Choosing the right peel

When choosing a peel, a simple equation should be taken into account the results expected from the peel must be greater than the sum of the fear of the treatment s complexity, the risk of complications, and the downtime and financial cost for the patient. The ratio [Results/(complex-ity + complications -I- downtime -I- cost)] must always be positive. During the preliminary consultation, the doctor should first discuss downtime and treatment cost with the patient, who always expects breathtaking results. It is easier to deal with these two factors first before embarking on the complexity of the technique and the potential risks and 

Solar or senile lentigines respond partially to peels to the Grenz zone and the papillary dermis. They sometimes require a peel to the reticular dermis to get rid of them completely. This deep peeling can be local. 

Stretch marks can only be treated definitively by applying aggressive treatments that can improve the epidermal and dermal atrophy that accompanies them. 

Peels are not indicated for hypertrophic scars. Some fine facial scars (from a face-Kft, for example) improve vastly after local application of some phenol peels others are improved by a combination of abrasion and peeling. Body peels produce fewer results and more problems that facial peels. 

Peels on the backs of the hands are very easy and cause few complications with trichloroacetic acid in the form of Easy TCA . 

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Choosing the right LA agent is also a safety factor, and we will see below why simple lidocaine without adrenaline is the best choice of molecule for a phenol peel, both local and full-face. 

If there were a secret to safety, it would lie in a thorough knowledge and understanding of this type of treatment. For doctors to give patients a wide range of choice, they must know how to use at least the three main types of conventional peels correctly alpha-hydroxy acids (AHAs), trichloroacetic acid (TCA) and phenol (for phenol, the doctor should at least know how to apply it locally). For each type of peel, the doctor must be perfectly acquainted with its indications, results, limitations and complications to be able to choose the right product for a given patient and to be able to apply it correctly. The patient should be informed of alternative techniques, their possibilities, contraindications, side-effects and cost. 

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