Deep Chemical Peels

Glycolic acid Jessner s solution Pyruvic acid Resorcinol Salicylic acid Trichloracetic acid Deep chemical peels... 

Since deep chemical peels are based on phenol-containing solutions, it seems that the history of this procedure starts at the moment of car-... 

Other chemicals in use in deep chemical peel formulas include septisol, water, and vegetable oils (glycerin, olive, sesame). 

The main indications for deep chemical peel include dyschromia, wrinkles, premalignant skin tumors, and acne scars. 

Originally, the ideal patient for deep chemical peel was a blond, blue-eyed woman of fair complexion. Our experience shows that phenol-based peels can be safely performed on olive- and dark-skinned patients with dark eyes... 

Fig.8.4 a,b. Idear candidate for deep chemical peeling middle-aged fair-skinned woman with blue eyes and blond hair and photodamage-induced wrinkling before (a) and after (b) deep chemical peel... 

Fig. 8.4c, d Dark-skinned women are also possible candidates for deep chemical peels. Note the accentuation of intradermal nevus next to the left ala nasi following the peel (d)... 

It is still debatable whether preparation of the skin is required for deep chemical peeling. We feel that topical retin A preparations used daily for 3-6 weeks prior to the procedure may create better and more even penetration of the peeling solution in sebaceous and hyperkeratotic skins. We did not find any benefit of this regimen in thin-skinned patients. 

Fig. 8.14. a Sixty-eight-old-year woman with idiopathic thrombocytopenia that prevented any cosmetic surgical intervention, b One year after the performance of deep chemical peeling... 

Acneiform eruption after deep chemical peel is a common phenomenon appearing immediately after reepithelialization. Its etiology is multifactorial and is related to either exacerbation of previously existing acne or is due to over-greasing of newly formed skin. Short-term systemic antibiotics together with discontinuation of any oily preparations will usually provide satisfactory solution. 

Deep Chemical Peels for Post-acne Scarring... 

The full description of the deep chemical peel procedure is found in Chapter 8. Before the peeling, the subcision (subcutaneous incision) technique is used to free the fibrous bands from the base of the scars. For this purpose we use an i8-gauge 1.5-inch NoKor Admix needle (Becton Dickinson and Co). This needle has a triangular tip similar to No. 11 blade (Fig. 9.5). it allows smooth separation of fibrous cords. The needle is inserted through a skin surface, and its sharp edges are maneuvered under the defect to make subcutaneous cuts or incisions. The depression... 

Combination of deep chemical peel with other minor surgical procedures such as punch excision, elevation and subcision provides a possibility to tailor an effective treatment for each person. 

Fig. 9.9. A 52-year-old patient with boxcar acne scars before (a) and 1 month after (b) deep chemical peel and skin abrasion...

---