Phenol peels contraindications

The sagging - more pronounced than the photoaging -contraindicate a phenol peel, which would have no effect on this patient. 

Moreover, phenol partially tightens the skin, and it may well be more worthwhile using Aptos threads as a second line of treatment, when the phenol has taken full effect, after at least three months. The presence of threads inserted in the skin several months previously is not a contraindication for a phenol peel, and it is possible to decide on the opposite course of action if the doctor thinks this is a better option for the patient Aptos threads can be inserted first and a phenol peel can be done afterwards. 

Histologically, freckles are characterized by a normal number of melanocytes in the basal layer. The melanocytes are, however, larger and more dendritic , and give up their melanosomes more readily to the keratinocytes. Freckles disappear completely and definitively with phenol. A TCA peel to the papillary dermis will also get rid of freckles. A local phenol peel is contraindicated on light skin phototypes - which in principle are a good indication for phenol - with freckles, as they will disappear where the phenol has been applied and will persist in the surrounding areas. A combination of local Lip Eyelid and Unideep (TCA to the papillary dermis) is suitable to avoid this freckle demarcation Hne. 

Insulin-dependent diabetes is an absolute contraindication to a phenol peel. Diabetes significantly increases the risk of secondary infection the vascular and/or immune disorders associated with this illness mean that complications are more of a probability than a possibility. Stabilized, non-insulin-dependent type 2 diabetes is not an absolute contraindication to a phenol peel. The doctor must take particular care with these patients to avoid secondary infections. 

Active herpes is an absolute contraindication to a phenol peel. A history of herpes is not a contraindication to phenol, but requires treatment to prevent herpes recurring. For more details, see Chapters 32 and 37. 

Monoamine oxidase (MAO) inhibitors are contraindications to the use of the majority of analgesics and psychotropic drugs required for patient comfort. This would make a phenol peel almost unbearable for a patient on MAO inhibitors, who is, by definition, psychologically imstable. 

Being alone is of course not in itself a contraindication to a phenol peel. The dramatic results of a peel could bring couples back together, but a few rules are necessary for the patient s safety. The phenol formulas of today allow patients to remain on their feet the patient can go home almost immediately after a phenol peel. However, it does causes significant edema that can sometimes make it difficult for patients to open their eyes. It is therefore out of the question for a patient who lives alone to go home after the peel. The patient needs help to go about his or her daily life during the first 3 days after the peel. Clinics with hospital beds can keep patients in during the first few days or even the first week after a peel. 

To screen for anemia, an obvious contraindication for a fuU-face phenol peel. 

Adrenaline is contraindicated in cases of diabetes, hyperthyroidism, serious heart arrhythmias and coronary insufficiency or in combination with beta-blockers or monoamine oxidase (MAO) inhibitors. Lidocaine with adrenaline has a very rapid onset of action. Its duration of action is longer than that of lidocaine without adrenaline. However, inadvertent injection of a lidocaine-adrenaline solution into the vessels located near the nerve trunks increases the heart rate (immediate sinus tachycardia at over 130 beats per minute, spontaneously reversible in around 15 minutes) and increases ventricular excitability (risk of fibrillation). It can trigger angina attacks that may lead to a heart attack. It is therefore preferable not to use adrenaline before a full-face phenol peel. 

The high risk of focal or widespread facial necrosis contraindicates a phenol peel immediately after a face-lift. If a face-lift and a deep peel have to be combined, the surgical face-lift must be done first and the chemical peel afterwards to avoid the demarcation line being surgically lifted to the cheek. Caution usually dictates a gap of 6 months between a surgical face-lift and a deep peel. It is of course possible to perform a face-lift without blepharoplasty and a phenol peel around the mouth and eyelids at the same time... 

Trichloroacetic acid (TCA) (Figs. 20.5 and 20.6) The 60% TCA peel has produced similar results in patients in whom phenol is contraindicated or undesired. TCA is a keratocoagulant. TCA may be applied more rapidly than phenol, but it is more likely to produce hypertrophic scarring (Fig. 20.6) [21]. 

If there were a secret to safety, it would lie in a thorough knowledge and understanding of this type of treatment. For doctors to give patients a wide range of choice, they must know how to use at least the three main types of conventional peels correctly alpha-hydroxy acids (AHAs), trichloroacetic acid (TCA) and phenol (for phenol, the doctor should at least know how to apply it locally). For each type of peel, the doctor must be perfectly acquainted with its indications, results, limitations and complications to be able to choose the right product for a given patient and to be able to apply it correctly. The patient should be informed of alternative techniques, their possibilities, contraindications, side-effects and cost. 

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