Phenol peels local

Localized phenol peels should only be carried out on patients with a skin phototype lower than IV, so that the area treated with phenol is not left lighter than the surrounding skin, even if it has been treated with a medium peel to even out the color. The same applies to patients with many freckles, which mostly disappear after a peel to the papillary dermis. 

The fact that in most cases they cannot use camouflage make-up makes it difticult to carry out a local or full phenol peel. Moreover, phenol peels produce less spectacular results on thick skins than on thin skins. Shaving does not pose a problem, as a peel to the basal layer of the epidermis does not rule out shaving, even with a blade. For a peel to the papillary or reticular dermis, it is best not to shave while the skin is flaking. It is usually possible to shave after the 8th day. Alcohol-based aftershaves should be avoided, and a hydrating, anti-oxidant or firming cream should be used instead, followed by effective sun protection. 

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. 

Skin phototype is even more important when using phenol locally a locaP phenol peel can only really be applied on light skin phototypes that will not show any significant and visible difference in color on the eyelids and around the mouth. The same applies to patients with a lot of freckles, keratoses or lentigines, which only disappear from the areas treated with phenol but still remain in the surrounding areas. The difference in skin quality is also very visible. These patients should only be treated with a full-face peel. 

It is nevertheless possible for these patients to have a local phenol peel combined with a full peel to the papillary dermis. Combining Lip Eyelid with Unideep provides a phenol peel and a peel to even out skin with lentigines, keratoses or freckles. The two peels should be done in the same session the phenol first, followed immediately afterwards by Unideep on the rest of the face, around the area treated with phenol. 

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... 

On the eyelids, however, the fat hernia around the orbit was removed through the transconjunctival approach and combined - in expert hands - successfully and safely with a local phenol peel. McCollough and Maloney combined surgical blepharoplasty with a phenol peel, but left the skin to rest for 3 months before doing the eyelid peel. 

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. 

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... 

These too can be treated with a local phenol peel combined with Easy TCA (Figure 30.21). 

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. 

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. 

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. 

Choosing the right LA agent is also a safety factor, and we will see below why simple lidocaine without adrenaline is the best choice of molecule for a phenol peel, both local and full-face. 

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 ... 

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. 

Phenol peels do not always produce the results hoped for, but fortunately it is rare that the results are so inadequate as to require extensive touch-ups or a complete re-peel. An extensive touch-up can be done 6 weeks after the peel. Fintsi reported an incidence of 30% of local touch-ups after Exoderm . In his study, 21 cases out of 558 had to be given more extensive touch-ups 20 times for acne and once for a hyperpigmentation problem. 

Clinically, it was reasonable to investigate the problem with her. Apart from surgery, what treatment options were there to lift the curtain of the upper eyelids After a quick look at the question, a peel seemed to be the only option. Alpha-hydroxy acids (AHAs) were ruled out immediately because of the risks involved and the fact that they are ineffective on the eyelids. Trichloroacetic acid (TCA) was ruled out, as the high concentrations needed to get the skin to retract would be dangerous and in any event ineffective. There was therefore only one option left phenol. I have not encountered many problems with regular use of full-face phenol peels and, on the contrary, have found them to be very successful. The results achieved locally on the eyelids have often been remarkable (Figure 36.2). 

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. 

If there are air bubbles in the occlusive dressing, the phenol cannot macerate evenly, and some areas will be undertreated, whereas if the occlusive mask is too tight, scars can form where the severe edema that develops in the first few hours after a phenol peel causes too much local pressure. 

A local phenol peel on the eyelids or lips (Lip Eyelid ) also gives rise to severe edema (Figure 37.54) that can make it difficult for patients to eat or open their eyes, which can make some patients extremely anxious. This edema reaches its peak, locally, during the first 2 days and then subsides according to the laws of gravity. During the 3rd and 4th days, edema of the eyelids migrates downwards to the cheeks and then the jaw, reaches the neck on the 5th day, and disappears on the 6th or 7th day. The edema that follows a localized phenol peel on the lips subsides more quickly, as it has less distance to cover before it reaches the neck. 

A combination of paracetamol (acetaminophen) plus codeine is especially well suited to post-peel pain, but should not be used in the hours following a phenol peel, as paracetamol (a phenol derivative) goes through the same detoxification pathways as phenol, which could create metabolic competition and the risks of toxicity associated with phenol might be increased. Preventive administration of benzodiazepines (lorazepam 2.5 mg before the peel and on the night of the peel before going to bed) relieves the anxiety caused by these unpleasant sensations and reduces the need for analgesics after the peel. In case of very severe, localized pain (extremely rare), a nerve block could be used. 

Prevention consists in clearly setting the lower limit of the peel before treatment, with the patient in the sitting position. If an occlusive phenol peel is used, the occlusive dressing should not be put under the lower jaw. The absence of occlusion under the jaw, between the face and the neck, reduces local maceration and therefore the depth reached this creates a transition zone in the area of shadow beneath the jaw (Figure 37.61). 

Phenol is a benzyl alcohol and a major oxidized metabolite of benzene that was introduced into medicine as an antiseptic (1). Although it can be prepared in an aqueous solution or in glycerine, it appears to be more effective when mixed in aqueous compounds. At a concentration of 0.2% it is bacteriostatic and at over 1% bactericidal (2). In addition to its uses as an antiseptic and disinfectant, phenol is also used as a sclerosant, as a local anesthetic on the skin, and as an analgesic, by injection into nerves or spinally, but its use was limited by severe adverse effects. Current medical uses include cosmetic face peeling, nerve injections, and topical anesthesia. It is also an ingredient of various topical formulations, and is used as an environmental disinfectant. 

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