Skin Rejuvenation Physician's Guide
This Skin Rejuvenation Physician’s Guide covers chemical peels; Retin-A® treatments; glycolic acid treatments; laser resurfacing (laser peel); collagen injections; and dermabrasion.
Indications for chemical peel include wrinkled, sun-damaged, blemished or unevenly pigmented skin. A chemical peel involves the application of a solution containing either alphahydroxy acids (AHAs), trichloroacetic acid (TCA) or phenol to remove the top layers of skin. The AHA peel is the mildest, removing the fewest layers of skin; phenol solutions achieve the deepest peel. The formulas for each type of peel can be adjusted for individual cases.
A chemical peel may be performed in conjunction with a face-lift, but it is not a substitute since it does not achieve the same effects. Chemical peels do not retard the effects of aging.
The AHA peel smooths rough, dry skin and improves the texture of sun-damaged skin. It may also help to improve mild acne. The AHA solution can be mixed with a bleaching agent to correct or improve pigmentation problems. Sometimes the AHA peel is used as a pretreatment to prepare the face for a TCA peel or for laser resurfacing.
An AHA peel may cause mild stinging, but no anesthetic is required. Several treatments may be needed to achieve the desired effects, but once this point is reached, the patient can maintain improved skin texture by using a low-concentration of an AHA, such as a glycolic or fruit acid, mixed with a facial cream or wash as part of a daily at-home skin care program.
The TCA peel is a medium peel that can be administered in various strengths to adjust the depth of the peel. The TCA peel is appropriate to smooth fine surface wrinkles, remove superficial blemishes and correct pigmentation problems. Unlike the other peels, the TCA peel may be used on the neck as well as the face, and this is the preferred peel for darker-skinned individuals.
To achieve the best effects, the skin is sometimes pretreated with Retin-A or AHA. A full-face TCA peel may take from 30 to 60 minutes. The peel does not require anesthesia, but the patient may be sedated to make him/her more comfortable. Repeat treatment may be necessary to maintain the desired effects.
The phenol peel is the deepest peel, achieving the most dramatic effects. A phenol peel can correct blotches caused by sun exposure, birth control pills and aging. It smooths coarse wrinkles, and is sometimes used to remove precancerous growths. The phenol peel is appropriate for use on the face only, as scarring can result on other parts of the body. Because of the depth of the phenol peel, it is not suitable for dark-skinned individuals. The best candidates for phenol peel are people with fair, thin skin and superficial wrinkles.
The duration of a phenol-peel procedure varies with the extent of the peel. A full-face peel may take up to two hours to perform. The phenol peel does not require anesthesia, but the patient usually receives sedation for greater comfort. He or she will probably also undergo precautionary cardiac (EKG) monitoring during the procedure. Although an outpatient facility is the usual setting for a phenol peel, selected patients may require a one or two day inpatient stay. A single treatment with phenol usually achieves the desired results.
Temporary side-effects and recovery time vary with the type and depth of chemical peel. After an AHA peel, the patient is likely to experience flaking, scaling, redness, dry skin and possibly minor crusting, but these conditions are transient and should not interfere with prompt resumption of normal activities. The patient should use a sunblock every day to protect the skin, however.
After a TCA peel, the patient may experience tingling or throbbing sufficient to require a mild pain medication, and there may be significant swelling, especially if a strong formula has been used. Swelling generally subsides within a week. Crusts or scabs that form on the treated areas begin to slough off in a week to 10 days. At this time, the patient can return to normal activities except for sun exposure, which should be avoided until complete healing has occurred. Then the patient should apply sunblock daily for protection.
The after-effects are most severe with a phenol peel. The patient's face may be quite swollen, even to the extent that the eyes are swollen shut for a day or two. The patient may be limited to a liquid diet for several days, and talking will be difficult. New, very red skin will begin to form in seven to ten days; the color will gradually fade to normal over a period of weeks to months. The skin may be acutely sensitive to the sun during this period, so it is important that the patient use a sunblock to prevent permanently blotchy skin. Going to work and other normal activities-including the wearing of makeup-can be resumed about two weeks after the peel.
Risks vary with the type and depth of the peel, but all peels carry a small risk of infection and/or scarring. Patients with allergies could experience a flare-up of skin allergies. Fever blisters and/or cold sores may also develop. The phenol peel also carries a risk of permanent abnormal skin-color changes, and while very rare, a patient may develop heart irregularities while undergoing treatment.
Results of an AHA peel are neither dramatic nor long-lasting. Improvements must be maintained by periodic treatments. The effects of a TCA peel are more noticeable and slightly more enduring, but they are not permanent. The results of a phenol peel are both dramatic and permanent, but new wrinkles will still develop with age. Patients considering a phenol peel should be aware that their facial skin will be permanently lightened and that this skin will never tan. Also, people who have had phenol peels must always wear sunblock.