some antibiotics can interfere so in the event
that you do have relations, use another form of protection as well. Not that you
will be remotely thinking of having sex but hey you never know.
The swelling
can be alleviated with ice packs. You may be instructed to apply ice (not
directly on skin), gel masks and vinegar soaks on your treatment area for the
first 48 hours. Your healing time
totally depends upon the depth of your treatment. You can expect to be
down for at least 1-2 weeks - unless the treatment is very superficial.
Which in that case a light chemical peel would suffice. Your skin will feel like
a wind or sun burn. It may weep and need dressing changes and additional
ointments which will be supplied by your doctor directly or by prescription.
You
may sometimes wear these bandages for about 5 to 7 days. You will more than
likely have them removed by your doctor on day 5 but this could be longer if the
penetration was pretty deep. After your bandages are removed your doctor will go
over with you the proper care for your treatment area such as cleansing and
applying ointment. If you notice crusty formations; DO NOT PICK AT THEM
OR PULL THEM OFF! You will scar as a result -- probably more than before your
treatment. But, don't worry, they usually subside by day 10. It can
look pretty gross so PLEASE do NOT pull or rub them off and prepare yourself
that you may see this, in advance.
You
may be given a bovine mucopolysaccharide ointment or cream, this is a
cow-derived cartilage extract that has the anti-inflammatory properties of 1-2%
hydrocortisone. It accelerates epidermal healing and stimulates the
production of prostaglandins and interleukins. The ointment and
cream act like a steroid application without the risk of steroid induced atrophy
or telangiectasia formation. The product is CX-10 Ointment and CX-5
Correction Cream, manufactured by Donell Inc. in NYC.
Post-operatively, you must use sun block faithfully! Your skin is very
susceptible to damage by UVA/UVB radiation (the sun). This includes
artificial sunlight like tanning beds as well as simply driving to the store or
around town all day in your car. Believe it or not you do get sun exposure
when you drive around. You should not use using AHA's, Vitamin A (Retin A)
or exfoliants until your surgeon advises it is safe to do so. Your skin is
very fragile in its healing stage, which could last for months.
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, of course, the depth of the abrasion.
You must take care of your skin in order to keep it looking vibrant and
fresh. Although, no procedure can keep your skin from aging -- it can give
you a young, relaxed appearance and buy you some time.
At about 2
weeks or as soon as there is no weeping and no crusting (but please ask
your doctor first) you can safely wear cosmetics to cover the
redness. There are special cosmetics one can buy to offset the
redness or you can experiment on your own with what you have.
Physician's Formula is am inexpensive and effective camouflaging
cosmetic line that can be bought in your local pharmacy or drug
store. Although you may consider "specially formulated",
more expensive brands if you wish it.
Risks &
Complications of Dermabrasion
Ascertain that your
surgeon discusses all of the risks and complications with you at your
consultation. There could be allergic reactions to the anesthetic. Just make
sure that you disclose your medical history and this is very important, your nationality.
If you are susceptible to Keloid scarring or have active skin infections or
afflictions such as herpes outbreaks, you may not be a good candidate for
Dermabrasion.
Very Important:
If you have a history of cold sores, herpes or other viral infections please
disclose this to your surgeon! After dermabrasion treatments, chemical
peels and and laser resurfacing -- viral anomalies may spread and severely
disfigure the treatment area. You will be placed on anti-viral medications
beforehand and continue during the healing phase. Bacterial infections are
also a severe risk and even water-borne or plant-borne bacterial infections can
severely scar your treatment area if they are exposed to your treatment area.
Don't worry about being embarrassed about telling your surgeon about
it, because if this happens when you are healing your face will literally be
ruined.
If your skin is
olive, black, brown and even yellow-toned -- take care in your choice of
resurfacing measures. Dermabrasion, laser resurfacing and chemical peels
can cause noticeable damage to ethnic skins. You should request a spot
test if you or your doctor are uncertain. You can never be too careful.
There is also the
risk of bullae (blisters), milia (or small whiteheads), infection,
thicker scar tissue of the treatment area and hypopigmentation as well as
hyperpigmentation, as said before. You must also be very careful if you have
taken Accutane within the past year and a half (12-18 months). Accutane
causes dermal thickening and can cause increased chances of keloid-like scarring.
Average
Prices for Dermabrasion
The average prices
for a Dermabrasion can run anywhere from $100.
(for spot treatment) to $4,000.US. for larger areas.
These prices usually include anesthesia and the surgeon's fee. Medications
and lab work, as well as any revision work, are not included in the above
prices. Prices will also vary significantly due to regions surgeon and
your needs.
References
Yale Medical Core Curriculum - Skin Resurfacing Procedures
Interview with Jeffrey Friedman, MD
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