Phenol peels formulae

Various phenol peel formulas can be found on the market that boast of the possibilities of doing a full-face peel without anesthetic . In some cases, this means without general anesthetic and in others the patient is put on strong analgesics, sedation and premedication. Some low-dose phenol peels (around 30%) are no more painful than a trichloroacetic acid to the papillary dermis, but they are not much more effective either. 

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. 

Lip Eyelid formula is a phenol peel that I first developed to increase dermatological safety and to achieve results without any occlusion on the sensitive skin of the eyelids. The same solution was then applied to the wrinkles around the mouth and then to the whole face, but with 24 hours occlusion in these two indications. It is an oil solution of phenol at over 60%. Four different oils are used in the various stages of the product s preparation. The aim of the oily formulation is to slow down the penetration of the phenol through the skin and to improve dermal and epidermal maceration. It limits the toxicity of phenol by saturating the biochemical hepatic detoxification pathways more slowly. 

The qualitative formulas of recent products are known, but the percentages and preparation methods are not revealed. Fintsi explained that adjuvanted and tamed phenol peels must be prepared according to a precise method and that he was afraid that if he revealed the exact proportions of the ingredients, doctors would try to make up the formula themselves without keeping to the necessarily strict order of preparation, and that this could lead to disastrous results. 

The changes described above last a long time. In histological sections taken 15 years after a phenol peel (Baker s formula) the difference between the treated and non-treated skin is incredible, and this explains why, most of the time, only one phenol peel is necessary for long-lasting rejuvenation of the face. 

During a full-face phenol peel, 2.5-5 ml of phenol solution is usually applied on the skin. The conventional formulas (Litton and Baker) use concentrations of around 50%. Applying 3-4 cm of solution therefore leaves 1.5-2 g of phenol on the skin. It is important to be aware of the fact that the toxicity of phenol solutions appears to be paradoxical, as, up to a certain point, diluted solutions can be more toxic than concentrated ones. Publications report that simple aqueous dilutions of 2 parts phenol to 1 part water (i.e. solutions with a concentration of around 33% ) are usually the most dangerous. Some phenol peel formulations still use this concentration, however, confusing speed of penetration with cosmetic effectiveness. 

Truppmann and Ellenby routinely used cardiac monitoring when doing phenol peels, and detected many arrhythmias. In 1979, they published the results of a study on 48 patients treated with phenol peels. Saponified and non-saponified Baker or Litton formulas were studied. They report that 23% of patients treated with phenol showed arrhythmia, on average 17.5 minutes after the phenol was first applied. These arrhythmias were often premature ventricular (Figure 28.3) or supraventricular contractions, bigeminy, or supraventricular (Figure 28.2) or ventricular tachycardias (Figure 28.7). Tachycardia, which in extreme cases can sometimes reach 220—230 beats per minute, can turn into ventricular fibrillation and lead to cardiac arrest. 

Rejuvenation of the eyes (a) before (b) 30 days after a full-face phenol peel (Lip Eyelid formula). 

Before (a) and after (b) a full-face phenol peel (Lip Eyelid formula) a combination of yellow skin, wrinkles, fine lines and lentigines in a patient who smokes. Thirty days after the peel the erythema is normal. The patient is not wearing any make-up. Botulinum toxin was injected 8 days before the peel (forehead, frown lines and crow s feet). 

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. 

Many phenol peel techniques require skin preparation before the peel to ensure that penetration is even and to reduce complications (see Chapter 2). No specific preparation is necessary before Lip Eyelid formula. 

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. 

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. 

Histological sections taken after phenol peels show that melanocytes are still present, though many of them are inactive. Clinically, fewer melanocytes are rendered inactive with the latest formulas (e.g. Lip EyeHd ). This means that long-term prognosis for sun exposure can be better with these peels than with older phenol formulations and that a few months or even a year after the peel, it is often difficult to see a demarcation Hne. The melanocyte toxicity of phenol means the practitioner must choose the product most suited to the patient s complexion. 

Phenol peels are always accompanied by severe erythema (Figures 37.14 and 37.15). The erythema appears immediately around the edges of the frosting caused by the phenol and can then be seen on all of the treated area, as soon as the frosting fades. This immediate erythema results from inflammatory vasodilation that follows chemical injury and is normal. After 24 hours, the patient appears severely burnt, as can be seen in Figure 37.14. The classical phenol formulas often cause erythema that last more than 3 months, or sometimes even several years. It can be permanent (in some rare cases). Lip Eyelid causes erythema that lasts 1-3 months on average. 

The application protocol recommended with one type of peel formula cannot necessarily be used with another. Nevertheless, although phenol is a deep peel, it... 

Recently, some phenol formulas have been presented as allowing a full-face peel without any anesthetic. A phenol peel that can be applied to the whole face without any type of anesthetic is a more superficial phenol peel that does not induce regeneration of the reticular dermis of the same quality as the classic phenol peels. Less pain goes hand in hand with inadequate results the results of this type of phenol peel are the same as for a TCA peel to the papillary dermis and may not have much effect on wrinkles. The pain caused by these peels is also the same as for a TCA peel to the papillary dermis. It is pointless to put a patient through the risks of phenol toxicity only to get the results that a simple, non-toxic molecule (TCA) can achieve. An effective, full-face phenol peel should therefore be used with an anesthetic (see Chapter 33). 

Hetter [285] noted that the addition of croton oil converts a 50 % phenol solution from a superficial peeling agent to a deep peeling formula, causing an injury of a wholly different magnitude [285]. In the same patient, he showed that 18 % phenol had a nunimal effect, 35 % phenol caused mild keratosis but no dermal effect, 50 % phenol caused some desquamation and perhaps a mild dermal effect, 88 % phenol caused an obvious upper dermal effect with healing in 4-5 days, and the addition of 0.7-2.1 % croton oil to 50 % phenol caused a profound dermal effect with healing in 7-11 days [285]. 

---