Frosting phenol peels

All the colors associated with a phenol peel can be seen here. The chin has pure white frosting just after the phenol has been applied. The cheeks have gray-white frosting after the same amount of phenol as applied on the chin has penetrated more deeply. The forehead is a pink color, where the frosting is fading, with patches of buff yellow. 

Phenol peels are always accompanied by severe erythema (Figures 37.14 and 37.15). The erythema appears immediately around the edges of the frosting caused by the phenol and can then be seen on all of the treated area, as soon as the frosting fades. This immediate erythema results from inflammatory vasodilation that follows chemical injury and is normal. After 24 hours, the patient appears severely burnt, as can be seen in Figure 37.14. The classical phenol formulas often cause erythema that last more than 3 months, or sometimes even several years. It can be permanent (in some rare cases). Lip Eyelid causes erythema that lasts 1-3 months on average. 

Gray frosting and/or yellowish patches (phenol) deep reticular dermis TCA should no longer be used for peels to the deep reticular dermis... 

Around 3 ml of solution is applied on the skin in successive coats to complete a full-face peel in over an hour. The endpoint is the appearance of an even gray-white frosting (see below). An assistant constantly sponges away any small reflex tears with a cotton ball or make-up remover pad, which is thrown away and replaced after each use to make sure that the next time the eyes are wiped, no phenol is carried into them with the tears that have just been sponged away. Any touch-ups can be done the next day on the same patient with the solution left in the bottle. Even though a phenol solution is antiseptic, it is out of the question to use this remaining solution on any other patient. 

An intraepidermal peel is characterized by the following symptoms erythema without frosting after an AHA peel or erythema and maybe some pinpoint frosting after a TCA peel. Phenol is not indicated for this depth of action. 

A peel to the basal layer (Figure 37.22) is characterized by erythema and the appearance of pinpoint frosting after TCA or generalized erythema after AHAs. Phenol is not indicated for this depth of peel. 

Phenol is the ideal agent for a peel to the reticular dermis. The following signs indicate that the peel has reached the reticular dermis even, pure white or gray-white frosting. 

A localized Litton or Baker-Gordon peel can be carried out with short-acting nerve blocks with 2% lidocaine without adrenaline (epinephrine). The pain is also short-lived. Phenol provides anesthesia that extends about 1 cm beyond the frosting, and the phenol can be applied slowly, step by step. 

Last peel session if the lentigines have not completely disappeared. Only Touch is reapplied locally. A fourth Easy TCA is then applied to the Grenz zone (cloudy-white frosting), except for the area treated with phenol. 

Graph representing the way to associate different types of peelings and the period for repeating these peelings. A local phenol is first applied (on the upper lid for example). Immediately after, Only Touch treats lentigines. When local frosting due to the deep TCA (Only Touch ) is perfect, Easy TCA is applied on the whole face, but not on the phenol treated area. 

Based on quantifiably reproducible experimental test peel patch studies on the right cheek and, later, left cheek test peel patches (reported below), using 48% phenol with 0.0% croton oil, 35% phenol with 0.4% croton oil, 35% phenol with 2.2% croton oil, and 35% phenol with 0.0% croton oil (see Fig. 8.1), a lowering of the threshold affect to create injury (Fig. 8.2) to between 5 and 20 rubs can be seen when croton oil is added. This is down from the 20 to 50 rubs required when croton oil is excluded. The early appearance of coagulation is not a true indicator of depth of peel, nor is the immediate density of frost as evidenced by the reported superficial results from 88% USP Phenol which can produce an immediate, dense, white frost. The length of time a given formula is applied, the concentration of phenol and croton oil, the volume of acid, the vigor and abrasiveness of the application and... 

Further application of TCA or phenol will penetrate the reticular dermis. We recommend caution with performing peels to this level. At this point the solid frost begins to take on a gray color. This is the maximum recommended depth for TCA peels. As with all resurfacing modalities that reach this depth, there is an increased incidence of scarring and hypopigmentation. 

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