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GuardedlyOptimistic

Why is mechanical dermabrasion better than Laser?

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Hello,

From reading results, I'm finding that people are more content with the mechanical, wire, dermabrasion results as opposed to the laser *Co2, treatment. Why is this? And, if the outcome is better with the former, why is it that it's so difficult to find a surgeon who specializes in the mechanical dermabrasion? All I hear is: Laser laser laser. But, people aren't happy with the results? Is ths laser a waste of time? I don't want to think so since it doesn't make sense that it shouldn't provide greater improvement. I mean, both the laser and the wire take off many layers of skin. So, why should there be any difference at all?

I'm pretty much a newbie when it comes to all the scar revision treatments, though I will surely need some. I really would like you guys to help me out.

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Ha ha, I know what you mean, GO - it's because I'm not here much anymore wink.gif

I think the fact that myself, Oursfan, animegirle and Emmanuel (all the scar board moderators) aren't able to visit very often does have an effect, as we usually try and reply to all the threads we can, so I'm sorry about that. I don't have internet access in my house at the moment. sad.gif

But enough about me! I think mechanical dermabrasion is preferable in many cases because it is more dependant on the skill of the surgeon, whereas laser can be unpredictable. There also seems to be more chance of a post-operative breakout with CO2 laser, although I'm not sure why.

I haven't had either procedure done myself, but this seems to be the general opinion.

This might sound patronising, but I really think you should look into less invasive procedures to start off with - procedures such as needling and subcision can give very good results, so it might be best to start with less expensive and less invasive procedures like this first before thinking of anything like CO2 or dermabrasion.

Just my opinion. smile.gif

Sorry for the initially frosty reception, again. eusa_angel.gif

Paul.

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Why the heck is no one responding? What the heck? I feel it's a little icy here in this forum. I'm not feeling the love.

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Why the heck is no one responding? What the heck? I feel it's a little icy here in this forum. I'm not feeling the love.

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Hello,

From reading results, I'm finding that people are more content with the mechanical, wire, dermabrasion results as opposed to the laser *Co2, treatment. Why is this? And, if the outcome is better with the former, why is it that it's so difficult to find a surgeon who specializes in the mechanical dermabrasion? All I hear is: Laser laser laser.  But, people aren't happy with the results? Is ths laser a waste of  time? I don't want to think so since it doesn't make sense that it shouldn't provide greater improvement. I mean, both the laser and the wire take off many layers of skin. So, why should there be any difference at all?

I'm pretty much a newbie when it comes to all the scar revision treatments, though I will surely need some. I really would like you guys to help me out.

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Hey Ross,

Thank you so much for posting. I really appreciate it. I have a few questions for you: because dermabrasion is more dependant on the skill of the surgeon, does that mean that there is a greater chance for scarring as well?

Please don't think you're being patronising at all!!! I appreciate your help so much. I will definitely look into less invasive procedures to start off with. The needling process scares me.

Write soon and take care,

GO

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Congrats on your dermabrasion. I look forward to hearing about your progress. Please update me. Thank you soo much for posting.

Thank you,

GO

PS Did you do the accutane as well. If so, how long ago?

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Hello,

Thank you so much for posting. Reading what you wrote, i'm confused as to why there would be more acne after a dermabrasion. Also, if this is the case, isn't that bad? I mean, won't the skin scar more after a dermabrasion because of it's healing sensitivity?

Thanks,

GO

Hi,

I know what you mean. There seem to be a lot more lurkers than contributors lately.  But I think the most active members who posted have gotten busy and there isn't much more to add I guess that hasn't been said.

In regard to dermabrasion vs. CO2 laser, I've had both.  I think dermabrasion goes deeper than the CO2 laser.  My experience in a nutshell:

-  Ultrapulse CO2 laser: shorter recovery period (even shorter should you go with Derma-K or Erbium), less breakouts, and less improvement (10% maybe).

- Dermabrasion: longer recovery period, more acne, and more improvement (20-25%).

If you want further details pm me.

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Hello,

Thank you for posting. I appreciate it. Others' experiences don't seem to echo what you say however. From all the posts i've read, I find that people that have done the laser aren't happy.

Also, fyi, I posted a whole 24 hours before anyone posted after me eusa_boohoo.gif

I think it would be an overgeneralization to say that one technique is better than the other, mostly because outcome is so greatly dependant on operater skill.  One of the main reasons why derms don't do much in the way of mechanical dermabrasion is that it is very messy, and in these days of blood-borne illnesses, it's just not a good idea to have bloody matter being flung about the place.  Also, dermabrasion is old-school, and derms like new-school/new-techie things much better.

Laser is not a waste of time, since in the right hands it can provide the same results as mechanical dermabrasion.  Again, it's operater skill that determines outcome, rather than modality.

Is it a common thing around here to start complaining about lack of replies after waiting just two hours?

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Mechanical dermabrasion with skillfull doctor can go 350 µm - 500µm deep, where typical ablative CO²-laser will go only 150 µm deep and it is defenetly not recommended to do whole face lasering deeper than that, or multiple sweeps at the same time. I don't know if anyone has tried it, but I think even manufacturer of the CO²-device do not take any responsibility if some doctor uses it against instructions. Also I would be very cautious to use CO2-radiation deeper because there are fibroblast cells with DNA and DNA knowingly doesn't much like any type of strong radiation. In upper layer of the dermis there is no fibroblasts which would suffer.

For a light shallow peeling, like to treat wrinkles, CO²-laser is easier and better, but for acne scars traditional mechanical dermabrasion seems to give better results, but is more difficult to do.

Also new doctors are simply taught wrong to forget the "old" mechinical treatment. There seems to be only handfull of surgeons all over the world who know the old skill.

A wirebrush is more difficult to handle than a diamond frase. A problem with diamond frase is that it looses its sharp edge soon, I've been told. I don't know if it is because it wears smooth after just couple of full face dermabrasions, or because the tiny edges get filled with bladed tissue very quickly during one operation; maybe both.

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Hello,

Thank you for posting. I appreciate it. Others' experiences don't seem to echo what you say however. From all the posts i've read, I find that people that have done the laser aren't happy.

I can understand that.  For every modality, you will always have a set of persons who do well, and those who don't (the ones who don't seem to be much more willing to let others know what happened).  Although our practice does not do laser resurfacing, the place I trained at did.  I personally know of a small group of patients who were/are quite pleased with their outcomes.

My post was not meant to say that one is better than the other, or to contradict what you have read.  All I'm saying is that one can be as good as the other if done correctly.

Also, fyi, I posted a whole 24 hours before anyone posted after me  eusa_boohoo.gif

sorry, I just looked at the post times, which had a spread of approx. two hours.  Perhaps I'm reading them wrong...

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This website has an article re laser vs. dermabrasion.

http://www.dermatologytimes.com/dermatolog...date=&&pageID=1

I've been told by one plastic surgeon that he no longer uses ablative lasers, primarily because of the risk of hypopigmentation. One of the key doctors in the largest laser center in Northern CA told me he no longer uses the CO2 because of that risk. He has moved over to Erbium YAG and nonablative. The message I got from this is for the same depth of scar correction, there is greater risk of hypopigmentaion with CO2 and also Erbium YAG, then there is with dermabrasion. This Dr. advised me against ablative because he did not think my case was severe enough to jusify the risk and downtown of Erbium. Dr. Y knows this Dr., as they are both "famous" in the cosmetic dermatology industry. This Dr. also has given lectures at symposiums in which he described dermabrasion as the gold standard for acne scar correction. Yet, he only uses lasers; primarily for wrinkles, pigment and skin rejuvenation.

So, while I have no first hand knowledge, I hope this Dr. hearsay helps.

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Thanks you guys. I really appreciate the help. What i'm not understanding though is: How does the dr. know how deep to go with the rotating brush? I mean, if he slips, can't he cut your face wide open? It's a scary thought.

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Hello,

Thank you so much for posting. Reading what you wrote, i'm confused as to why there would be more acne after a dermabrasion. Also, if this is the case, isn't that bad? I mean, won't the skin scar more after a dermabrasion because of it's healing sensitivity?

Thanks,

GO

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Hey Kooky,

How were your scars before the procedures? Why did you decide to do the CO2 after the dermabrasion? Did the dermabrasion not satisfy your expectations?

Thanks for the reply by the way smile.gif

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How does the dr. know how deep to go with the rotating brush? I mean, if he slips, can't he cut your face wide open? It's a scary thought.

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Thank you very much. Your post is one of the most informative ones I have ever read. You've given me much to think about. I thank you again. The procedure does seem painful. I am also afraid that if I get it doen, they will uncover underlying sinus tracts. I"m quite afraid.

Anyway, write soon with any further comments and thanks again!!!

The depthcontrol is indeed difficult. That's why there is only handfull of surgeons in the world who know the skill of full face dermabrasion. The CO2-laser manufacturers sold their equipments well just because the difficulties in mechanical operation and in many medical schools mechanical dermabrasion was said to be passé. Fortunately little by little schools are told back they teach wrong, CO2-laser is not suitable to treat from moderate to deep acne scars.

However the dermis is very strong. Collagen fibers themself are stronger than steel wire of the same diameter. So it won't be cut open very easily, although there definitely is the risk.

The doctor sees the current depthness from the color of the operated area, in what shade of red it is. Only experience will teach the surgeon how to do it right and how deep he can go. Unexperienced doctors tend to go too shallow, therefore having minimal results to acne scars. One can oneself notice how deep the dermabrasion was, by observing how long the scabbing and redness will last, but only after the operation.

I have said this before also, but I hope Dr Y will make thorough and highly detailed video documents about his methods before he retires.

[EDIT: later added]

I found one video, but it is an old one, from 1997. Has anyone seen this video?

http://www.aafprs.org/physician/products/1100_tapes.html

"Dermabrasio

John Yarborough, M.D. (1987) 22:00 minutes. This tape demonstrates full-face dermabrasion by the wire brush technique. Appropriate use of the technique is described and morphological landmarks regarding depth of abrasion are delineated.

1105 • $115 member/$145 non-member"

Also small sample video here

http://www.emedicine.com/derm/topic744.htm

http://www.emedicine.com/derm/images/Large/1790Clip5.mpg

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GO-- You do seem very "Guarded." If they uncover sinus tracts, have them filled whilst you consider what to do about them permanently. Or, if you like, permanently fill them...

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Hi Rex,

You are right. I am very guarded. In fact, I am terrified. I was wondering, since I know close to nothing about Sinus tracts, how would they permanently fill these? Would they have to do a skin graft? Also, are sinus tracts usually uncovered only in very severe ice pick scarring cases? Just wondering.

I also wanted to say thank you to everyone that has responded. I really and truly appreciate it from the bottom of my heart.

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