Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation begins with a thorough physical examination of the skin. The surgeon evaluates the skin’s texture, thickness, and oiliness. Palpation helps determine the depth of scars and the boundaries of structural irregularities. The surgeon also identifies active skin conditions that would contraindicate surgery, such as active acne, eczema, or rosacea flares.
During this phase, the surgeon maps out the aesthetic units of the face. Dermabrasion is often performed on an aesthetic unit (e.g., the entire upper lip or the entire cheek) rather than spot-treating to avoid visible lines of demarcation between treated and untreated skin.
Determining the patient’s Fitzpatrick skin type is a critical safety step. This scale classifies skin based on its reaction to sun exposure and melanin content. Types I and II (very fair) are generally the best candidates with the lowest risk of pigmentation issues.
Types III through VI have progressively higher risks of post-inflammatory hyperpigmentation (darkening) or hypopigmentation (permanent lightening). The surgeon uses this classification to discuss realistic risks and determine if pre-treatment with bleaching creams is necessary or if the procedure should be avoided entirely.
A comprehensive review of the patient’s medical history focuses on factors that affect wound healing. The surgeon asks explicitly about a history of keloid scarring, connective tissue disorders, and immune system status. A history of cold sores (Herpes Simplex) is vital information, as prophylaxis is required.
Previous surgeries and facial treatments are noted. Specifically, prior use of isotretinoin (Accutane) is a significant concern. Recent use of isotretinoin can impair wound healing and lead to atypical scarring. Most surgeons require a washout period of 6 to 12 months post Accutane before performing dermabrasion.
The trauma of dermabrasion can trigger a reactivation of the herpes simplex virus, even in patients who do not recall having a cold sore. A herpetic outbreak on a raw, resurfaced face can lead to severe scarring and systemic illness.
Therefore, standard protocol involves prescribing antiviral medication (such as valacyclovir or acyclovir) to begin a few days before surgery and continue until re-epithelialization is complete. This prophylactic measure is non-negotiable for patient safety.
To optimize the skin’s ability to heal, patients may be placed on a preoperative skincare regimen. This typically involves using a topical retinoid (Tretinoin) for several weeks. Retinoids accelerate cell turnover and thicken the epidermis, priming the skin for rapid regeneration.
For patients with darker skin tones, hydroquinone or other pigment inhibitors may be prescribed to suppress melanocyte activity. This helps reduce the risk of post-inflammatory hyperpigmentation immediately following the procedure.
The consultation is the time to align patient expectations with surgical reality. The surgeon explains that dermabrasion provides improvement, not perfection. It is emphasized that while scars can be significantly smoothed, they may not be completely erased.
The recovery process is described in detail, including the appearance of the raw skin and the duration of redness. Visual aids or photos of the healing process are often shown to help the patient mentally prepare for the immediate postoperative appearance, which can be distressing to the unprepared.
The choice of anesthesia is discussed and decided upon. For small areas, such as the upper lip, local anesthesia injections may suffice. For full face dermabrasion or treatment of large scars, intravenous sedation (twilight sleep) or general anesthesia is typically recommended.
The surgeon explains the pros and cons of each option, taking into account the patient’s anxiety level, the duration of the procedure, and the depth of resurfacing required. Safety and patient comfort are the guiding principles for this decision.
Undergoing facial resurfacing requires psychological resilience. The recovery involves a period of social downtime during which the face appears wounded. The surgeon assesses the patient’s support system and ability to cope with this isolation.
Patients with body dysmorphic disorder (BDD) or unrealistic expectations are screened out. The surgeon ensures the patient is motivated by personal goals and understands the timeline for the final result, which can take months to mature fully.
Dermabrasion for cosmetic reasons is not covered by insurance. The consultation provides a transparent breakdown of costs, including surgeon fees, anesthesia, and facility fees. Financing options may be discussed.
Logistical planning includes arranging a ride home after surgery and ensuring the patient has sufficient time off work. The patient is advised on the supplies they will need for home care, such as specific cleansers, ointments, and gauze, so that they can acquire them beforehand.
A final preoperative visit is typically scheduled shortly before the surgery date, and at this appointment, standardized “before” photographs are taken. These photos are crucial for documenting the skin’s baseline condition.
Consent forms are signed after a final review of the risks and benefits. The patient receives specific instructions on fasting (if sedation is used), morning-of-surgery skin-cleansing protocols, and medication schedules.
While dermabrasion treats scars, it also carries a risk of causing new scars if complications arise. The surgeon evaluates the risk of hypertrophic scarring, particularly in areas like the jawline or neck.
The depth of the procedure is planned to avoid the deep reticular dermis in high-risk zones. The patient is informed about the signs of abnormal scarring so that early intervention (such as steroid injections) can be implemented during recovery if necessary.
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Yes. Smoking constricts blood vessels and significantly delays healing. It increases the risk of skin death and infection. You must stop smoking for at least 2 weeks before and after the surgery to ensure safe healing.
No. You should arrive with your face completely clean. Makeup, lotions, and creams increase the risk of infection and can interfere with the procedure. Your face will be thoroughly scrubbed with an antiseptic before the surgery begins.
Most surgeons require you to be off Isotretinoin (Accutane) for 6 to 12 months before dermabrasion. Accutane affects the sebaceous glands, which are critical for skin regeneration. Operating too soon carries a high risk of severe scarring.
Yes. If you receive any form of sedation or general anesthesia, you cannot drive yourself home. Even with local anesthesia, your eyes might be swollen or covered with ointment, impairing your vision and safety.
You will typically need white vinegar (for soaks), plenty of gauze, a prescribed ointment (like Aquaphor or an antibiotic ointment), and mild, non-detergent cleansers. Your surgeon will provide a specific list.
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