Scarring of the face is most commonly caused by acne, although chickenpox and other infections, trauma or surgery occasionally result in disfiguring marks. Acne can produce pitted scars varying in size and shape from narrow to wide, shallow to deep, depressed or thickened. Dermabrasion has been used for many years to remove superficial scars and improve deeper scars by softening their edges and thus reducing their obvious appearance. Pitted or ice-pick-like, bound-down scars may not be improved significantly by dermabrasion. Full-thickness skin grafts, using the punch graft technique, now represents the best way to treat pitted scars of the face. This technique is commonly done before a dermabrasion to obtain the best results.

Dermabrasion: Indications
Dermabrasion is a surgical procedure done for the improvement of scars of various causes, i.e. as the result of acne, trauma or surgical procedure, skin discoloration, changes due to sun damage, and rhinophyma (adult bulbous nose).

Dermabrasion: The Procedure
The procedure, simply defined, is the surgical removal of superficial layers of skin. This usually is accomplished with using a diamond fraise or wire brush that is attached to the end of a drill-like apparatus This apparatus, by virtue of its rotary movements, is used as a sander to smooth out the rough edges of the surface of the skin. In order to reduce discomfort during the procedure, a local anesthetic is injected into the skin in the areas to be treated. This will cause numbing of the surface of the skin. The procedure, performed on an outpatient basis, usually requires 30 minutes to one hour to complete, depending on various factors, including the extent and severity of the problem to be treated.

Appearance and Care After Dermabrasion
At the end of a dermabrasion, the face becomes swollen. The areas dermabraded will be covered with bandages and there will be some oozing from these areas. Between 8 to 14 days, the deep redness of the skin begins to lighten and the new skin toughens and thickens. It is imperative that exposure to direct sunlight be avoided for at least 3 months after the dermabrasion to avoid variations in pigmentation in the newly healed skin.

What Type of Improvement Can One Expect?
The degree of improvement varies considerably from patient to patient, and it is very difficult to predict to what extent the scars will be improved. One can expect anywhere from 20% to 80% improvement, but no guarantees can be given. The final results are best appreciated only after 3-6 months after the dermabrasion. It is important to remember that not all scarring can be removed by dermabrasion and that some scarring will remain after the procedure, even after multiple dermabrasions.

Complications or Undesired Results
Complications are similar to those seen in laser resurfacing, including, increased or decreased pigmentation, excessive scarring, infection and cysts. However, proper after surgery care usually can avoid these complications.

Punch Grafting for the Treatment of Deep Ice-Pick Type Scars
For larger, deeper scars caused by acne, chicken pox, and other disorders, the technique of full thickness punch skin grafting can be used in combination to dermabrasion. The scars are first anesthetized with a local anesthetic. The scars are then removed with a punch instrument. Skin is then removed from the donor site (usually from behind the ear), and then placed into the excised scar openings and taped or glued into place. After approximately two months, dermabrasion or another skin leveling procedure (e.g., laser resurfacing) can be done. The grafts occasionally can be seen immediately after the dermabrasion or other resurfacing procedure, but as the skin heals, the grafts generally become less apparent.