Peel and heal

At very low speeds of crack propagation through the adhesive joint, to the left of Fig. 34, the peeling and healing curves should coincide. However, it was found experimentally that there was always a gap between the curves, which was small for silicone rubbers but larger for less elastic materials. This gap was defined as the adhesive hysteresis. The equilibrium work of adhesion was somewhere within this gap, around 70 mJ m, but could not be found exactly in this experiment. 

Understanding the skin healing process after a peel allows evaluation of the risks of scarring, infection and dyschromia. For more information on how the skin heals in relation to the depth of the peel and on risk evaluation, see the section on scars in Chapter 37. 

The directions for use of TCA Cream Peel tell us that, thanks to chelation, not only is this peel as deep and smooth (sic) as regular TCA but also that it uses much milder concentrations (the stakes are being raised) and so there is less pain and stinging and healing is faster. Is chelation the ultimate answer for TCA The Holy Grail of the peeler ... 

At the end of treatment, the doctor can apply a corticosteroid cream to the lesions treated with OT to limit the inflammatory reaction. This application should not be repeated imtil after more than 72 hours. Between peels and for at least 6 weeks after the last peel, the patient should apply effective sim protection " 3 times a day after Blending Bleaching cream. The patient should be warned not to touch or pull off the scabs these are normal and to be expected (Figure 22.13). Vaseline can be applied to the scabs to enhance healing. 

The post-peel mask cream should be applied twice 50% immediately after the peel and the remaining 50% the morning of the first day after the peel. It stimulates the skin and breaks the vicious oxidative circle inflammation free radicals , and accelerates healing time. It also helps to limit the vicious inflammatory circle that follows any medium-depth peel and coimters post-peel pigmentary changes. 

Poor application technique can lead to inadequate results. The technique should be corrected and Lip Eyelid should be reapplied after 6 weeks. The second peel will heal more quickly than the first. 

It is noted that the residual tensile strength depends primarily on the strength of the thermoplastic particles and the thickness of the thermoplastic layer within the narrowed crack. The reason is that the molten thermoplastic forms a thin film in the narrowed crack under the recovery pressure by the SMPFs, similar to the adhesive layer in an adhesively bonded joint (here the fractured two half beams serve as the adherends). It has been well demonstrated that the tensile and shear resistance of adhesively bonded joints highly depends on the adhesive thickness. A thinner adhesive layer usually leads to higher peel and shear resistance [28-32]. This is one reason why a 100% pre-strained SMPF leads to a higher healing efficiency because... 

This theory presumes that the crack can also heal at the same force. In practice, the force has to be sUghUy reduced for healing to be seem. For the most perfect elastic system, there is a force which can be suspended on the film whereby the aack does not know whether to peel or heal. The crack is essentially in thermodynamic equilibrium in which a slight increase in force will cause separation, and a slight decrease wiU cause healing. This is the situation to which the peel equation F = Wb can be applied. 

Combined with topical therapy (5% ascorbic acid), results were superior compared to TC A alone in treating epidermal melasma [136]. TCA 35% applied in conjunction with GA or Jessner s solution achieves a midlevel peel, with healing time between 7 and 10 days [9,25]. 

The foundation of an effective chemical peel is skin preparation. This begins in the weeks leading up to the peel, and also includes the actual preoperative steps before the peel. With adequate priming, the skin will frost rapidly and more uniformly than unprimed skin. TCA in particular is usually applied expeditiously to rninirnize discomfort a more rapid and complete frost will enhance the patient s experience. Although relatively uncommon, adverse effects such as hypo- or hyperpigmentation, delayed reepitheUaUzation and prolonged erythema may also be minimized because skip areas are usually minimized as well. Finally, the postoperative phase can be shortened as a result of more rapid healing in primed skin. 

These lesions can be treated singly with a 70% glycolic acid peel solution until epidermolysis occurs. The areas treated will then scab and peel within 7 days and heal easily. Topical antibiotic ointments or Vaseline or petrolatum jelly should be used in an effort to keep the skin moist. 

All Tretinoin 0.02-0.1% cream Nightly preferably at least 14 days before peel Promotes uniform peel and accelerates healing... 

The healing process after a chemical peel must be as rapid as possible so as to avoid infections. While uncommon, infections may deepen the wounds irregularly, converting an anticipated superficial peel into a deep peel and increasing the chance of scarring. If excessive crusting occurs, topical and/or oral antibiotics should be prescribed to treat presumed bacterial infection. 

This consequence is fairly common after chemical peels and usually appears immediately after reepithelialization. Its etiology is multifactorial and is related to either exacerbation of previously existing acne or occlusion resulting from emollients being applied to healing skin. Treatment... 

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