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| NON-INVASIVE REJUVENATION | ARTICLE The epidermis, dermis & fatty tissue


Proprietary or compounded? Chemical peel solutions can be compounded pharmaceutically or purchased as ready-to-use preparations. This is generally true with regard to superficial products. Deeper peels usually need to be compounded, unless provided as part of an educational event. Experienced peelers prefer to prepare their own solution, sometimes combining different concentrations for different skin areas. For beginners, proprietary peels are usually a safer choice.


The depth of the peel depends on a number of


factors, such as the chemicals used, their concentration, mode of application, and condition of the skin. There is a direct correlation between the depth of the procedure, level of discomfort and post-peel healing time, risk for potential complications and the intensity of overall skin improvement.


When are chemical peels indicated? Normal human skin has an inherent mechanism of renewal.


Newly-formed


epidermal cells mature and move up from the basal to corneal layer over a period of 28 days. A complex enzymatic process causes their separation and shedding from the epidermis to be substituted by younger cells. This is a normal peeling process of young skin. As we age, this process becomes less efficient. As a result, the corneal layer thickens and the skin loses its natural luminosity. In addition, abnormal pigment is deposited in the skin layers and fibroblast function slows down, negatively affecting the renewal of the extracellular matrix. External factors, such as sun exposure and smoking, further deteriorate the appearance of the skin. Chemical peels replace the pathological components


of the skin with younger and healthier cellular and acellular components. Therefore, peels are indicated in both cosmetic and medical skin conditions. Cosmetic indications include dull skin appearance, uneven tone, dyschromia, and skin wrinkling. Medical conditions that can benefit from chemical peels include solar keratosis, active acne and acne scars, and extensive stable facial vitiligo. Chemical peels can be performed locally, such as in cases of periorbital pigmentation or rhinophyma. Bodily peels require extra caution, as these areas will often heal poorly in comparison to the face.


Chemical peels replace the


pathological components of the skin with younger and healthier cellular and acellular components.


Patient consultation and selection When evaluating the patient for the peeling procedure, an extensive medical history should be taken. The patient must be questioned with regard to general health status, medication, allergies, smoking, previous cosmetic procedures, recurrent herpetic outbreaks, and keloid formation, for example. There are almost no absolute contraindications for superficial peels. Deeper procedures require stable patients, both physically and mentally, being able and willing to precisely and obediently follow all post-procedural instructions. Pregnant and lactating patients are always excluded. Darker phenotypes can be peeled after discussing the benefits of the peeling procedure against the risk of post-inflammatory hyperpigmentation. Any pre-existing cardiac condition should be cleared with the patient’s treating cardiologist before carrying out a phenol peel. The concept of oral isotretinoin being an exclusion criteria for chemical peels has been recently challenged3 Pre-peel skin preparation is usually advised using retinoic acid and melanin inhibitors.


.


Figure 1 A patient treated with salicylic acid 25% peel.


Precipitation of the salicylic acid on the skin appears similar to frosting


prime-journal.com | November/December 2012 ❚


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