Dermabrasion comes back into vogue

Stanford, Calif. - Dermabrasion might have been considered a lost art when CO₂ lasers entered the dermatology scene in the mid 1990s, but Stephen H. Mandy, M.D., finds the pendulum swinging back toward a renewed interest in the facial sanding resurfacing technique.

"There's a new interest in reviving an art that, for a while, was tossed out as passé," says Dr. Mandy, clinical professor in the department of dermatology at the University of Miami and in private practice at South Beach Dermatology, Florida, and Aspen Skin Clinic, Colorado.

He says in the last decade, there was a "rush to judgment that lasers were such a wonderful thing." But some long-term results did not meet promised expectations. And CO₂ laser's anticipated short learning curves did not necessarily turn out that way. Dr. Mandy says many cosmetic surgeons who learned CO₂ lasers in a day produced some poor long-term outcomes, and even injury.

With sufficient training and experience, Dr. Mandy recognizes that CO₂ lasers are not difficult to use and says the learning curve for dermabrasion is longer. In addition, mastery of dermabrasion impacts the quality of outcomes more so than with CO₂ lasers, which are more precise and less dependent upon the experience of the surgeon.

The complexity of CO₂ laser wound management is another factor that is bringing dermabrasion back into favor with patients and dermatologists. Patients are opting for the non-invasive techniques that have quicker healing and minimal downtime. Dermabrasion fits the bill. The cold steel injury caused by dermabrasion heals quicker than the thermal injury of lasers.

He contends that many lasers do the job just fine for their single applications, and he employs several in his practice for hair removal and facial rejuvenation. But dermabrasion has multiple indications: dermal tumors, rhinophyma, tattoo removal, resurfacing, and scars from acne, trauma or surgery. For acne scarring and resurfacing, he finds dermabrasion to be superior.

"No laser has been shown to do a better job at accomplishing the end result that dermabrasion does," he says. "Tomorrow, there may be new laser technology that will do better than dermabrasion, but for 2004, dermabrasion remains the gold standard for surgical treatment of acne scarring and it is still very effective for facial rejuvenation to treat sun damage."

There in lies another benefit of dermabrasion when compared with CO₂ lasers. Dr. Mandy explains that while laser technology is continually evolving and advancing, dermabrasion has evolved and is fairly consistent. So, this year's laser purchase for a single indication may very well be obsolete by next year when newer technology is made available. Keeping current is more expensive with lasers than with dermabrasion.

Even at startup, dermabrasion is the more economical option, with an entire setup costing less than $1,500. Cost of a single laser can be $100,000.

Dr. Mandy says dermatologists who still perform CO₂ laser procedures skillfully and for multiple procedures are few and far between. Many have moved away from lasers to dermabrasion.