When the skin has an irregular or uneven texture from acne scarring or from previous injuries, a level II or III dermabrasion (performed with a spinning brush or fraise) may provide improvement. It is also a helpful adjunct to laser resurfacing when treating wrinkled, sun-damaged, or deeply pigmented areas of skin (Fig. 23.1).
The technique of dermabrasion is equivalent to sanding a scratch from a wooden surface in that the work is actually done on the elevated areas in an attempt to take them down closer to the lowest portion of the defect. When successful, this diminishes the high-low junctions that are responsible for casting shadows when light strikes the face from an angle. The result is skin that is smoother and tighter than before.
When the texture of the facial skin is very irregular from excessive or deep scarring, a second treatment may be required 6 to 12 months after the initial treatment. These drawings represent an area of skin that might contain scars and defects of different widths, depths, and configurations (Fig. 23.2).
As the drawings demonstrate, the more superficial defects might be completely removed by dermabrasion. Those that are moderately deep may be improved but not removed, and some of the deeper or “ice-pick” type scars may not be improved at all.
In some cases a second dermabrasion within 6 to 12 months can provide additional improvement to those moderately deep scars (Fig. 23.3, Fig. 23.4). In some circumstances, dermabrasion can be done a third time, but there is a limit. Prior to surgery it is difficult to predict the degree of improvement, since each patient’s skin responds to the same treatment by the same surgeon in a different manner.
Skin pores are the surface openings of the oil glands. Neither dermabrasion, nor a laser, nor a peel is designed to alter them.
Fig. 23.1 When cystic acne does not respond to medical treatment, a level III therapeutic dermabrasion can often improve both the appearance and medical problems in the affected areas. The procedure may be repeated if necessary within several months. Although I do not contend that dermabrasion is a treatment for every case of acne, many patients have received some improvement following this procedure. Acne is generally a medical condition, not surgical; therefore, its treatment should be supervised by the patient’s dermatologist.
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