Tissue resurfacing is a powerful tool in the surgeon’s armamentarium for facial rejuvenation and scar revision. It can be used as a primary treatment modality or as an adjuvant procedure once the initial stages of healing are complete. Several options exist on how the resurfacing is accomplished. This includes chemical peels, dermabrasion, and laser resurfacing. Dermabrasion is the oldest and most well-established method. As with any procedure, it demands technical proficiency, experience, and an appreciation of its applications and limitations. While all resurfacing modalities share common risks and complications, understanding the procedure allows the surgeon to minimize these risks. When comparing the different modalities, dermabrasion’s appeal is obvious. It has a relatively short learning curve, produces reliable and effective results, has low capital investment costs, has low maintenance costs, and can be used in almost any outpatient setting. In this chapter, an in-depth overview of the procedure will be discussed along with periprocedural care, history, complications and their management, and supporting research studies.
The procedure of mechanical resurfacing, also known as dermabrasion, has been around for thousands of years. It is a minimally invasive procedure aimed at smoothing small surface irregularities resulting in a softer scar appearance. It was first described around 1500 BC by the Egyptians, who used sandpaper to smooth scars. However, it wasn’t until 1905 when Kromayer, a German dermatologist, developed modern, motorized dermabrasion. He used rapidly rotating burrs to remove skin to varying depths and determined that ablation down to the reticular dermis would result in healing without leaving a scar. Since then, multiple studies have expanded our knowledge on wound healing, scar formation, and the microscopic effects of the procedure. In 1994, standardized “guidelines of care of dermabrasion” were published outlining the optimal time to perform and appropriate pretreatment and posttreatment care. Also, in that same year, a study was conducted evaluating the difference in manual versus motorized dermabrasion, demonstrating equal efficacy.1 More recently, it has been studied extensively and when compared to laser resurfacing, it has a lower cost, a better safety profile, and can be used in almost any outpatient setting.2,3 Additionally, dermabrasion should not be confused with microdermabrasion, which is a newer cosmetic procedure performed by nonphysician personnel for exfoliation.
INDICATIONS AND PATIENT SELECTION
When selecting a patient for scar revision, it is important for both the surgeon and the patient to realize that it is impossible to erase the scar or scars, as all wounds and incisions result in scar formation. Many options, both surgical and nonsurgical, exist to improve the appearance. For analysis, the ideal scar is one that is narrow, flat, level with surrounding skin, and difficult for the untrained eye to see due to incision/scar placement and color match.2–7
Generally, we look to revise or consider alternative treatment modalities at least 6 to 8 weeks following tissue ...