Complementary Information on Dermabrasion

As early as 3,500 years before our era, a papyrus text praised the benefits of abrasive pastes: the Egyptians used a mixture of milk and honey with alabaster particles. This shows that throughout history, men and women have sought to smooth away certain superficial skin imperfections (wrinkles, scars, keratoses, pigmented spots) by smoothing their skin surface, to improve it, preserve its freshness and rejuvenate it.

This smoothing corresponds to abrasion and today's abrasion techniques can be:

• Mechanical: this is Dermabrasion
• Chemical: these are Chemical Peels
• Thermal: this is Laser Resurfacing

Dermabrasion is performed using a rotating brush or burr with a rough surface connected to a handpiece and electric motor. The choice of rotation speed, the abrasive power of the burr and the pressure exerted by the surgeon allow qualitative control of the abrasion.

Many other dermabrasion methods have been proposed: rasps, brushes, sandpaper, grinding wheels. But the principle of mechanical abrasion remains the same.

Dermabrasion consists of eliminating the superficial layer of the skin, i.e., the epidermis, and may extend to the superficial dermis.

Its depth depends on the severity of the defect to be corrected, the area to be treated, the skin quality and the desired goal.

This destroyed superficial layer then restores itself through natural healing processes from islets of dermo-epidermal basement membrane and pilo-sebaceous appendages contained in the deep dermis: this is re-epidermisation or re-epithelialisation. This implies a healing period during which the skin remains fragile and requires careful attention. It is this skin surface restoration that creates a smoother appearance: a mechanical smoothing that more or less "erases" the imperfections to be treated.

Furthermore, dermo-epidermal healing occurs with a certain degree of skin retraction, a genuine cutaneous "tightening" effect, variable and more or less significant depending on the case.

It should be distinguished from microdermabrasion, which is in fact only a very superficial dermabrasion: the result is a glow, an effect on complexion producing a refreshing result without resurfacing.

The consultation aims to evaluate the request, specify the indication, inform the patient of what can be treated and what will not, and explain all facts relating to this type of procedure.

Preoperative skin preparation is important to optimise the result: skin cleansing, fruit acid or vitamin A acid creams, antibiotic coverage may be prescribed by your surgeon during the 2 or 3 weeks preceding the procedure to prepare your skin so that it arrives at the time of the procedure in the best possible local condition.

These modalities should be discussed with your surgeon. The procedure can be performed:
• Under local, locoregional, general anaesthesia or analgesia.
• With one or more days of hospitalisation or as a day case.

Type of anaesthesia: The principle for anaesthesia during facial dermabrasion is the pursuit of comfort for both the patient and the practitioner.

This objective is more easily achieved by general anaesthesia or analgesia:
• Standard general anaesthesia, during which you sleep completely,
• Analgesia, which is local anaesthesia supplemented by tranquillisers administered intravenously (twilight anaesthesia).

However, local or truncal anaesthesia may also be used:
• Truncal nerve blocks are very well suited for the eyelids and the midface area (forehead, nose, lips and chin). These blocks are effective and easy to manage. They consist of injecting an anaesthetic product around a sensory nerve that innervates a skin area: this area is thus numbed for the duration of the procedure.
• Pure local anaesthesia: an anaesthetic product is injected locally subcutaneously to numb the area to be treated. The lateral parts of the face (cheek, temporal region), difficult to access for truncal blocks, respond very well to this technique.
• Anaesthetic creams such as EMLA have value on thin skin, especially if the abrasion remains superficial. Improvements are expected in this type of anaesthetic cream.

Hospitalisation: The procedure can be performed as a day case, i.e., with discharge on the same day after a few hours of monitoring.

If hospitalisation, generally quite short, is recommended, admission takes place the evening before or the morning of the procedure, with discharge the following or next day.

After cleaning and disinfection of the skin and placement of sterile drapes, dermabrasion is performed with a rotating brush or burr of variable size, shape and grain, connected to a handpiece and electric motor allowing high rotation speed (15,000 to 35,000 rpm).

The choice of rotation speed, abrasive power of the burr and pressure exerted by the surgeon allows qualitative control of the abrasion and its depth. This depth depends on the severity of the defect to be corrected, the area to be treated, the skin quality and the desired goal.

Maximum delicacy is required when approaching the eyelids, hair, eyebrows and lip mucosa.

At the end of dermabrasion, the exposed dermis causes bleeding.

This dermis must then be covered and protected:
• Either by a closed dressing, dry or greasy, to be changed daily due to significant oozing.
• Or by an open dressing consisting of the application of petroleum-based emollient to be repeated several times daily.

Immediately after dermabrasion, an exudate forms on the surface of the exposed dermis, causing redness, oedema and oozing.

From the 5th day, a thin epidermal layer reforms: it is very fragile as its attachments to the underlying dermis are still weak, hence the danger of rubbing, trauma and scratching.

Local care, using emollients or dressings, will protect and support healing until complete, achieved in 10 to 15 days. Well directed by your surgeon, these local treatments will prevent crust formation, which even if undesirable may occasionally develop and should not be removed, to respect the underlying healing in progress and avoid the risk of residual scarring.

Progressively, skin of better tone, smoother, regenerates. Pigmentation begins to appear after about one month and must under no circumstances be stimulated, quite the contrary, by sun exposure, at the risk of hyperpigmentation.

Adapted make-up and sun protection are recommended from the 10th day to camouflage an erythema of variable intensity (red or pink appearance of the treated skin for 1 to 2 months or more, which does not constitute a complication but a normal outcome).

The skin may be uncomfortable, dry, fragile, irritable, intolerant to usual beauty products for several weeks. Rashes with redness and warmth may occur for a few months.

A systemic treatment (analgesic, anti-inflammatory, antibiotic, anti-herpes, anti-pruritic) is often prescribed by your surgeon alongside local care.

This recovery period is sometimes psychologically difficult for the patient: your practitioner is available to help and advise you during the post-procedure consultations, which are necessary for proper healing management. Do not hesitate to call or return for consultation to resolve any issue.

Indications by location:
The success of dermabrasion depends essentially on the skin's ability to regenerate through natural healing processes, from the pilo-sebaceous appendages and dermo-epidermal basement membrane islets contained in the preserved dermis.

Logically, this technique is most suitable when these appendages and islets are abundant and deep enough not to be affected by the abrasion. The most favourable area is the face, bearing in mind that the surgeon will exercise great caution when approaching the eyelids, the red lip and the neck, as these areas are either very thin or poor in pilo-sebaceous appendages.

Indications by cause:
Dermabrasion essentially treats the skin of a facial area or the entire face marked by:
• Depressed scars such as acne scars. It smooths and improves surface irregularities.
• Signs of ageing, particularly sun-related (spots, elastosis, superficial or moderate wrinkles). It is a skin surface treatment that can of course be combined with techniques treating ageing-related skin laxity such as facelifts or blepharoplasties. It may also be combined with other techniques such as filler injections or botulinum toxin injections.
• Other indications are more secondary, such as tattoos. Only superficial tattoos, particularly traumatic ones, constitute an indication, to be weighed against the highly effective depigmenting lasers that are much better suited to treat tattoos than dermabrasion.

Dermabrasion, although performed for essentially aesthetic motivations, nevertheless constitutes a cutaneous, epidermal and dermal aggression, which implies the risks associated with any medical-surgical act.

By choosing a qualified and competent practitioner, trained in this type of procedure, you minimise these risks as much as possible, without however eliminating them entirely.

Fortunately, true complications are rare following a dermabrasion performed according to standard practice. In practice, the vast majority of procedures proceed without any problems and patients are fully satisfied with their results. Nevertheless, despite their rarity, you should be aware of the possible complications:

• Microbial infection,
• Acne flare-up,
• Milia (small white cysts),
• Hyperpigmentation (especially on darker skin), early and almost always transient, often due to premature sun exposure.
• Hypopigmentation, often permanent, appears more rarely and later,
• Persistent redness,
• Healing disorders and hypertrophic scars
are possible but rare. They indicate overly deep destruction, scratching, failure to respect the fragile early re-epidermisation, or inadequately or belatedly treated infection.

Allergy: products used for skin disinfection or care may also cause allergy; it is therefore important to consider all allergies the patient has had throughout their life.
Pain during the first days, diffuse sensation of heat or burning in the treated area. Analgesics will be prescribed by the physician.
Insufficient result, especially due to the severity of the defect to correct: in these cases, your surgeon will inform you of the value of a new treatment after a minimum interval of one year.

Overall, risks should not be overestimated, but one should simply be aware that a medical-surgical act, even apparently simple, always involves a small element of uncertainty. Choosing a qualified practitioner ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.

These are the information elements we wished to provide as a complement to the consultation. We advise you to keep this document, re-read it after the consultation and reflect on it at your leisure.

This reflection may raise new questions for which you will need additional information. We are at your disposal to discuss them again at a future consultation, by telephone, or even on the day of the procedure itself, when we will in any case see each other before the anaesthesia.