PRIME PRoMotIon |
melanogenesis (Table 2). For TCA peeling, the author recommends CosmoPeel™ by DermaCeutic TCA 15%, 18% with its enhancing CosmoCream, or the TCA options of 12% and 20%. When using medium peels containing TCA, it is
imperative to remember that it is certainly effective on actinic marks, but is much less so on melasma, with an almost unpredictable risk of aggravation.
Deep peels
Trichloracetic acid TCA is not a deep-peeling chemical; beyond a concentration of 30%, the risk of abnormal healing is significant.
Phenol The procedure is as
Phenol is the only chemical currently used to carry out a deep peel. The formula of phenol used for a deep peel is fundamentally important, and while certain practitioners claim to juggle with these formulas by cutting them and making them stretch further, there are very few who have truly mastered the subject. This is why a reference formula is highly desirable, and the author recommends the use of ExoPeel™. The procedure is as important as the formula, and the same formula can provide very different results depending on the technique used. In a nutshell, experience is paramount. Nevertheless, correctly used, phenol resolves 99% of pigmentary problems. The most common question raised here is with
regard to the depigmenting effect of phenol. The real cause of achromia is the depth of the effect. Whatever the method of resurfacing — whether peel, laser CO2
, or
mechanical dermabrasion — if a deep action is required then achromia will occur. And yet, there is a difference in the colour of the skin
following a phenol peel. It is well known that young skin is always clearer and rosier, but over the years the skin will take on a citrine appearance mainly caused by a change in dermal refraction owing to changes in density and positioning of collagen and elastic fibres. As a result, skin rejuvenated using a phenol peel will appear clearer and rosier, and one of the difficulties with this technique is not to create too distinct a border along the jaw line.
important as the formula … the same formula can provide very different results depending on the technique used.
Specific spot peels SpotPeel™ SpotPeel™ is primarily designed to treat melasma. It also has a ‘rejuvenating’ effect, but it is not in this area that it makes the most difference. There is a specific procedure that should be followed when using this product: ■ Application of the Cleanser 5 or Foamer 15 that cleanse the skin and contains glycolic acid, which will clean the skin and permeate its corneal layer ■ Rinsing and drying ■ Application, using a brush, of a small quantity of MilkPeel™ (1.5 ml) quickly over the whole face. In the case of SpotPeel™, MilkPeel™ will be left on the skin for a very short amount of time (for approximately 1 minute)
■ The ideal would be to apply very little, very quickly, over the entire surface then rinse with water without necessarily aiming to remove it in its entirety. MilkPeel™ is used to etch the skin, in order to facilitate the penetration of the SpotPeel™ and also to homogenise the permeability of the cutaneous surface ■Application of the SpotPeel™ itself, which comes in the form of a cream. A small quantity is applied over the whole face, then massaged. It is important to then wait for a few minutes before proceeding with the second application, followed by the third. The third application is applied either to the melasma only, or to the whole face. The product needs to be left in place for at least 8 hours, longer for convenience, to avoid the patient having to wake during the night to wash his/her face.
If the patient wishes to cover his/her marks in the period following the treatment, he/she must wait 20 minutes before using powders or foundations, which should be applied by lightly dabbing, and never by rubbing or massaging as these risk diluting the SpotPeel™. At the designated time, the skin is cleansed by the patient using an active Cleanser. There are a number of after-effects to this process that the patient should be made aware of: ■Sometimes a sensation of heat is felt during the application of SpotPeel™ ■The skin reddens towards the end of the peel ■From day 1–2 the skin will often be red ■From day 3–4, and sometimes up to day 5, there will be a fairly subtle light exfoliation. From the time of the peel to the last of the shedding,
an intense repair and nourishing cream is applied (K Ceutic with built-in SPF 40). When exfoliation and irritation disappears, the patient should apply SpotCream™ in the evening and continue to use K Ceutic during the day (Table 2). If the pigmentation is older and more persistent,
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SpotCream™ should immediately start to be applied morning and night with a gradual reduction in the
July 2011 |
prime-journal.com
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