eMedicine Specialties > Plastic Surgery > Skin

Skin Resurfacing, Dermabrasion

Gaurav Bharti, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center; Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine

Updated: Sep 1, 2009

Introduction

The face is arguably the most critical aesthetic unit of the human body. The art of facial rejuvenation has been practiced since ancient civilizations, and the interest in this subject continues to grow. Various options exist to perform skin resurfacing of the face, including dermabrasion, laser resurfacing, and chemical peels.^1,2,3 All skin resurfacing modalities aim to remove damaged skin and stimulate normal wound healing. Dermabrasion is a simple, cost-effective means of skin resurfacing that can provide repeated and reliable results when used on the face or many other areas of the body.

History of the Procedure

Dermabrasion is an effective technique of skin resurfacing that has been in use for nearly 100 years. The core principle of dermabrasion involves the use of various abrasive instruments to remove superficial layers of skin using appropriate anesthesia, most often with high-speed rotary instruments with abrasive end pieces. The epidermis then regenerates from epidermal appendages in the deep dermis. The end result following dermabrasion is an organized remodeling of the dermis, yielding rejuvenated skin that is smoother and firmer than before.

Physicians in ancient Egypt used sandpapering techniques similar to dermabrasion to treat scars. In 1905, Kromayer first reported controlled abrasion of the skin using carbon dioxide snow and ether spray for anesthesia.⁴ His technique involved the use of rotating wheels and rasps, which differed little from tools used for present day dermabrasion. He treated acne scars, keratoses, tattoos, hair, nevi, and areas of hyperpigmentation. Despite this early report of success, dermabrasion did not gain widespread popularity until the early 1950s, when Abner Kurtin renewed interest in the procedure.⁵

Kurtin, a dermatologist at Mount Sinai Hospital in New York, was the first to present a series of patients who underwent dermabrasion with modified dental equipment in 1953.⁵ Various abrasive end pieces were described, such as rasps, burrs, and wire brushes. Blau and Rein then coined the term dermabrasion in 1954. Alt and Yarborough further contributed to this field by advocating use of the diamond fraise and of wire-brush end pieces, respectively.

Dermabrasion has had a bimodal peak in its popularity in the 1950s and the 1980s. With the advent of new modalities such as carbon dioxide cutaneous lasers and various chemical peels, dermabrasion has fallen in its popularity because of concerns regarding which method provides optimal aesthetics and safety.⁶

Presentation

History and physical examination

A detailed history and physical examination should be performed, including preoperative photography. The severity and depth of the patient’s condition needs to be assessed. Patients should be questioned about previous exposure or any outbreaks of herpes simplex (ie, cold sores). For patients with a positive history of exposure or outbreaks, high dose prophylactic antiviral medications are recommended. Prophylaxis with oral acyclovir 400 mg taken 3 times per day before and continued after the procedure can help reduce the risk of a herpetic outbreak.

A detailed drug history is important, specifically regarding isotretinoin because isotretinoin is a relative contraindication to dermabrasion. Shrunken sebaceous glands due to recent use of isotretinoin can delay reepithelialization and increase the risk of hypertrophic scarring. To the authors' knowledge, no controlled studies have examined this problem; however, case reports have described delayed wound healing and keloid formation after treatment with dermabrasion.⁸ Therefore, notable controversy remains regarding the use of isotretinoin in the setting of dermabrasion. In the current medicolegal climate, avoiding dermabrasion for at least 6 months after the completion of isotretinoin therapy is recommended.

The use of other medications, such as exogenous estrogens, oral contraceptives, or other photosensitizing drugs, may predispose patients to pigmentary changes after dermabrasion. The physician should ask about drug allergies, particularly allergies to topical petrolatum products or local anesthetics, to help prevent adverse reactions before and after the procedure. Use of medications that result in excessive bleeding (eg, aspirin, clopidogrel bisulfate [Plavix], warfarin sodium [Coumadin]) should also be noted.

When obtaining the patient history, physicians must determine if the patient may have infectious diseases that can be transferred by blood contact, such as HIV or hepatitis C. Dermabrasion causes a bloody field and aerosolization of blood. Even with the use of personal protective equipment such as goggles, masks, and scatter shields, the risk of viral transmission is not eliminated. Thus, dermabrasion is not recommended in patients who are HIV-positive; other resurfacing options should be implemented. 

Patient selection

As mentioned above, physicians should first obtain a detailed medical history and physical examination. Preoperative photographs should also be obtained. Next, the physician should determine the severity and depth of the condition to be treated and the need for additional or alternative procedures. The patient's skin type should be assessed using the Fitzpatrick classification (see Table below). This classification is used to categorize the skin according to its ability to tan or its likeliness to burn when it is exposed to ultraviolet (UV) light.

Fitzpatrick Skin Classification⁹

In general, light skin types (types I-II) are most likely to heal without permanent color change, or dyschromia. Dark skin types are associated with increased rates of hypopigmentation and hyperpigmentation. Preexisting discolorations should be documented. Although dermabrasion produces some dyschromia in all patients, this effect can be minimized with appropriate patient selection.

The physician should examine the patient's ear lobes, upper chest, and shoulders for existing keloids or hypertrophic scarring, as these findings indicate that patient has tendency to scar poorly. The physician should also inquire about a history of psoriasis, lichen planus, pyoderma gangrenosum, or other pathergic diseases. For patients with any of these findings, dermabrasion should first be done in a test spot and the results evaluated.

Finally, the patient's specific motivation should be identified, and realistic expectations about outcomes should be established before the procedure.¹⁰ Patients should expect only partial improvement and not complete eradication of the treated defects. They should understand that repeat treatments may be necessary as well as the use of other resurfacing modalities. In addition, patients should recognize the possibility of scar formation and hypopigmentation.

Indications

Dermabrasion was initially developed to combat acne scars; this is the most common indication for its use. It can also be used to effectively treat traumatic or surgical scars, irregular scarring from skin grafts, photo-damage, some benign tumors, actinic keratoses, rhinophyma, and perioral rhytides.⁷ Manual dermasanding has also been used in the treatment of periorbital wrinkles and fine lines.¹¹

Dermabrasion has been used to manage superficial malignancies such as squamous cell carcinoma in situ and superficial basal cell carcinoma.¹² Also, pigmentary changes due to melasma, tattoos, or postinflammatory hyperpigmentation can be lightened with dermabrasion. Dermabrasion can be comparable to laser resurfacing in the treatment of these conditions and may be used in conjunction with laser resurfacing for optimal results.¹³

Dermabrasion is used for specific areas of the face more often than laser resurfacing or chemical peeling because it is less likely to cause pigmentary changes by injuring the pigment-containing melanocytes. When laser resurfacing and chemical peeling are applied to only a portion of the face, they often leave lines of demarcation between treated and untreated regions. Dermabrasion, however, can soften sharp edges of demarcated scars, making them inconspicuous. In addition, dermabrasion may be much less costly to the patient than laser resurfacing or chemical peeling.

The high concentration of pilosebaceous glands and the rich vascular network of the face aid in wound healing. This makes the face the most common and ideal site for dermabrasion, though other areas of the body can also undergo dermabrasion. The results of dermabrasion on areas other than the face are satisfactory but not as good, and scar formation is often increased.

Acne scars that are narrow, pitted, and sharply edged and cast shadows on the face are most amenable to dermabrasion. Some acne scars are deep and extend into the subcutaneous tissue. Dermabrasion of the epidermis, papillary dermis, and upper reticular dermis is possible. However, abrasion below these levels is prohibitive and results in scarring. Therefore, deep lesions are best managed by first excising them with punch biopsy with or without use of a full-thickness graft; after healing, these lesions can be treated with dermabrasion.

Dermabrasion can also be used to treat rhinophyma, a condition marked by swelling and redness of the nose caused by hyperplasia of the sebaceous glands and prominent vascularization of the skin.¹⁴ Thickening hyperplasia is often present, especially in the tip of the nose and in the alar regions. Dermabrasion allows the physician to substantially reduce this condition, and a full-thickness skin graft is rarely required. Reepithelialization is rapid, usually occurring within several days. Often, the surgeon can use electrofulguration and laser resurfacing of contractive tissue as an adjunct to dermabrasion.

Dermabrasion has also been used for the treatment of burn scars. It has been used as an adjunct for the treatment of deep dermal burn scars of the face with excellent results. It can be used for the treatment and management of acute burn injury to the face as well as for the treatment of mature hypertrophic burn scars and the resurfacing of split-thickness skin grafts. Abrasion can be performed using high-speed rotary instruments or, more simply, using sandpaper wrapped around a digit or test tube.

Relevant Anatomy

The most important element in dermabrasion is recognition of the appropriate depth of treatment. The skin is composed of 2 mutually dependent layers, the epidermis and the dermis, which rest on a fatty subcutaneous layer. The epidermis contains no blood vessels and protects the underlying dermis from the external elements. The epidermis is entirely dependent on the underlying dermis to deliver nutrients and to remove waste by means of diffusion across the dermoepidermal junction. An important function of the dermis is to sustain and support the epidermis. The dermis is divided into 2 layers: the relatively superficial papillary dermis and the relatively deep reticular dermis. Collagen, elastic tissue, and reticular fibers are present throughout both layers.

Epidermal appendages are intradermal epithelium-lined structures that can divide and differentiate. They develop as downgrowths of the epidermis into the dermis. They include sebaceous glands, sweat glands, apocrine glands, mammary glands, and hair follicles. Epidermal appendages serve an important role as a source of epithelial cells. These appendages are responsible for reepithelialization if the overlying epidermis is removed or destroyed in situations such as partial-thickness burns, chemical peeling, dermabrasion, traumatic abrasions, or harvesting of split-thickness skin grafts.

Skin anatomy.

Contraindications

Recent or ongoing use of isotretinoin was once thought to be an absolute contraindication to dermabrasion but is now regarded as a relative contraindication. Isotretinoin causes atrophy of pilosebaceous glands, which delays reepithelialization and increases the risk of hypertrophic scarring. No definitive study provides a clear-cut correlation between isotretinoin treatment and postdermabrasion scarring. Increased scarring in patients who were treated with isotretinoin has been reported; patients in whom no adverse outcomes occurred with dermabrasion and the use of isotretinoin have also been reported.⁸ To avoid a possible adverse outcome, physicians should inform patients of potential risks and instruct them to stop using isotretinoin for a period of 6-12 months before dermabrasion.

Ablative resurfacing may exacerbate certain inflammatory conditions that impair reepithelialization and lead to scarring. Examples of such conditions are scleroderma, cutis laxa, psoriasis, congenital ectodermal dysplasia, and collagen disorders due to abnormal adnexal structures.

Dermabrasion is contraindicated if recent surgery (eg, rhytidectomy) has involved undermining the skin that is slated to undergo dermabrasion. Dermabrasion should be postponed for at least 6 months to allow the underlying vascular bed to heal. The risks of necrosis and delayed wound healing are increased because of the compromised blood supply.

Previous radiation therapy leading to radiodermatitis is a relative contraindication because the skin is thinned in irradiated areas. Therefore, the risk of delayed healing with excessively deep dermabrasion is increased.

Bleeding disorders, immunosuppression, and diabetes mellitus may also delay healing and increase the risk of surgical infection. Therefore, these conditions are relative contraindications.

Dermabrasion should be avoided over small areas in patients with freckled skin because the freckles may disappear in those areas (but not elsewhere).

Although deep rhytides and excessive facial skin are not definitive contraindications, these conditions may not be significantly improved with dermabrasion. Patients with these findings are likely best served with traditional face-lift procedures. For more information, see the Rhytidectomy section of eMedicine's Plastic Surgery journal.

Dermabrasion is also contraindicated in patients with active herpetic lesions and in women who are pregnant or nursing.

Dermabrasion should be avoided in patients who develop atypical scars such as keloids.

Treatment

Preoperative Details

Equipment

Dermabrasion is typically performed in an office-based setting, not requiring inpatient hospitalization or general anesthesia.¹⁰ Appropriate lighting is critical, and the operator and assistant must wear surgical gowns, gloves, and masks with eye protection. Because of the high rate of rotation, the surgical field should be cleared of sponges, towels, and other equipment that may become entangled and injure the physician, assistant, or patient.

The dermabrader consists of an electric hand engine with a high-speed rotary motor and an interchangeable abrading end piece. The surgeon may control the speed with a foot pedal or handheld device. Pressure exerted on the hand piece and the revolutions per minute of the hand piece are the most important variables in technique. Avoiding excessive pressure on the hand piece is important because excessive pressure can result in gouging. Suggested rotational speeds of 12,000-15,000 revolutions per minute (rpm) for the abrading heads result in controlled gradual planing of the treated surface.

The most commonly used end pieces are diamond fraises, wire brushes, or serrated wheels. Diamond fraises are available in many shapes, sizes, degrees of coarseness, and levels of quality. Small devices are used in confined spaces, such as around the nose or eyelids. Experienced surgeons tend to use the coarse or extra coarse fraises. Large wheels are used on broad flat surfaces, such as the forehead and cheeks. Diamond fraises can be used without a spray refrigerant, whereas wire brushes require cooling. The wire brush produces microlacerations in the skin but causes little thermal injury and is often preferred by experienced surgeons over the diamond fraise. The diamond fraise is easiest to learn to use, but it can increase thermal injury because deep resurfacing requires several passes applied with pressure. The wire brush is recommended for deeper scars and the diamond fraise is recommended for more superficial scars.

Use of sandpaper wrapped around a digit or cylinder (eg, a test tube) is the simplest means to perform dermabrasion.^15,16 It has been demonstrated to provide excellent outcomes and is extremely cost-effective. This technique is less likely to cause injury, but it is difficult to perform finer and deeper areas of resurfacing with this technique.

Counseling

Preoperative counseling is imperative to ensure realistic patient expectations. The patient's desired outcome must be clearly communicated and understood. Physicians may show patients preoperative and postoperative photos of patients treated with dermabrasion; complications should be included. In general, dermabrasion yields 35-50% subjective improvement of skin texture. Patients should not expect restoration of perfect skin, and dermabrasion does not affect skin redundancy or eliminate the possible need for rhytidectomy. Patients should be told that the greatest improvement is usually observed 6 months after surgery. Patients should be provided a reference list of alternative procedures as well and instructed that combining other procedures with dermabrasion is not uncommon.^17,18

Patients should avoid sun exposure before and after the procedure. Some surgeons prescribe antiviral prophylaxis to all patients, and patients with a history of herpes simplex should receive strong prophylactic doses of acyclovir 400 mg 3 times daily or valacyclovir 500 mg twice daily. The herpes virus requires viable epidermal cells to establish an infection. Therefore, antiviral therapy should continue for 10-14 days to allow complete reepithelialization to occur. Prophylactic antibiotics are usually not needed. However, patients with a history of impetigo, staphylococcal skin infection, or a compromised immune system may benefit from antibiotics.

After a patient is appropriately selected, the physician obtains informed consent for the procedure. This process includes a thorough discussion of possible complications. Select patients may require preoperative laboratory screening to include complete blood count and serum chemistries. In addition, at-risk individuals should be screened for HIV and infectious hepatitis.

Skin preconditioning

Trans-retinoic acid (Retin-A, Renova), a topical exfoliative agent, is believed to increase the rate of epidermal turnover. This turnover promotes rapid reepithelialization after dermabrasion. Trans-retinoic acid may be applied every night or every other night for several weeks before dermabrasion, depending on the degree of skin irritation and the patient's tolerance. An alternative product relatively new to the market is Kinerase (Valeant Pharmaceuticals North America, Costa Mesa, Calif.), which is reported to be less irritating and less sensitizing to sunlight than trans-retinoic acid.¹⁹

Topical hydroquinone applied for several weeks before dermabrasion may decrease hyperpigmentation. Dermabraded areas respond well to this treatment.

In addition, patients should be instructed to clean the face and avoid using moisturizers or makeup the morning prior to dermabrasion.

Intraoperative Details

The physician's preference determines the type of anesthesia needed. Patients should be given preoperative anesthetic medication prior to beginning the procedure. Patients may also be given an anxiolytic medication if needed. Dermabrasion may be performed with general anesthesia, a regional block, or local anesthesia with or without conscious sedation. The skin may be pretreated for 20-30 minutes with an ice pack. Refrigerant sprays (eg, fluoroethyl, freon-114) used prior to dermabrasion can produce topical anesthesia, decrease bleeding by means of vasoconstriction, and stiffen the surface of the skin. Care must be taken with refrigerant agents to prevent freezing too deeply and causing cell damage due to cryonecrosis. When using sedation or general anesthesia, the patient’s heart rate, blood pressure, and oxygen saturation must be monitored.

The areas to be treated are marked in sections and then prepared and draped in a sterile fashion. The patient’s skin should be held taut by using both of the surgical assistant's hands and the surgeon's nondominant hand. The surgeon and staff should practice strict exposure precautions, including the wearing of protective face shields, to avoid contact with aerosolized matter and blood-borne pathogens. In addition, the assistant should wear cotton gloves on top of rubber gloves to prevent injury, as the rotating handpiece can catch rubber gloves very quickly. Gentian violet staining of the treated area can be used to determine the degree of abrasion. 

The abrading instrument is correctly held by placing the forefingers around the body of the instrument with the thumb outstretched on the shaft for stability and control.

Technique and hand position for dermabrading raised scars.

Dermabrasion of a raised scar.

Technique of dermabrasion for a depressed scar.

The key to successful dermabrasion is controlling the wound created. The rotating head should be kept parallel to the skin surface, and the hand piece should be in motion at all times. The motion should be deliberate, firm, steady, and with even pressure. Planing the epidermis down to the dermal junction begins the abrasion. No bleeding occurs during dermabrasion through the epidermis because of a lack of blood vessels in this layer. Decreased pigmentation is encountered when the process continues through the epidermis. The dermoepidermal junction is reached next, followed by the papillary layer of the dermis. Uniform bleeding from punctate sites over a smooth, shiny surface marks this layer. The deep papillary dermal layer is encountered when the surface becomes rough and when bleeding points increase.

Although each site bleeds only minimally, the multitude of bleeding sites can result in considerable blood loss. As the depth of abrasion increases, the superficial reticular dermis is reached, and bleeding becomes brisk and confluent. This layer is rougher than the deep papillary dermis and represents exposed dermal collagen. This surface has a whitish yellow appearance. Dermabrasion should not be performed below the superficial reticular dermis. Below this level, yellow fat globules are encountered, and clinically significant scarring would result if dermabrasion were continued here.

At the periphery of the abraded area, the borders are lightly feathered by decreasing the pressure and the number of strokes to yield a uniform appearance. Caution should be exercised over bony prominences, where excessively deep dermabrasion commonly occurs.

As the skin warms, increased bleeding may occur. Saline-moistened sponges or sponges soaked in dilute epinephrine solution with or without lidocaine can be applied to the treated area for 5-10 minutes to decrease pain and provide hemostasis.

Postoperative Details

Postoperative care is aimed at providing an ideal environment for moist wound healing to prevent dehydration and promote epithelial cell migration. After the procedure, a topical petroleum product should be applied to all treated areas. Scented or mentholated antibiotic ointments should be avoided because of their potential to cause hypersensitivity reactions.

An open or closed wound care regimen may be followed. In a typical open wound care regimen, compresses moistened with saline solution or 25% vinegar are applied 4-5 times per day to cleanse the area, followed by the petroleum ointment mentioned above. Reepithelialization requires 10-14 days. A closed wound care regimen may decrease the time for complete reepithelialization by 50% to only 5-7 days. Semipermeable dressings, such as petroleum-impregnated gauze, are applied directly to the skin and covered with nonstick dressings, gauze, and net dressing. Patients undergo dressing changes every 24 hours, and the patient is then serially evaluated to monitor progression.

Patients may be given prescription medications for pain relief, a course of systemic antibiotics (often cephalexin), or a short course of oral steroids with a quick taper to reduce instances of inflammation. If the patient has a history of herpes virus outbreaks, antiviral medications such as acyclovir or valacyclovir should be prescribed.

Follow-up

In the early stages of wound healing, the patient should be reexamined early and repeatedly, generally within 48 hours and again every several days. Any buildup of fibrinous exudate or significant eschar should be removed to prevent infection, delayed healing, and possible scarring. Some physicians use intramuscular steroid injections or oral steroids to reduce periorbital and cheek edema.

After reepithelialization is complete, the new skin may be bright pink or red, with deeply abraded areas appearing most erythematous. This coloration typically fades within 8-12 weeks. Patients may use makeup to camouflage the appearance, though they should be instructed not to apply makeup, trans-retinoic acid, or skin care products until the face is healed to the satisfaction of the treating physician.

Some practitioners have used topical agents that contain platelet products or growth factors after dermabrasion. Although these products have been shown to improve wound healing in clinical situations other than dermabrasion, the present authors know of no data from randomized controlled clinical trials that support their use in this setting. Further research continues in this area.

Patients must use sunblock to protect the new sensitive skin after it reepithelializes to prevent burning and dyschromia. Patients should use sunscreen every day for 6-12 months after dermabrasion. Some patients have transient hyperpigmentation for 4-6 weeks after surgery. Bleaching creams, such as hydroquinone, may be used 3 weeks after surgery to help prevent this effect.

Postoperative edema continues to improve for 3 months. As the edema resolves, deep rhytides and acne scars may initially appear to be persistent. Collagen remodeling continues for another 3-6 months, and new collagen fills deep defects. Patients should be told that the greatest improvement is usually observed 6 months after surgery.

Complications

Postoperative spot bleeding, erythema, milia formation, and flare-ups of acne are normal sequelae of dermabrasion and should be discussed with the patient preoperatively. A common effect is hyperpigmentation 4-6 weeks after the procedure, but this is usually transient and responds well to hydroquinone. Patients at increased risk include those taking oral contraceptives, exogenous estrogens, or other photosensitizing medications. When hyperpigmentation does not respond to topical treatment, nonablative laser therapy can be performed to diminish the pigment.

The most clinically significant complications are hypertrophic scarring and permanent hypopigmentation. The risk of prolonged erythema, scarring, and hypopigmentation is directly proportional to the depth of dermabrasion and to the delay of wound healing after the normal time for reepithelialization. Therefore, every effort should be made to control these factors.

No good treatment is available to manage the complication of hypopigmentation. This complication occurs to varying degrees in 20-30% of patients. Hypopigmentation is due to the destruction or inhibition of melanocytes. Because they originate from neural crest cells, melanocytes cannot regenerate or divide. Hypopigmentation is most noticeable in darkly pigmented patients and may be difficult to assess until erythema subsides; however, it may be permanent at that point. Pigmentary changes are less likely to occur with dermabrasion than with alternate techniques, such as chemical peeling or laser resurfacing. Camouflage methods are currently the best options to treat hypopigmentation, though certain lasers may be used to stimulate the melanocytes in some patients.

Hypertrophic scarring and keloid formation are the most worrisome complication and can result from dermabrasion through the deep dermis or an exaggerated inflammatory response. Therefore, any history of keloid formation in the patient's history should serve as a contraindication to dermabrasion.

Persistent erythema and delayed reepithelialization should alert the physician and patient that scarring is imminent. Erythema after dermabrasion typically lasts only 8-12 weeks as opposed to 3-6 months of erythema after laser resurfacing. Wounds that demonstrate a lack of reepithelialization by day 14 are at risk for hypertrophic scarring. Early recognition and aggressive treatment are essential. Aggressive measures, such as the application of compressive silicone sheets, scar massage, topical or intralesional steroids, or pressure garments, may minimize the appearance of the scar. Mid- to high-potency topical steroid creams may be used. If induration is present, intralesional steroids (eg, triamcinolone acetonide [Kenalog]) may be given every 2-3 weeks. Pulsed-dye vascular lasers have been used with some success during the erythematous phase of hypertrophic scarring. Scar excision or further dermabrasion may be necessary if the results of these therapies are unsatisfactory.

Infectious complications are unusual but must be recognized quickly to prevent undesirable scarring. Postoperative viral infections, especially those due to herpes simplex virus, may occur despite prophylaxis. If pain, erythema, or ulcerations appear 7-10 days after the procedure, viral infection should be suspected, and a full-strength antiviral therapy should be administered (valacyclovir 1 g 3 times a day for 7 days or famciclovir 500 mg 3 times a day for 7 days). Infections due to staphylococcal, streptococcal, and pseudomonal bacteria or candidal fungus may occur. If they do, wound cultures should be ordered, and appropriate oral or topical antibiotics or antifungal treatment should be started.

Milia, or intraepidermal collections of keratinaceous debris, are commonly observed after dermabrasion. These collections appear as small white cysts. Treatment consists of abrasive soaps, electrodessication, unroofing, or lancing the cysts with a needle or scalpel.

Outcome and Prognosis

Dermabrasion is a well-established technique for skin resurfacing using mechanical abrasion of the skin. It can yield excellent results when a well-trained surgeon performs the procedure for the appropriate patient. The keys to performing dermabrasion are experience and understanding of its principles to provide sufficient resurfacing to the appropriate depth and minimize scar formation.⁷ Careful patient screening is crucial to ensure realistic expectations.⁷ With meticulous postoperative care, the results can be highly satisfying for patients.

Multimedia

Media file 1: Skin anatomy.

Media file 2: Technique and hand position for dermabrading raised scars.

Media file 3: Dermabrasion of a raised scar.

Media file 4: Technique of dermabrasion for a depressed scar.

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Keywords

skin resurfacing, dermabrasion, cutaneous plastic surgery, microdermabrasion, acne scars, dermabrasion technique, dermabrasion treatment, scar removal, acne scar removal, skin planing, controlled skin abrasion, hyperpigmentation, diamond fraise, wire brush, Fitzpatrick skin classification, Fitzpatrick's skin classification, rhytidectomy, acne scar, traumatic scars, surgical scars, photodamage, actinic keratoses, perioral rhytides, rhinophyma, skin treatments, scar treatment, skin rejuvenation, facial rejuvenation

Contributor Information and Disclosures

Author

Gaurav Bharti, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Gaurav Bharti, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, and Phi Kappa Phi
Disclosure: Nothing to disclose.

Coauthor(s)

Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Christian N Kirman, MD is a member of the following medical societies: North Carolina Medical Society
Disclosure: Nothing to disclose.

Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine
Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Peripheral Nerve Society, and Wound Healing Society
Disclosure: KCI, Inc.  Honoraria Speaking and teaching; Integra Life Sciences Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Medical Editor

Tolbert Wilkinson, MD, Consulting Staff, Department of Surgery, Southwest Texas Methodist Hospital
Tolbert Wilkinson, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, Phi Beta Kappa, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Gregory Caputy, MD, PhD, FICS, Chief Surgeon, Aesthetica Plastic and Laser Surgery Center, Inc
Gregory Caputy, MD, PhD, FICS is a member of the following medical societies: American Medical Association, American Society for Laser Medicine and Surgery, Canadian Medical Association, Hawaii Medical Association, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association, and Wound Healing Society
Disclosure: Nothing to disclose.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Danielle M Dauria, MD, Margaret Napolitano, MD, Christian Paletta, MD, FACS, and Michael Brent Seagle, MD, to the development and writing of this article.

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