Rhytides

Baker TJ, Gordon HL (1961) The ablation of rhytids by chemical means a preliminary report. J Fla Med Assoc 48 541... 

Peel indications differ between light and dark skin. Key indications in Fitzpatrick s skin types I-III include photodamage, rhytides, acne. 

In a hemiface trial in humans 5% vitamin E reduced rhytides, skin roughness, length of facial lines, and depth of wrinkles more than vehicle.68 Topical tocopherol acetate was also shown to significantly increase stratum corneum hydration in human volunteers with additionally enhancing the water-binding capacity as compared to vehicle. The optimum concentration for these effects was 5% tocopherol acetate.69... 

Bosniak, S., Cantisano-Zilkha, M. Glavas, I. P. (2004) Nonanimal stabilized hyaluronic acid for lip augmentation and facial rhytid ablation. Arch Facial Plast Surg, 6, 379-83. 

Several areas of the face require particular consideration. Care must be taken in the periorbital area to prevent any excess TCA solution from rolling into the eye, and as such TCA should not be applied to the upper eyelid. If tearing occurs, this can be gently wicked using a cotton-tipped appUcator. With areas of deeper rhytides such as in the perioral area, the wrinkled skin should be stretched and the TCA applied over the folds. In addition, TCA should be applied evenly over the lip skin to the vermiUion. 

A number of small studies have indicated that the amelioration of more severe acne scars, moderately deep rhytides, and the effects of photoaging, which are often recalcitrant to standard treatment regimens, can be improved by combining microdermabrasion and super-hcial chemical peels in one treatment session. While more published data to support the use of this combined technique would be welcome, the data that are available indicate that it is highly effective, well tolerated, and more convenient for patients. 

Photoaged or photodamaged skin Pigmentary dyschromia Rhytides (skin wrinkles)... 

Helpful hints from other authors (Monheit) include stretching wrinkled skin to allow for penetration of the peel solution into folds as well as painting oral rhytides with the wooden end of the cotton tip. It is not recommended to aggressively treat deep furrows as they will not improve. 

The Baker-Gordcm formula, pubhshed in its revised form in 1962 (3 mL phenol, 2 mL H2O, 8 drops of sep-tisol, and 3 drops of croton oil yield 48.5% phenol and 2.2% croton oil) was used for deep rhytids. Healing time was said to be long, redness prolonged, hypopigmentation common, and scars not unusual. 

Miid rhytids and hyperpigmentation with eariy actinic and seborrheic keratoses wiii benefit significantiy from a 1 minute appiication of the Stone VK formuia. 

Moderate and severe rhytids and keratoses wiii improve 80-100% with 1 minute of Stone VK foiiowed by 4 minutes of Stone ii formuia. 

Caucasian, mild rhytids 2 min/zone using one dip of large swab 1 min added to deeper rhytids using one dip of large swab Thymol iodide powder at 24 hr for 6 days or immediate Aquaphor ointment until healed... 

Caucasian, moderate rhytids and dyschromia 1 min/zone for analgesic effect 4 min on top of Stone VK, using two dips of large swabs Immediate tape for 48 hr. Thymol iodide powder for 6-7 days... 

Apply a generous coat of waterproof tape to each zone in patients with mild rhytids for even peel (favorable technique). 

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