Phenol peels

Delayed hypopigmentation is a reason why some doctors dislike the long-term results of deep peels. Hypopigmentation after phenol peels is proportional to the depth of the peel, amount of the solution used, inherent skin color, and post-peel sun-related behavior. Complete avoidance of any sun exposure years after the peel creates ivory skin color. 

Deep Peels Unoccluded or occluded Baker s phenol peel,... 

Trichloroacetic acid and phenol peels (see peel sections) have been used extensively to treat photodamage [60, 61]. However, TCA peels in concentrations above 35% are unpredictable. Albeit efficacious for severe photodamage, phenol peels are associated with myriad side effects [61]. Hence, combination medium-depth peeling agents have become increasingly popu-... 

StuzinJM. 1998. Phenol peeling and the history of phenol peeling. Clin Plast Surg 25 1-19. 

With TCA-SAS, resorcinol, salicylic acid, azelaic acid or phenol peels, the skin needs to be thoroughly cleansed of make-up, degreased and disinfected. Easy TCA solution, on the other hand, contains saponins that make pre-peel make-up removal and degreasing unnecessary the skin s natural defenses are only very slightly diminished by this peel, and therefore there is no need for any particular prepeel preparation against infections. 

There are cosmetic products that have been specially created for application very soon after a peel. They can be used the morning after the first AHA peel, Easy Phytic or Easy TCA . With TCA-SAS, Only Touch or phenol peels, cosmetics usually are not applied until the 8th day after the peel. With Unideep , an anti-oxidant cream (Renutriv ACE Lipoic Complex ) can be applied two days after the peel. 

After a phenol peel the crust of bismuth subgallate appears dry but actually helps healing in a moist environment. 

Localized phenol peels should only be carried out on patients with a skin phototype lower than IV, so that the area treated with phenol is not left lighter than the surrounding skin, even if it has been treated with a medium peel to even out the color. The same applies to patients with many freckles, which mostly disappear after a peel to the papillary dermis. 

The fact that in most cases they cannot use camouflage make-up makes it difticult to carry out a local or full phenol peel. Moreover, phenol peels produce less spectacular results on thick skins than on thin skins. Shaving does not pose a problem, as a peel to the basal layer of the epidermis does not rule out shaving, even with a blade. For a peel to the papillary or reticular dermis, it is best not to shave while the skin is flaking. It is usually possible to shave after the 8th day. Alcohol-based aftershaves should be avoided, and a hydrating, anti-oxidant or firming cream should be used instead, followed by effective sun protection. 

Preventing laryngeal edema in smokers undergoing a 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. 

Peels are not indicated for hypertrophic scars. Some fine facial scars (from a face-Kft, for example) improve vastly after local application of some phenol peels others are improved by a combination of abrasion and peeling. Body peels produce fewer results and more problems that facial peels. 

Lip Eyelid formula was originally developed to treat only the lips and eyelids before its indications were extended to the full face. It can be applied locally without nerve blocks or any kind of anesthetic (see Chapter 36). A TCA Unideep peel (to the papillary dermis) is applied to the rest of the face immediately after the phenol peel has been applied locally (Figure 5.11). The Unideep must not come into contact with the skin that has been treated with phenol. 

Botulinum toxin often has to be used at the same time as a deep peel on patients with thick skins in order to limit the contractions of the orbicular muscle of the Kps and to improve/maintain results. The horizontal fold between the lower Kp and the prominence of the chin does not usuaUy respond weU to peels, even deep ones, ft can easily be filled in, however, together with the nasolabial folds 1-2 months after the phenol peel. 

If the patients in Figures 5.13(a) and 5.14(a) want quick rejuvenation that will last around 15 years, a phenol peel is the only indication (Figures 5.13(b) and 5.14(b)). The extent of the problems would be beyond dermal fillers, and if these were used, the results would be temporary. 

TCA has some effect on shallow scars, but can only improve the general condition of the skin and cannot get rid of scars altogether. TCA can be combined with sandpaper abrasion (see the discussion of abrasive peels in Chapter 15) or scar subcision before the acid is applied. Even a phenol peel cannot always guarantee to heal acne scars. High concentrations of TCA can be directly applied on acne scars, levelly, with good results. 

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. 

AKs and SLs have been improved - sometimes temporarily - by peels to the papillary dermis (see Chapter 23). A full-face phenol peel is the most effective and long-lasting treatment for keratoses and solar lentigines (see Chapter 30). 

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