CONSIDERING ALTERNATIVE PROCEDURES

If you're planning "surface repairs" on your face, you may also be considering chemical peel or laser as alternative methods of surgically removing the top layer of skin. However, dermabrasion and dermaplaning use surgical instruments to remove the affected skin layers, while chemical peel uses a caustic solution.

Many plastic surgeons perform all three procedures, selecting one or a combination of procedures to suit the individual patient and the problem. Others prefer one technique for all surface repairs. In general, chemical peel or laser is used more often to treat fine wrinkles, and dermabrasion and dermaplaning for deeper imperfections such as acne scars. A non-chemical approach may also be preferred for individuals with slightly darker skin, especially when treating limited areas of the face, since dermabrasion and dermaplaning are less likely to produce extreme changes and contrasts in skin color.

If you'd like more information on chemical peel, ask your plastic surgeon for the ASPS brochure on that topic.

THE BEST CANDIDATES FOR DERMABRASION

Dermabrasion and dermaplaning can enhance your appearance and your self-confidence, but neither treatment will remove all scars and flaws or prevent aging. Before you decide to have a skin-refinishing treatment, think carefully about your expectations and discuss them with your surgeon.

Men and women of all ages, from young people to older adults, can benefit from dermabrasion and dermaplaning. Although older people heal more slowly, more important factors are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after a skin-refinishing treatment. People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. If you have freckles, they may disappear in the treated area.

In addition, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection. The same may be true if you've had radiation treatments, a bad skin burn, or a previous chemical peel.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Dermabrasion and dermaplaning are normally safe when they're performed by a qualified, experienced board-certified physician. The most common risk is a change in skin pigmentation. Permanent darkening of the skin, usually caused by exposure to the sun in the days or months following surgery, may occur in some patients. On the other hand, some patients find the treated skin remains a little lighter or blotchy in appearance.

You may develop tiny whiteheads after surgery. These usually disappear on their own, or with the use of an abrasive pad or soap; occasionally, the surgeon may have to remove them. You may also develop enlarged skin pores; these usually shrink to near normal size once the swelling has subsided.

While infection and scarring are rare with skin-refinishing treatments, they are possible. Some individuals develop excessive scar tissue (keloid or hypertrophic scars); these are usually treated with the application or injection of steroid medications to soften the scar.

You can reduce your risks by choosing a qualified plastic surgeon and closely following his or her advice.

PLANNING YOUR SURGERY

Because these treatments have sometimes been offered by inadequately trained practitioners, it's especially important that you find a doctor (generally a plastic surgeon or a dermatologist) who is trained and experienced in the procedure. After all, dermabrasion and dermaplaning usually involve the most visible part of your body-your face.

In your initial consultation, be open in discussing your expectations with your surgeon, and don't hesitate to ask any questions or express any concerns you may have. Your surgeon should be equally open with you, explaining the factors that could influence the procedure and the results-such as your age, skin condition, and previous plastic surgeries.

The surgeon will discuss your medical history, conduct a routine examination, and photograph your face. He or she should explain the procedure in detail, along with its risks and benefits, the recovery period, and the costs. Insurance usually doesn't cover cosmetic procedures, however, it may cover dermabrasion or dermaplaning when performed to remove precancerous skin growths or extensive scars. Check your policy or call your carrier to be sure.

PREPARING FOR YOUR SURGERY

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and on avoiding aspirin and other medications that affect blood clotting. You may also be given special instructions regarding the care and treatment of your skin prior to surgery. If you smoke, you'll probably be asked to stop for a week or two before and after surgery, since smoking decreases blood circulation in the skin and impedes healing.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a day or two if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Your treatment may be performed in a surgeon's office-based facility, an outpatient surgery center, or a hospital. It's usually done on an outpatient basis, for cost containment and convenience. However, if you're undergoing extensive work, you may be admitted to the hospital.

TYPES OF ANESTHESIA

Dermabrasion and dermaplaning may be performed under local anesthesia, which numbs the area, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort. Sometimes a numbing spray, such a freon, is used along with or instead of local anesthesia. Or, in more severe cases, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.

THE SURGERY

Dermabrasion and dermaplaning can be performed fairly quickly. The procedures usually take from a few minutes to an hour and a half, depending on how large an area of skin is involved. It's not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved.

In dermabrasion, the surgeon scrapes away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, attached to a motorized handle. The scraping continues until the surgeon reaches the safest level that will make the scar or wrinkle less visible.

In dermaplaning, the surgeon uses a hand-held instrument called a dermatome. Resembling an electric razor, the dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects. This skimming continues until the lowest point of the acne scar becomes more even with the surrounding skin.

The surgeon may then treat the skin in a number of ways, including ointment, a wet or waxy dressing, dry treatment, or some combination of these.

AFTER YOUR SURGERY

Right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You'll probably feel some tingling, burning, or aching; any pain you feel can be controlled with medications prescribed by your surgeon. The swelling will begin to subside in a few days to a week.

If you remember the scrapes you got when you fell down as a child, you'll have an idea of what to expect from this type of surgery. A scab or crust will form over the treated area as it begins to heal. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and your surgeon may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no scab will form.

In any case, you surgeon will give you detailed instructions to care for your skin after surgery. For men, this will include delaying shaving for a while, then using an electric razor at first. It's very important that you understand your doctor's instructions and follow them exactly, to ensure the best possible healing.

If you notice the treated area beginning to get worse instead of better-for example, if it becomes increasingly red, raised, and itchy after it has started to heal-it may be a sign that abnormal scars are beginning to form. Call your surgeon as soon as possible, so that treatment can begin early.

GETTING BACK TO NORMAL

Your new skin will be a bit swollen, sensitive, and bright pink for several weeks. During this time, you can begin gradually resuming your normal activities.

You can expect to be back at work in about two weeks. Your surgeon will probably advise your to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of chlorinated water for at least four weeks. It will be at least three to four weeks before you can drink alcohol without experiencing a flush of redness.

Above all, it's important to protect your skin from the sun until the pigment has completely returned to your skin- as long as six to twelve months.

YOUR NEW LOOK

Refinishing treatments can offer dramatic improvements in the surface of your skin, but it will take some time before you see the final results.

The pinkness of your skin will take about three months to fade. In the meantime, you'll probably want to wear non-allergenic makeup when you go out. (For tips on hiding your condition while it heals, ask your surgeon for the ASPS brochure on camouflage cosmetics.) When your new skin is fully repigmented, the color should closely match the surrounding skin, making the procedure virtually undetectable.

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