Phenol peels application

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. 

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. 

Moderate (tame) its systemic toxicity. Different substances have been combined with phenol to reduce its adverse effects. It should be noted that the only demonstrated way to avoid cardiac toxicity lies in the application technique for a full-face phenol peel. 

Experience of conventional" phenol peels also shows that a small percentage of patients complain of nausea or even vomiting shortly after a deep peel. This nausea and vomiting occur within a few hours after the application of an occlusive mask." The cause-and-effect relationship between these symptoms and excessive phenolemia has not been officially established. 

Normal face-lift scars are not usually too unsightly, but some patients want a treatment to soften them or get rid of them completely. A full-face phenol peel is the best option (Figure 30.19), but a local application of phenol precisely on the scar is also a possibility, in combination with another more superficial peel (to the papillary dermis, the Grenz zone or the basal layer). Standard scars from an upper blepharoplasty do not seem to respond as well to a... 

Another less well-knovm indication for a phenol peel is the treatment of generalized verrucous epidermal nevi, a disorder that can be associated with a certain number of bone, ophthalmic or neurological malformations. Treatment consists in shave excision of the lesions followed by an application of phenol to the hyperpigmented areas of the face. ... 

The preparation procedure for a local phenol peel has some aspects in common with those for a full-face phenol peel -however, a local application of phenol is far easier. 

Unlike a local application of phenol, a full-face phenol peel cannot be done without anesthetic There are several different possibilities. 

The use of cotton balls is not advised, as they are not easy to handle in delicate areas such as the eyelids and also because of the risk of runs. Cotton buds are not suitable for large surface areas, as they do not allow even application. In a very localized phenol peel (i.e. eyelids or upper lip), however, phenol is applied with a single cotton bud, as it is more precise and uses up less of the product. The applicator should only ever be used once. 

End of application of the phenol peel. Occlusion dressing is nearly complete. 

Chapter 33 is devoted to the details of anesthesia for a phenol peel. Lip Eyelid formula can be applied without any anesthetic on small areas, however. Patients feel an intense burning sensation a few seconds after application. They will have been told that the burning sensation only lasts for 15 seconds and that they can have a nerve block if they want. Vocal anesthesia plays an important part, and the patient can take a paracetamol (acetaminophen) plus codeine tablet 1 hour before the treatment. Nerve blocks are often used to increase patient comfort 2% Hdocaine without adrenaline (epinephrine) is used, and its duration of action is sufficient. The patient should be given paracetamol plus codeine tablets for the post-peel pain, which is inevitable during the first 24 hours because of the severity and rapidity of inflammation caused by the peel. 

Lip Eyelid is one of the safest phenol peels on the market, but incorrect application can lead to the usual local side effects of chemical peels. 

Phenol (Lip Eyelicf formula) if a full-face phenol peel does not produce adequate results, a second peel can be applied to the areas that did not respond to the first peel. The touch-up can be localized or full-face, if the condition of the skin permits and if there has been a long rest period. Skin regeneration after the second peel is much quicker, there is less edema and post-peel erythema is of a much shorter duration (2 weeks at the most). If a third phenol peel were indicated (in extremely rare cases of very thick skin, patients who smoke, or rapid resumption of facial expressions), it would most often be localized. The author has only once had to do a third phenol peel on the lip and cheek area after inadequate results on skin that was extremely oily and thick. Recovery was even faster after a third application of phenol and there was hardly any erythema. It should be noted that if a second phenol peel can boost inadequate results, a third phenol peel only brings a very slight improvement over the second. 

First session combined peels application of Lip 8c Eyelid formula (occlusive protocol) on the upper lip, immediately followed by an application of Only Touch peel on the lentigines. Next, Easy TCA is applied to the whole face, except for the area treated with phenol. 

A porcine animal model of 40 different phenol-croton oil, hexachlorophene foam, and ethyl alcohol preparations noted that when any amount of croton oil was added, there was a more brisk inflanunatory response than when croton oil was not added [312]. Phenol peels were found to be deeper with increasing concentrations and with inCTeasing concentrations of croton oil, and multiple applications of phe-nol/croton oil increased the depth of the peel in this animal model [312]. 

Figure 8.3 African-American with truncal congenital Becker nevus treated with one formula (Stone II 60% phenol, 0.2% croton oil) over twelve test patches, six In each of two rows. (A) Immediately after peel applications (from left to right) of 1, 5, 10, 20, 50, and 100 rubs (B) top row covered with waterproof tape, bottom row covered with Aquaphor ointment (C) at 48 hours tape removed, thymol Iodide powder applied. Threshold effect between 10 and 20 rubs seen at 10 days (D) and 73 days (E) post peel...

The most oommon systemic effect seen with phenol peeling is oardiotoxicity. The majority of phenol is absorbed within the first 30 minutes of its application. 

Phenol is toxic when used in high doses. Phenol is metabolized in the liver and excreted by the kidneys. Although it has the potential to cause hepatorenal toxicity, this is not usually seen in chemical peels because the dose absorbed is not high enough. The most common systemic effect seen with phenol peeling is cardiotoxicity. The majority of phenol is absorbed within the first 30 minutes of its application. Thus, higher doses over a short amount of time are more likely to have systemic effects. The toxicity produces arrhythmias despite prior normal heart function. The occurrence of these arrhythmias is not... 

After application of peeling solution, there is a quick absorption of phenol from the skin surface to the circulation [18]. Seventy-five percent of phenol is excreted directly through kidney or detoxified by liver. The other 25% is metabolized to CO and water. 

Therefore, full-face phenol-based peel should always be performed under full cardiopulmonary monitoring. The average lag time for the onset of the arrhythmias was 17.5 min from the beginning of the peel, and they are usually not delayed for more than 30 min after the peel. Cardiac arrhythmias are more common while applying the solution on the thin skin of eyelids. In this area skin absorption is maximal therefore, application should be performed extremely cautiously. If arrhythmia occurs, the application of phenol should be stopped until... 

Stone PA, Lefer LG (2001) Modified phenol chemical face peels recognizing the role of application technique. Clin Facial Plast Surg 9 351-376... 

Wexler MR, Halon DA, Teitelbaum A, et al (1984) The prevention of cardiac arrhythmias produced in an animal model by topical application of a phenol preparation in common use for face peeling. Plast Recontsr Surg 73 595-598... 

In cases of patients with olive skin (Fitzpatrick Results of phenol-based peels for various inskin type 3 or 4), the application of Kligman dications are shown in Figs. 8.11,8.12,8.13, 8.14 preparation is recommended to prevent reac- and 8.15. tive hyperpigmentation. 

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