Last Updated on July 31st, 2019
Dermabrasion is a process of wearing away the outermost layers of scarred or blemished skin so they can be replaced by new, smooth skin without blemishes. Dermabrasion used to be a scary procedure accomplished with rotating metal brushes designed to make the skin bleed. Nowadays microdermabrasion is a procedure you can do at home with minimal to zero risk of pain or bleeding. Different dermabrasion techniques, however, cost more or less and get faster or slower results in restoring acne-prone skin.
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The first dermatologist to use controlled, intentional dermabrasion of the skin was a German doctor named Ernst Kromayer, who reported his results in a medical journal in 1905. Dr. Kromayer used a system of rotating brushes and rasps to grind away the top-most layers of the skin over acne scars, brown spots, and thickened skin. Because he published his findings in German, doctors in the English-speaking world did not begin to use dermabrasion until the 1950’s, when it became very popular for treating acne scars1.
Understanding the way dermabrasion works requires a knowledge of the differences between the epidermis and the dermis of the skin. The epidermis is the outermost layer of the skin. It has no blood vessels. It depends on the dermis beneath for nutrients, oxygen, and waste disposal, all of which are accomplished through the dermo-epidermal junction.
The dermis is also responsible for the growth of the epidermis2. It reaches into the dermis with “epidermal appendages” filled with cells that can grow into new dermis if the skin is injured. Some of these epidermal appendages do double duty as skin pores, sweat glands, and hair follicles, providing a path for waste products to exit the skin. Other epidermal appendages lurk deep in the fat beneath skin, only activated when there is a major trauma to the skin above them.
Peeling off the epidermis activates epidermal appendages deep in the skin. They provide extra skin growth that replace skin marked by scars or excessive pigmentation that may be years or even decades old. Just 24 hours after the skin above these low-lying epidermal appendages is stripped away, they start producing new skin with the same organization and smoothness as youthful skin, without scars or spots.
The secret to successful dermabrasion is to remove the epidermis of the skin without injuring the dermis of the skin, since the dermis contains the cells that make quick regeneration of the skin. For most of the twentieth century, doctors and aestheticians operated high-speed brushes to tear away skin just until it began to bleed. Going deeper would only create a new and even worse scar.
But why in this age of chemical peels and laser resurfacing would anyone get old-fashioned dermabrasion for acne? After all, lasers are much more precise, and peels don’t go as deep into the skin. What could possibly be the reason for doing dermabrasion3?
In in the twenty-first century, there are certain people who get a better result from dermabrasion than from any other technique. Generally speaking, surgery is best for tiny areas of deep skin tissue. Peels are best for treating large areas of damaged skin. Dermabrasion is best for focused treatment skin. It is useful for pitted acne scars that cast a shadow on the skin, as well as for tattoos, age spots caused by sun damage, brown spots caused by acne, damage to the nose by rhinophyma (a subtype of rosacea), chicken pox scars, and acne scars around the mouth.
Dermabrasion is better when there is a problem with not enough pigment in the skin. It is more useful for fair skin, and for treating skin when there is a risk of vitiligo. Dermabrasion has an advantage over laser resurfacing in that dermabrasion does not leave a clear line between treated and untreated skin, as laser resurfacing often does.
Some people should not have dermabrasion4. Most dermatologists will not use dermabrasion to treat blemishes on dark brown or black skin. There is too much risk of permanent discoloration of the skin. And most dermatologists will not do dermabrasion on skin of people who have Sjögren’s disease because the results of the procedure are too unpredictable.
Most doctors will ask their patients to use tretinoin topical or Renova (products that are forms of Retin-A) for about two weeks before having dermabrasion. These products cause the skin to grow faster, and are thought to speed healing from dermabrasion. The day of the procedure, it is important not to have any soap, moisturizers, or cosmetics on the skin that could be transferred to deep layers of the skin and cause inflammation.
Dermabrasion is performed under local anesthetic. The surgeon uses a handheld device rotating at 200 to 250 revolutions per second to rub a sandpaper-like bur, wire brush, or diamond fraise over the skin. The device usually has a foot pedal the doctor uses to control its speed and to keep it from cutting too deep into the skin. The doctor will either hold the skin taut with one hand or apply a freezing spray to the skin—but the use of freezing spray requires a lighter touch with dermabrasion to prevent grooving of the skin. Dermabrasion around the eyes or on the nose may be done with a manual device that is much slower but much less likely to cause excessive bleeding.
Done correctly, dermabrasion begins to produce results in 24 hours, although the skin may take up to two weeks to heal6 It is absolutely essential to apply healing ointments exactly as directed by the doctor, and not to use any sunscreen or cosmetics until the doctor has given the OK. Don’t pick at any scabs. While you are not using sunscreen, stay indoors to avoid damage to unprotected skin.
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