If you're
considering chemical peel...
Chemical peel uses a chemical solution to improve
and smooth the texture of the facial skin by removing
its damaged outer layers. It is helpful for those
individuals with facial blemishes, wrinkles and
uneven skin pigmentation. Phenol, trichloroacetic
acid (TCA) and alphahydroxy acids (AHAs) are used
for this purpose. The precise formula used may
be adjusted to meet each patient's needs. Although
chemical peel may be performed in conjunction
with a facelift, it is not a substitute for such
surgery, nor will it prevent or slow the aging
process. This brochure provides basic information
about certain types of chemical peel treatments
and the results you might expect. It won't answer
all your questions, since a lot depends on your
individual circumstances. Once you and your plastic
surgeon have decided on a specific peel program,
be sure to ask about any details that you do not
understand.
Deciding if chemical peel is right for you Chemical
peel is most commonly performed for cosmetic reasons
-- to enhance your appearance and your self confidence.
Chemical peel may also remove pre-cancerous skin
growths, soften acne facial scars and even control
acne. In certain cases, health insurance may cover
the peel procedure. Be sure to check your policy
and contact your insurance company before the
procedure is performed.
Alphahydroxy acids (AHAs), such as glycolic,
lactic, or fruit acids are the mildest of the
peel formulas and produce light peels. These types
of peels can provide smoother, brighter-looking
skin for people who can't spare the time to recover
from a phenol or TCA peel. AHA peels may be used
to treat fine wrinkling, areas of dryness, uneven
pigmentation and acne. Various concentrations
of an AHA may be applied weekly or at longer intervals
to obtain the best result. Your doctor will make
this decision during your consultation and as
the treatment proceeds. An alphahydroxy acid,
such as glycolic acid, can also be mixed with
a facial wash or cream in lesser concentrations
as part of a daily skin-care regimen to improve
the skin's texture.
Trichloroacetic acid (TCA) can be used in many
concentrations, but it is most commonly used for
medium-depth peeling. Fine surface wrinkles, superficial
blemishes and pigment problems are commonly treated
with TCA. The results of TCA peel are usually
less dramatic than and not as long-lasting as
those of a phenol peel. In fact, more than one
TCA peel may be needed to achieve the desired
result. The recovery from a TCA peel is usually
shorter than with a phenol peel.
Phenol is the strongest of the chemical solutions
and produces a deep peel. It is used mainly to
treat patients with coarse facial wrinkles, areas
of blotchy or damaged skin caused by sun exposure,
or pre-cancerous growths. Since phenol sometimes
lightens the treated areas, your skin pigmentation
may be a determining factor as to whether or not
this is an appropriate treatment for you. Phenol
is primarily used on the face; scarring may result
if it's applied to the neck or other body areas.
All chemical peels carry some uncertainty and
risk Chemical peel is normally a safe procedure
when it is performed by a qualified, experienced
plastic surgeon. However, some unpredictability
and risks such as infection and scarring, while
infrequent, are possible.
AHA peels may cause stinging, redness, irritation
and crusting. However, as the skin adjusts to
the treatment regimen, these problems will subside.
With a TCA peel, your healed skin will be able
to produce pigment as always; the peel will not
bleach the skin. However, TCA-peel patients are
advised to avoid sun exposure for several months
after treatment to protect the newly formed layers
of skin. Even though TCA is milder than phenol,
it may also produce some unintended color changes
in the skin.
With a phenol peel, the new skin frequently loses
its ability to make pigment (that is, tan). This
means that not only will the skin be lighter in
color, but you'll always have to protect it from
the sun. Phenol may pose a special risk for patients
with a history of heart disease. It's important
that you make your surgeon aware of any heart
problems when your medical history is taken.
It is also possible that phenol will cause some
undesired cosmetic results, such as uneven pigment
changes. Certain modified phenol peels are gentler
and may be preferred in some circumstances.
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.
Sometimes 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 treatmentsmay 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.
*Information in this page is brought
to you by America Society of Plastic Surgeons.
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