Phenol peels face-lift

With a phenol peel, a demarcation line is left under the jaw that is partially hidden by shadow. A face-lift after a phenol peel could raise this demarcation line to the cheeks any face-lift should therefore be done before a phenol peel. More importantly still, using a phenol peel (or even a deep TCA peek ) at the same time of operation on an area that has just been treated with a surgical lift can potentially cause extensive facial necrosis. The general principle is not to undermine the skin s inner vitality with surgery at the same time as injuring the outer layers of the skin with a peel. In other words a face-lift should not be done on the same day as a full-face deep phenol peel. 

Sagging skin only responds to a phenol peel and only if the skin is relatively thin. Peels are not indicated for sagging in thick skins or for nasolabial folds. Chemical peels cannot compete with surgical face-lifts they cannot stretch the skin as well as the latter do. 

Along with laser and abrasion treatment, a full-face phenol peel is certainly one of the best options for treating facial scars. It is not completely effective, however, and it is often necessary to use chemabrasion - that is, a combination of a phenol peel followed (immediately or the next day) by abrasion with a diamond fraise or sandpaper. See Chapter 30 for more information on the treatment of acne scars and phenol peel face lifts. 

A patient 8 years after a full-face phenol peel the quality of the skin has remained much improved, but the wrinkles and sagging did not really benefit from the peel. A face-lift would be indicated for this patient. 

The patient in Figure 29.9 is a typical case where the facial photoaging would benefit far more from a full-face phenol peel than from a neck- and face-lift. Nevertheless, phenol, with difficulty, tightens and rejuvenates the neck, which will only benefit from surgery followed by a peel to the papillary dermis or several peels to the Grenz zone (with ETCA) to improve the quality and the color of the skin after the surgical face-lift. 

When the wrinkles are on the eyelids and around the mouth, the problem is therefore easily solved. In the case of sagging and wrinkled skin, it is clear that the best results can be achieved with a combination of treatments that should be carried out at different times (see below). The large majority of patients are in this situation, and the degree of facial ptosis will be the deciding factor in whether to suggest a face-lift or a phenol peel. 

Phenol peel combined with a surgical face-lift... 

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... 

Normal face-lift scars are not usually too unsightly, but some patients want a treatment to soften them or get rid of them completely. A full-face phenol peel is the best option (Figure 30.19), but a local application of phenol precisely on the scar is also a possibility, in combination with another more superficial peel (to the papillary dermis, the Grenz zone or the basal layer). Standard scars from an upper blepharoplasty do not seem to respond as well to a... 

Clinically, it was reasonable to investigate the problem with her. Apart from surgery, what treatment options were there to lift the curtain of the upper eyelids After a quick look at the question, a peel seemed to be the only option. Alpha-hydroxy acids (AHAs) were ruled out immediately because of the risks involved and the fact that they are ineffective on the eyelids. Trichloroacetic acid (TCA) was ruled out, as the high concentrations needed to get the skin to retract would be dangerous and in any event ineffective. There was therefore only one option left phenol. I have not encountered many problems with regular use of full-face phenol peels and, on the contrary, have found them to be very successful. The results achieved locally on the eyelids have often been remarkable (Figure 36.2). 

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... 

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