Surgery, peels after

Wrinkles can only be improved by using deep peels folds usually only respond to surgery, support threads or fillers. An improvement in the appearance of fine lines can be seen after 4-6 months of daily application of 10-12% glycolic acid cream. 

Melablock HSP 50-1- ° should be applied before the patient leaves the surgery, as the skin is very sensitive after the peel. 

The patient in Figure 29.9 is a typical case where the facial photoaging would benefit far more from a full-face phenol peel than from a neck- and face-lift. Nevertheless, phenol, with difficulty, tightens and rejuvenates the neck, which will only benefit from surgery followed by a peel to the papillary dermis or several peels to the Grenz zone (with ETCA) to improve the quality and the color of the skin after the surgical face-lift. 

With a phenol peel, a demarcation line is left under the jaw that is partially hidden by shadow. A face-lift after a phenol peel could raise this demarcation line to the cheeks any face-lift should therefore be done before a phenol peel. More importantly still, using a phenol peel (or even a deep TCA peek ) at the same time of operation on an area that has just been treated with a surgical lift can potentially cause extensive facial necrosis. The general principle is not to undermine the skin s inner vitality with surgery at the same time as injuring the outer layers of the skin with a peel. In other words a face-lift should not be done on the same day as a full-face deep phenol peel. 

Any pre-existing abnormalities will be recorded to avoid any potential medical and legal problems later. In this way, a round eye appearance after surgery, lagophthahnia or ectropion should be photographed and this noted in the file. Nevi and other lesions should be photographed in particular. The whole peel procedure could also be filmed. The patient, preferably accompanied by a member of his or her family, will have seen sequenced photos showing the aftereffects of a phenol peel, day by day. 

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). 

Rivas S, Pandya AG. Treatment of melasma with topical agents, peels, and lasers an evidence-based review. Am J Clin Derm 2013 14(5) 359-76. Le Q, Wang X, Lv L, Sun X, Xu J. In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery. Cornea 2012 31(8) 876-82. 

Maloney BP, Millman B, Monheit G et al 1998 The etiology of prolonged erythema after chemical peel. Dermatologic Surgery 24 337-341... 

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