Phenol peels indications

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. 

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. 

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. 

A phenol peel is mainly indicated to treat facial skin for severe photoaging. It is the only type of peel that can get rid of deep wrinkles and regenerate elasticity and firmness in... 

A patient 8 years after a full-face phenol peel the quality of the skin has remained much improved, but the wrinkles and sagging did not really benefit from the peel. A face-lift would be indicated for this patient. 

We have seen above that there is no problem with performing a localized phenol peel at the same time as a surgical face-lift if the two treatments are aimed at different areas. When both treatments are indicated for the whole face, the face-lift should be done first, followed by a rest period of around 6 months before the deep peel (Figure... 

A phenol peel is the deepest type of peel, the one that gives the most dramatic results but that is also the most dangerous. Its indications are precise and limited to cases that cannot be treated by other peels. If an alpha-hydroxy acid (AHA) or trichloroacetic acid (TCA) peel can solve a skin problem, it will be chosen over a phenol peel without hesitation. The main indication for a phenol peel is severe photoaging. 

These can respond very well to a phenol peel (Figure 30.2). Deep cheek wrinkles (Figure 30.3) caused purely by sun damage are one of the best indications for a phenol peel. 

These usually result from excessive skin laxity. Deep folds and furrows are not a good indication for phenol. They result from intrinsic aging and can sometimes be filled before a phenol peel. There is no need for a long time interval between... 

Other wrinkles, such as cheek wrinkles (see Figure 30.9) or forehead wrinkles, are excellent indications for a full-face phenol peel, but are usually not treated locally, as not only are the results less obvious than after a full-face peel but also the difference between the treated area and the surrounding skin can be too obvious. This type of local treatment is reserved for very particular cases, when there is no risk of tone and structure differences between the locally treated area and the surrounding skin. 

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. 

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. ... 

GA does not make the patient more comfortable or any safer. On the contrary, it adds the inherit risks of general anesthesia to those of the phenol peel. GA is not the ideal choice for a full-face phenol peel. It is never indicated for a local phenol peel. 

This Eutectic Mixture of Local Anesthetics is used successfully in many brief but painful minor operations. EMLA has been tried as a local anesthetic for phenol peels. However, the following arguments should restrict its use in this indication ... 

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. 

Our data indicate that this clinical improvement was correlated with a decrease in the tumor thickness, and the histological depth of tumor cell injury approached a maximum of 164.2 18.4 pm to 346.4 43.5 pm thickness in tumor tissues. In the present study, the tumor thickness of the PD patients was 570.7 164.7 pm, implying that the phenol peel might not be recommended for the treatment of >400-pm thick tumor tissues in AKs (such as grade 3 AK Figs. 20.8 and 20.9). 

Phenol peels have in the past been primarily indicated for deep rhytides in older, fair-skinned individuals because of the risk for hypopigmentation. Although any... 

Results of phenol-based peels for various indications are shown in Figs. 8.11,8.12,8.13, 8.14 and 8.15. 

Cardiovascular Effects. There have been several reports of cardiac arrhythmias associated with application of phenol solutions to the skin in connection with the surgical procedure of skin peeling (Gross 1984 Truppman and Ellenby 1979 Warner and Harper 1985). In this procedure, a mixture of phenol ( 50% w/v), hexachlorophene, and croton oil is applied to the skin while the patient is under anesthesia. In a series of 54 patients in which the whole face was peeled in 1 day, cardiac arrhythmias were reported in 39%, while in a series of patients in which half the face was treated on 1 day, and the second half was treated 24 hours later, cardiac arrhythmias were reported in 22% (Gross 1984). The study author also indicated that the arrhythmias were less severe in the patients treated over a longer period of time. 

Table 6.5 shows the distribution of the three phenolies in the peel and flesh ofthe Korean Superior potato variety available in four sizes large, medium, small, and very small. The data indicate that the size of the potato does not seem to influence the total phenolic content, except that the ratio of peel to flesh for the very small potatoes (7.95) is about one half the corresponding ratios of the other three potatoes. These results indicate that the distribution of phenolic compounds between peel and flesh varies widely among different potato varieties. They also suggest that... 

With regard to acne, in 80% of cases, the first application of ETCA to active papulopustular facial lesions improves their number and severity by 50%, and the lesions seem to heal without scarring. ETCA is applied on the basis of one peel per week for 4 weeks that clear the lesions almost completely without having to resort to antibiotics. Deep wrinkles and acne scars do not disappear they lie deep under the skin and even phenol or carbon dioxide laser resurfacing cannot always treat them. A combination of several different techniques is clearly needed in these indications. 

Medicine has made wide use of phenols in many indications, as we shall see later in this book. Medical publications on peels aboimd in terms that are no longer in use and names of outdated molecules, which makes some texts difficult to read. It is therefore worthwhile taking a quick look at what these terms and compoimds correspond to. 

Raised telangiectasias may become more visible in patients with thin and transparent skin. Facial telangiectasias can be electrocoagulated immediately before the phenol is applied, while the patient is under nerve-block anesthesia for the peel. An Elhnan radiofrequency unit is completely satisfactory in this indication. 

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