Deep peels phenol

Medium-depth peel (TCA) 2-3 weeks Deep peel (phenol) 6-8 weeks... 

Following the fundamental work by Gregory Hetter [ii], it is now commonly accepted that at the heart of solutions for deep peeling is a combination of croton oil and phenol. 

Delayed hypopigmentation is a reason why some doctors dislike the long-term results of deep peels. Hypopigmentation after phenol peels is proportional to the depth of the peel, amount of the solution used, inherent skin color, and post-peel sun-related behavior. Complete avoidance of any sun exposure years after the peel creates ivory skin color. 

The main disadvantage of deep peel is the special set up needed for the procedure, due to the potential cardiotoxicity of phenol. In addition, special training is needed for the doctor and the office staff before the implementation of this technique in the daily practice. 

Deep Peels Unoccluded or occluded Baker s phenol peel,... 

Medium and deep peels utilize TCA concentrations of 30-40% or greater or phenol combina-... 

If we leave aside these variables, we can fit the dilferent types of peels into their appropriate slots. This is just for the beauty of the exercise however, as the variables stiU need to be taken into account. It is clearly possible to perform a superficial or medium peel using phenol. But, given the inherent toxicity of phenol, what would be the point What is more, 70% unbuffered glycolic acid that is left for 10-15 minutes on a thin, sensitive skin that has been prepared with retinoic acid can result in a cosmetic disaster. It is possible to carry out good-quality, deep peels with TCA, but the risks can be greater than if phenol is used correctly. 

Botulinum toxin often has to be used at the same time as a deep peel on patients with thick skins in order to limit the contractions of the orbicular muscle of the Kps and to improve/maintain results. The horizontal fold between the lower Kp and the prominence of the chin does not usuaUy respond weU to peels, even deep ones, ft can easily be filled in, however, together with the nasolabial folds 1-2 months after the phenol peel. 

The cells that are most active in skin regeneration after a deep peel are those that are least damaged by the sun s rays, the cells that have undergone the least UV-induced genetic mutation. After a phenol peel, the skin is much healthier than the skin that the acid coagulated, and statistically will develop fewer cancers. Moreover, phenol may well coagulate and get rid of any intraepidermal cancer in situ. 

After a deep peel, the body takes 4-6 weeks" to regenerate a structurally normal skin. During these 6 weeks, the skin appears very red, as the many newly formed blood vessels are showing through an incomplete, thinned and pale epidermis. Six weeks is usually the minimum time that erythema lasts after a phenol peel. After this time, inflammation may persist and the skin can still appear red for several more months. 

Experience of conventional" phenol peels also shows that a small percentage of patients complain of nausea or even vomiting shortly after a deep peel. This nausea and vomiting occur within a few hours after the application of an occlusive mask." The cause-and-effect relationship between these symptoms and excessive phenolemia has not been officially established. 

We have seen above that there is no problem with performing a localized phenol peel at the same time as a surgical face-lift if the two treatments are aimed at different areas. When both treatments are indicated for the whole face, the face-lift should be done first, followed by a rest period of around 6 months before the deep peel (Figure... 

Phenol is applied up to the lower limits set before the start of the peel this forms the demarcation line (Figure 34.14). The skin on the neck is structurally different to that on the face it has fewer appendages and pilosebaceous imits. After a deep peel, the skin regenerates from these appendages. A phenol peel on the neck carries an increased risk of scarring. What is more, the usual post-peel facial edema tends to extend downwards to the neck, and if the neck is treated... 

Asian patients might pose a problem of residual depigmentation with deep peels. Dark Asian skins are treated like black skins. Lighter Asian skins can be treated with deeper peels. Fintsi and Professor Damiano Kim (Korea) applied phenol successfully to light Asian skins. AHAs, Easy Phytic and Easy TCA can be used in all cases. TCA in simple aqueous solution (TCA-SAS) often triggers post-inflammatory hyperpigmentation on Asian skin. Unideep should be used with caution on Asian skin phototypes. 

In principle, the texture of their skin makes them good candidates for phenol, as they get wrinkles sooner than darker skin phototypes and do not often suffer from post-inflammatory hyperpigmentation after a medium or deep peel. All the freckles will disappear, however, leaving the skin depigmented and a demarcation line on the neck. Red-haired patients are the ones most at risk of complete... 

The application protocol recommended with one type of peel formula cannot necessarily be used with another. Nevertheless, although phenol is a deep peel, it... 

Various cosmetic treatments ectropion can occur after deep peels with TCA or phenol and after laser treatment or mechanical abrasion. 

The possibility of using phenol as a more superficial peel has been broached elsewhere in this book. Because of the relatively high risk of toxicity and complications, this agent should only be used for deep peels carried out under strict control. 

The high risk of focal or widespread facial necrosis contraindicates a phenol peel immediately after a face-lift. If a face-lift and a deep peel have to be combined, the surgical face-lift must be done first and the chemical peel afterwards to avoid the demarcation line being surgically lifted to the cheek. Caution usually dictates a gap of 6 months between a surgical face-lift and a deep peel. It is of course possible to perform a face-lift without blepharoplasty and a phenol peel around the mouth and eyelids at the same time... 

---