A popular way to improve the surface appearance of the skin, dermabrasion is an exfoliating technique which makes use of a rapidly rotating instrument (a wire brush or diamond wheel with rough edges, referred to as a fraise or burr), known as a dermabrader, to remove the outer (superficial) layers of the skin. The spinning or rotating action of the instrument levels off (also known as planing or abrading) the top layers of the skin, revealing newer and smoother ones for re-growth.
This process is abrasive and does ‘injure the skin’ somewhat, causing it to bleed a little. The skin that grows back during the healing process, replacing the damaged layers of skin, is usually younger-looking and smoother.
The depth of skin removal may depend on the following factors:
- The amount of pressure that is applied (and the duration of time)
- The overall condition of the skin being treated
- The coarseness of the instrument used and how fast it rotates
Usually an outpatient procedure done in a dermatologist or plastic surgeon’s office, this treatment is most often used for correcting sun damage, fine lines, rosacea, uneven texture and acne scars (often on the facial area). The appearance of unwanted marking such as lines and scars can be considerably reduced with dermabrasion treatments.
Many have dermabrasion treatments for these purposes as stand-alone procedures or in combination with other recommended cosmetic procedures. The ‘sanding down’ of skin can leave it feeling rather sensitive and inflamed for a short period of time (a few weeks), which gradually fades.
Why is dermabrasion done?
The most common skin concerns that can be effectively treated with dermabrasion treatments are:
- Fine lines and wrinkles (especially around the mouth)
- Age spots
- Acne scars (or those caused by chicken pox)
- Surgical or other injury associated scars (which aren’t too deep)
- Sun damage
- Uneven skin tone
- Rhinophyma (thick and red or swollen skin on the nose)
- Pre-cancerous skin markings or patches, such as actinic keratoses
- Tattoos (in most instances, laser resurfacing treatments may be recommended, but sometimes dermabrasion can be effective)
A dermatologist or surgeon may opt to treat any of the aforementioned conditions with dermabrasion, but can also offer alternative treatments. Dermabrasion can also sometimes be used to treat small cysts or epidermal nevi (abnormal, non-cancerous patches of skin that develop as a result of an overgrowth of cells in the outermost layer of skin). Between yourself and your specialist, you can decide on the best option for the desired result you most wish to achieve.
What skin conditions are not recommended for this treatment?
Not all skin conditions can be treated with a dermabrasion procedure. Skin problems such as recurrent herpes (herpes simplex virus type 1 / HSV-1) flare-ups, inflammatory acne, congenital skin defects, pigmented birthmarks, most moles, burn scars or radiation burn markings are not suitable for dermabrasion treatment.
Certain medications which thin out the skin may also prevent a dermatologist from recommending dermabrasion treatments. If you have taken isotretinoin (or Accutane), an acne medication, within 6 to 12 months prior to seeking dermabrasion treatment, a dermatologist or surgeon may discourage the procedure as well. This is due to the fact that this medication can impair healing and cause scarring.
A person with a very dark skin tone will need to be carefully assessed. If naturally very dark, a dermatologist may not recommend this treatment procedure as it can result in further scarring or discolouration. Fairer skinned individuals appear to experience the best results following this treatment procedure.
Other reasons dermabrasion may not be recommended include:
- Skin areas that have been affected by a brow or face-lift (those that have not been affected by such procedures may be considered for treatment).
- The appearance of or a history of abnormal scarring, such as hypertrophic scars or keloids.
- Problems with blood flow or other immune-related issues that can affect healing.
What to think about before having a dermabrasion treatment?
Know what to expect
It is important to ensure that you are thoroughly aware of what the treatment process entails and how it will affect your skin. The rotation motion of the instruments used (directly on the skin’s surface) has a ‘wounding’ effect, which ‘destroys’ the skin’s outer layers.
Your chosen specialist should explain this effect in detail before you opt to have any treatments done. It will take some time for the skin to heal and rejuvenate itself following such an abrasive treatment.
During the healing process, the skin will be sensitive and will require appropriate care. It’s important that you adhere to the care guidelines a specialist gives you as it can help the skin to heal properly, as well as avoid potential infections. It can also take some time for the true effect of the treatment to be clearly visible. Depending on the condition was being treated, it can take between several weeks and a few months to clearly see the results of the procedure.
Just as important is understanding what a dermabrasion treatment can and can’t do. It is not a 100% removal technique, for any appropriate skin issue or condition. For many, a good result is considered to be around a 50% appearance improvement. Therefore, while dermabrasion improves the appearance of a skin marking, it cannot completely remove it.
Be open to other skin resurfacing techniques
Dermabrasion is just one of many effective resurfacing methods, your specialist may also offer or recommend other techniques you can consider. Laser resurfacing or chemical peels are other methods that can be used to improve the appearance and texture of the outer layers of skin.
These options also ‘destroy’ the outer (superficial) layers and work to help the skin to regrow. A specialist will discuss all available options with you following a thorough assessment of your skin and your preferred results. In some instances, the best result may be achieved with more than one resurfacing technique.
Preparing for a treatment
Before dermabrasion treatments commences, a specialist will carefully assess the nature of your skin and what you wish to have treated. He or she will take notes on your medical history and ask a series of questions relating to your specific issue, as well as note any previous cosmetic procedures you may have already had.
Included in this review will be questions regarding medications and supplements you may have taken recently (sometimes up to a year prior) or are currently taking. These will include any prescribed, over-the-counter medications, or supplements (nutritional and herbal).
It is important to disclose all medications and supplements as some can increase your risk of bleeding or result in adversely darkening the surface of the skin (hyperpigmentation).
Your specialist will carefully inspect the skin to be treated and the surrounding area. This is to assess what possible changes can be accomplished with a dermabrasion treatment and how it will affect your physical features (especially the thickness and tone of the skin) following the procedure.
Some recommendations your specialist may make in preparation for treatment include:
- Avoid smoking: If you’re a smoker, your specialist may request that you cut down or avoid smoking altogether in the weeks leading up to your treatment. Smoking can cause decreased blood flow to the skin, which can slow down the healing process after having a treatment.
- Sun exposure: Your specialist may also try and gain a clear understanding of the average time you spend out in the sun. In the lead up to treatment, he or she will also stress that you use sufficient protection on your skin, as too much sun exposure can lead to discolouration of the skin during the healing process (post treatment). You will also be advised to take adequate precautions such as applying sunscreen lotions and wearing a hat when spending time in the sun after treatment to ensure proper healing.
- Recommended medications: Before treatment commences, a specialist may recommend the taking of antiviral medications (to prevent any potential viral infections), oral antibiotics (to prevent any potential bacterial infections) and the use of retinoid creams or lotions with vitamin A content (to promote healing following the procedure).
- Organised transport: The procedure does require the administering of anaesthetic. Your specialist may advise you to arrange for transport home following the treatment as the effects take a little time to wear off and you will most likely be a little drowsy.
How is dermabrasion done?
Anaesthetic is required for this treatment procedure, which is usually done in a dermatologist or surgeon’s office, or in an outpatient surgical facility (clinic). For extensive treatment, a specialist may highly recommend that the procedure be done in hospital.
The type of anaesthetic your specialist will recommend will depend on what specifically is being treated. In most instances, a local anaesthetic (with or without mild sedation) is sufficient. If the extent of treatment is more complex (such as a large area to be treated), stronger sedation (sometimes general anaesthetic) may be necessary for comfort during the procedure. Anaesthetic will help you to relax (when light sedation is administered), but can make you a little drowsy.
In preparation for the treatment, the skin area will be cleaned and covered. If your face is being treated, your eyes will also be covered over. A topical anaesthetic may be rubbed onto the skin area to numb sensation. Then a local or general anaesthetic will be given to numb the area completely.
An ice pack may be placed on the skin for up to 30 minutes beforehand or a cryogenic (freezing) spray may be used to harden the surface of the skin (a spray may be used for deeper abrasions or if the ice packs have not been effective).
A dermatologist or surgeon’s assistant will tautly hold the skin area being treated. The specialist will then move the rotating dermabrader across the skin, applying a gentle, but constant pressure to remove the outer layers of skin. For larger treatment areas, a circular dermabrader will be used.
Larger treatment areas may also be done in several sessions. A petite version (with a little tip) of the dermabrader may be used to treat smaller areas, such as the corners of the mouth.
The procedure is done one small area at a time and can take anywhere between a few minutes to an hour, depending on the extent of the treatment required. Sometimes the cryogenic spray is used during the procedure (if needed), returning to the procedure within a few seconds.
Deep scarring or large skin areas aren’t normally done in one session. These may require multiple sessions and will be done in stages, all of which will be predetermined in the initial examination. If any bleeding occurs, gauze will be applied to stop the bleeding and then covered with ointment and a clean dressing.
Once the entire area of skin has been treated with the dermabrader, the skin will be covered with a moist dressing. This will need to be changed at the first follow-up appointment the very next day.
Before you leave your specialist’s office, he or she will give you instructions for home-care overnight, as well as for the duration of the healing period. This will entail detailed instruction on how to change dressings, when they need changing, how best to treat the affected area and which products are best used or avoided.
A follow-up appointment may be requested the day after treatment, as well as after two weeks.
How will the skin look and feel after the treatment procedure?
The action of the dermabrader will cause some distress to the skin, resulting in swelling and inflammation. You may feel a burning, aching or tingling sensation. Some may experience a little oozing of a clear or yellowish liquid, which will crust over during the healing period. The newer, smoother skin will itch a little as it grows during the weeks following treatment, and is also likely to crust over as it heals.
Your skin will settle quite a bit within the first few weeks following treatment, but it can take up to 3 months to fully heal, and for the pink or red colouration to fade completely. New skin typically starts growing back within 5 to 8 days, but inflammation can take between 6 to 12 weeks to completely heal. The skin texture will be smoother as well.
Most will be able to resume normal activity (within reason) soon after treatment. You are likely to be able to return to work or school within one week following treatment.
Recovery and homecare
It is advisable to follow your specialist’s homecare instructions exactly as directed. This involves how to change your non-stick dressings, and when to clean or apply protective ointments to the affected area. This will help to keep the treated area moist and promote healing. You may be asked to clean the affected area several times a day to alleviate risk of infection, and to remove crusting that occurs as the skin heals.
Prescribed or over-the-counter pain relievers may be recommended during the weeks following the procedure, especially if an extensive area was treated. A dermabrasion procedure can be somewhat painful to experience. These medications will help to alleviate any physical discomfort.
You will be advised to avoid swimming pool water (especially those treated with chlorinated products), as well as any other activities that may accidently cause harm to the sensitive area of skin (such as active sports using a ball) for 4 to 6 weeks.
You will also be asked to be mindful of sun exposure. Once peeling and crusting of the skin has ceased, you will need to apply sunscreen to the skin every day. The new skin is incredibly sensitive to sun exposure and this can result in sun damage and discolouration if protective measures aren’t implemented effectively.
If the skin around the mouth was treated, an antiviral medication may be prescribed to help prevent infections.
You will be asked to be as gentle with handling your skin as you can be. You will need to avoid the use of harsh skincare products and cleansers. It is also best not to scrub, rub or pick at your skin (especially when crusting occurs).
You may use a thick moisturising cream or lotion (petroleum jelly is quite effective) in treating the very sensitive skin following treatment.
Once a specialist has assessed the treated skin during follow-ups and is comfortable that the new skin completely covers the area, you may be allowed to apply cosmetic products to conceal the appearance of inflammation (redness). He or she will check the healing process, treat any problems that occur, and be on the look-out for any early signs of infection as well.
It can happen that adverse reactions occur. If the treated skin area becomes increasingly itchy, red or raised during healing, your specialist will want to assess any signs of scarring or other non-desired reactions. Darkening of the skin once the skin has completely healed can also happen. In this case, bleaching agents may be recommended to help even out your skin tone.
How well does dermabrasion work?
Dermabrasion can help to treat damage that already exists. It cannot prevent future sun damage or even the formation of new lines and wrinkles. Results of a treatment procedure are also not a permanent solution to various skin issues.
Your lifestyle habits will also have an effect on results, both in the short-term and long-term. Those with the habit of spending limited (and protected) time in the sunshine, especially those are a fairer in complexion, tend to experience better and longer lasting results. Those with darker complexions may not experience the best long-term results, especially if they spend a lot of time in the sun.
Dermabrasion is also not really effective for the treatment of deep wrinkles. It can however, be quite effective for fine lines, especially around the mouth and eyes.
On the plus side, what can dermabrasion treatment achieve?
- A smoother, more even skin texture.
- Scarred skin can become more uniform in appearance.
- The skin surface around acne scars can be improved or ‘nearly flattened’ (deeper acne scars may require multiple types of resurfacing treatments such as excision, punch grafting or elevation).
- Results for surgical or injury-related scars are best when dermabrasion treatments are done between 8 and 13 weeks after the injury or surgery took place.
- Improvement of pigment or colour changes on the skin (especially when bleaching agents and Retin-A) are used.
Are there any risks or complications associated with dermabrasion?
There are some short-term risks which will be discussed with you before opting to have a dermabrasion treatment.
The most common factors to consider include:
- Swelling and inflammation (sensitive and red skin)
- Colour changes of the skin, known as hyperpigmentation (the treated area may darken during the healing period). Hypopigmentation (lightening of the skin or blotches) may also occur.
- The skin may become more sensitive to sunlight
- If prone to acne, flare-ups may occur (sometimes tiny milia or cysts can also occur)
- Bleeding of the skin
- Enlarged pores in the skin (this is usually temporary and resolves through healing when swelling decreases)
Less common risks include:
- Potential scarring or the development of keloids (deeper abrasions being treated are at higher risk of scarring after treatment as deeper layers of skin may require treatment).
- Lasting inflammation (redness) of the treated area.
- Damage to tissue if an excessive amount of freezing (cryogenic) spray is used during the treatment.
- Long-term colour loss (darker complexions are at higher risk of this).
- Infection of the treated area (bacterial, viral or fungal).
- Allergic reactions to anaesthetic
- Loss of freckles
Microdermabrasion vs Dermabrasion – what is the difference?
For a microdermabrasion treatment procedure, a dermatologist (skin specialist) makes use of tiny exfoliating crystals on the skin (much like an exfoliating and skin rejuvenating treatment). These are often sprayed onto the skin to treat problems such as brown spots or patches, age spots or dull skin.
The crystals gently remove the outer layer of skin, but this is much less abrasive than dermabrasion. This means that no numbing medications need be applied in order to perform the procedure.
This treatment option in contrast to a dermabrasion procedure results in more subtle changes to the skin. Unlike the initial brush-burn effect of dermabrasion, the skin appears a little inflamed, but renewed, softer and brighter following a treatment. Skin may feel a little tight or dry (much like sunburn or windburn).
Scarring, wrinkle lines or deep acne scars are not suitable for a microdermabrasion treatment at all.
Anaesthetic is also not required for the treatment procedure, as is necessary for a dermabrasion session.
The nature of treatment does not result in the need for as much downtime as with a dermabrasion procedure. The treatment does result in some inflammation to the skin (redness), but it doesn’t last as long and usually begins to fade within 24 hours following a treatment.
Care for the skin is similar in that sun exposure should be limited and skin protected during the healing period. During this time, moisturiser can be applied but some types of make-up should not be used. The most common side-effect, other than minor inflammation is a little irritation which can happen in the eyes if not sufficiently protected during the treatment.
Do medical health insurance providers cover the cost of a dermabrasion procedure?
Dermabrasion is mostly done for cosmetic purposes and thus is not normally covered by most medical health insurance providers.