PEEL
FORMULAS AT A GLANCE
Alphahydroxy acids (AHAs)
Uses:
- Smooths rough, dry skin
- Improves texture of sun-damaged skin
- Aids in control of acne
- Can be mixed with bleaching agent
to correct pigment problems
- Can be used as TCA pre-treatment
Considerations:
- A series of peels may be needed
- As with most peel treatments, sunblock
use is recommended
Trichloroacetic acid (TCA)
Uses:
- Smooths out fine surface wrinkles
- Removes superficial blemishes
- Corrects pigment problems
Considerations:
- Can be used on neck or other body
areas
- May require pre-treatment with Retin-A
or AHA creams
- Treatment takes only 10-15 minutes
- Preferred for darker-skinned patients
- Peel depth can be adjusted
- Repeat treatment may be needed to
maintain results
- Sunblock must be used for several
months
- Healing is usually quick, much quicker
than with a phenol peel
Phenol Uses:
- Corrects blotches caused by: sun
exposure, birth-control pills, aging
- Smooths out coarse wrinkles
- Removes pre-cancerous growths
Considerations:
- Used on the face only
- Not recommended for dark-skinned
individuals
- Procedure may pose risk for patients
with heart problems
- Full-face treatment may take one
hour or more
- Recovery may be slow - Complete healing
may take several months
- May permanently remove facial freckles
- Sun protection, including sunblock,
must always be used
- Results are dramatic and long-lasting
- Permanent skin lightening and lines
of demarcation may occur
PLANNING
FOR A CHEMICAL PEEL
In some states, no medical
degree is required to perform a chemical peel - even
the strongest phenol peels. Many states have laws that
permit non-physicians to administer certain peel solutions,
but regulate the strengths which they are permitted
to apply. You should be warned that phenol and TCA peels
have been offered by inadequately trained practitioners
claiming "miracletechniques" to rejuvenate
the skin.
It is very important that
you find a physician who has adequate training and experience
in skin resurfacing. Your plastic surgeon may offer
you a choice of peel techniques or suggest a combination
of peels to obtain the best result for you.
During your initial consultation,
it is important that you discuss your expectations with
your plastic surgeon. Don't hesitate to ask any questions
or express any concerns that you may have. Expect your
plastic surgeon to explain the planned procedure in
detail, including its risks and benefits, the recovery
period and the costs. If you have a history of herpes,
you should inform your physician prior to the procedure.
Remember, chemical peel treatments are usually not covered
by medical insurance unless they are performed for medically
related problems.
PREPARING
FOR YOUR CHEMICAL PEEL
Your plastic surgeon will
instruct you on how to prepare for your peel treatment.
Retin A - a prescription
medication derived from Vitamin A - is used to pre-treat
the skin. This thins out the skin's surface layer, allowing
the TCA solution to penetrate more deeply and evenly.
If your skin won't tolerate Retin-A pre-treatment, an
AHA cream may be used instead. Hydroquinone, a bleaching
agent, is sometimes used in conjunction with Retin-A
or AHA pre-treatment, especially if you have blotchy
skin areas or pigmentation problems. You may have to
spend a month or more in the pre-treatment phase before
the doctor will schedule your actual peel.
You will need to arrange
for someone to drive you home and help you out for a
day or two if you are having a phenol or deeper TCA
peel. You probably won't need any extra assistance if
you're having an AHA peel or superficial TCA peel.
WHERE
YOUR PEEL WILL BE PERFORMED
Most chemical peels may
be safely performed in a plastic surgeon's office, office-based
surgical facility or outpatient surgical center. Your
plastic surgeon may want you to stay overnight in a
facility or hospital if other cosmetic procedures are
performed simultaneously.
TYPES
OF ANESTHESIA
Anesthesia isn't required
for phenol or TCA peels because the chemical solution
acts as an anesthetic. However, sedation may be used
before and during the procedure to relax you and keep
you comfortable.
No anesthesia is needed
for AHA peels since they cause only a slight stinging
sensation during application.
THE
PEEL
AHA peels/treatments:
Your doctor will apply the AHA solution to your cleansed
facial skin, a process that usually takes no more than
10 minutes. No "after-peel" ointment or covering
is required. Depending on the strength of the peel,
periodic treatments may be necessary until the desired
effects are achieved.
For some patients, the
application of an AHA-based face wash or cream once
or twice a day at home will be sufficient to accomplish
the desired goal. Your plastic surgeon may add Retin-A
or a bleaching agent to your at-home treatment schedule.
After several weeks of at-home use, your doctor will
examine your skin to determine if your regimen needs
adjustment.
Phenol and TCA peels:
Typically, the skin is first thoroughly cleansed. Then,
the surgeon will carefully apply the phenol or TCA solution.
You may feel a stinging sensation as the peel solution
is applied, but this feeling will quickly pass.
A full-face TCA peel usually
takes no more than 15 minutes. Two or more TCA peels
may be needed to obtain the desired result, and those
may be spaced out over several months. Mild TCA peels
may be repeated as often as every month.
If phenol solution has
been used, your plastic surgeon may coat the treated
area with petroleum jelly or a waterproof adhesive tape.
With lighter peels, no covering is necessary.
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 take only 10 or 15 minutes.
A single treatment usually suffices.
AFTER
YOUR TREATMENT
After an AHA peel, it
is common to experience some temporary flaking or scaling,
redness and dryness of the skin. However, these conditions
will disappear as the skin adjusts to treatment.
After a phenol or TCA
peel, your doctor may prescribe a mild pain medication
to relieve any tingling or throbbing you may feel. If
tape was used to cover your face, it will be removed
after a day or two. A crust or scab will form on the
treated area. To help your face heal properly, it is
essential that you follow your doctor's specific post-operative
instructions.
A TCA peel may also cause
significant swelling, depending on the strength of the
peel used.
If you've had a phenol
peel, your face may become quite swollen. Your eyes
may even be swollen shut temporarily. You will need
someone to help care for you for a day or two. You may
also be limited to a liquid diet and advised not to
talk very much during the first few days of recovery.
GETTING
BACK TO NORMAL
With an AHA peel, the
temporary redness, flaking and dryness that you experience
will not prevent you from working or engaging in your
normal activities. A fresher and improved skin texture
will result with continued AHA treatments. Remember,
protecting your skin from the sun is also important
following these mild acid peels. Ask your doctor to
recommend a sunblock with adequate UVA and UVB protection
and use it every day.
With a TCA peel, the moderate
discomfort and mild swelling you may experience will
subside within the first week. In about a week to ten
days, your new skin will be apparent and you should
be healed sufficiently to return to your normal activities.
It is best to avoid sun exposure unless you are adequately
protected.
With a phenol peel, new
skin will begin to form in about seven to ten days.
Your 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 sunblock or blotchy, irregular skin coloring may
result.
About two weeks after
treatment, you may return to work and resume some of
your normal activities. Your skin will be healed enough
for you to wear makeup. (For makeup tips, ask your plastic
surgeon for the ASPS brochure on camouflage cosmetics.)
YOUR
NEW LOOK
Improvements from AHA
peels may be very subtle at first. You may detect a
healthier glow to your skin. With continued treatments,
you will notice a general improvement in the texture
of your skin.
The results of a TCA peel
are usually not as long-lasting as those of phenol peel.
However, your skin will be noticeably smoother and fresher-looking.
If you're planning a phenol
peel, you can expect dramatic improvement in the surface
of your skin - fewer fine wrinkles, fewer blemishes
and more even-toned skin. Your results will be long-lasting,
although not immune to the effects of aging and sun
exposure.
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