Peeling combination peel

The cured polymers are hard, clear, and glassy thermoplastic resins with high tensile strengths. The polymers, because of their highly polar stmcture, exhibit excellent adhesion to a wide variety of substrate combinations. They tend to be somewhat britde and have only low to moderate impact and peel strengths. The addition of fillers such as poly (methyl methacrylate) (PMMA) reduces the brittleness somewhat. Newer formulations are now available that contain dissolved elastomeric materials of various types. These mbber-modifted products have been found to offer adhesive bonds of considerably improved toughness (3,4). 

Thin coatings contain in general many polar groups that promote adhesion. Low polar or nonpolar thick coatings (e.g., PE) are usually combined with polar adhesives to achieve the necessary bond strength against peeling. 

Combinations peels salicylic acid + trichloracetic acid... 

Gladstone HB, Nguyen SL, Williams R, Ottomeyer T, Wortzman M, Jeffers M, Moy RL (2000) Efficacy of hydroquinone cream (USP 4%) used alone or in combination with salicylic acid peels in improving photodamage on the neck and upper chest. Dermatol Surg 26(4) 333-337... 

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

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. 

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

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. 

Results of a combination of phenol-based peel with abrasion and subcision are shown below (Figs. 9.9,9.10,9.11,9.12,9.13,9.14 and 9.15). 

Fig. 9.11. A 44-year-old patient with rolling acne scars before (a) and 3 months after (b) deep chemical peel combined with subcision and dermabrasion...

Ayhan S, Baran CN, Yavuzer R, Latifoglu O, Ceneto-glu S, Baran NK (1998) Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face. Plast Reconstr Surg 102(4) 1238-1246... 

Horton CE, Sadove RC (1987) Refinements in combined chemical peel and simultaneous abrasion of the face. Ann Plast Surg 19(6) 504-511... 

In 2002, Grimes reported the efficacy of combination salicylic acid/TCA 10% peeling [1]. She treated patients with moderate to severe melasma with this combination regimen. In the series, nine patients were classified as Fitzpatrick skin type IV, eleven were skin type V, and seven were skin type VI. Many of the subjects included in the study had not responded to salicylic acid or glycolic acid peels. The concentration of salicylic acid was 20 and 30%, and the TCA concentration was 10%. A series of four peels was performed at 2-week intervals. Thirty percent of the patients experienced moderate improve-... 

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