Peeling medium

Microdermabrasion Superficial chemical peeling Medium-depth peeling Deep peeling Ablative laser resurfacing Nonablative laser resurfacing Radio frequency therapy Facial lifting procedures... 

Very light peel Medium light peel Medium heavy peel Heavy peel... 

As in the superficial peel, medium-depth peel solution is compounded using a weight/volume method. A concentration of 35% should be prepared as described above (see Making up the solution). Combination peels are those using solid CO2 ice plus 35% TCA (Brody combination), Jessner s solution plus 35% TCA (Monheit combination), or 70% glycolic acid and 35% TCA (Coleman combination). These peels will be discussed in greater detail later. 

Light peel Medium peel Deep peel... 

Used directly in lubricating clarification in a "blotter press", it acts much the same manner as the paper pads, but is much thinner and is not reused. As a precoat, paper protects the filter medium from slimy fines it may be peeled off and discarded after clogging, leaving the medium underneath clean. 

Glycolic acid can be applied simultaneously with TCA, which represents another technique for a medium-depth peel. Glycolic acid is also used in creams for self-treatment. Since complications such as hyperpigmentation, infection, irritation, and photosensitivity are very rare, it is well tolerated. 

Monheit GD (1989) Jessner s + TCA peel a medium depth chemical peel. J Dermatol Surg Oncol 15 ... 

Rubin MG (1995) Manual of chemical peels superficial and medium depth. J.B. Lippincott Company, Philadelphia, pp79-88... 

Fig. 7.ia-c. Medium depth chemical peel for widespread lentigines in type 11 skin, (a) Pre-operative, (b) 10 days status post medium depth chemical peel, (c) One month status post medium depth chemical peel... 

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. 

TCA in concentration of 10-25% can be used safely for superficial depth peels and in concentrations >30% can be used for medium-depth peels. However, multiple coats of even the lower concentrations of TCA can result in a deeper penetration of this agent, thus essentially resulting in a medium-depth peel. In general, use of TCA in concentrations >40% is not recom-... 

Koppel RA, Coleman KM, Coleman WP (2000) The efficacy of EMLA versus ELA-Max for pain relief in medium-depth chemical peeling a clinical and histopathologic evaluation. Dermatol Surg 26 61-64 Brody HJ (2001) Complications of chemical resurfacing. Dermatol Clin 3 427-437... 

Phenol-based peel can be performed as a full-face or partial procedure. If only one cosmetic unit is peeled with phenol-based solution, it is strongly recommended to perform medium depth peel on the rest of the facial skin. Full-face peels should be carried out under full cardiopulmonary monitoring with intravenous... 

Al-Waiz MM, Al- Sharqi AI (2002) Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg 28 383-387... 

Trichloroacetic Acid (TCA) causes precipitation of proteins and coagulative necrosis of epidermal cells [4]. The extent of damage is indeed concentration dependent. Concentrations range from 10 to 50%. Superficial TCA peeling is induced by concentrations of 10-30% whereas higher concentrations cause medium depth or deep peeling. The combination of salicylic acid followed by TCA 10-15% induces superficial wounding. 

Medium depth chemical peels 35% trichloracetic acid,50-70% pyruvic acid [7]... 

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