Scar Revision

Dermabrasion, Punch Removal & Elevation, and Subscision

SCAR REVISION: DERMABRASION
Information Sheet

What is Dermabrasion?
Dermabrasion is a procedure in which the superficial layers of the skin are removed to smooth out scars and texture.   It is useful for improving the appearance of surgical scars, skin grafts, acne scars, and rhinophyma (a condition in which the texture of the nose changes).   In contrast to microdermabrasion, which removes only superficial dead skin cells and has very little downtime, dermabrasion removes multiple layers of skin and has around 1 week of downtime. During this period, the wound resembles a “knee scrape.”

What should I expect during the procedure?
If treating larger areas, the scars will be outlined with ink.   Next, local anesthetic is injected through a small needle.  Most patients tolerate this well; however, if desired, numbing cream can be applied prior to the injections.  Once the skin is numb, dermabrasion is performed by moving the equivalent of sterile sandpaper back and forth until the desired depth is achieved.  You will feel pressure during the procedure though you should not feel any pain.   The duration of the procedure depends on the size of the area treated.  Small surgical scars and grafts take around 15 minutes, while larger areas (such as the cheeks) may take several hours.

What should I expect following the procedure?
Immediately following the procedure, your skin will be raw and oozing.  Healing ointment and bandages will be applied in the office and you will change these twice daily.  By keeping the wounds covered and moist, postoperative pain is significantly reduced and the healing process is expedited.   Ice compresses may be applied on top of the bandages after the numbing wears off.  It is okay to get the areas wet in the shower.   Dermabrasion wounds usually reepithelialize (i.e. are pink and no longer raw) within 7 days, though this varies depending on the depth of the procedure.  Makeup may be applied once reepithelialization occurs.  It is important to keep the areas out of the sun while healing.  Some patients are prone to a condition termed “post inflammatory hyperpigmentation” which can be triggered by small bursts of sun exposure.  If this happens, the pink skin will turn brown.  While this complication is temporary, it can take numerous months to go away.  There are no limitations on activity following dermabrasion, though a bandage will be required for at least 1 week.  It is okay to drive yourself to and from the procedure.  

How many treatments will I need?
Generally, this procedure is performed once.  However, if desired, a second treatment may be performed for further improvement as early as 8 weeks following the first procedure.

How do I prepare for the procedure?
Avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician).  These are blood thinners and will make you bleed more during the procedure.  In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment.   Tylenol is NOT a blood thinner and is OKAY to take.  All products may be resumed 2 days after the procedure if desired.  In addition, we suggest avoiding sun exposure for 4 weeks prior to and after each treatment.   Being tan (for your skin type) increases the risk of side effects.

SCAR REVISION: PUNCH REMOVAL AND ELEVATION
Information Sheet

What is scar punch removal?
An instrument (about the same size as the scar) is used to remove a small plug that contains the pitted scar. This area is then stitched, and the pitted scar is replaced by a line scar. This technique is most commonly used on the face where the skin heals quickly and sutures are less likely to leave a long term mark (than on a site such as the trunk).

What is scar punch elevation?
Scar punch elevation is a method of elevating the base of the pitted scar.   It is a minor surgical procedure in which the area is numbed, and then an instrument (the same size as the scar) is used to free the scar from its underlying tissue.  The base of the scar floats to the surface, which then heals in its new elevated position.  Small adhesive strips (i.e. steri strips) are placed over the areas to help them remain in their new position.  Punch elevation is particularly useful in areas such as the trunk.

What should I expect with the procedure?
The scars will be numbed using a local anesthetic which is injected through a tiny needle.  Once the skin is numb, you will feel pressure during the procedure though you should not feel any pain.  The duration of the procedure depends on the number of scars being treated, though most treatments last 15-30 minutes.  With both procedures, bandages should be worn for 1 week.  With acne scar punch removal, a stitch is placed and removed in 1 week.  There are no limitations on showering with either procedure, though exercise should be avoided for 1 week.   

How many treatments will I need?
Generally, this procedure is performed once for each pitted scar.   It will take around 6-8 weeks to see the full benefit.  While this procedure may improve the scar, it will not be completely gone.  Other treatments such (such as fractional resurfacing and/or subcision) may complement this procedure and provide additional improvement if desired.

How do I prepare for the procedure?
To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician).  In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment.   Tylenol is NOT a blood thinner and is OKAY to take.  All products may be resumed the day after the procedure if desired.

SCAR REVISION: SUBCISION
Information Sheet

What is scar subcision?
Scar subcision is a method for improving the appearance of depressed scars, such as acne scars.  It entails placing a needle underneath the scar to release any fibrous attachments that tether the scar downward.   Scar subcision is used primarily for “rolling” scars which have sloping edges.  It is not helpful for treating ice pick scars which have sharp edges and a pitted appearance. Because scars cannot be completely eliminated, the goal of this procedure is improvement.

What should I expect with the procedure?
Prior to numbing, the scars will be outlined with ink.   Next, local anesthetic is injected through a small needle.  Most patients tolerate this fine though, if desired, numbing cream can be applied to your skin prior to the injections.   Once the skin is numb, subcision is performed by inserting a slightly larger needle underneath the scars and moving it back and forth like a wind shield wiper in a horizontal plane.  You may feel pressure during this procedure though you should not feel any pain.   The duration of the procedure depends on the number of scars being treated, though most treatments last 30-60 minutes.  

How many treatments will I need?
Generally, this procedure is performed once.  Depressed scars often benefit from multiple types of procedures (such as laser therapies).  While it is impossible to eliminate your scars, we will make every effort to improve your scars with the fewest number of procedures possible.   

How do I prepare for the procedure?
To minimize the risk of bruising, avoid aspirin and nonsteroidal anti-inflammatory medications (such as ibuprofen and naproxen) for 2 weeks before treatment (unless you were placed on these medications by a physician).  In addition, vitamins C, E, garlic, St John’s wort, ginseng, and/or gingko biloba are also blood thinners and should be stopped 1 week before treatment.   Tylenol is NOT a blood thinner and is OKAY to take.  All products may be resumed the day after the procedure if desired.

What should I expect following the procedure?
Bruising, swelling, and tenderness are the most common side effects.   Bruising and swelling may last for several weeks.  The needles used for subcision create small puncture wounds that may take up to a week to heal.  You may apply makeup the day following the procedure though the puncture wounds should be avoided until healed.  The areas treated will be tender for 1-2 weeks following the procedure.  Ice compresses are helpful in minimizing bruising and reduce swelling.  There are no limitations on activity, and it is okay to drive yourself to and from the procedure.