Superficial peels combinations

Jessner s solution contains 14% resorcinol, 14% salicylic acid and 14% lactic acid. Jessner s solution has been used alone for superficial peeling, or in combination with TCA 35% to achieve a medium-depth peel. Increasing the number of coats applied to the treated area increases the depth and reaction induced by the Jessner s peel. These peels are well tolerated with minimal side effects in the author s practice. As with glycolic acid and salicylic acid peels, Jessner s peels are most commonly used as adjimctive therapy for moderate to severe facial dyschromias, acne, oily skin, texturally rough skin, fine wrinkles, and pseudofolliculitis barbae. 

EPS is the first slow-release AHA peel not to need neutralizing, in spite of its pH of 0.5-1. This makes it extremely safe to use. It combines the known superficial peeling... 

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... 

As in the superficial peel, medium-depth peel solution is compounded using a weight/volume method. A concentration of 35% should be prepared as described above (see Making up the solution). Combination peels are those using solid CO2 ice plus 35% TCA (Brody combination), Jessner s solution plus 35% TCA (Monheit combination), or 70% glycolic acid and 35% TCA (Coleman combination). These peels will be discussed in greater detail later. 

Jessner s solution contains 14% resorcinol, 14% salicylic acid and 14% lactic acid. It has been used alone for superficial peeling, or in combination with TCA 35% for medium-depth peeling. 

For more mild sun damage, a series of retinoic acid (1— 10% peels can also be performed. A series of 3-4 peels are done at 2 week intervals. If a patient s sun damage is more pronounced, a combination of superficial peels can employed. In this case, the Jessner or Salicylic acid (20-30% peel is applied first followed by the retinoic acid peel. The retinoic acid peel imparts a yellowish hue to the skin during its application period, which is then rinsed off with water at home by the patient in 4—6 hours. Postpeel care is similar to other superficial peels. 

Trichloroacetic Acid (TCA) causes precipitation of proteins and coagulative necrosis of epidermal cells [4]. The extent of damage is indeed concentration dependent. Concentrations range from 10 to 50%. Superficial TCA peeling is induced by concentrations of 10-30% whereas higher concentrations cause medium depth or deep peeling. The combination of salicylic acid followed by TCA 10-15% induces superficial wounding. 

AHA peels help rid the superficial layers of the epidermis of an excess of melanin, and AHA creams applied daily increase keratinocyte turnover, with the melanin produced being diluted in the increased number of keratinocytes. Combined used of effective sun protection reduces melanocyte production and improves the results. 

AHA peels have been used unsuccessfully in the treatment of stretch marks, both as monotherapy and in combination with corundum crystal microdermabrasion before the peel. Treating the stretch marks with microdermabrasion beforehand enhances AHA penetration, but does so linearly, in the form of claw marks (Figure 8.1). The results are poor, even on fine, white, superficial stretch marks. 

Other peels can be used, depending on the case being treated. Unideep is also indicated for the treatment of keratoses on the scalp the Unideep solution produces even frosting more rapidly. Only Touch can be used in combination with a more superficial ETCA peel (cloudy-white frosting instead of even white frosting) on isolated keratoses on the scalp. 

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