Dr. Alan John Weiss, MD

During dermabrasion, a nurse or other healthcare professional holds the skin taut so that the doctor can apply gentle but constant pressure on the skin using the device. Depending on how much skin needs treatment, it may take a few minutes to over an hour to complete the surgery.

A waxy or moist dressing is placed on the skin at the end of the procedure. The treated area will be red and swollen for about two to three weeks. Itchiness and tingling will likely be present for some time. Although less common, enlarged pores, cold sores, rashes, and permanent skin discoloration may also occur. Normal activities may be resumed about two weeks following dermabrasion. However, swimming in chlorinated water and sports that involve the use of balls should be avoided for four to six weeks.

The choice of reconstruction technique depends on the size and severity of the defect. If tissue loss is small to moderate, the wound may simply be sutured close. For larger defects, however, tissue from other parts of the body may be needed. Tissue may be taken (or harvested) from the ear, scalp, abdomen, roof of the mouth, inside of the check, or the eyelid itself.

The Hughes procedure and the Cutler-Beard procedure are reconstruction techniques that use eyelid tissue. In the Hughes procedure, a piece of neighboring tarsoconjunctival tissue is cut, slid onto the wound, and then sutured together. The tarsoconjunctiva is made up of the connective tissue that provides support to the eyelid, called tarsus, and the membrane covering the white of the eyes, called conjunctiva. This technique is suited for defects that are located on the sides of the eyelid. The Cutler-Beard procedure requires a thicker segment of tarsoconjunctival tissue and is used to repair defects in the center of the eyelid.

Eyelid reconstruction is commonly done at an outpatient facility. There will be bruising and swelling for about four to ten days following surgery. Patients should keep their heads elevated, use cold compress, and apply antibiotic cream on their eyelids for the first few days. Strenuous activities must be avoided for four weeks, but patients may be able to return to work after about a week.

In all cases, the skin graft may either be full-thickness or partial-thickness. While thicker grafts make recovery more difficult for the donor site, they heal more easily than thinner grafts.

Before skin graft surgery, patients are given anesthesia so they cannot feel any pain. If using an autograft, the surgeon carefully measures and removes the skin from the donor site. Sometimes the graft is cut in a mesh-like pattern, to allow a small piece of donated skin to stretch and cover a larger area. This also helps oxygen pass through the graft. The site where the skin graft will go is cleaned well to remove any dirt, bacteria, or dead skin cells. Then the skin graft is placed and attached with stitches or staples. It is often covered with antibacterial ointment and supportive bandages for the first few days.

As the skin graft heals into its new position, new blood vessels grow to reach and support the skin. Depending on the thickness of the graft, oil glands, sweat glands, and hair follicles may also regrow. Recovery time depends on the thickness of the graft and the overall health of the skin in the grafted area, but it generally takes from two to four weeks.