What is Dermabrasion?

Dermabrasion is a cosmetic procedure designed to improve the appearance of the skin by using abrasive instruments, such as a rotating wire brush, diamond fraise, or sterile sandpaper, to remove the outer layers. This controlled removal of the epidermis and part of the dermis induces wound healing, leading to smoother skin texture and a reduction in scars, wrinkles, lentigines (Sunspots), rhinophyma, and actinic keratoses.
Surgeons also use dermabrasion for scar refinement following Mohs surgery or excision, typically six to ten weeks post-procedure. However, the technique is generally considered safe only when limited to the superficial or mid-reticular dermis. Deeper penetration increases the risk of complications, including scarring, depigmentation, and infection.¹
The origin of this technique dates back to 1905. But, in 1953, Kurtin introduced modern dermabrasion. Later on, several other techniques were also invented, but dermabrasion remains a time-tested and effective technique for improving the skin.²

Indications of Dermabrasion

At first, dermabrasion was used to treat acne scars, but now it can also reduce fine lines and wrinkles and reverse sun damage. It can also improve pigmentary abnormalities, Darier’s disease, and adnexal tumors. Nowadays, this technique is being used to remove tattoos.³ Common indications include:

Scarring and Skin Texture Improvement

Deep acne scars
Traumatic and surgical scars
Extensive actinic damage
Heavy rhytides (wrinkles)
Photoaged skin

Pigmentary and Dermatological Conditions

Lentigines
Seborrheic keratosis
Darier’s disease
Adnexal tumors

Benign Cutaneous Lesions

Dermabrasion is effective for the superficial removal of:

Epidermal nevi
Syringomas
Trichoepitheliomas (Benign hair follicle tumors)
Angiofibromas
Molluscum (viral skin infection)
Milia
Cysts

Other Applications

Pseudofolliculitis barbae (ingrown hairs from shaving)
Rhinophyma (thickened nose skin)
Cystic acne vulgaris

While dermabrasion was historically used for tattoo removal, it has largely been replaced by laser treatments, which offer greater precision and fewer complications.⁴⁵

Suitable Candidates for Dermabrasion

Patient selection is a key to obtaining maximum benefits from the treatment. At the initial consultation, the surgeons take history thoroughly and perform a physical exam.⁶

Patients may be asked about:

Alcohol, drug, or tobacco use
Any known drug allergies
Current medications
Use of vitamins or supplements
Previous medical treatments

Dermabrasion is suitable for individuals of all ages, though older adults may experience slower healing. Skin type is also a factor—individuals with darker skin tones, including Black, Asian, or those with naturally deeper pigmentation, should be aware that dermabrasion may cause changes in skin color.
Candidates should have realistic expectations regarding the outcome. Those who are immunocompromised or prone to hypertrophic scarring and hypopigmentation may not achieve the desired results.⁷
Dermatologists should also discuss potential risks. Patients with conditions such as skin sensitivities, allergic reactions, active acne, cold sores, fever blisters, or significant burns may be at higher risk for complications.

Who Should Avoid Dermabrasion?

While dermabrasion is effective for many, it is not suitable for everyone.

Active Acne: Undergoing dermabrasion with active acne increases the risk of post-procedure infections.
Recent Isotretinoin Use: Patients who have taken isotretinoin (commonly used for severe acne) within the past six months are not good candidates. Isotretinoin can lead to delayed wound healing and an increased risk of keloid or hypertrophic scar formation. Surgeons typically advise stopping isotretinoin for about a year before considering dermabrasion.⁸
Herpes Simplex Virus (HSV): Individuals with active HSV infections should not undergo dermabrasion. Those with a history of HSV should take antiviral medications, such as valacyclovir or acyclovir, starting two days before and continuing for two weeks after the procedure. Antiviral prophylaxis is recommended to prevent outbreaks, and any prior infection should be dormant for at least six to eight weeks before treatment.
Fitzpatrick Skin Type III or Higher: People with medium to dark skin tones are at a greater risk of developing hyperpigmentation or hypopigmentation after dermabrasion. To reduce the likelihood of dyspigmentation, dermatologists often recommend a four-week pre-treatment regimen with 4% hydroquinone.⁹

Equipment used for Dermabrasion

The dermabrasion machine is actually a portable hand-held dermabrader. It possesses a wire brush or a diamond fraise and serrated wheel. Elective or pneumatic motors power the dermabraders. The machine is attached to a unit that controls the rotational speed of the endpiece. The required rotation for dermabrasion is 12,000 to 15,000 revolutions per minute (RPM). However, the device is capable of rotations from 10,000 to 85,000 RPM.¹⁰
Mostly the machines can rotate the fraise or brush into both clockwise and anti-clockwise directions. The device becomes more powerful with the faster rate of spin. The faster spin rate decreases the need for pressure. But on the other hand, it can increase the risk of accidental thermal injury and depth penetration. Thus, the speed and pressure of the device are the key factors in achieving a successful dermabrasion.¹¹

Roles of Different Parts of the Machine:

The design of the rotary wire brush and diamond fraise are specific for their specific functions.

Rotary Wire Brush:

The tips of these brushes consist of 2 to 3 mm wires. These wires protrude from a central cylinder. They come in different shapes, sizes, and coarseness. The wire brush can penetrate the skin with mild pressure. The recommended revolution speed of the brush is more than 25000 RPM. This part of the device induces injury in the skin by producing microlacerations.¹²

Diamond Fraises:

Diamond fraises are diamond chip-studded tips. The fraises abrade the skin through frictional injury, and the diamond projections are tiny enough to minimize the deep penetration. They are easier to control than wire brushes. They are more suitable for trainee surgeons.¹³ They come in various shapes, like pears, wheels, cylinders, cones and bullets. The grift is also variable.

Finer fraise
These fraises are suitable for dermabrasion of delicate skin in small areas and to improve superficial scars.
Corser Fraises
These fraises are suitable for skin with deep scars and also for the dermabrasion of the full face.¹⁴

Preparations Before the Procedure

If you have booked an appointment for dermabrasion, there are some pre-procedure self-care routines. Your healthcare provider will give specific instructions, including the following:

Photoprotection

The provider advises a strict photoprotection from about two months before the procedure. It will minimize the risk of dyspigmentation after the procedure.

Quit smoking

Smoking can decrease the blood flow and can slow the process of healing. The provider will ask you to quit smoking for at least two weeks leading to your procedure and after the procedure.

Quit Certain Drugs

Certain medications should be discontinued before dermabrasion. Blood thinners such as aspirin, warfarin, and NSAIDs should be avoided at least 10-14 days before the procedure unless otherwise instructed by a doctor. Additionally, medications that may affect pigmentation, such as hormone therapy, should be discussed with the provider.

Pre-Treatment with Hydroquinone and Retinoids

Patients, especially those with darker skin tones, may be advised to apply a 4% hydroquinone cream for four weeks before the procedure to prevent post-inflammatory hyperpigmentation. A topical retinoid (such as tretinoin) is also recommended for at least one month before dermabrasion to accelerate healing and collagen production.¹⁵

Patient Preparations on the Day of the Procedure

The provider will ask you to wear a gown before entering the operating room. All medical personnel present will wear protective gear, including surgical gowns, gloves, face shields, and facemasks, to minimize exposure to aerosolized particles and blood. They will clean your skin with an antiseptic to decrease the chances of infection.
To maximize the patient’s comfort during the procedure, the provider will use a numbing spray, an anesthetic injection, and a topical anesthetic gel.
In the case of regional dermabrasion, they facilitate the patients with nerve block or localized anesthesia injections.
For full-face dermabrasion, they use general anesthesia, intravenous sedation, or tumescent anesthesia.¹⁶

Procedure

The procedure of the dermabrasion is as follows:

The provider will mark the skin that requires treatment.
The surgeon will choose the dermabrasion tip according to the required treatment and will fix it on the handpiece.
A cooling spray is applied to the skin to minimize discomfort and prevent thermal injury.
The skin is manually stretched to maintain tightness.
Then, the surgeon will move a high-speed rotary device with a wire brush or diamond wheel with gentle and uniform pressure on your skin.
In the case of brushes, the surgeon will move the device unidirectionally on your face, while with diamond fraise tips, he will move the device only back and forth direction.¹⁷
While proceeding to the abrasion of a new skin area, the surgeon usually halts the device and readjusts the tension to a new area.¹⁸
The procedure will scrap away the outer layers of your skin and reveal the underlying fresh layers.

Precautions During the Treatment:

There are numerous techniques, so the surgeons have to wisely choose the best one according to the patient and the area of the treatment.
Proper control over the pressure of the device is crucial. It can prevent adverse outcomes during the surgery.
The surgeons must hold the device like a spatula or a pencil.
A clear demarcation is a must in between the untreated and treated skin.
The surgeons have to put extra care in the areas of loose skin such as lips, eyelids, and nasal ala.¹⁹
It is wise to avoid any cloth or gauze in the field. They can become easily wrapped around the circulating machine and can cause injury to both the treatment team and the patient.²⁰

Post-Operative Care

The time after the surgery is the re-epithelization period. During this period, the patients can have closed or open dressing systems.

The providers usually recommend the use of hydrocolloid dressing. This dressing should be changed daily for about five to seven days. The hydrocolloid dressing can promote a faster re-epithelialization and wound healing process. These dressings, such as the Vigilon, can also reduce the post-surgery pain associated with the dermabrasion.
Many dermatologists report that moist and hydrated wounds heal faster than dry wounds. The provider will recommend you apply petroleum-based or non-petroleum-based ointments and hydrating creams on your face.
To avoid infection, cleaning and reapplication of the ointment is a must for two to four times a day.
The dermatologist can also recommend the use of antiviral antibacterial and systemic corticosteroids.
If pain persists, you can use acetaminophen with codeine.
Residual erythema is common for about four weeks.
Photoprotection in the first postoperative month is essential.
You can avoid adverse events with proper pre- and post-operative care and recommended medications.²¹

Recovery Period of Dermabrasion

The recovery period varies. After this procedure, the patients can return to their work after about two weeks, as it can take at least two weeks for the skin to heal. Avoid sun until the skin pigment has completely returned (it can take six to 12 months). Avoid activities that can cause a hit or bump on the face for at least two weeks, as any injury can delay your healing process.

Benefits of Dermabrasion

There are several benefits of the dermabrasion. These include:

The first and most important benefit of dermabrasion is that it promotes new and healthier skin layers by removing damaged skin cells.
It stands out for its effectiveness in removing fine lines from the skin (especially around the mouth and eyes) and offers a more youthful look.
It improves the skin tone and skin texture.
It treats uneven pigmentation and rough patches of the skin.
Effective at reducing deep acne scars.
This resurfacing technique induces collagen remodeling and formation.
It improves the histological and clinical appearance and skin integrity.²²

Complications or Side Effects of Dermabrasion

Adverse effects are rare when skilled surgeons perform dermabrasion. The common complications include:

Hypermic, streaked, or blotchy skin (if pressure is not constant)
Milia
Hyperpigmentation
Scarring
Infections
Eczema
Atrophy
Dermatitis
Postinflammatory hypopigmentation
Persistent Erythema
Post-inflammatory hyperpigmentation
Keloids²³

Dermabrasion versus Microdermabrasion

Dermabrasion and microdermabrasion are both skin-resurfacing treatments. Both treatments aim to achieve smoother and more youthful skin. They sound similar, but they are different in terms of their outcomes and risks.

Dermabrasion	Microdermabrasion
It is a surgical method of removing the uppermost layers of the skin	It removes the upper layers of dead skin through controlled exfoliation.
Surgeons use hand-held devices to peel away the layer of the skin.	The specialist uses a hand-held device to provide gentle abrasion to the skin.
It is an invasive procedure.	Microdermabrasion is a non-invasive procedure.
Dermabrasion requires the use of general or local anesthesia.	Microdermabrasion typically does not require anesthesia.
Dermabrasion can be more painful as it is an intensive procedure.	It is less painful.
The recovery period of this procedure is fairly long.	Microdermabrasion requires minimal recovery time.
Dermabrasion is greater in benefits as it can deal with severe skin issues.	It only targets dead skin cells.
Dramatic improvement after treatment.	Subtle improvement after treatment.
Patients are at higher risk of side effects like scarring and permanent changes in skin color.	The complications are mild, such as temporarily red or swollen skin.

Laser Dermabrasion

Laser dermabrasion, also known as lasabrasion, laser vaporization, and laser peel, is a newer technology used to reduce scars and facial wrinkles. It uses focused light energy to vaporize the upper layers of the skin. Plastic surgeons use different types of lasers such as CO2 and Erbidoum. The selection of the laser type depends on the area and depth of the treatment. The recovery time is usually shorter than traditional dermabrasion. Negative effects are mild to moderate.

Final Remarks

Dermabrasion is a useful skin resurfacing technique. Dermabrasion mechanically reshapes the skin at the dermis level, promoting collagen remodeling for smoother, healthier, and younger-looking skin. It requires skilled surgeons for optimal results and is ideal for treating severe skin conditions.

Refrences

1
Bedford L, Daveluy S. Skin Resurfacing Dermabrasion. StatPearls [Internet]: StatPearls Publishing; 2023.
2
Hruza GJ. Dermabrasion. Facial Plastic Surgery Clinics of North America. 2001;9(2):267-81.
3
Behshad R. Dermabrasion. Evidence-Based Procedural Dermatology. 2019:325-51.
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Behshad R. Dermabrasion. Evidence-Based Procedural Dermatology. 2019:325-51.
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Harmon CB. Dermabrasion. Dermatologic clinics. 2001;19(3):439-42.
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Behshad R. Dermabrasion. Evidence-Based Procedural Dermatology. 2019:325-51.
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Paul MD, Hovsepian RV, Rotunda AM. Cosmetic Medicine and Minimally Invasive Surgery: Saunders; 2011.
8
Gold MH. Dermabrasion in dermatology. American journal of clinical dermatology. 2003;4:467-71.
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AlKhawam L, Alam M. Dermabrasion and microdermabrasion. Facial Plastic Surgery. 2009;25(05):301-10.
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Bedford L, Daveluy S. Skin Resurfacing Dermabrasion. StatPearls [Internet]: StatPearls Publishing; 2023.
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Smith JE. Dermabrasion. Facial Plastic Surgery. 2014;30(01):035-9.
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Nelson BR, Metz RD, Majmudar G, Hamilton TA, Gillard MO, Railan D, et al. A comparison of wire brush and diamond fraise-superficial dermabrasion for photoaged skin: A clinical, immunohistologic, and biochemical study. Journal of the American Academy of Dermatology. 1996;34(2):235-43.
13
Smith JE. Dermabrasion. Facial Plastic Surgery. 2014;30(01):035-9.
14
Gold MH. Dermabrasion in dermatology. American journal of clinical dermatology. 2003;4:467-71.
15
Surowitz JB, Shockley WW. Enhancement of facial scars with dermabrasion. Facial plastic surgery clinics of North America. 2011;19(3):517.
16
Bedford L, Daveluy S. Skin Resurfacing Dermabrasion. StatPearls [Internet]: StatPearls Publishing; 2023.
17
Gold MH. Dermabrasion in dermatology. American journal of clinical dermatology. 2003;4:467-71.
18
Smith JE. Dermabrasion. Facial Plastic Surgery. 2014;30(01):035-9.
19
Surowitz JB, Shockley WW. Enhancement of facial scars with dermabrasion. Facial plastic surgery clinics of North America. 2011;19(3):517.
20
Smith JE. Dermabrasion. Facial Plastic Surgery. 2014;30(01):035-9.
21
Gold MH. Dermabrasion in dermatology. American journal of clinical dermatology. 2003;4:467-71.
22
Bedford L, Daveluy S. Skin Resurfacing Dermabrasion. StatPearls [Internet]: StatPearls Publishing; 2023.
23
Gold MH. Dermabrasion in dermatology. American journal of clinical dermatology. 2003;4:467-71.

Dermabrasion: Revitalize Your Skin for a Smoother Look

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