Chemical peeling and mechanical peeling (dermabrasion) allow the controlled removal of skin layers and thus the correction of contour irregularities. With the experience and trials gained over time, it has been understood which treatment method will be effective in which cases, and today the two methods are used interchangeably.

DERMABRAZYON

Dermabrasion is a procedure based on the principle of peeling the epidermis and superficial dermis layers of the skin in order to correct contour irregularities. It is also useful in eliminating superficial skin darkness. It is often used in the treatment of facial wrinkles, acne scars, traumatic scars, chickenpox and smallpox scars, superficial lentigo and dermal tattoos.

The Healing Process

The success of dermabrasion depends on the skin's ability to form a new epidermal layer from the deep dermal skin appendages. Therefore, healing is better in areas with more hair and sweat glands and thicker skin. Conversely, areas with thin skin or poor sebaceous glands and hair follicles, such as the eyelids, lower anterior neck, and inner arms, experience delayed healing and may develop hypertrophic scars after dermabrasion. The face, with the exception of the eyelids, is a thick-skinned area and heals quickly. The back, despite its thick skin, is poor in adnexal structures and may result in unsatisfactory healing in some cases. Similarly, the lower neck and chest respond poorly to dermabrasion.

Compared to chemical peeling, changes in skin structure after dermabrasion are moderate. The major change seen after dermabrasion is that the dermis does not regain its original thickness. Direct mechanical removal of the dermis smooths out contour irregularities.

In Which Situations Is Dermabrasion Suitable?

Acne: Today, the most common use of dermabrasion is the treatment of acne scars. A medium-depth peel that reaches the base of the acne furrows causes a significant improvement in appearance. Dermabrasion acts more as a camouflage mechanism. Rather than eliminating the scar, it reduces the height difference with the surrounding tissue and makes it less noticeable. If there are deep lesions, a second or even third dermabrasion procedure may be necessary, but the improvement that will develop after each procedure decreases. The results of dermabrasion for acne scars are better than chemical peels, and dermabrasion is replacing chemical peels, especially for superficial acne scars.

Scar: Traumatic or surgical scars generally respond well to dermabrasion. Both sunken and raised scars can be improved with surgical flattening. This reduces the level difference between the scar and the surrounding tissue and corrects shadowing caused by contour irregularities. While raised scars can be corrected directly with dermabrasion, surgical flattening of the surrounding skin is generally preferred for sunken scars.

Facial scars can also be seen after herpes zoster virus infections (shingles), smallpox and chickenpox, and these lesions respond well to dermabrasion.

Tattoo: Amateur or traumatic tattoos can be removed with dermabrasion. The more superficial the pigment is in the dermis, the better the response to treatment. In professional tattoos, the pigment is in the deep dermis and these lesions are usually outside the reach of dermabrasion. In these types of lesions, direct excision, skin grafts and laser treatment are more appropriate.

Pigmentation: Pigmented nevi tend to recur after dermabrasion, unless the pigment is confined to the basal layer of the epidermis. Hyperpigmentation, such as that seen in diseases such as chloasma and melasma, can also be corrected by dermabrasion.

Keratotic Lesions: Aging or seborrheic keratoses can be removed quickly and reliably with dermabrasion.

Wrinkles: Although less dramatic than chemical peels, facial wrinkles respond to dermabrasion. For patients with damaged skin who require treatment of the entire face, chemical peeling is a more effective and long-lasting method. Dermabrasion is also used effectively for wrinkles on the upper lip. The lines between the eyebrows also respond well to dermabrasion.

The most important advantage of dermabrasion is that the depth of the treatment is more controllable and gentler than chemical peels, and recovery is quicker. The duration of subsequent redness after the peel is also shorter.

In patients with dark skin, the whitening effect of dermabrasion is less and there is less discoloration between the treated skin and the surrounding tissue.

At the same time, dermabrasion is a very effective treatment option in the treatment of rhinophyma (excessive growth and enlargement of the nose tip and wings).

Contraindications

Dermabrasion is a treatment that is often limited to the face area because the adnexal structures are scarce in the back and chest area.

Isotretinoin: It is recommended to avoid dermabrasion for at least 6 months following isotretinoin treatment.

Radiodermatitis: Dermabrasion should be done very carefully and superficially.

Infectious Diseases: Dermabrasion is postponed in patients with cold sores until the cold sore lesions have healed, and is also contraindicated in HIV+ patients as it may predispose patients to infection.

What type of anesthesia is used?

The operation can be performed under local or general anesthesia.

How is Post-Procedure Care Performed?

After the procedure, antibiotic ointments given by your doctor will help to maintain the lubricity of the face and protect it from infection until the wound healing is complete. The patient can wash their face with water the day after the operation. The patient should also be informed that they need to keep the wound moist throughout the reepithelialization process, which takes 5 to 7 days. The patient can start using cosmetic products on the 10th day after the procedure, so that the redness in the abrasion area can be covered. Moisturizers should be used until the skin returns to its normal appearance to prevent dryness and crusting. It is recommended to avoid sunlight and use sunscreen creams or concealer makeup to prevent pigment changes during the wound healing process.

CHEMICAL PEELING

Chemical peeling is a process that involves applying chemicals to the skin to cause changes in its structure. The application of certain chemical mixtures causes controlled and predictable damage to the skin. After healing, chemical peeling results in smoother, firmer skin. Chemical peeling is often used to remove facial wrinkles and irregular blemishes.

Who is Chemical Peeling Suitable For?

Patients who require chemical peels are usually middle-aged people who have skin damage from excessive sun exposure in addition to the aging process. Degenerative changes occur in both the epidermis and the dermis. Skin changes caused by aging and sun damage generally run parallel to each other.

Elastosis is the most obvious change in sun-damaged skin. This is a degeneration process in which dermal collagen is replaced by a thick, dense accumulation of elastic fibrils. As elastic fibrils begin to replace collagen, the elastic properties of the skin decrease. At the same time, irregularly arranged, dilated veins begin to appear in sun-damaged skin.

In sun-damaged skin, the epidermis is thickened, the melanocytes are increased in number, hypertrophied and unevenly distributed. This uneven distribution also explains the formation of sunspots.

What Changes in the Skin After Chemical Peeling?

Damaged elastotic skin is removed and replaced by new collagen tissue as a result of wound healing.

After chemical peeling, epidermal regeneration begins at the 48th hour and ends approximately on the 7th day. The most important change in the dermal structure in the 3rd month after the procedure is that the fluctuating, irregular dermal collagen structure is replaced by a more solid and regular collagen structure. In other words, the collagen layer of the skin is corrected, the darkening of the color is lightened, the elasticity of the skin increases and skin rejuvenation is achieved.

In Which Situations is Chemical Peeling Appropriate?

• Fine facial lines
• Skin Darkening and Sun Spots
• Superficial acne scars

What to Pay Attention to After the Procedure

Since the chemical peeling process removes a significant amount of pigment from the skin, the skin becomes noticeably whiter after the operation and loses its original resistance to the sun. Patients should be warned to protect themselves from direct or reflected sunlight until healing is complete. This is especially important in the early stages when the skin is red. Patients must definitely follow the following recommendations regarding sunlight:

• Skin that has undergone chemical peeling can never tan normally and must be treated with sunscreen for life.
• Patients should be protected from direct sunlight for 3-6 months.
• It is also necessary to protect from reflected light. Make-up concealers containing sunscreen may need to be used for a long time.