Phenol peels demarcation line

With a phenol peel, a demarcation line is left under the jaw that is partially hidden by shadow. A face-lift after a phenol peel could raise this demarcation line to the cheeks any face-lift should therefore be done before a phenol peel. More importantly still, using a phenol peel (or even a deep TCA peek ) at the same time of operation on an area that has just been treated with a surgical lift can potentially cause extensive facial necrosis. The general principle is not to undermine the skin s inner vitality with surgery at the same time as injuring the outer layers of the skin with a peel. In other words a face-lift should not be done on the same day as a full-face deep phenol peel. 

Patients with dark skin should be warned about the demarcation line between the treated and untreated areas, both with a full-face peel and a localized phenol peel. 

Phenol is applied up to the lower limits set before the start of the peel this forms the demarcation line (Figure 34.14). The skin on the neck is structurally different to that on the face it has fewer appendages and pilosebaceous imits. After a deep peel, the skin regenerates from these appendages. A phenol peel on the neck carries an increased risk of scarring. What is more, the usual post-peel facial edema tends to extend downwards to the neck, and if the neck is treated... 

The usual appearance of the skin, 7 days after a phenol peel. The skin is thin, sensitive and red. The demarcation line is particularly visible between the face and the neck. A TCA peel (Easy TCA ) has actually been applied to the neck and decolletage on the 3rd day after the peel and these areas are now flaking (see also Figure 30.8). 

In principle, the texture of their skin makes them good candidates for phenol, as they get wrinkles sooner than darker skin phototypes and do not often suffer from post-inflammatory hyperpigmentation after a medium or deep peel. All the freckles will disappear, however, leaving the skin depigmented and a demarcation line on the neck. Red-haired patients are the ones most at risk of complete... 

It is easy to predict the risk of a visible demarcation line (Figure 37.62). Not coimting the hypopigmenting (with phenol) or hyperpigmenting (with TCA) properties of different peeling agents, the parameters that should be taken into account are the depth of the peel and the patient s skin type. 

Neck demarcation line after 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... 

Figure 15.8 This patient developed a clear line of demarcation following a periocular phenolic peel and a Baker s peel periorally. She preferred the use of make-up to further peeling...

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