Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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On the day of surgery, the chosen anesthesia protocol is initiated. If local anesthesia is used, nerve blocks are administered to numb the entire facial region. For sedation or general anesthesia, the anesthesiology team manages the patient’s comfort and vital signs.
For many dermabrasion procedures, a “chilling” spray (cryoanesthesia) such as Freon or ethyl chloride is applied immediately before the procedure. This temporarily freezes the skin, making it rigid. This rigidity allows for a more even abrasion and prevents the skin from distorting under the torque of the handpiece.
The surgeon selects the appropriate burr for the specific skin type and defect. A wire brush is often favored for deep scarring and thick skin as it cuts aggressively and encourages collagen remodeling. A diamond fraise, which comes in various grits (coarse to fine), acts more like sandpaper and is used for finer detail work or thinner skin.
The motorized handpiece rotates at high speeds (up to 30,000 RPM). The surgeon controls the speed via a foot pedal. The selection of the tip and the speed are critical variables that the surgeon adjusts in real time based on the tissue response.
The surgeon holds the skin under tension to create a flat, taut surface. The handpiece is moved across the skin in smooth, consistent strokes. The direction of the strokes is varied to prevent grooving and to ensure a uniform removal of the epidermis and upper dermis.
The surgeon constantly wipes away blood and debris to visualize the depth. They look for the bleeding patterns that indicate the level of the dermis reached. Feathering is performed at the edges of the treated area to blend the abraded skin seamlessly with the untreated skin, preventing a sharp line of demarcation.
Bleeding is an inherent part of dermabrasion as it involves removing vascularized tissue. The cryoanesthesia helps limit initial bleeding. Once the abrasion is complete, the surgeon applies compresses soaked in saline or epinephrine solution to control capillary oozing.
Thorough hemostasis is essential before applying dressings. However, unlike surgical incisions, there are no vessels to tie off. The bleeding stops as the clotting cascade is activated across the raw surface.
There are two main approaches to postoperative care: open and closed. In the closed technique, the wound is covered with a non-adherent dressing, biosynthetic skin substitute, or petrolatum gauze. This creates a moist environment that speeds up re-epithelialization and reduces pain.
In the open technique, a thick layer of ointment is applied, and the wound is left exposed to the air. A crust eventually forms, acting as a natural biological dressing. The choice depends on the surgeon’s preference and the area treated.
The first day after surgery is characterized by oozing and mild to moderate discomfort. The face will feel hot and throb, as if from a severe scrape. Patients are instructed to keep their heads elevated to reduce swelling.
Pain is generally managed with prescribed oral analgesics. The dressings may become saturated with serous fluid, which is normal. Patients must avoid touching their faces to prevent infection. If an open technique is used, frequent reapplication of the ointment is necessary to prevent drying.
Swelling typically peaks around 48 to 72 hours. The face may become quite puffy, and the eyes may swell shut if the upper cheeks are treated. The skin will appear intensely red, resembling a raw burn.
This inflammatory phase is a necessary part of the healing process. Patients continue taking antiviral medication. During this time, the old skin layers and any crusts begin to separate as new cells underneath start to proliferate.
Strict hygiene is critical. Patients are often instructed to perform vinegar soaks (diluted white vinegar and water) several times a day. These soaks are antimicrobial and help gently dissolve crusts and debris without scrubbing.
After soaking, the skin is gently patted dry, and a fresh layer of ointment is applied. This cycle of wash and lubricate is repeated multiple times daily to prevent heavy scab formation, which can impede smooth healing and lead to scarring.
Re-epithelialization, the regrowth of the outer skin layer, typically occurs within 7 to 10 days. The skin regenerates from the hair follicles and sweat glands that were preserved deep in the dermis.
As the new skin covers the raw surface, the weeping stops, and the pain subsides significantly. The skin transitions from a raw wound to a dry, tender, pink surface. At this point, the intense soaking regimen can usually be tapered down.
As the skin heals, intense itching (pruritus) is a common symptom. This is a sign of nerve regeneration and healing, but it can be distressing. Patients must be warned in no uncertain terms not to scratch, as this can cause scarring and infection.
Oral antihistamines are often prescribed to manage the itch. The new skin is also susceptible to temperature and products. Mild, non-irritating cleansers and moisturizers are introduced only after the skin is entirely reepithelialized.
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A full-face dermabrasion typically takes 60 to 90 minutes, depending on the depth and complexity. Treating smaller areas, such as the upper lip, may take only 15 to 20 minutes.
It feels like a bad sunburn or a “road rash.” There is a burning, throbbing sensation. The skin will weep clear fluid for a few days. It is uncomfortable but usually manageable with medication.
You will perform specific soaks rather than traditional washing for the first week. You should not let the shower water hit your face directly. Once the skin has healed over (after 7-10 days), you can gently wash with a mild cleanser.
Most patients need 10 to 14 days off work. By two weeks, the raw skin has healed, and the intense redness has faded to a pink color that can be covered with corrective makeup.
The goal of modern moist wound care is to minimize the formation of hard scabs. However, some soft crusting is normal. You should never pick at these crusts; let them fall off naturally during your cleansing soaks.
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