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ARTICLE | NON-INVASIVE REJUVENATION |


sunscreens. The erythema gradually subsides over a period of approximately 2 months. During this time, make-up with a green foundation is encouraged to allow the patient to resume all daily activities. In cases of olive-skinned patients, the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. Deep peels are considered to be the most powerful


non-surgical method for facial skin rejuvenation, and the term a ‘non-surgical face lift’ has been coined to describe this procedure (Figure 3).


sedation or regional blocks make the procedure


pain-free. For application of the peeling solution, cotton-tipped applicators are used. The usual end-point is an ivory–white to gray–white colour of the skin. Immediately after the face is covered with the solution, waterproof zinc oxide non-permeable tape is applied to the skin. After 24 hours, the tape mask is removed and the skin exudate is cleaned using sterile saline. The face is covered with bismuth subgalate antiseptic powder for 7 days. Other options include occlusive moisturisers, antibiotic ointments, and biosynthetic occlusive dressings. After the skin has achieved a full re-epithelisation, the powder mask is removed (usually at 8 days post-peel) and the patient is advised to use water-based lotion creams and potent broad-spectrum


References


1. American Society of Plastic Surgeons. 2011 Plastic Surgery Procedural Statistics. http://tinyurl.com/ cte8b4v (accessed 5November 2012)


2. Cosmetic Plastic Surgery Research. 2010 National Totals for Cosmetic Procedures. http://tinyurl.com/ caj7g94 (accessed 5November 2012)


3. Larson DL, Flugstad NA, O’Connor E, Kluesner EA, Plaza JA. Does systemic isotretinoin inhibit healing in a porcine model? Aesthet Surg J 2012; 32(8): 989–98


4. Ditre CM, Griffin TD, Murphy GF et al. Effects of alpha hydroxyl acids on photoaged skin: a pilot clinical, histologic and ultrastructural study. J Am Acad Dermatol 1996; 34(2 Pt 1): 187–95


5. Kakita LS, Petratos MA. The use of glycolic acid in Asian and darker skin types. J Geriat Dermatol 1996; 4: 8–11


6. Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg 1999; 25(1): 18–22


7. Lee HS, Kim IH. Salicylic acid peels for the treatment Key points


■ Chemical peeling is a procedure used for the cosmetic improvement of the skin or for the treatment of some medical skin disorders. A chemical exfoliating agent is applied to the skin to destruct specific portions with the


48 ❚


subsequent regeneration and rejuvenation of its components


■ Chemical peels are divided into three categories depending on the depth of the wound created by the peel: superficial, medium or deep


■ 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


■ Deep peels are considered to be the most powerful non-surgical method for facial skin rejuvenation, and the term ‘non-surgical face lift’ has been coined to describe this procedure


of acne vulgaris in Asian patients. Dermatol Surg 2003; 29(12): 1196–9


8. Brubacher JR, Hoffman RS. Salicylism from topical salicylates: review of the literature. J Toxicol Clin Toxicol 1996; 34(4): 431–6


9. Monheit GD. The Jessner’s-trichloroacetic acid peel. An enhanced medium-depth chemical peel. Dermatol Clin 1995; 13(2): 277–83


10. Brody HJ, Hailey CW. Medium-depth chemical peeling of the skin: a variation of superficial chemosurgery. J Dermatol Surg Oncol 1986; 12(12): 1268–75


11. Coleman WP 3rd, Futrell JM. The glycolic acid trichloroacetic acid peel. J Dermatol Surg Oncol 1994; 20(1): 76–80


12. Hetter GP. An examination of the phenol-croton oil peel: Part I. Dissecting the formula. Plast Reconstr Surg 2000; 105(1): 227–39


13. Landau M. Cardiac complications in deep chemical peels. Dermatol Surg 2007; 33(2): 190–3


Figure 3 A patient (A) before and (B) 3 months after one deep peel treatment (‘non-surgical face lift’)


Complications Despite a deep understanding of the procedure and its meticulous performance, complications may still occur. The risk of potential complications increases with wound peeling depth and includes the following: pigmentary changes (hyper- and hypopigmentation), scarring, infection, pruritus, textural changes, milia, and acneiform eruptions. All are treatable if a patient is followed-up closely until full skin rehabilitation The most important potential complication of phenol-based peels is cardiotoxicity13


. No hepatorenal or central nervous


system toxicities have been reported in the literature following the use of deep peels. The incidence of cardiac arrhythmia is approximately 6% and it is successfully managed if a peel is carried out under the correct conditions.


Conclusions Chemical peels provide a diverse, powerful, yet inexpensive tool for the medical and aesthetic practice. The spectrum of conditions with potential to benefit from the peeling procedure is extremely broad. Chemical peels can be combined with other procedures, such as surgery, dermal fillers and toxins.


 Declaration of interest None  Figure images 1–3 ©Dr Marina Landau


 For those who are interested to learn more about chemical peels, contact the International Peeling Society: contact@peelingsociety.com


November/December 2012 | prime-journal.com


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