| NON-INVASIVE REJUVENATION | ARTICLE The TCA solution is compounded in a weight to
volume preparation. To prepare a 35% solution, 35 g of TCA crystals are dissolved in a small amount of water, then further water is added to make a total volume of 100 mL. TCA is stable at room temperature and not light-sensitive. TCA peeling is a painful procedure; therefore, local
injection anaesthesia or intravenous sedation should be considered. A patient usually becomes completely comfortable 15–20 minutes after the procedure, when the frosting subsides. During the procedure, TCA is painted using a q-tip
according to the cosmetic units and until a white frost appears. The degree of the frosting correlates with the depth of solution penetration: ■ Level I is speckled white frosting with mild erythema and corresponds to superficial penetration
■ Level II is characterised by an even white-coated frost with background erythema. This degree of frosting is usually desirable for medium depth peels
■ Level III is solid white opaque frost with little or no background erythema, usually characterising deep peels and not desirable in a TCA procedure. During the first few days after the peel, patients are expected to feel a tightening and swelling of the skin, as
The main
indications for deep chemical peels include
dyschromia, fine and coarse wrinkles,
pre-malignant skin tumours, and acne scars.
well as a gradual crusting and darkening. On day 3 or 4 post-peel, the skin starts to crack and desquamation begins. Full re-epithelisation is usually complete after 5–7 days (Figure 2). A 35% TCA peel can be combined with Jessner’s
solution (resorcinol 14%, lactic acid 14%, and salicylic acid 14% in alcohol), solid CO2
10, or 70% glycolic acid11 .
Deep peels The main indications for deep chemical peels include dyschromia, fine and coarse wrinkles, pre-malignant skin tumours, and acne scars. Deep peeling solutions penetrate to the mid-reticular dermis and create the maximum effect for the production of new collagen. The solutions for deep peels are composed of a combination of croton oil and phenol at different concentrations. Phenol is an aromatic hydrocarbon originally derived from coal tar. Croton oil is an extract of the seed of the plant Croton tiglium, which causes skin vesiculation. Other chemicals in use in deep chemical peel formulae include septisol, water, and vegetable oils (glycerin, olive, sesame)12
. A phenol-based peel is carried out under full
cardiopulmonary monitoring with intravenous hydration throughout the procedure. Intravenous
prime-journal.com | November/December 2012
❚
47
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76