Dermabrasion

Dermabrasion is carried out using a brush or rotary milling cutter, with a rough surface connected to a handpiece and an electric motor. The choice of rotation speed, the abrasive power of the cutter and the pressure exerted by the surgeon allow a qualitative control of the abrasion.
Many other dermabrasion methods have been proposed: rasps, brushes, abrasive papers, grinding wheels. But the principle of mechanical abrasion remains the same.
Dermabrasion consists of the removal of the superficial layer of the skin, i. e. the epidermis, and can extend to the superficial dermis.
Its depth depends on the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose.
Then this destroyed surface layer will be restored thanks to natural healing phenomena from the islets of the basal dermo-epidermal membrane and the pilosebaceous annexes contained in the deep dermis: it is reepidermisation or reepithelialisation. This implies a healing time where the skin remains fragile and requires careful care. It is this restoration of the skin surface that will create a smoother appearance: it is a mechanical smoothing that will erase, more or less, the imperfections that you want to treat.
In addition, dermo-epidermal healing will take place with a certain amount of skin retraction, a real "tensor" effect on the skin, which varies according to the case.
It must be distinguished from microdermabrasion, which is in fact only a very superficial dermabrasion: the result is a radiance boost, an action on the complexion by producing a refreshing effect without resurfacing.

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The purpose of the consultation is to assess the request, clarify the indication, inform the patient of what can and will not be treated and explain all the facts about this type of intervention.
The preparation of the skin before surgery is important in order to optimize the result: skin cleansing, creams with fruit acids or vitamin A acid, antibiotic coverage, are sometimes prescribed by your surgeon during the 2 or 3 weeks preceding the procedure to prepare your skin until it arrives at the time of the procedure under the best possible local conditions.
These modalities are to be discussed with your surgeon, the procedure can be done:
• Under local, locoregional, general or analgesic anesthesia.
• With a hospitalization of one or more days or on an outpatient basis.
Type of anesthesia:
The principle for anesthesia during facial dermabrasion is the search for comfort, both for the patient and the practitioner.
This objective is easier to achieve with general anesthesia or analgesia:
• Classical general anaesthesia during which you sleep completely
• Analgesia is a local anaesthesia supplemented by tranquilizers administered intravenously (vigilant anaesthesia).
However, local or truncal anaesthesia may be used:
• Truncal blocks are very well suited for the eyelids and for the median part of the face (forehead, nose, lips and chin). These blocks are efficient and easy to handle. They consist of the injection of an anesthetic product around a sensitive nerve that innervates a cutaneous area: this area is thus anaesthetized 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.
• EMLA anesthetic creams have an interest in thin skins, especially if the abrasion remains high. Progress is expected on this type of anaesthetic cream.
Hospitalization conditions:
The procedure can be performed "on an outpatient basis", i.e. with a same-day discharge after a few hours of supervision.
If a generally short hospital stay is recommended, entry is the day before or the same morning with an exit the next day or two days later.

After cleaning and disinfecting the skin and installing the sterile fields, dermabrasion is carried out by a brush or rotary cutter of variable size, shape and grain, connected to a handpiece and an electric motor allowing a high rotational speed (15 to 35,000 rpm).
The choice of rotation speed, abrasive power of the cutter and the pressure exerted by the surgeon allow the quality control of the abrasion and its depth. This depth depends on the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose.
The delicacy of the gesture is maximum when you approach the eyelids, hair, eyebrows, lip mucosa.
At the end of the dermabrasion, the dermis is exposed, resulting in bleeding.
This dermis must then be covered and protected:
• Either by a closed bandage, dry or greasy, to be repeated every day due to the significant oozing.
• or by an open bandage which consists in the application of vaseline fat to be repeated several times a day.

Immediately after dermabrasion, exudate forms on the surface of the exposed dermis, causing redness, oedema and oozing.
From the 5th day, a thin epidermal layer is reformed: it is very fragile because its attachments with the underlying dermis are still fragile, hence the danger of friction, trauma, scratching.
Local treatments, based on fats or bandages will promote and protect until complete healing, obtained in 10 to 15 days. If properly managed by your surgeon, this local care will prevent the appearance of scabs, which even if undesirable, may eventually form and should not be torn off to respect the underlying healing process under way and not run the risk of a possible residual scar.
Gradually, skin that is better toned and smoother regenerates. Pigmentation begins to appear after one month and should under no circumstances be stimulated, quite the contrary, by exposure to the sun at the risk of hyperpigmentation.
Appropriate make-up and sun protection are recommended from the 10th day onwards to camouflage an erythema of variable intensity (red or pink appearance of the treated skin for 1 to 2 months or more, which is not a complication, but a normal continuation).
The skin may be uncomfortable, dry, fragile, irritable, intolerant to usual cosmetics for several weeks. Rashes with redness and heat can occur for a few months.
A general treatment (analgesic, anti-inflammatory, antibiotic, anti-herpetic, anti-pruritic) is often prescribed by your surgeon in parallel with local care.

About Dermabrasion

After several months, the final result shows a smoother skin, having benefited from a tightening effect, with an epidermis of normal thickness.
The purpose of this intervention is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you complete satisfaction.
Possible complications:
• Microbial infection • Acne flare-up
• Milium grains (small white cysts)
• Hyperpigmentation (especially on dark skins): early and almost always transient, it is often due to premature exposure to the sun.
• Hypopigmentation: often permanent, appears less frequently and later
• Persistent redness
• Healing disorders and hypertrophic scars are possible but rare. They show excessive destruction, scratching, failure to respect the fragile re-epidermisation of the beginning of the healing process, and infection that is poorly or late treated.
• Allergy: products used for skin disinfection or care can also cause an allergy, so it is important to consider all the allergies the patient has had in their lifetime.
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