Professional Skin Care With Deep Phenol Peels

Professional Skin Care with Deep Phenol Peels

A deep chemical peel is a non-surgical, professional skin care procedure that compares favorably with other surgical and non-surgical professional skin care procedures such as surgical face-lifting, dermabrasion, and laser resurfacing.

Deep phenol peels as a professional skin care procedure provide a cost-effective method that provides significant results and a high degree of patient satisfaction particularly for those with special skin care requirements due to acne.

Patient Selection

The best candidates for deep chemical peeling are people, who have dyschromia, fine and coarse wrinkles, pre-malignant skin tumors and acne scars.

Originally, the ideal patients for deep chemical peel were only blond, blue-eyed females with a fair complexion, but lately the phenol-based peels have been developed so that they can be safely performed on patients with olive and dark skin, and dark eyes and hair.

Contraindications

In general people in poor health and mentally unstable people are unsuitable for deep peels. So are pregnant and nursing mothers. A phenol peel is a significant undertaking and people do need to be in good general physical health to avoid complications as a result of the procedure. Phenol peeling involves an injury to the skin and exposure to what is effectively a toxic chemical. The body must be capable of resisting any long term negative effects of the treatment.

However the peels can be safely performed on patients with hypertension, diabetes mellitus, thrombocytopenia, thyroid malfunction, etc., as long as their disease is well-controlled and stable.

Professional Skin Care before the procedure

A strict regimen of facial skin care, and avoidance of sun exposure are an essential requirement for making the skin ready for any professional skin care approach involving deep phenol peels.

The deep chemical peel is performed under sedation, so patients are required to have an electrocardiogram and complete blood count for a general assessment of their health before the procedure.

Patients with coronary disease require special precautions. Prophylactic acyclovir, valacyclovir, or famciclovir is given to patients with a history of recurrent herpes simplex to prevent the peel procedure from activating the virus. Systemic isotretinoin needs to be stopped at least 6 months before the procedure for those using it.

Peeling Preparation

One day prior to the procedure, the patient is required to avoid using all cosmetics and skin care creams and products.

Before the actual procedure begins, marking is done on the face with the patient in the upright position. The area just below the jaw line where the peel is blended into what will be untreated skin is very critical. A marking is feathered at the edges to avoid a distinct line of demarcation being visible after the procedure.

Once the marking is done, the face is thoroughly degreased with acetone on a gauze pad. This procedure is done to remove the stratum corneum layer of the epidermis and any dead epithelium. It allows for an even peel with optimal penetration.

The actual peeling procedure

A phenol-based peel is carried out under full cardiopulmonary monitoring and intravenous hydration throughout the procedure.

The surgeon will carefully apply the phenol or TCA solution with cotton tipped applicators. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.

A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may just take only 10 or 15 minutes to perform. A single treatment usually suffices for the treatment.

The application of the phenol is started on the forehead, with feathering into all hair-bearing areas, including scalp and eyebrows. Phenol does not interfere with hair growth when applied correctly.

Treatment around the eyes requires extra care. Peeling the upper and lower eyelids is avoided in a deep chemical peel owing to the risk of scarring on what is very thin eyelid skin. The cotton tip applicator is dried before the periorbital application. Care is taken to keep the peel solution out of the eyes and to prevent any tears from falling onto peeled skin.

The transition area between the facial skin and the lip is often inadequately peeled. An assistant is generally needed to stretch the vermilion border of the upper and lower lips and make it flattened so the surgeon is able to apply the peel solution evenly over the vertical rhytids along the lip. When treating deep furrows, the wooden end of the applicator stick is often used to deliver the peel solution into the depths of the rhytids.

Immediately after the face is covered with the solution, a mask of waterproof zinc oxide non-permeable tape in short strips is applied to the skin, anchoring it to the hair line. Generally overlapping strips are applied so as to allow slight motion and flexibility to the swelling areas on the face.

After 24 hours, the tape mask is removed and the skin exudates is cleaned with sterile saline. To check any potential infection, the face is covered with antiseptic powder to remain as such for the following 7 days. Dry powder is preferred because it can absorb large amounts of exudates.

Pain killers (nonsteriodal anti-inflammatories) are given every 4 hours for the first 2 days. Neck swelling is generally expected after a deep peel which typically disappears within 4 to 6 days.

On the 8th day, soaking of the face is done to soften the powder mask to remove it. Water-based lotion creams and potent sunscreens are applied to the face.

In patients with olive skin (Fitzpatrick skin type 3 or 4), something called a Kligman preparation is applied to prevent reactive hyperpigmentation.

A good amount of post operative care is needed after a deep peel procedure to avoid potential complications resulting from infection.

New skin will begin to form in about seven to ten days. The face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sun block otherwise blotchy, irregular skin coloring may develop.

Potential Complications

Cardiac arrhythmias, pigmentary changes, scarring, infection, milia, acneiform dermatitis, and skin atrophy are some of the potential complications from phenol peels. The most important complication of phenol-based peels is cardio-toxicity because phenol is directly toxic to the myocardium.

Scarring remains the most dreadful complication of chemical peels. Scarring is caused by uncontrolled penetration of the peeling agent to the deeper layers of the skin. Avoidance of this is mainly down to the experience of the surgeon applying the chemical and their knowledge of how much to apply while staying within safe limits.

Results

Results with the deep phenol peels are dramatic and long-lasting. Significant improvement in photoaged skin with reduction in wrinkles and an improved complexion is possible. Permanent skin lightening and lines of demarcation between treated and untreated areas may occur as a result of the procedure, but these can be hidden by camouflage make-up.

Deboshri Roy, 'Ablative Facial Resurfacing', Ophthalmol Clin N Am 18 (2005) 259 - 270

Marina Landau, "Advances in Deep Chemical Peels", Dermatology Nursing, December 2005/Vol. 17/No. 6

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Deep phenol peels as a professional skin care procedure provide a cost-effective method that provides significant results and a high degree of patient satisfaction particularly for those with special skin care requirements due to acne. Patient Selection The best candidates for deep chemical peeling are people, who have dyschromia, fine and coarse wrinkles, pre-malignant skin tumors and acne scars. Originally, the ideal patients for deep chemical peel were only blond, blue-eyed females with a fair complexion, but lately the phenol-based peels have been developed so that they can be safely performed on patients with olive and dark skin, and dark eyes and hair. Contraindications In general people in poor health and mentally unstable people are unsuitable for deep peels. So are pregnant and nursing mothers. A phenol peel is a significant undertaking and people do need to be in good general physical health to avoid complications as a result of the procedure. Phenol peeling involves an injury to the skin and exposure to what is effectively a toxic chemical. The body must be capable of resisting any long term negative effects of the treatment. However the peels can be safely performed on patients with hypertension, diabetes mellitus, thrombocytopenia, thyroid malfunction, etc., as long as their disease is well-controlled and stable. Professional Skin Care before the procedure A strict regimen of facial skin care, and avoidance of sun exposure are an essential requirement for making the skin ready for any professional skin care approach involving deep phenol peels. The deep chemical peel is performed under sedation, so patients are required to have an electrocardiogram and complete blood count for a general assessment of their health before the procedure. Patients with coronary disease require special precautions. Prophylactic acyclovir, valacyclovir, or famciclovir is given to patients with a history of recurrent herpes simplex to prevent the peel procedure from activating the virus. Systemic isotretinoin needs to be stopped at least 6 months before the procedure for those using it. Peeling Preparation One day prior to the procedure, the patient is required to avoid using all cosmetics and skin care creams and products. Before the actual procedure begins, marking is done on the face with the patient in the upright position. The area just below the jaw line where the peel is blended into what will be untreated skin is very critical. A marking is feathered at the edges to avoid a distinct line of demarcation being visible after the procedure. Once the marking is done, the face is thoroughly degreased with acetone on a gauze pad. This procedure is done to remove the stratum corneum layer of the epidermis and any dead epithelium. It allows for an even peel with optimal penetration. The actual peeling procedure A phenol-based peel is carried out under full cardiopulmonary monitoring and intravenous hydration throughout the procedure. The surgeon will carefully apply the phenol or TCA solution with cotton tipped applicators. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may just take only 10 or 15 minutes to perform. A single treatment usually suffices for the treatment. The application of the phenol is started on the forehead, with feathering into all hair-bearing areas, including scalp and eyebrows. Phenol does not interfere with hair growth when applied correctly. Treatment around the eyes requires extra care. Peeling the upper and lower eyelids is avoided in a deep chemical peel owing to the risk of scarring on what is very thin eyelid skin. The cotton tip applicator is dried before the periorbital application. Care is taken to keep the peel solution out of the eyes and to prevent any tears from falling onto peeled skin. The transition area between the facial skin and the lip is often inadequately peeled. An assistant is generally needed to stretch the vermilion border of the upper and lower lips and make it flattened so the surgeon is able to apply the peel solution evenly over the vertical rhytids along the lip. When treating deep furrows, the wooden end of the applicator stick is often used to deliver the peel solution into the depths of the rhytids. Immediately after the face is covered with the solution, a mask of waterproof zinc oxide non-permeable tape in short strips is applied to the skin, anchoring it to the hair line. Generally overlapping strips are applied so as to allow slight motion and flexibility to the swelling areas on the face. After 24 hours, the tape mask is removed and the skin exudates is cleaned with sterile saline. To check any potential infection, the face is covered with antiseptic powder to remain as such for the following 7 days. Dry powder is preferred because it can absorb large amounts of exudates. Pain killers (nonsteriodal anti-inflammatories) are given every 4 hours for the first 2 days. Neck swelling is generally expected after a deep peel which typically disappears within 4 to 6 days. On the 8th day, soaking of the face is done to soften the powder mask to remove it. Water-based lotion creams and potent sunscreens are applied to the face. In patients with olive skin (Fitzpatrick skin type 3 or 4), something called a Kligman preparation is applied to prevent reactive hyperpigmentation. A good amount of post operative care is needed after a deep peel procedure to avoid potential complications resulting from infection. New skin will begin to form in about seven to ten days. The face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sun block otherwise blotchy, irregular skin coloring may develop. Potential Complications Cardiac arrhythmias, pigmentary changes, scarring, infection, milia, acneiform dermatitis, and skin atrophy are some of the potential complications from phenol peels. The most important complication of phenol-based peels is cardio-toxicity because phenol is directly toxic to the myocardium. Scarring remains the most dreadful complication of chemical peels. Scarring is caused by uncontrolled penetration of the peeling agent to the deeper layers of the skin. Avoidance of this is mainly down to the experience of the surgeon applying the chemical and their knowledge of how much to apply while staying within safe limits. Results Results with the deep phenol peels are dramatic and long-lasting. Significant improvement in photoaged skin with reduction in wrinkles and an improved complexion is possible. Permanent skin lightening and lines of demarcation between treated and untreated areas may occur as a result of the procedure, but these can be hidden by camouflage make-up. Deboshri Roy, 'Ablative Facial Resurfacing', Ophthalmol Clin N Am 18 (2005) 259 - 270 Marina Landau, "Advances in Deep Chemical Peels", Dermatology Nursing, December 2005/Vol. 17/No. 6