http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract
The complications of keloids, pigment changes, loss of skin texture, and enlarged facial pores remain a problem with dermabrasion patients. Their occurrence can be reduced by proper patient selection, proper dermabrasion technique, proper wound management, and prompt treatment. Keloids are rapidly resolved with the use of flurandrenolide tape covered with positive-pressure chin-strap dressings. Streaks of hyperpigmentation are lightened with a combination of sunscreen, opaque makeup, tretinoin, and hydroquinone lotions. The loss of skin texture can be prevented by not abrading too deeply and avoiding subsequent bacterial contamination during wound healing. However, enlarged skin pores in the central portion of the face and hypopigmentation can be permanent complications.
There is another little-publicized, but significant risk with medium resurfacing. Doctors have discovered that medium resurfacing does not work well on a significant fraction of the population and can make their skin appearance much worse. Even if penetration is not excessive, in some people, particularly those with large pores and a lot of skin oil, the epidermis may not regenerate well, resulting in a much worse surface texture than before the procedure. This is due to variations in the way new epidermal cells grow outward from the pores and sweat gland openings. Also, the basal or bottom layer of the epidermis, which forms new skin cells, may not return to it's normal pre-operative state. Even though wrinkles may be reduced, up close the resulting epidermis may be thin and have an uneven, orange-peel appearance. The pore openings may appear larger than before with tiny fissures around them, particularly in the center of the face. Loss of pigment can also make large pores appear more prominent. If you have any healed abrasions or chemical and thermal burns, you may see a similar difference in texture compared to your normal skin.
Long-term use of tretinoin may help this problem somewhat, but the skin texture may never look smooth up close. These serious risks of poor skin texture and enlarged pores are mentioned in some patient consent forms and journal articles on resurfacing, but are usually not covered in consumer information. See for example, "The Prevention and Management of Postdermabrasion Complications, "Journal of Dermatological Surgery and Oncology, 17(5), 431-437, 1991 May (abstract available on Medline). Even though this is a major problem, inexplicably, some medical textbooks on resurfacing don't discuss this risk, and many medical websites that cover resurfacing also say nothing about it. If you have large pores and a noticeable amount of skin oil or any acne, you should probably not have medium resurfacing for photoaging. Instead, you should use the topical treatments mentioned previously or nonablative treatments (see below). Don't risk scarring your face.